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International Review of Psychiatry Volume 31, 2019 - Issue 1: Miliatry Psychiatry
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Review Article

Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward

David ForbesCentenary of Anzac Centre, Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia; Correspondence[email protected]
ORCID Iconhttp://orcid.org/0000-0001-9145-1605
ORCID Icon,
David PedlarCanadian Institute for Military and Veteran Health Research, Kingston, ON, Canada; Correspondence[email protected]
,
Amy B. AdlerCenter for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA;
,
Clare BennettNew Zealand Defence Force, Wellington, New Zealand;
,
Richard BryantCentenary of Anzac Centre, Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia; ;School of Psychology, University of New South Wales, Sydney, Australia;
,
Walter BusuttilCombat Stress, Surrey, UK;
,
John CooperCentenary of Anzac Centre, Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia;
,
Mark C. CreamerCentenary of Anzac Centre, Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia;
,
Nicola T. FearKing’s Centre for Military Health Research, King’s College London, London, UK; ;Academic Centre for Military Mental Health Research, London, UK;
,
Neil GreenbergKing’s Centre for Military Health Research, King’s College London, London, UK; ORCID Iconhttp://orcid.org/0000-0003-4550-2971
ORCID Icon,
Alexandra HeberVeterans Affairs Canada, Charlottetown, Canada; ;Department of Psychiatry, University of Ottawa, Ottawa, Canada;
,
Mark HintonCentenary of Anzac Centre, Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia;
,
Mal HopwoodCentenary of Anzac Centre, Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia;
,
Rakesh JetlyDirectorate of Mental Health, Canadian Armed Forces, Ottawa, Canada;
,
Ellie Lawrence-WoodCentre for Traumatic Stress Studies, University of Adelaide, Adelaide, Australia;
,
Alexander McFarlaneCentenary of Anzac Centre, Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia; ;Centre for Traumatic Stress Studies, University of Adelaide, Adelaide, Australia;
,
Olivia MetcalfCentenary of Anzac Centre, Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia; ORCID Iconhttps://orcid.org/0000-0001-9570-8463
ORCID Icon,
Meaghan O’DonnellCentenary of Anzac Centre, Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia;
,
Andrea PhelpsCentenary of Anzac Centre, Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia; ORCID Iconhttp://orcid.org/0000-0002-9235-8012
ORCID Icon,
J. Don RichardsonDepartment of Psychiatry, Western University, London, Canada; ;McDonald/Franklin OSI Research Centre, London, Canada;
,
Nicole SadlerCentenary of Anzac Centre, Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia;
,
Paula P. SchnurrNational Center for PTSD, White River Junction, VT, USA; ;Department of Psychiatry, Geisel School of Medicine, Hanover, NH, USA;
,
Marie-Louise SharpKing’s Centre for Military Health Research, King’s College London, London, UK; ORCID Iconhttp://orcid.org/0000-0001-8516-0166
ORCID Icon,
James M. ThompsonVeterans Affairs Canada, Charlottetown, Canada; ;Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada;
,
Robert J. UrsanoCenter for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
,
Miranda Van HooffCentre for Traumatic Stress Studies, University of Adelaide, Adelaide, Australia;
,
Darryl WadeCentenary of Anzac Centre, Phoenix Australia–Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, Australia;
&
Simon WesselyKing’s Centre for Military Health Research, King’s College London, London, UK;
show all
Pages 95-110 | Received 05 Feb 2019, Accepted 11 Mar 2019, Published online: 02 May 2019
 
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Abstract

Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with the development of PTSD in this population, considers issues relating to engagement in treatment, and discusses the empirical support for best practice evidence-based treatment. The paper goes on to explore the challenges in those areas, with particular reference to treatment engagement and barriers to care, as well as treatment non-response. The final section addresses innovative solutions to these challenges through improvements in agreed terminology and definitions, strategies to increase engagement, early identification approaches, understanding predictors of treatment outcome, and innovations in treatment. Treatment innovations include enhancing existing treatments, emerging non-trauma-focused interventions, novel pharmacotherapy, personalized medicine approaches, advancing functional outcomes, family intervention and support, and attention to physical health.

Acknowledgements

The authors recognize the support of the 5 Eyes Mental Health Research and Innovation Collaborative (5 Eyes MHRIC) in the development of this review paper. The 5 Eyes MHRIC is a collaboration of mental health researchers in Canada, Australia, the US, the UK, and New Zealand that strives to have a demonstrable impact on improving mental health outcomes for past and present military personnel and their families.

Disclosure statement

The authors report no conflicts of interest.

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