The War on Terror has led to an extended war in the Middle East that started with a U.S. intervention in Afghanistan, spread to Iraq, and has steadily engulfed other states as well. Returning veterans from Afghanistan and Iraq have suffered from post traumatic stress disorder (PTSD), which has impacted the work and family life of these veterans (Vogt et al., 2017). 1.3 million veterans of the Afghanistan and Iraq interventions are at risk for suicide (Kang et al., 2015). Hundreds of thousands of this same population suffer from identity adjustment as the return to civilian life and attempt to make the transition from military norms to civilian living (Orazem et al., 2017). This paper will discuss this specific population, its needs, policies and laws that impact this population, barriers to resource utilization, and how the nursing profession can promote change to improve healthcare outcomes for this veteran population.
The Population
2.8 million veterans of the Afghanistan and Iraq wars served and 1.3 million make up the population of this study as that many are estimated to be at risk for some form of PTSD-related symptoms (Kang et al., 2015). Their military experience typically includes more than one tour of duty in either of the two Middle Eastern nations. Combat infantry units serve as the primary group of service members at risk for developing PTSD. The risk stems from their exposure to traumatic events, such as violent assault, near-death encounters, seeing dead bodies, losing friends in combat, risking their lives, entering into armed conflict with the enemy, sexual assault, and living in a war zone. Numerous studies have attempted to dissect this population in terms of particular combat zones, gender distinctions and so on but none of these studies have produced comprehensive results, which means this population is still relatively unknown (Hines, Sundin, Rona, Wessely & Fear, 2014). However, the U.S. Department of Veterans Affairs (2016) reports that 11%-20% of all Afghanistan/Iraq war veterans will suffer from PTSD per year.
Demographics
Age. Veterans of the Afghanistan/Iraq wars are 18+. The highest risk population is between the ages of 18 and 24 as they are most likely to see combat.
Race/Ethnicity. There is no statistical data available on this particular demographic at this time. Race and ethnicity statistics are also difficult to obtain due to a lack of accurate records relating to PTSD among Iraq and Afghanistan veterans, as hundreds of thousands are believed to suffer from these symptoms but do not report their issues to medical care providers.
Gender. 60% of male veterans are likely to experience trauma and be at risk for PTSD. 51% of women are likely to experience trauma and be at the same risk. Currently, an estimated 460,000 veterans of the Afghanistan/Iraq wars are believed to suffer from PTSD (Department of Veterans Affairs, 2015).
Single/Married. There is no statistical data available on this particular demographic at this time, as specifics on this population are difficult to attain for the reason that so many fail to report or qualify for medical benefits as a result of their PTSD and self-inflicted harm.
Total Number of the Population
The era of service for this population begins in 2003 and continues to this day. The total number of the population is estimated at 1.
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3 million persons or approximately half of all veterans of the Iraq and Afghanistan wars. The disability status of these individuals is unknown for the simple fact that so few actually seek treatment, instead attempting to self-medicate through the use of drugs or alcohol (Giordano et al., 2016).
Most of these individuals do not have a college degree as they are between the ages of 18-24 when the PTSD develops. Their employment status is also unknown along with their income. Their geographical location is the U.S. and their combat experience is in the Middle East.
Healthcare Needs
The healthcare needs of this population include a need for therapy and pharmacological intervention. They can suffer from depression, isolation, withdrawal, anti-social behavior, substance abuse disorders, and suicide ideation (Department of Veterans Affairs, 2015). They also routinely suffer from a lack of access to care as many veterans avoid reporting their symptoms because of the military culture around them: they fear being perceived as weak or lacking the strength to cope with traumatic situations. The military is an environment in which strength is constantly promoted, so to confess to a doctor that one is suffering from a traumatic experience is almost to seem like it is going against the code of the military (Kang et al., 2015).
Policies Impacting the Population
The American Public Health Association (2014) is committed to improving “access to mental health care, particularly for vulnerable populations.” Many policy statements need to be updated, however, as the Association points out. For that reason, the organization has updated its statements on suicide prevention among veterans suffering from PTSD, accountability and nondiscrimination. The wars in Iraq and Afghanistan have prompted the organization to update its policies because of hundreds of thousands of new veterans are returning home with PTSD. One of the problems that the Association points out is that in order to receive medical benefits at VA hospital, a veteran must be honorably discharged or released. Veterans who are dishonorably discharged are not available for benefits. That is problematic because if a soldier is suffering from PTSD, it may manifest in behavior that leads to dishonorable discharge. This means the veteran will not receive the benefits required for quality care (American Public Health Association, 2014).
Resources Available
The main resource available to this population is the VA hospital, but as the American Public Health Association points out and as other researchers have shown, it is difficult to access the resource at times—especially if the veteran is attempting to self-medicate, fears being perceived as weak, or lacks the right to medical benefits because of a dishonorable discharge.
American Public Health Association. (2014). Removing barriers to mental health. Retrieved from https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2015/01/28/14/51/removing-barriers-to-mental-health-services-for-veterans
Department of Veterans Affairs. (2015). Mental health effects. Retrieved from https://www.ptsd.va.gov/public/PTSD-overview/reintegration/overview-mental-health-effects.asp
Department of Veterans Affairs. (2016). How common is PTSD? Retrieved from https://www.ptsd.va.gov/public/ptsd-overview/reintegration/overview-mental-health-effects.asp
Giordano, A., Prosek, E., Stamman, J. et al. (2016). Addressing Trauma in Substance Abuse Treatment. Journal of Alcohol and Drug Addiction, 60(2): 55-71.
Hines, L. A., Sundin, J., Rona, R. J., Wessely, S., & Fear, N. T. (2014). Posttraumatic stress disorder post Iraq and Afghanistan: prevalence among military subgroups. The Canadian Journal of Psychiatry, 59(9), 468-479.
Kang, H. K., Bullman, T. A., Smolenski, D. J., Skopp, N. A., Gahm, G. A., & Reger, M.A. (2015). Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars. Annals of epidemiology, 25(2), 96-100.
Mason, B. & Suresh, S. (2017). Effectiveness of an interprofessional team approach at reducing CLABSI in a community hospital. American Journal of Infection Control, 45(6), S100.
Orazem, R. J., Frazier, P. A., Schnurr, P. P., Oleson, H. E., Carlson, K. F., Litz, B. T., & Sayer, N. A. (2017). Identity adjustment among Afghanistan and Iraq war veterans with reintegration difficulty. Psychological Trauma: Theory, Research, Practice, and Policy, 9(S1), 4.
RAND Corporation. (2017). Changing landscape for Veterans’ mental health. Retrieved from https://www.rand.org/pubs/research_briefs/RB9981z2.html
Vogt, D., Smith, B. N., Fox, A. B., Amoroso, T., Taverna, E., & Schnurr, P. P. (2017). Consequences of PTSD for the work and family quality of life of female and male US Afghanistan and Iraq War veterans. Social Psychiatry and Psychiatric Epidemiology, 52(3), 341-352.
or drug abuse and thus going untreated. This paper will discuss how care providers can more effectively treat veterans with PTSD by becoming aware of the challenges to effective treatment and identifying ways forward.
One of the main reasons that it is so difficult to treat veterans for PTSD is that there is a taboo associated with trauma—especially for soldiers who are brought up in military culture in which they are not supposed to show fear or weakness. Admitting to a counselor that trauma has occurred and that one is suffering from PTSD-related symptoms is to appear vulnerable and exposed for a soldier. It goes against the grain… Continue Reading...
