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The Fallout of Combat Trauma

Q & A with Kathryn Basham, School for Social Work

Recent reports about mental health issues among troops – including one by the Office of the U.S. Army Surgeon General on soldiers deployed to Iraq – reveal serious psychological problems. Smith School for Social Work Professor Kathryn Basham reflected on the subject based on what she has learned through her own research.

For the past several years, Basham has also served on the  congressionally mandated committee sponsored by the Institute of Medicine of the National Academies of Science exploring the physiologic, psychologic and psychosocial effects of deployment-related stress during the Gulf War and in Iraq and Afghanistan. That committee is slated to present a final report on Capitol Hill in September 2007.

Basham recently responded to questions about her research.

The Grécourt Gate: What types of psychological problems are most common among members of the military?

Kathryn Basham: Many soldiers and marines navigate the terrain of deployment fortified by their resilience and do not suffer adverse mental health effects. Yet, combat trauma is one of the most horrific traumatic events that a person can suffer. It involves a unique brand of horror including exposure to terrifying life-threatening events along with a mixture of fear, anxiety, and despair as well as pride, excitement and a sense of loyalty. The most significant stressor noted beyond combat trauma involves the separation from family with the consequent anxieties, conflicts, shifts in family roles and financial tensions.

A recent study conducted by researchers at Walter Reed Army Medical Center (Hoge, Terhakopian, Castro, Messer & Engel, 2007) confirms the findings from this Pentagon report that combat exposure was directly linked with subsequent post-traumatic stress disorder (PTSD), depression and other anxiety disorders. There were also elevated rates of suicide among troops. Those who were physically injured suffered three times the risk of PTSD, promising a deluge of wounded soldiers and marines returning from combat who will need physical, psychological and psychosocial supports for themselves and their families as they adjust to their new circumstances.

Gate: How do the reported rates of mental health problems among troops compare with previous wars?

KB: The report that 40 percent of troops returning home have psychological problems, with 20 percent reporting serious disorders, parallels some of the data about Vietnam veterans (Vietnam Veterans Era Readjustment Study). While the circumstances of pre-deployment differ in terms of the impact of the draft on Vietnam veterans, the intensity of combat exposure and length of deployment are directly associated with negative mental health outcomes, similar to those experienced by Vietnam veterans. Although we have known this for years, our leaders have not heeded the obvious warnings. Instead, we hear regularly about extended deployments of up to 18 months, with many reservists deployed for their second or third tour of duty. The intensity of combat is heightened for the military in Iraq, in particular, since there is no safe place whether they are inside or outside “the wire.” Restrictions on respite time in the military and shortened periods of leave time between deployments impose additional burdens on troops.

At the same time improved medical care has contributed to saving the lives of many who would have died in previous wars. This is wonderful good fortune for these individuals and their families, however, the soldiers are also at higher risk for developing mental health disorders. As a result, the ferocity and pervasiveness of violence in these combat zones combine to assault the physical, psychological and spiritual wellbeing of our troops.

Gate: What needs to be done?

KB: I strongly support the Mental Health Advisory Team’s recommendations for the periods of pre-deployment, deployment and post-deployment. Those stress the importance of “battlemind training” during all of the phases and either extending the interval between deployments to 18 to 36 months or decreasing deployment length to allow additional time for soldiers and marines to “reset” their mental health. The Pentagon report does not fully address the wide range of services that will be needed to assist troops and their families upon homecoming. Given the heightened incidence of trauma-related anger and interpersonal violence, couple and family mental health interventions are needed soon after returning home. In order to avoid the emergence of more severe mental health and psychosocial outcomes, interventions must occur within the first several months. I also think it is very important for the public to hear about the seriousness of these mental health problems confronting many of our returning troops.

Gate: Did the report by the Office of the U.S. Army Surgeon General include any surprises?

KB: Although we have been keenly aware of the pressures imposed on caregivers in active military hospitals and VA Centers, I was struck by the scope of the problem of ensuring optimal mental health care. The report clearly outlined the need for additional education to strengthen the skills of the direct mental health care providers.

An area that was not stressed related to the role of gender. Although there were no significant differences reported between male and female soldiers in regard to incidence of anxiety, depression or acute stress, the serious problem of increased military sexual assault, primarily from men against women, was not addressed. We also need to be mindful of the effects of separation of troops from their children, partners and extended family, especially for those who had functioned in a primary care-giving role at home.

During the 2007-08 academic year, Basham will serve as the field liaison for Smith School for Social Work students interning at the Walter Reed Medical Center in Washington D.C. While there, Basham will provide educational workshops for the departments of social work and psychiatry focusing on the effects of combat trauma on couples and families.

7/18/07   Compiled by Kristen Cole
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