This paper presents a comparative research proposal examining Post-Traumatic Stress Disorder (PTSD) among two populations exposed to the Iraq war zone: active-duty U.S. military personnel and non-military private contractors. Drawing on existing literature regarding PTSD prevalence, symptoms, treatments, and long-term effects, the paper identifies a critical gap in research — private contractors face combat-zone stressors comparable to soldiers yet lack access to military-provided mental health resources. The study proposes a survey-based methodology administered to both groups three months after deployment, with statistical analysis comparing PTSD symptoms and treatment access. The paper hypothesizes that both groups will exhibit PTSD symptoms, but that military personnel will demonstrate better coping skills due to greater access to structured treatment.
Conflict is a part of the human condition. Although most would prefer peace, sometimes war represents an inevitable reality. Since the founding of our nation, Americans have been called to serve in the armed forces numerous times, and the latest conflict is only one event in a long chain of wars dotting American history. Every time there is a conflict, three things are inevitable: casualties, fatalities, and survivors.
Fatalities are a part of life in the war zone — a reality that every military person faces every day. For those who become casualties, permanent reminders of their time in the war zone are often left behind. However, not all casualties are physical. Life in the war zone leaves lasting emotional scars on everyone who survives, whether they were injured or not. Often these emotional scars go unrecognized or have no apparent effect on daily life, but for some, they can affect life to a degree that makes it difficult to cope. These emotional effects are the topic of this research.
The war zone is one of the most stressful environments on earth. Personnel and civilians face a constant physical threat, and the long-term stress associated with combat leaves lasting emotional scars on everyone — not only military personnel. Life in the war zone is an ongoing exercise in coping with grief and loss. Post-Traumatic Stress Disorder (PTSD) occurs as a result of exposure to a traumatic event or ordeal (NIMH, 2008). Many people are familiar with PTSD as it relates to combat veterans; however, PTSD is not limited to combat veterans — it can occur in anyone as a result of exposure to any traumatic event (NIMH, 2008).
PTSD can be brief and mild, or it can be devastating and last a lifetime. Much of a person's reaction depends on personality traits and coping skills. A person does not have to be directly affected by the event to develop PTSD; casual observers and those who witness the event can be affected as easily as those directly in harm's path (NIMH, 2008). This was demonstrated by many who witnessed the bombing of the World Trade Center on television. People across the country developed PTSD simply by watching events unfold. Almost all adults in a nationwide survey reported at least one symptom of PTSD after watching the events of September 11, 2001 on television (Schuster, Bradley, & Jaycox, 2001). For a few hours, the nation was in a war zone, if only on the television screen.
Although PTSD can affect anyone who witnesses a traumatic event, those who are geographically close or directly involved in the conflict are at the greatest risk for developing severe PTSD. Therefore, this research focuses on the impact of PTSD on U.S. military personnel currently serving in a war zone. The purpose of this study is to examine current literature on PTSD, current theories and treatments, and the ability to adapt to society after returning to a conflict-free environment. This research uses a survey to examine the effectiveness of current treatments for PTSD among a population of military personnel and private contractors stationed in the war zone. This study will play an important role in the further development of techniques to help those who spend time in a war zone avoid PTSD and to allow them to return to a state of normalcy as quickly as possible.
According to available statistics, there are approximately 142,000 active-duty U.S. troops in Iraq, in addition to approximately 8,000 Reserve units including the National Guard, for a total of approximately 150,000 troops stationed in Iraq (O'Hanlon & Campbell, 2008). There are also approximately 23,000 non-U.S. coalition troops in Iraq (O'Hanlon & Campbell, 2008). The number of troops on the front lines versus those in support positions changes daily and is not made available to the general public for national security reasons.
Of the troops stationed in Iraq, approximately 30,000 have suffered serious brain and spinal injuries, excluding psychological injuries (White, 2008). Approximately 30% of all U.S. troops develop serious mental health problems within three to four months after returning home (White, 2008). U.S. military troops are not the only ones stationed in Iraq at risk of suffering from serious emotional trauma. There are approximately 180,000 private contractors in Iraq working in support of U.S. military troops (White, 2008) — meaning there are more private contractors than actual military personnel.
These individuals are also at risk for the development of mental health disorders, yet no statistics are available on health risks to private contractors. This is an important group to consider, as they do not receive assistance from the military for PTSD and related problems. It falls to their companies and private insurance providers to offer treatment for these personnel. It is not known whether these persons are receiving the care they need or whether they are slipping through the cracks of the system.
War can have many different effects on individuals, and PTSD manifests in a number of ways. In combat soldiers who responded to a survey after deployment, there was a strong correlation between combat experiences — such as being shot at, handling or viewing dead bodies, knowing someone who was killed, or killing enemy combatants — and the development of PTSD (Hoge, Castro, & Messer et al., 2004). However, like most studies, only military personnel were considered. Private contractors can still be exposed to these same experiences during their deployment to Iraq.
There are a number of signs and symptoms associated with PTSD, including both physical and mental manifestations. PTSD affects every individual differently, but common characteristics that indicate a person is suffering from PTSD include chronic fatigue syndrome (Kang et al., 2003), depression (Henkel et al., 2003), and all associated symptoms of these disorders (Smith, Ryan, Wingard, et al., 2008). Symptoms can include intense memories of the event, nightmares, feelings of anxiety associated with the event, and physiological distress symptoms triggered by stimuli associated with the event (Smith, Ryan, Wingard, et al., 2008).
One of the most troubling factors in the treatment of PTSD among combat veterans is the stigma attached to it, which prevents many veterans from seeking the help they need (Seal, Bertenthal, & Maguen et al., 2008). Most treatment for PTSD comes from Veterans Administration (VA) clinics. Although any mental health professional can offer treatment for PTSD, because the most well-known cases are associated with military personnel, most statistics and information regarding PTSD stem from VA health clinics. There are few statistics available for non-military populations.
Treatments offered by the U.S. Department of Veterans Affairs stand as the standard for PTSD treatment and are considered the authority in terms of effective treatment methods. According to the VA, a number of treatment options are available for those suffering from PTSD. The most common therapies include cognitive-behavioral therapy, cognitive therapy, exposure therapy, and eye movement desensitization and reprocessing (EMDR) therapy (National Center for PTSD, 2007a). A number of medications are also used to enhance other therapy methods, including selective serotonin reuptake inhibitors (SSRIs) and other medications typically used to treat depression (National Center for PTSD, 2007a). According to the VA, drug therapies are seldom used alone to treat PTSD; some form of counseling is usually employed, with or without pharmaceutical support (National Center for PTSD, 2007a).
Individual treatments are not the only option available. Group therapy and family therapies are also used to help both the sufferer and those around them. Treatment lasts on average three to six months but can extend to as long as two years (National Center for PTSD, 2009a). In cases where comorbidity is present, therapy can be more complicated and of longer duration (National Center for PTSD, 2007a). The treatment approach and its duration are individualized and reflect the complexity of the condition and the coping skills of the individual.
"Long-term PTSD impacts across different war eras"
"Survey design comparing military and contractor groups"
The impact of being on the front lines extends beyond the symptoms displayed by the veteran. The war zone affects every aspect of the rest of their lives — their future vocation, their ability to carry out meaningful employment, their relationships with family and friends, and their capacity to pursue a meaningful social life. The experiences of the veteran extend to others around them through the ways those experiences affect their ability to function in society.
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