Mar. 28 2013

Report Identifies Ways to Meet Urgent Health Needs of Returning Veterans

Mailman School Epidemiology Chair Sandro Galea is a co-author of Congressionally mandated study

More than 2.2 million U.S. troops served in Iraq and Afghanistan, the longest sustained U.S. military engagements since the Vietnam War. For Americans, the toll includes more than 6,600 lives lost, 48,000 injured, and an estimated 44% of veterans who continue to suffer from more than one health condition, including traumatic brain injuries and symptoms of posttraumatic stress disorder, depression, and substance abuse.

Concerns about the difficulties that veterans face in adjusting to life after war led Congress to require the Department of Defense and the Veteran’s Administration to conduct a study of the health needs of returning soldiers. The four-year study was conducted in two parts by a special committee of the Institute of Medicine, whose second report was just released.

While the first report laid the groundwork, the second report looked at original data to try to understand the key barriers facing veterans in reintegrating into their communities, explains Sandro Galea, MD, DrPH, Gelman Professor and Mailman School chair of the Department of Epidemiology. Dr. Galea was a co-author of both reports, which were led by George W. Rutherford, MD, of the University of California, San Francisco.

Among the findings of the new report:

  • Both the DoD and VA are “at the forefront of providing evidence-based care for traumatic brain injuries and psychological issues,” but there is a clear need for better training of clinicians treating veterans.

  • Some methodologies used in programs for veterans lack an adequate evidence base. These include a tool used by the DoD to assess cognitive function after head injury and a VA-approved treatment for depression called Acceptance and Commitment Therapy.

  • Clinical follow-up is often inadequate and/or untimely. Documentation of treatment is also often inadequate.

  • While research shows that some suicides can be prevented by restricting access to guns and other lethal means, DoD policy prohibits restricting access to privately owned weapons.

  • Current services and policies to not adequately take into account the growing diversity of U.S. service men and women.

“Although several federal agencies are actively trying to address the support needs of current and former service members deployed to Iraq and Afghanistan as well as their families, the response has been slow and has not matched the magnitude of this population's requirements,” said Dr. Rutherford.

Among the Committee’s recommendations to improve readjustment to post-deployment life:

  • Ensure that healthcare systems have capacity to provide timely and adequate care to service members, veterans, and family members.

  • Boost efforts to reduce the stigma associated with getting care for mental health and substance abuse problems.

  • Utilize diagnostic tools and therapies that are in line with the latest medical evidence.

  • Organize a combined electronic health record for service members and veterans to easily navigate the services offered by the U.S. Departments of Defense and Veteran Affairs and ease the transition from one to the other.

  • Expand the definition of family and provide support to include nontraditional households.

  • Focus on efforts to identify and test new prevention and treatment intervention.

  • Fund well-designed research studies on the social, psychological, and economic effects of deployment.

  • Place a high priority on reducing domestic violence in families of service members deployed to Iraq and Afghanistan.

“With another 3,400 service members returning over the next 12 months, we felt a sense of urgency in our work to understand the scope of the readjustment challenges,” said Dr. Galea, an expert on PTSD who also serves as president of the Society for Epidemiologic Research. “The challenges are formidable, but we believe our second phase IOM report will help guide the VA and Department of Defense in identifying both the needs and some important directions for addressing them.”

Read the Executive Summary.