Mental health impact of the Iraq and Afghanistan conflicts: A review of US research, service provision, and programmatic responses

Abstract

Although documentation that war inflicts psychological casualties dates back to the American Civil War and earlier, most research began after the Vietnam conflict, when studies focused on post-traumatic stress disorder (PTSD). With ongoing conflicts in Iraq and Afghanistan, there has been significant research to illuminate the epidemiology of war-related psychological casualties. Significant findings include an appreciation for the role combat plays in the development of mental disorders, including PTSD and traumatic brain injury (TBI). Recent research has endeavoured to understand and improve psychological resilience to temper potentially adverse mental health effects of military service in the theatre of combat operations. Over 2 million US service members have now deployed and returned over 3 million times to the Iraq and Afghanistan conflicts. Mental health providers in the Departments of Defense and Veterans Affairs healthcare systems have consequently observed steep increases in mental health service use among these personnel. The Departments have responded aggressively to bolster staffing levels, increase capacity, improve available services, and anticipate future needs. Scientists and clinicians continue efforts to understand the determinants, prevention, recognition, and treatment of combat-related mental disorders.

Acknowledgments

We thank Daniel Kivlahan, Associate National Mental Health Director for Addictive Disorders, Office of Mental Health Services, Veterans Health Administration, for his insight into VA healthcare use; and Aaron I. Schneiderman, Acting Director, Environmental Epidemiology Service, Veterans Health Administration, for his insight into VA healthcare use.

Declaration of interest: This work represents report 11-XX, supported by the Department of Veterans Affairs, and the Department of Defense, under work unit no. 60002. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of the Army, Department of the Air Force, Department of Defense, Department of Veterans Affairs, or the US Government. This research has been conducted in compliance with all applicable federal regulations governing the protection of human subjects in research (Protocol NHRC.2000. 0007). Approved for public release; distribution is unlimited. The authors alone are responsible for the content and writing of the paper.