Fallout of Combat Trauma
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
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.
What types of psychological problems are most common among
members of the military?
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
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
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.