Cover -- Preface -- Contents -- Figures -- Tables -- Summary -- Acknowledgments -- Abbreviations -- Part I: Introduction, Current Policy Context,and Historical Perspective -- Chapter One - Introduction -- Signature Wounds -- Unique Features of the Current Deployments -- Changes in Military Operations, Including Extended Deployments -- Higher Rates of Survivability from Wounds -- Traumatic Brain Injuries -- Caring for Invisible Wounds -- The Current Policy Context -- The Purpose of the RAND Study -- Scope of the Monograph -- Organization of This Monograph -- References -- Chapter Two - The Wars in Afghanistan and Iraq-An Overview -- What the Current Fighting Force Looks Like -- Troops Deployed to OEF/OIF -- The Conflicts in Perspective -- What Makes the Conflicts in Afghanistan and Iraq Different? -- Operation Enduring Freedom -- Operation Iraqi Freedom -- Casualties and Improvised Explosive Devices -- The Military and Veterans Health Systems -- Concluding Comments -- References -- Part II: The Nature and Scope of the Problem -- Chapter Three - Prevalence of PTSD, Depression, and TBI Among ReturningServicemembers -- Methods -- Results -- Screening for PTSD, Depression, and TBI in Epidemiological Surveys -- Defining a Case -- Mental and Cognitive Conditions Pre-Deployment -- Mental and Cognitive Conditions in Theater -- Mental and Cognitive Conditions Post-Deployment -- Emergent Themes -- Discussion -- Consistencies and Inconsistencies Across Studies -- Strengths and Limitations of the Existing Studies -- Future Research Directions -- Conclusion -- References -- Chapter Four - Survey of Individuals Previously Deployed for OEF/OIF -- Introduction -- Methods -- Eligibility and Sampling -- Informed Consent -- Interviews -- Measures -- Statistical Analysis -- Results -- Discussion -- Strengths and Limitations -- Conclusions -- References.

Part III: Immediate and Long-Term Consequences of Post-TraumaticStress Disorder, Depression, and Traumatic Brain Injury -- Chapter Five - Predicting the Immediate and Long-Term Consequences ofPost-Traumatic Stress Disorder, Depression, and TraumaticBrain Injury in Veterans of Operation Enduring Freedom andOperation Iraqi Freedom -- The Challenge of Predicting the Future -- Goals and Scope of Our Discussion -- Theoretical Perspectives on the Consequences of Mental Health andCognitive Conditions -- The Stress-Diathesis Model -- Life-Span Developmental Perspectives -- An Integrated Model of the Consequences of Post-Combat Mental Health andCognitive Conditions -- Empirical Research on the Consequences of Post-Combat MentalHealth and Cognitive Conditions -- Co-Morbidity and Other Mental Health Problems -- Suicide -- Physical Health and Mortality -- Substance Abuse -- Labor-Market Outcomes: Employment and Productivity -- Homelessness -- Marriage and Intimate Relationships -- Parenting and Child Outcomes -- Summary and Recommendations -- Recommendations for Future Research -- Conclusions -- References -- Part IV: Economic Consequences -- Chapter Six - The Cost of Post-Deployment Mental Health and CognitiveConditions -- Introduction -- Prior Cost Estimates -- The Cost of PTSD and Major Depression and the Benefits of Evidence-Based Care -- Background -- Motivation for the Microsimulation Approach -- Overview of the Microsimulation Framework -- Model Limitations -- Model Results -- Discussion -- The Cost of Deployment-Related Traumatic Brain Injury in 2005 -- Previous Estimates of the Cost of TBI -- Data and Assumptions Regarding Deployment-Related TBI and Costs -- Estimates of the Cost of Deployment-Related TBI in 2005 -- Limitations -- Discussion -- Conclusion -- Appendix 6.A: Model Map -- Appendix 6.B: Model Architecture, Assumptions, and Parameters.

References -- Part V: Caring for the Invisible Wounds -- Chapter Seven - Systems of Care: Challenges and Opportunities to ImproveAccess to High-Quality Care -- Introduction -- Access and Quality Challenges -- Study Approach -- Access to Mental Health Care for PTSD and Major Depression -- What Is the Gap in Access to Care? -- Overview of Health Service Systems -- What Structural Factors Impede or Facilitate Access to DoD Mental Health Services? -- What Structural Factors Impede or Facilitate Access to Mental Health ServicesWithin the VA? -- Transitions and Coordination Across Systems Pose Challenges to Access andContinuity of Care -- State and Local Community Initiatives Aim to Fill Gaps in Access -- What Social, Cultural, and Personal Factors Impede or Facilitate Servicemembers'and Veterans' Access to Mental Health Care? -- Quality of Mental Health Care -- What Is High-Quality Evidence-Based Treatment for PTSD and Major Depression? -- What Organizational Models Support High-Quality Mental Health Care? -- To What Extent Are Quality Standards and Processes for Mental Health CareSupported in Systems of Care for Veterans and Military Servicemembers? -- Summary of Critical Gaps -- Gaps in Access to Care and Care Quality for Active Duty Military Servicemembers -- Gaps in Access to Care and Care Quality for OEF/OIF Veterans -- Special Issues for Traumatic Brain Injury -- Mild TBI -- Moderate and Severe TBI -- What Is High-Quality Care for TBI? -- Summary of Gaps and Recommendations for TBI Services -- Appendix 7.A: Approach to Interviews with Administrators andProviders -- Appendix 7.B: Summary of Focus Groups with MilitaryServicemembers and Spouses -- Appendix 7.C: Evidence-Based Practices -- Appendix 7.D: Studies of Mental Health Services Utilization AmongServicemembers -- Appendix 7.E: State and Local Mental Health Resources -- References.

Part VI: Conclusions and Recommendations -- Chapter Eight - Treating the Invisible Wounds of War: Conclusions andRecommendations -- Key Findings -- Prevalence of Mental Health Conditions and TBI -- Long-Term Consequences of Mental Health and Cognitive Conditions -- Costs -- Systems of Care -- Strengths and Limitations -- Recommendations -- Treating the Invisible Wounds of War -- References.

Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Early evidence suggests that the psychological toll of these deployments?many involving prolonged exposure to combat-related stress over multiple rotations?may be disproportionately high compared with the physical injuries of combat. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. Many recent reports have referred to these as the signature wounds of the Afghanistan and Iraq conflicts. With the increasing concern about the incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet, these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. This monograph summarizes key findings and recommendations from a larger RAND document entitled Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery (Tanielian and Jaycox [Eds.], Santa Monica, Calif.: MG-720-CCF, 2008), a comprehensive study RAND conducted of the post-deployment health-related needs associated with the three conditions among OEF/OIF veterans; the

health care system in place to meet those needs; gaps in the care system; and the costs of filling those gaps and providing quality health care to all those in need. Readers desiring more details are referred to that document. Both monographs should be of interest to mental health treatment providers; health policymakers, particularly those charged with caring for our nation?s veterans; and U.S. service men and women, their families, and the concerned public. All the research products from this study are available at http://veterans.rand.org.

Description based on publisher supplied metadata and other sources.

Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, 2018. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries.