Caring for Veterans With Deployment-Related Stress Disorders: Iraq, Afghanistan, and Beyond
According to recent studies, at least one-fourth of military personnel returning from duty in Afghanistan and Iraq have received a diagnosis of posttraumatic stress disorder (PTSD); approximately 10–15% of these veterans will experience significant symptoms. Whether the causes stem from a more complex environment in these post–9/11 war zones, or from more survivability because of improved body armor, better medical care, and more sophisticated diagnosis, the prevalence of PTSD and other war-related stress disorders among returning military personnel is on the rise.
Veterans of any war face major challenges reintegrating into civilian society, but these challenges become much more complex with an accompanying stress disorder. And the new demographic profile of today's military — more female, more married, and more ethnically diverse — means that troops on and off the battlefield are more vulnerable to combat and noncombat stressors, the latter including sexual abuse. Suicide rates among these veterans are at an alarming high. The higher prevalence of these deployment-related stress disorders also has troubling ramifications among the parents, spouses, and children of these veterans.
Caring for Veterans With Deployment-Related Stress Disorders explores the myriad causes and consequences of these peculiar war-zone disorders, yet its emphasis is on prevention and treatment through better assessment, psychopharmacological and psychotherapeutic interventions (including couple/family therapy), and appropriate evidence-based treatments. The final part of this edited volume concludes with broad guidelines for minimizing current barriers to treatment for stress-disordered veterans and their families by shifting care to the local/community level of health care providers.
Contributors to Caring for Veterans With Deployment-Related Stress Disorders are leaders in the clinical and research communities devoted to studying and treating PTSD and other war-trauma stress disorders among military personnel. The editors of the volume are all top officials and researchers at the Veterans Administration's National Center for PTSD.
Introduction: Addressing the Mental Health Needs of Active Duty Personnel and Veterans
Josef I. Ruzek, Paula P. Schnurr, Jennifer J. Vasterling, and Matthew J. Friedman
I. Epidemiology and Course
- Epidemiology of Trauma Events and Mental Health Outcomes Among Service Members Deployed to Iraq and Afghanistan
Rajeev Ramchand, Terry L. Schell, Lisa H. Jaycox, and Terri Tanielian
- Posttraumatic Stress Reactions Over Time: The Battlefield, Homecoming, and Long-Term Course
Jennifer J. Vasterling, Erin S. Daly, and Matthew J. Friedman
- Assessment of Trauma, Posttraumatic Stress Disorder, and Related Mental Health Outcomes
Dawne S. Vogt, Lissa Dutra, Annemarie Reardon, Rebecca Zisserson, and Mark W. Miller
- Assessment and Treatment in Polytrauma Contexts: Traumatic Brain Injury and Posttraumatic Stress Disorder
David L. Butler, Robin A. Hurley, and Katherine H. Taber
- Assessment and Management of High-Risk Suicidal States in Postdeployment Operation Enduring Freedom and Operation Iraqi Freedom Military Personnel
Cynthia A. Claassen and Kerry L. Knox
III. Noncombat Stressors and Their Ramifications
- Sexual Harassment and Sexual Assault During Military Service
Amy E. Street, Rachel Kimerling, Margret E. Bell, and Joanne Pavao
- Couple and Family Issues and Interventions for Veterans of the Iraq and Afghanistan Wars
Candice M. Monson, Steffany J. Fredman, and Casey T. Taft
- Meeting the Wartime Needs of Military Children and Adolescents
Stephen J. Cozza
IV. Prevention and Treatment
- Comprehensive Soldier Fitness, Battlemind, and the Stress Continuum Model: Military Organizational Approaches to Prevention
William P. Nash, Lillian Krantz, Nathan Stein, Richard J. Westphal, and Brett Litz
- Evidence-Based Treatments for Posttraumatic Stress Disorder in Operation Enduring Freedom and Operation Iraqi Freedom Military Personnel
Barbara O. Rothbaum, Maryrose Gerardi, Bekh Bradley, and Matthew J. Friedman
V. A Public Health Approach
- Barriers to Mental Health Treatment Engagement Among Veterans
Tracy Stecker and John Fortney
- Enhancing Systems of Care for Posttraumatic Stress Disorder: From Private Practice to Large Health Care Systems
Josef I. Ruzek and Sonja V. Batten
Conclusion: Understanding the Effects of Deployment to a War Zone
Paula P. Schnurr, Josef I. Ruzek, Jennifer J. Vasterling, and Matthew J. Friedman
About the Editors
Josef I. Ruzek, PhD, is the director of the Dissemination and Training Division of the U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder (PTSD). He is coeditor of Cognitive-Behavioral Therapies for Trauma, (2nd ed.; 2006), and a contributing author for the National Center for PTSD's Iraq War Clinician Guide.
Dr. Ruzek is cochair of the Early Intervention special interest group of the International Society for Traumatic Stress Studies and was a member of the team that developed the joint Veterans Affairs–Department of Defense Clinical Practice Guidelines for Management of Traumatic Stress.
Paula P. Schnurr, PhD, has served as deputy executive director of the National Center for Posttraumatic Stress Disorder since 1989. She is a research professor of psychiatry at Dartmouth Medical School and is editor-in-chief of the Journal of Traumatic Stress and the Clinician's Trauma Update–Online. She received her doctorate in experimental psychology at Dartmouth College in 1984 and then completed a postdoctoral fellowship in the Department of Psychiatry at Dartmouth Medical School.
Dr. Schnurr is past-president of the International Society for Traumatic Stress Studies and is a fellow of APA and of the Association for Psychological Science. Her research focuses on methodological and statistical issues as well as substantive topics, especially PTSD treatment and on risk and resilience factors associated with the long-term physical and mental health outcomes of traumatic exposure. Her current projects include a trial evaluating a PTSD decision aid and another trial evaluating integrated primary care treatment for PTSD.
Jennifer J. Vasterling, PhD, obtained her doctorate in psychology from Vanderbilt University in 1988, subsequently completing pre- and postdoctoral training in clinical neuropsychology at the Boston Veterans Affairs (VA) Medical Center. She currently serves as chief of psychology at VA Boston Healthcare System and as a clinical investigator in the Behavioral Science Division of the National Center for Posttraumatic Stress Disorder.
Dr. Vasterling is a professor of psychiatry at Boston University School of Medicine and a lecturer in psychiatry at Harvard Medical School. Prior to her current positions, Dr. Vasterling served as the associate director for research for the VA South Central (VISN 16) Mental Illness, Research, Education, and Clinical Center; as staff psychologist at the New Orleans VA Medical Center; and as a clinical professor of psychiatry and neurology at Tulane University School of Medicine.
Dr. Vasterling's research has centered on furthering the understanding of the neurocognitive and emotional changes that accompany war-zone deployment and posttraumatic stress responses. She is the lead editor of a book on the neuropsychological correlates of PTSD and currently serves on the editorial board of the Journal of the International Neuropsychological Society. Her recent work includes a longitudinal study examining neuropsychological and emotional outcomes of military deployment to Iraq.
Matthew J. Friedman, MD, PhD, is executive director of the National Center for Posttraumatic Stress Disorder and professor of psychiatry and of pharmacology and toxicology at Dartmouth Medical School. He has worked with PTSD patients as a clinician and researcher for 35 years and has published extensively on stress and PTSD, biological psychiatry, psychopharmacology, and clinical outcome studies on depression, anxiety, schizophrenia, and chemical dependency. He has more than 200 publications, including 19 books and monographs.
Listed in the "Best Doctors in America," he is a Distinguished Lifetime Fellow of the American Psychiatric Association, past president of the International Society for Traumatic Stress Studies (ISTSS), past chair of the scientific advisory board of the Anxiety Disorders Association of America, a member of the American Psychiatric Association's DSM-V Anxiety Disorders Work Group, and has served on many Veterans Affairs, Department of Defense, and National Institute of Mental Health research, education, and policy committees. He has received many honors, including the ISTSS Lifetime Achievement Award in 1999 and the ISTSS Public Advocacy Award in 2009.