Many military veterans experience a group of mental health conditions that tend to disproportionately affect military personnel. These conditions may include posttraumatic stress (PTSD), depression, anxiety, traumatic brain injury (TBI), and substance abuse, among other issues. Due to the traumatic environment in which active military combatants serve, veterans are at a significantly higher risk for developing these health concerns. These concerns can often be addressed and resolved with the support of a mental health professional.

PTSD IN VETERANS

Posttraumatic stress is an anxiety issue that may develop after an individual is exposed to a traumatic or overwhelming life experience. While the human body tends to return to baseline levels after experiencing a stressful event, people experiencing PTSD continue to release stress-related hormones and chemicals. Posttraumatic stress is characterized by four basic types of symptoms:

Reliving the event

  • Repeatedly experiencing the event in flashbacks
  • Having intrusive, repeated, and upsetting memories of the event
  • Regularly having nightmares about the event
  • Having intense and discomforting reactions to objects or situations that remind you of the event

Avoidance

  • Staying away from people, places, or even thoughts that remind you of the event
  • Emotional numbness
  • Feelings of detachment
  • Memory problems
  • Loss of interest in everyday activities
  • Being emotionally guarded
  • Feelings of hopelessness

Hyperarousal

Negative thoughts, moods, or feelings

  • Feeling guilty about the event
  • Criticizing or blaming other individuals for the event
  • Loss of interest in activities and people

Though traumatic incidents—such as participating in combat, experiencing sexual abuse, or having a car accident—must occur for a person to develop PTSD, not all traumatic experiences result in posttraumatic stress. Only a small percentage of people who go through trauma experience PTSD. The lifetime prevalence of PTSD among American women is 10%, while only 4% of American men will experience PTSD at some point during their life.

American combat veterans have a much higher prevalence of PTSD than American civilians. Between 11-20% of veterans from Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) experience posttraumatic stress in a given year. Approximately 12% of Gulf War (Desert Storm) veterans and 15% of Vietnam veterans are affected by PTSD on an annual basis. The lifetime prevalence of PTSD for Vietnam veterans is 30%.

Military personnel are at higher risk for developing posttraumatic stress because service members are intimately involved in wartime incidents that may be frightening, horrifying, and at times, life-threatening. One emotionally overwhelming incident may be enough for PTSD to develop, but combat often facilitates prolonged and repeated exposure to traumatic events.

SEXUAL ABUSE IN THE MILITARY

Military sexual trauma (MST), defined by the Department of Veteran Affairs (VA) as “sexual harassment that is threatening in character or physical assault of a sexual nature that occurred while the victim was in the military, regardless of geographic location of the trauma, gender of the victim, or the relationship to the perpetrator,” is a significant and pervasive concern in the military.

Some studies estimate that approximately 1% of veteran males (32,000 men) and 22% of veteran females (23,000 women) are exposed to sexual assault or repeated sexual harassment during their military service. Between 10% and 33% of servicewomen may experience attempted rape during this time period. The prevalence rates of MST may range from 4% to as high as 85% based on the method of data collection and the definition of MST used.

There are a variety of emotional, behavioral, physical, and mental health issues that have been linked to MST.  Primary among these are depression, posttraumatic stress, anxiety, substance dependency, and an increased risk of suicide. Roughly 50-60% of female veterans who experience MST eventually develop posttraumatic stress. This rate is approximately three times higher than male veterans in similar circumstances. Of servicewomen who develop PTSD due to military sexual trauma, an estimated 75% develop co-morbid depression, and over 30% may develop anxiety.

Servicemen who experience posttraumatic stress due to exposure to military sexual trauma are more likely to abuse alcohol, drugs, and other substances than servicewomen who have experienced similar trauma. A study involving more than 2300 male and female military personnel who served in OEF/OIF revealed that sexual harassment was the only stressor that was independently linked to suicidal ideation among female veterans—even when accounting for depression and the misuse of alcohol.

DEPRESSION AND ANXIETY IN VETERANS

Mental health conditions that adversely affect mood, such as depression and anxiety, are also prevalent among military veterans—and veterans may experience these issues for many different reasons. Factors such as poor health (physical and mental), unemployment, and financial difficulties can contribute to negative thoughts and moods.

Upon returning home, some veterans report feeling disconnected from family members and friends. The belief that no one is able to relate to their experiences or offer meaningful emotional support can prompt service members to bottle up their feelings or even seek social isolation. Such actions though, may only serve to exacerbate the situation.

There are other factors which may also play a role in developing negative thought patterns. For example, the grief of losing one’s friends during combat, coupled with feelings of survivor’s guilt can lead to the development of depression and anxiety if they are not effectively treated.

TRAUMATIC BRAIN INJURY (TBI) AND VETERANS

Traumatic brain injury is currently one of the most discussed topics in the medical and mental health communities, as many veterans have returned home with the symptoms of the condition. It has even been called a “signature injury” of Operations Iraqi Freedom and Enduring Freedom. Traumatic brain injury may be caused by a blow to the head, the head striking an object, or by an explosion in close proximity.

People who experience a brain injury may become confused, disoriented, experience slow or delayed thinking, and may even slip into a coma. Memory loss of events preceding and immediately following the injury is also common. Other symptoms associated with TBI are headaches, dizziness, and difficulty paying attention. In some cases, traumatic brain injury can result in physical deficits, behavioral changes, emotional deficiencies, and loss of cognitive ability.

In the most recent conflicts in Afghanistan and Iraq, 78% of all combat injuries are caused by explosive munitions. Mild TBI or concussion is one of the most prevalent combat injuries, affecting roughly 15% of all active military combatants in Iraq and Afghanistan. Due to the devastating effect of roadside bombs in these countries, the ability to effectively treat traumatic brain injury is of great importance in veteran care.

OTHER MENTAL HEALTH ISSUES EXPERIENCED BY VETERANS

While posttraumatic stress, depression, anxiety, and traumatic brain injury are at the forefront of most people’s minds when it comes to veteran care, there are other mental health conditions that warrant attention. These include:

An individual who serves in the military will not necessarily develop a mental health condition. Further, a mental health concern experienced by a veteran may have no relation to the veteran’s military service. Mental health professionals who work with veterans will typically assess each person individually and take all symptoms and life experiences into consideration before making a diagnosis or starting treatment