PTSD in Afghanistan and Iraq War Veterans: Care and Policy

Introduction

The War on Terror led to an extended conflict in the Middle East that began 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 significantly impacted both their work and family lives (Vogt et al., 2017). An estimated 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 struggle with identity adjustment as they return to civilian life and attempt to transition from military norms to civilian living (Orazem et al., 2017). This paper discusses this specific population, its needs, the policies and laws that affect it, barriers to resource utilization, and how the nursing profession can promote change to improve healthcare outcomes for these veterans.

The Population and Demographics

Approximately 2.8 million veterans served in the Afghanistan and Iraq wars, and an estimated 1.3 million are 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 represent the primary group of service members at risk for developing PTSD. This risk stems from exposure to traumatic events such as violent assault, near-death encounters, witnessing dead bodies, losing friends in combat, risking their own lives, entering armed conflict with the enemy, sexual assault, and living in a war zone. Numerous studies have attempted to analyze this population in terms of particular combat zones, gender distinctions, and other variables, but none have produced comprehensive results, meaning this population remains relatively understudied (Hines, Sundin, Rona, Wessely, & Fear, 2014). The U.S. Department of Veterans Affairs (2016) reports that 11%–20% of all Afghanistan and Iraq war veterans will suffer from PTSD in any given year.

Veterans of the Afghanistan and Iraq wars are 18 and older. The highest-risk group is between the ages of 18 and 24, as individuals in this range are most likely to see combat.

No reliable statistical data is currently available on this demographic. Race and ethnicity statistics are also difficult to obtain due to a lack of accurate records relating to PTSD among Iraq and Afghanistan veterans; hundreds of thousands are believed to experience symptoms but do not report them to medical care providers.

Approximately 60% of male veterans are likely to experience trauma and be at risk for PTSD, while 51% of female veterans face the same risk. An estimated 460,000 veterans of the Afghanistan and Iraq wars are believed to suffer from PTSD (Department of Veterans Affairs, 2015).

No statistical data is currently available on this demographic either, as specifics on this population are difficult to obtain given that so many veterans fail to report their condition or do not qualify for medical benefits due to PTSD-related behavior or self-inflicted harm.

The era of service for this population begins in 2003 and continues to the present. The total number in this population is estimated at 1.3 million persons—approximately half of all veterans of the Iraq and Afghanistan wars. The disability status of these individuals is largely unknown because so few actually seek treatment, instead attempting to self-medicate through drugs or alcohol (Giordano et al., 2016).

Most of these individuals do not hold a college degree, as their PTSD typically develops between the ages of 18 and 24. Their employment status and income are also largely unknown. Geographically, they are located throughout the United States, while their combat experience was in the Middle East.

Healthcare Needs

The healthcare needs of this population include both therapy and pharmacological intervention. Veterans with PTSD can suffer from depression, isolation, withdrawal, anti-social behavior, substance use disorders, and suicidal ideation (Department of Veterans Affairs, 2015). They also routinely face a lack of access to care, as many veterans avoid reporting their symptoms due to military culture: they fear being perceived as weak or lacking the strength to cope with traumatic situations. The military environment constantly promotes strength and resilience, so confessing to a doctor that one is suffering from a traumatic experience can feel like a violation of the military code (Kang et al., 2015).

Conclusion

The Afghanistan and Iraq wars have introduced hundreds of thousands of veterans with PTSD since 2003. Many of those veterans cannot receive proper care either because they were dishonorably discharged or because they fear coming forward to acknowledge that they are suffering from trauma. Nurses can help raise awareness about the challenges this population faces by publishing in journals, hosting conferences, forming professional networks, and lobbying for change both within their healthcare facilities and within government. The need for systemic change is clear, as researchers and organizations like the RAND Corporation have demonstrated. The American Public Health Association has also published policy statements affirming that this population requires suicide prevention support and greater access to care. Interprofessional collaboration could benefit this population significantly by providing a holistic approach to treatment, ensuring that all symptoms are addressed and that patients are able to cope with and process the underlying trauma at the root of their difficulties.

References

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.

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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 U.S. Afghanistan and Iraq war veterans. Social Psychiatry and Psychiatric Epidemiology, 52(3), 341–352.