Problems with veteran-family communication during operation enduring freedom/operation Iraqi freedom military deployment

Twenty Reserve component (Army and Marines) and Army National Guard male veterans of Operational Enduring Freedom/Operation Iraqi Freedom discuss their deployment and postdeployment family reintegration experiences. A Grounded Theory approach is used to highlight some of the ways in which family miscommunication during deployment can occur. Communication with civilian family members is affected by the needs of operational security, technical problems with communication tools, miscommunication between family members, or because veterans have "nothing new to say" to family back home. These communication difficulties may lead to an initial gulf of understanding between veterans and family members that can cause family strain during postdeployment family reintegration. We end with a discussion of veteran family reintegration difficulties.     

Reported stressors and health care needs of active duty Navy personnel during three phases of deployment in support of the war in Iraq

Literature has generously documented the stress of military members and their families during deployments in noncombat periods. Deployment has been shown to increase the needs of family members for health care, both physical and psychological. The purpose of this study was to describe the health care needs and perceived stressors of active duty members deployed to Iraq during the predeployment, mid-deployment, and postdeployment phases. Active duty Navy service members deployed on three aircraft carriers during Operation Enduring Freedom and Operation Iraqi Freedom in 2002-2003 were randomly selected to participate in an anonymous study that evaluated member well-being, adaptation, coping, anxiety, stress, and health care needs during three phases of deployment. Data were obtained from 474 Navy members in predeployment, 445 in mid-deployment, and 276 in postdeployment. Logistic regression analyses indicated that many variables predicted extreme anxiety during deployment, including mid-deployment phase, age of under 25 years, being childless, nonattendance at church, being enlisted, zero- or one-deployment history; no high school education, and being currently in counseling. Active duty members in all phases of deployment had equally disturbing levels of anxiety. All phases reported suicidal ideation at alarming rates (2.4% in predeployment, 4.9% in mid-deployment, and 3% in postdeployment). This study sheds new light on the stressors and subsequent health care needs of active duty members on carriers during war and provides valuable information for the prevention of high-risk anxieties and subsequent health risks for all service members during similar deployments.     

Does the repressor coping style predict lower posttraumatic stress symptoms?

We tested whether a continuous measure of repressor coping style predicted lower posttraumatic stress disorder (PTSD) symptoms in 122 health care professionals serving in Operation Iraqi Freedom. Zero-order correlational analyses indicated that predeployment repressor coping scores negatively predicted postdeployment PTSD symptoms, r(s) = -0.29, p = 0.001, whereas predeployment Connor-Davidson Resilience Scale (CD-RISC) scores did not predict postdeployment PTSD symptoms, r(s) = -0.13, p = 0.14. However, predeployment trait anxiety was chiefly responsible for the association between repressor coping and PTSD symptom severity, r(s) = 0.38, p = 0.001. Four percent of the subjects qualified for a probable PTSD diagnosis. Although service members with relatively higher PTSD scores had lower repressor coping scores than did the other subjects, their level of predeployment anxiety was chiefly responsible for this relationship. Knowing someone's predeployment level of trait anxiety permits better prediction of PTSD symptoms among trauma-exposed service members than does knowing his or her level of repressive coping.     

Assessment of changes in mental health conditions among sailors and marines during postdeployment phase

Previous research regarding the mental health ramifications of military deployments focused on the U.S. Army population. As part of its deployment health surveillance mission, Navy and Marine Corps Public Health Center conducted a study of the Department of Navy population to identify reported mental health effects associated with Operation Iraqi Freedom, describe mental health care utilization by returning service members previously deployed in support of Operation Iraqi Freedom, and examine the relationships between self-identified risks and provider referral practices. Despite a considerable number of self-reported mental health concerns, referral for mental health consultations and health care utilization were rare. The psychological well-being of service members is essential to the military's optimum functionality and operational readiness; therefore, continued research in this area has significant bearing on future force health protection efforts. Additionally, this study highlights the need for further research on deployment-related mental health concerns.     

The recommended role of exposure biomarkers for the surveillance of environmental and occupational chemical exposures in military deployments: policy considerations

A lack of individual exposure information limited the evaluation of exposure-outcome relationships after the Gulf War. Exposure concerns during Operation Enduring Freedom and Iraqi Freedom deployments have increased interest in individual environmental and occupational chemical exposure assessment. Currently, deployment assessments are conducted using intermittent ambient air monitoring, occasional focused evaluations based on these results, and postdeployment questionnaire documentation of exposure and/or health concerns. Although this strategy is an improvement over previous practice, it has limitations, including a reliance on evidence of an acute problem, to initiate in-depth health evaluation. Exposure biomarkers may have the potential to overcome some of the limitations of current environmental and occupational exposure assessment tools. This article examines current exposure assessment methods, reviews emerging technologies, and recommends a phased approach to introducing exposure biomarkers into a comprehensive occupational and environmental health surveillance program.     

Characteristics of deployed Operation Iraqi Freedom military personnel who seek mental health care

INTRODUCTION: This study reports on the feasibility of using validated mental health screening instruments for deployed Operation Iraqi Freedom military personnel. METHODS: For a 3-month period in 2005, all service members (N=296) who initially presented to the U.S. Military Hospital Kuwait mental health clinic completed an intake questionnaire that gathered demographic information and contained validated instruments to screen for mental disorders and functional impairment. RESULTS: A total of 19% of the sample subjects screened positive for post-traumatic stress disorder-related symptoms, 35% for a major depressive disorder, and 11% for severe misuse of alcohol. Significant levels of distress and functional impairment were reported by 58% of the sample. Women represented a disproportionately high percentage of those presenting for care (27%). CONCLUSIONS: Screening instruments were well accepted and useful in detecting psychopathological conditions and functional impairment. Female service members might represent a high-risk group. These results are useful for those caring for service members during or after deployment.     

Deployment risk factors and postdeployment health profiles associated with traumatic brain injury in heavy drinking veterans

Along with post-traumatic stress disorder (PTSD), mild traumatic brain injury (mTBI) is considered one of the "signature wounds" of combat operations in Iraq (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]), but the role of mTBI in the clinical profiles of Veterans with other comorbid forms of post-deployment psychopathology is poorly understood. The current study explored the deployment risk and postdeployment health profiles of heavy drinking OIF and OEF Veterans as a function of mTBI. Sixty-nine heavy-drinking OIF/OEF Veterans were recruited through a Veterans' Affairs Medical Center and completed questionnaires and structured interviews assessing war-zone experiences, postdeployment drinking patterns, and PTSD symptoms. Veterans with positive mTBI screens and confirmed mTBI diagnoses endorsed higher rates of combat experiences, including direct and indirect killing, and met criteria for PTSD at a higher rate than Veterans without a history of mTBI. Both PTSD and combat experiences independently predicted screening positive for mTBI, whereas only combat experiences predicted receiving a confirmed mTBI diagnosis. mTBI was not associated with any dimension of alcohol use. These results support a growing body of literature linking mTBI with PTSD.     

The prevalence and impact of respiratory symptoms in asthmatics and nonasthmatics during deployment

OBJECTIVE: The purpose of this study was to compare the prevalence, severity, and impact of respiratory symptoms in asthmatics and nonasthmatics during Operation Enduring Freedom and Operation Iraqi Freedom. METHODS: A survey was given to 1,250 active duty soldiers and Department of Defense contractors returning from Operation Enduring Freedom/Operation Iraqi Freedom. Subjects were asked about demographics, smoking habits, respiratory symptoms, and impact on job performance before and during deployment. Patients with a history of asthma were asked method of diagnosis, current symptoms, and asthma therapy. RESULTS: A total of 1,193 subjects returned the completed questionnaire (95% response rate). Mean age of respondents was 38 +/- 11 years, 83% (n = 977) were male, and 31% (n = 375) were past or present smokers. Sixty-one subjects (5%) reported a previous diagnosis of asthma. Both asthmatics and nonasthmatics had increased respiratory symptoms of wheezing, cough, sputum production, chest pain/tightness, and allergy symptoms during deployment compared to predeployment (p < 0.05 for all). When compared to nonasthmatics, asthmatic subjects reported more wheezing, sputum production, and chest pain/tightness during deployment (p < 0.0001, 0.05, 0.05 respectively), had more difficulty with military duties (p < 0.05), and were more likely to seek medical attention and receive duty restrictions (p < 0.0001). Twenty-six percent (n = 16) of asthmatics reported poor baseline symptom control, and this group had significantly increased symptoms, functional limitations, and health care utilization when compared to asthmatics who were symptom-controlled at baseline. CONCLUSIONS: Respiratory symptoms were common among both asthmatics and nonasthmatics during deployment. Differences in symptoms and health care utilization in this group of asthmatics were primarily due to subjects with poor baseline control.     

Self-rated health and subsequent health care use among military personnel returning from international deployments

Individual health status assessment upon completion of U.S military deployments was standardized in 1999 with a brief health assessment questionnaire. This cohort study analyzed health status responses and their relationship to postdeployment health outcomes among 16,142 military personnel who completed a health questionnaire after a deployment ending in 1999. Respondents were Army and Air Force personnel returning from Europe or Southwest Asia. Fourteen percent documented at least one health concern and 1.8% had fair/poor self-rated health. In the 6 months after deployment, 1.4% were hospitalized, 25% made five or more outpatient visits, and 4% separated from military service. Deployers with fair/poor self-rated health were at a significantly increased risk for high use of outpatient services (risk ratio, men 1.8, women 1.7) but not for hospitalization or separation. Self-report of low health status or other health concerns may help identify deployers with higher health care needs after future deployments.     

Predictors of barriers to mental health treatment for Kosovo and Bosnia peacekeepers: a preliminary report

In this study, we assessed basic, physical, and mental health needs of peacekeepers; determined barriers to mental health treatment; and examined predictors of barriers to mental health care. Active duty peacekeepers were surveyed before and after their deployment to Kosovo (n = 203) concerning their stress symptoms and attitudes about seeking mental health care after peacekeeping. Sixty-five peacekeepers were evaluated before and after their peacekeeping deployment to Bosnia. Upon returning from their mission, between 5% and 9% of Kosovo and Bosnia peacekeepers reported needing help for anger or hostility, depression, or deployment-related stress. The most frequently endorsed barrier was concern about the personal cost of mental health care. Among Kosovo peacekeepers, pre- and postdeployment post-traumatic stress disorder symptoms were the most robust predictors of mental health treatment barriers. Peacekeepers report a number of treatment needs and barriers that could prevent them from receiving care. The soldiers most in need of services are also those who report the most barriers to care.     

Occupational correlates of low back pain among U.S. Marines following combat deployment

Many U.S. Marines have experienced routine combat deployments during Operation Iraqi Freedom, which present numerous occupational hazards that may result in low back pain (LBP). The objective of this retrospective cohort study was to identify new-onset LBP among Marines following initial deployment to Operation Iraqi Freedom. Active duty Marines deployed to Iraq or Kuwait between 2005 and 2008 were identified from deployment records and linked to medical databases (n = 36,680). The outcome of interest was an International Classification of Diseases, 9th Revision, Clinical Modification code indicating LBP (724.2) within 1 year postdeployment. Multivariate logistic regression examined the effect of occupation on LBP. Overall, 4.1% (n = 1,517) of Marines were diagnosed with LBP. After adjusting for covariates, the service/supply (odds ratio 1.33, 95% confidence interval, 1.12-1.59) and electrical/mechanical/craftsworker occupations (odds ratio 1.31, 95% confidence interval, 1.12-1.53) had higher odds of LBP when compared to the administrative/other referent group. Within these groups, the highest LBP prevalence was in the construction (8.6%) and law enforcement (6.2%) subgroups. Although infantry occupations purposefully engage the enemy and often face sustained physical rigors of combat, LBP was most prevalent in noninfantry occupations. Future studies should include detailed exposure histories to elucidate occupation-specific etiologies of LBP in order to guide prevention efforts.     

Survey of repellent use by service members arriving in Kuwait for Operation Iraqi Freedom 2

The 8th Medical Brigade, deployed to Kuwait in January 2004 in support of Operation Iraqi Freedom provided theater-wide health service support and medical command and control. An historic "surge" of troops and equipment occurred during our deployment as 140,000 service members (SMs) redeployed out of theater and 110,000 arrived to take their place. The brigade's preventive medicine personnel conducted a questionnaire-based survey at military camps in northwestern Kuwait in mid-March to determine whether SMs had been provided with supplies and information to protect them against endemic vector-borne diseases. Of 1,200 questionnaires distributed, 870 (73%) were returned. In addition to military affiliation information, the survey contained specific questions related to the provision of n-diethyl-m-toluamide repellents, permethrin and treated uniforms, and medical threat briefings. On average, less than one-half of the SMs received these resources before their arrival in Kuwait. Significant differences of resource provision existed among service branches, components, and mobilization or deployment stations.     

Division mental health in the new brigade combat team structure: part II. Redeployment and postdeployment

OBJECTIVE: Recent Army transformation has led to significant changes in roles and demands for division mental health staff members. This article focuses on redeployment and postdeployment. METHODS: The postdeployment health assessment behavioral health screening and referral process and redeployment plan are reviewed, and data on postdeployment rates of negative events are reported. RESULTS: All soldiers and many of their families participated in an aggressive education program. Of the 19,500 soldiers screened, 2,170 (11.1%) were referred for behavioral health consultation; of those referred, 219 (10.1%) were found to be at moderate or high risk for mental health issues (1.1% of total screened). Of the moderate/highrisk soldiers, 146 (71.9%) accepted follow-up mental health treatment upon return to home station. Fewer cases of driving under the influence, positive drug screens, suicidal gestures/ attempts, crimes, and acts of domestic violence were seen, in comparison with rates seen after an earlier deployment of this unit to Iraq. CONCLUSIONS: A formalized approach with command support and coordination can have a positive impact on successful referral and treatment and reduce negative postdeployment events.     

Process of care for battle casualties at the Walter Reed Army Medical Center: Part III. Physical medicine and rehabilitation service

The Physical Medicine and Rehabilitation Service provides a critical role in the assessment, management, and disposition of the newly injured combatant. This role has been well demonstrated during Operation Enduring Freedom and Operation Iraqi Freedom. Military physiatrists are uniquely suited to support military service members as they maximize their function and either return to duty or transition to civilian life.     

Self-rated health and health care utilization after military deployments

Self-rated general health is one element of the standard health assessment required of U.S. military service members upon completion of major deployments. A cohort study of 22,229 male U.S. Army and Air Force personnel returning from Europe or Southwest Asia in 2000 used survival analysis methods and Cox proportional hazard models to examine postdeployment self-rated health (SRH) status and subsequent hospitalization, separation, and ambulatory care visits. Self-rated health was fair/poor for 1.5% and good for 20.4%; 11% documented at least one health concern. During 30,433 person-years of follow-up (median, 1.5 person-years), there were 22.8 hospitalizations per 1,000 person-years and 4.0 ambulatory care visits per person-years. After adjustment, deployers with fair/poor SRH had an increased risk for hospitalization (hazard ratio [HRI, 1.6; 95% confidence interval [CI], 1.0,2.7); the risk was lower for those with good SRH (HR, 1.3; 95% CI,1.1,1.5). Deployers with fair/poor SRH health had an increased risk for illness-related ambulatory care visits (HR, 1.8, 95%; CI, 1.6,2.1) and administrative visits (HR, 1.4; 95% CI, 1.1,1.7), but not injury-related visits (HR, 1.2; 95% CI, 0.8,1.7). Self-reported low health status and other health concerns identify military members with higher levels of health care needs following return from major deployments.     

Developing an effective medication soldier readiness process

With the ever high operation tempo that our Armed Forces experience, it is imperative that military providers understand their soldiers' medication needs and how to ensure that those medications are properly processed by the supporting military pharmacy. Without a definitive plan, the surgeons responsible for soldiers' health will fail. This article outlines the experiences of the 4th Infantry Division and Darnall Army Community Hospital while preparing the 4th Infantry Division soldiers for deployment in support of Operation Iraqi Freedom 2005-2007. It details some important statistics that medical planners and unit surgeons can use when preparing their soldiers for deployment. Finally, we outline the lessons learned from this latest deployment and suggest components of an effective medication soldier readiness process.     

Exploring veteran identity and health services use among Native American veterans

The objectives of this study were to describe the military experiences of Native American veterans and to explore how factors related to veteran identity influence their use of health services. Study participants completed a demographic and health questionnaire, followed by participation in a focus group session. The findings revealed that, despite their negative experiences during military service, most participants had a positive veteran identity. Almost 46% of participants reported having a service-related illness or injury. Almost one-third (28.2%) used the Indian Health Service (IHS) exclusively for their health care, followed by those who used both IHS and Veterans Affairs (VA) services (23.5%), followed by VA-only users (21.2%). We conclude that Native American veterans highly identify with their military service but may turn to IHS for their medical care. The data support the current VA policy of strengthening coordination with the IHS to ensure that the medical needs of Native American veterans are addressed.     

Test-retest reliability of the Traumatic Brain Injury Screening Instrument

The Traumatic Brain Injury Screening Instrument (TBISI) was implemented in Veterans Affairs medical facilities in an attempt to identify Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans with possible mild TBI. Despite its widespread implementation, the reliability and validity of the screening tool has not yet been established. The current study reports preliminary findings on the test-retest reliability of the TBISI in 44 OEF/OIF veterans referred for neuropsychological evaluation following a positive TBI screen. Results suggest overall poor test-retest reliability of the TBI screening tool with regard to type of event, injuries sustained, and resulting sequelae. These findings underscore the importance of further investigation of its psychometric properties to promote accurate identification and referral of veterans with possible TBI.