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Guest VetWife Advocate

Sending Combat Troops Back W/antidepressants!

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Guest VetWife Advocate

Running out of troops!! VetWife Advocate!!!!!

Subject: US Re-Deploys Sick Soldiers on Meds


Michelle Pilecki


US Re-Deploys Sick Soldiers on Meds (24 comments )

READ MORE: Afghanistan, Iraq

It's no secret that a lot of soldiers return from combat zones with mental health problems -- the Associated Press reported as much on a study by the Journal of the American Medical Association at the end of last month, and the story was widely carried.

Thirty-five percent of Iraq veterans received mental health care during their first year home, according to the study.In addition, 12 percent of the more than 222,000 returning Army soldiers and Marines in the study were diagnosed with a mental problem. Nineteen percent of those back from Iraq reported mental health concerns, compared with 11 percent of those back from Afghanistan and 8.5 percent of those returning from other places, such as Bosnia.

But now the San Diego Union Tribune is reporting that "mentally ill service members are being returned to combat" equipped "with a cache of antidepressant and anti-anxiety medications." You know, the kind that say on the bottle: May cause drowsiness. Use caution when operating a car or dangerous machinery. Like, say, heavy weaponry? The redeployments are legal, and nobody is forcing the soldiers to go, reports the Union-Trib. But Sen. Barbara Boxer (D-Calif) says the policy needs more civilian oversight, i.e. the Department of Defense Task Force on Mental Health, which should start next month. Boxer, who wrote legislation establishing the task force, told the Union-Trib, "We've also heard reports that doctors are being encouraged not to identify mental-health illness in our troops.... If people are suffering from mental-health problems, they should not be sent on the battlefield."

Officials from the Defense Department and Camp Pendleton, where some units have been to Iraq three times, said they don't track personnel deployed while taking mental-health medication or the number diagnosed with mental illness.

But medical officers for the Army and Marine Corps acknowledge that medicated service members - and those suffering combat-induced psychological problems - are returning to war. And anecdotal evidence, bolstered by the government's own studies, suggest that the number could be significant.

A 2004 Army report found that up to 17 percent of combat-seasoned infantrymen experienced major depression, anxiety or post-traumatic stress disorder after one combat tour to Iraq. Less than 40 percent of them had sought mental-health care.

Even more troubling than perhaps complicating soldiers' mental-health illnesses and endangering their combat-readiness, is the allegation from Steve Robinson, director of the National Gulf War Resource Center in Silver Spring, Md., that the Pentagon is trying to pare its budget by cutting needed services to soldiers and vets.

Robinson said three Army doctors have told him about being pressured by their commanders not to identify mental conditions that would prevent personnel from being deployed.

"They are being told to diagnose combat-stress reaction instead of PTSD," he said. "That does two things: It keeps the troops deployable and it makes it hard for them to collect disability claims once they get out of the military."


Mental Health Problems, Use of Mental Health Services, and Attrition From Military Service After Returning From Deployment to Iraq or Afghanistan

Charles W. Hoge, MD; Jennifer L. Auchterlonie, MS; Charles S. Milliken, MD

JAMA. 2006;295:1023-1032.

Context The US military has conducted population-level screening for mental health problems among all service members returning from deployment to Afghanistan, Iraq, and other locations. To date, no systematic analysis of this program has been conducted, and studies have not assessed the impact of these deployments on mental health care utilization after deployment.

Objectives To determine the relationship between combat deployment and mental health care use during the first year after return and to assess the lessons learned from the postdeployment mental health screening effort, particularly the correlation between the screening results, actual use of mental health services, and attrition from military service.

Design, Setting, and Participants Population-based descriptive study of all Army soldiers and Marines who completed the routine postdeployment health assessment between May 1, 2003, and April 30, 2004, on return from deployment to Operation Enduring Freedom in Afghanistan (n = 16 318), Operation Iraqi Freedom (n = 222 620), and other locations (n = 64 967). Health care utilization and occupational outcomes were measured for 1 year after deployment or until leaving the service if this occurred sooner.

Main Outcome Measures Screening positive for posttraumatic stress disorder, major depression, or other mental health problems; referral for a mental health reason; use of mental health care services after returning from deployment; and attrition from military service.

Results The prevalence of reporting a mental health problem was 19.1% among service members returning from Iraq compared with 11.3% after returning from Afghanistan and 8.5% after returning from other locations (P<.001). Mental health problems reported on the postdeployment assessment were significantly associated with combat experiences, mental health care referral and utilization, and attrition from military service. Thirty-five percent of Iraq war veterans accessed mental health services in the year after returning home; 12% per year were diagnosed with a mental health problem. More than 50% of those referred for a mental health reason were documented to receive follow-up care although less than 10% of all service members who received mental health treatment were referred through the screening program.

Conclusions Combat duty in Iraq was associated with high utilization of mental health services and attrition from military service after deployment. The deployment mental health screening program provided another indicator of the mental health impact of deployment on a population level but had limited utility in predicting the level of mental health services that were needed after deployment. The high rate of using mental health services among Operation Iraqi Freedom veterans after deployment highlights challenges in ensuring that there are adequate resources to meet the mental health needs of returning veterans.

Author Affiliations: Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research (Drs Hoge and Milliken) and Army Medical Surveillance Activity, US Army Center for Health Promotion and Preventive Medicine (Ms Auchterlonie), Washington, DC.

This Week in JAMA

JAMA. 2006;295:967.


Mental Health Service Use After Military Deployment

Journal Watch Psychiatry 2006;2006:3-3.


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DOD says it's not REALLY PTSD, and a few days rest from battle will cure it!



Story below:


What is combat stress?

Frequently overlooked are the many adaptive or "good" combat stress reactions. These might include increased alertness, exceptional strength, heightened endurance or tolerance to pain and hardship.

"Combat stress" is a term used to describe normal physiological, behavioral, and psychosocial reactions experienced before, during or after combat. In the past, it was thought that service members experiencing combat stress reactions were mentally ill.

Experience has shown this is not the case. Most conditions related to stress during combat are normal reactions to the abnormal circumstances of war. Typical (maladaptive and adaptive) combat stress reactions include difficulty concentrating, extreme anxiety or "fright," diarrhea, regression, and marked sadness, and are often not mental illness at all.

Is combat stress that big a deal?

Proper management of battle fatigued military members has reduced the rate of chronic mental illness following combat.

Yes! Failing to prevent or effectively manage combat stress reactions has resulted in significant preventable combat losses. During World War II an average of one combat stress casualty for every four wounded typically occurred. However, in battles such as Okinawa, involving particularly heavy fighting, a ratio as high as one stress casualty for every two wounded was possible.

Past experience has proven that dedicated combat stress control efforts have prevented unnecessary evacuation of battle fatigued service members and has led to greatly increased return to duty rates for affected members.

What is "battle fatigue"?

Battle fatigue is the term used by the Army to describe combat stress casualties—that is, service members experiencing combat stress reactions to the point where they are no longer combat effective. Battle fatigue is not a disease. It is a transient state and a normal response to the abnormal circumstances of war.

How are battle fatigued service members managed?

Battle fatigued service members are most often managed using the four R's. Rest, Replenishment, Reassurance, and Restoration.

* Rest: Minimum of rest (4-6 hours) and respite (or shelter from heat, cold, rain, snow).

* Replenishment: Provide plenty to drink, a hot meal, a wash, as possible to restore the service member's energy level and hygiene.

* Reassurance: Reassure the military member that he/she is OK and allow him/her to verbalize what happened. Members (75-95 percent) experiencing battle fatigue are experiencing a normal response brought about by a combat situation and not necessarily suffering from a mental illness or a "weakness." The fact is most of these military members can return to duty, with no ill-effects, within 24-72 hours. In the past, when a member has been labeled as sick or disturbed, he/she was more likely to develop a real psychological problem and less likely to return to duty.

* Restoration: Engage the military member in tasks which restore his/her identity as an active duty member (rather than a patient) and that restores his/her sense of competency as a capable, combat effective member of the team.

Although these are the basics used in managing battle fatigue casualties, there of course will be service members who also require a brief medical or neuropsychiatric evaluation to rule out serious physical/mental illness or injury.

If I experience combat stress, does that mean I have a mental problem?

No! As mentioned above, most service members who experience combat stress reactions are not mentally ill and make a full recovery within 24-72 hours. This is because the majority of combat stress reactions are simply related to fatigue or are normal reactions to abnormally stressful or traumatic situations.

Source: 528th Medical Detachment, Fort Bragg, U.S. Army

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The Navy almost deployed me to the first Gulf War. My ship wasn't the least bit concerned about my being on paxil.


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