Military Medicine

PhD, Barbara A. Hermann,;MPH, Brian Shiner, MD,;PhD, Matthew J. Friedman, MD,

doi: 10.7205/MILMED-D-12-00114pmid: 22953435

ABSTRACT This article summarizes information about the prevalence of post-traumatic stress disorder (PTSD) in military personnel and Veterans who have served in the Iraq and Afghanistan conflicts as well as the disorder’s impact and efforts to prevent it in this population. We examine prevalence in light of epidemiologic methods and discuss associated outcomes, etiology, and factors affecting risk for PTSD. Prevention strategies are presented both in terms of individual-level interventions and operational strategies designed to mitigate the development of PTSD. Our findings indicate that while research into the prevalence and consequences of PTSD in the Iraq and Afghanistan cohort has been significant, relatively little is known about the effectiveness of approaches designed to prevent it. Reprint & Copyright © Association of Military Surgeons of the U.S.

PhD, Blair E. Wisco,;PhD, Brian P. Marx,;PhD, Terence M. Keane,

doi: 10.7205/MILMED-D-12-00111pmid: 22953436

ABSTRACT Post-traumatic stress disorder (PTSD) is a prevalent problem among military personnel and veterans. Identification of effective screening tools, diagnostic technologies, and treatments for PTSD is essential to ensure that all individuals in need of treatment are offered interventions with proven efficacy. Well-validated methods for screening and diagnosing PTSD are now available, and effective pharmacological and psychological treatments can be offered. Despite these advances, many military personnel and veterans do not receive evidence-based care. We review the literature on screening, diagnosis, and treatment of PTSD in military populations, and discuss the challenges to implementing the best evidence-based practices in clinical settings. Reprint & Copyright © Association of Military Surgeons of the U.S.

PhD, David S. Riggs,;PsyD, Diana Sermanian,

doi: 10.7205/MILMED-D-12-00140pmid: 22953437

ABSTRACT In the past decade, military personnel supporting the wars in Iraq and Afghanistan have faced multiple deployments and repeated traumatic stressors. Despite efforts to prevent post-traumatic stress disorder (PTSD) and other combat-related emotional difficulties, a significant number of military personnel experience psychological injuries during and following their deployments. Despite increased attention to prevention and treatment of these problems, it is clear that substantially more work is required to fully understand the emotional impact of combat and to better intervene to prevent potentially chronic problems. In the present article, the authors discuss possible avenues for future research and interventions (clinical and otherwise) to better prevent the development of combat-related PTSD. We discuss screening, assessment, education, and intervention for PTSD throughout the deployment cycle. In this discussion, we attend to both the needs of the current cohort of combat veterans and the potential advances that may mitigate the severity and chronicity of post-traumatic problems arising from future conflicts. Reprint & Copyright © Association of Military Surgeons of the U.S.

BSC, Deborah Sirratt, USAF;PhD, Alfred Ozanian,;USA, Barbara Traenkner, MS

doi: 10.7205/MILMED-D-12-00139pmid: 22953438

ABSTRACT U.S. military service members have been in active combat for more than 10 years. Research reveals that combat exposure increases the risk of substance use disorders, post-traumatic stress disorder, major depression, and tobacco use. The Services and the field of addiction medicine are working hard to find a common definition for prescription drug misuse, which is a growing concern in both the general U.S. population and the force. Meanwhile, leaders at all levels of Department of Defense are diligently working to address barriers to care, particularly stigma related to substance abuse care, by seeking a balance between improving service member privacy in order to encourage self-referral for medical care and a commander’s need to know the status of the unit and its combat readiness. The treatment and management of substance abuse disorders are a complex force health issue that requires the use of evidence-based medical interventions and policies that are consistent with them. Reprint & Copyright © Association of Military Surgeons of the U.S.

PhD, Eric J. Hawkins,;PhD, Joel Grossbard,;MSW, Jim Benbow,;ABPP, Vladimir Nacev, PhD,;PhD, Daniel R. Kivlahan,

doi: 10.7205/MILMED-D-12-00125pmid: 22953439

ABSTRACT Substance use disorders (SUDs) are among the most common and costly conditions in veterans and active duty military personnel, adversely affecting their health and occupational and personal functioning. The pervasive burden of SUD has been a continuing concern for the Department of Veterans Affairs (VA) and Department of Defense (DoD), particularly as large numbers of service members return from Operations Enduring and Iraqi Freedom. The VA and DoD have prioritized implementation of evidence-based practices and treatment services to enhance the recognition and management of SUD in general medical and SUD specialty-care settings. This article summarizes the clinical practice guidelines for identifying, diagnosing, and treating SUD in VA and DoD general medical and SUD specialty-care settings, highlights evidence-based pharmacotherapy and psychosocial interventions for managing SUD, and describes barriers to successful treatment of veterans and service members at risk for SUD in VA and DoD health care systems. Reprint & Copyright © Association of Military Surgeons of the U.S.

PhD, Sean J. Tollison,;PhD, Ryan C. Henderson,;PhD, Johns S. Baer,;MD, Andrew J. Saxon,

doi: 10.7205/MILMED-D-12-00126pmid: 22953440

ABSTRACT The two articles presented previously in this volume provide state-of-the-art reviews of the etiology, epidemiology, screening and treatment of substance use disorder (SUD). This article identifies next steps in research and development for understanding and treating SUD in Operation Enduring Freedom/Operation Iraqi Freedom service members and veterans. Four promising areas are reviewed: advances in psychopharmacological treatment of SUD, innovations in behavioral treatments, the use of technological advances for the screening and treatment of SUD, and integration of treatment services. Future directions are explored and suggestions for research, development and implementation of each of these trends are discussed. Reprint & Copyright © Association of Military Surgeons of the U.S.

PhD, Anne M. Gadermann,;USA, Charles C. Engel, MC;PhD, James A. Naifeh,;PhD, Matthew K. Nock,;PhD, Maria Petukhova,;USN, Patcho N. Santiago, MC;MS, Benjamin Wu,;PhD, Alan M. Zaslavsky,;PhD, Ronald C. Kessler,

doi: 10.7205/MILMED-D-12-00103pmid:

PhD, Jeffrey Greenberg,;MPH, Anderson A. Tesfazion,;BSC, Christopher S. Robinson, USAF

doi: 10.7205/MILMED-D-12-00102pmid: 22953442

ABSTRACT The U.S. military and its civilian partners have identified that psychological health problems such as depression and traumatic brain injury represent a significant threat to the health and readiness of the military force. Depression is a growing problem in the military with rates increasing from 2007 to 2010 across all services. Depression can be correlated with negative outcomes such as risk of suicide, risk of harm to others, incarceration, family problems including divorce, and occupational and social problems such as unemployment and homelessness. The military seeks to mitigate and prevent these negative outcomes through screening, diagnosis, and treatment of disorders such as depression. To support that effort, we have reviewed a sample of the literature base to support best practices for the screening, assessment, and treatment of depression within the Military Health System. Reprint & Copyright © Association of Military Surgeons of the U.S.

PA-C, Kathryn R. Marshall, MS, MPH,;PA-C, Sherray L. Holland,;ACNP, Kimberly S. Meyer, MSN,;MA, Elisabeth Moy Martin, RN-BC,;PA-C, Michael Wilmore, MPAS,;USA, Jamie B. Grimes, MC

doi: 10.7205/MILMED-D-12-00110pmid: 22953443

ABSTRACT The majority of combat-related traumatic brain injury (TBI) within the U.S. Armed Forces is mild TBI (mTBI). This article focuses specifically on the screening, diagnosis, and treatment aspects of mTBI within the military community. Aggressive screening measures were instituted in 2006 to ensure that the mTBI population is identified and treated. Screenings occur in-theater, outside the contiguous United States, and in-garrison. We discuss specific screening procedures at each screening setting. Current diagnosis of mTBI is based upon self-report or through witnesses to the event. TBI severity is determined by specific Department of Defense criteria. Abundant clinician resources are available for mTBI in the military health care setting. Education resources for both the patient and the clinician are discussed in detail. An evidence-based clinical practice guideline for the care of mTBI was created through collaborative efforts of the DoD and the U.S. Department of Veterans Affairs. Although symptoms following mTBI generally resolve with time, active treatment is centered on symptom management, supervised rest, recovery, and patient education. Medical specialty care, ancillary services, and other therapeutic services may be required. Reprint & Copyright © Association of Military Surgeons of the U.S.

USA, Scott A. Marshall, MC;MD, Ronald G. Riechers, II,

doi: 10.7205/MILMED-D-12-00142pmid: 22953444

ABSTRACT Traumatic brain injury exists in a spectrum of severity among wounded personnel. The evaluation and clinical presentation, initial management, and treatment interventions to prevent secondary injury processes for combat-associated moderate and severe traumatic brain injury are reviewed. Promising therapies are discussed, and a current review of the literature is provided. Footnotes The opinions and views expressed herein belong solely to those of the authors. They are not nor should they be implied as being endorsed by the Uniformed Services University of the Health Sciences, Department of the Army, Department of Defense or any other branch of the Federal Government of the United States. Reprint & Copyright © Association of Military Surgeons of the U.S.