THIRD TRIMESTER BLEEDING

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Home from the War Where can I get the help I
need?

Beth Wick, Manager of 2-1-1 Texas IR
Network Mary Cooksey, Director of 2-1-1 West
Central Texas
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Goal

• To provide scope of the problem for the
  individual, families, and societal impacts of
  OIF/OEF.
• To provide information on how one IR decided to
  be part of the solution.

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OIF/OEF

• Operation Iraq Freedom
• Operation Enduring Freedom

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No one comes home from war unchanged.

• Iraq and Afghanistan Veterans

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Scope of Issue

• 1.5 Million Soldiers have served
• 449,000 deployed gt 1 tour
• 20 Female Soldiers
• As of January 23, 2006, DoD reports 505,366
  OIF/OEF Veterans eligible for VA services
• 43 separated Active Duty troops
• 57 Reserve/National Guard members

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What We Know About OIF/ OEF Veterans

• 19 OIF, and 11 OEF have mental health problems
• 17 of OIF Soldiers and Marines screened
  positive for PTSD, generalized anxiety, or
  depression
• 35 OIF veterans accessed MH services in first
  year
• Hoge, Journal of American Medical Association,
  2006

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What we know

• Survey of 894 Army soldiers from Operation Iraqi
  Freedom
• 95 observed dead bodies or human remains
  93 were shot at or received small-arms fire
  89 were attacked or ambushed 65 observed
  injured or dead Americans 48 were responsible
  for the death of an enemy combatant
• Charles Hoge et al., 2004

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What we know about the families

• Over half of service members are married
• At least 1.8 million children have one or both
  parents in the military
• 1.2 million with Active Duty parents and 650,000
  with parents in reserves
• Ages of children affected by deployment
• 0-5 40
• 6-11 33
• 12-18 25

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Military Families cont

• Dual military families (6.9)
• Single active duty parents (5.4)
• Families with special health care needs (7.3)

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Military Families cont

• Over ½ said their child had trouble sleeping
• 1/3 of the children were categorized as high
  risk for psychosocial problems (which is 2.5x
  the national norm)
• Parenting stress levels were double that of
  normative data
• Parental stress was most significant predictor of
  childs mental health
• (Flake et al., 2008)

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Military Families cont

• Nationally, rate of child maltreatment in
  families of enlisted soldiers was 42 percent
  higher when military spouses were off at war than
  when they were at home
• Female civilian parents were twice as likely to
  abuse a child physically and almost four times
  more likely to neglect a child when male soldiers
  were deployed than at other times.
• Gibbs (2007) Studied U.S. Army families
  worldwide 2001 - 2004 using Army human-resource
  data and Army Central Registry

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Military Youth Unique Challenges

• Frequent moves
• Changing schools, friends, activities, etc.
• Parent working long hours and away for long
  periods of time
• Unprecedented combat deployments
• Many parents returning home with physical and/or
  emotional wounds

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Military Youth cont

• 53 worry about my military parent while he/she
  is deployed
• 38 worry about the person who takes care of me
  while my parent is deployed
• 57 of interviewed youth said that getting to
  know their parent again (upon homecoming) was
  difficult.
• Chandra et al 2008

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Military Youth cont

• ACADEMIC PROBLEMS Parental deployments may be
  related to modest decreases in test scores across
  most subjects effects may be long-term (Engel
  et al., 2006)
• PHYSIOLOGICAL DIFFERENCES Teens whose parents
  had been deployed to Iraq had significantly
  higher levels of systolic blood pressure, heart
  rate, and perceived stress than a civilian
  comparison group (Barnes et al., 2007).

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Scope of Problem

• 30-40 Iraq Veterans will face depression,
  anxiety, or PTSD
• Multiple tours and prolonged deployments increase
  combat stress by 50
• National Guard and Reserve at increased risk for
  MH issues and Suicide

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Scope of Problem

• MH symptoms reported to a health care provider
• 56 of Active Duty
• 60 of Reservists
• 76 of Veterans
• Dole-Shalala Commission

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Scope of Problem

• 300,000 OIF/OEF Veterans with PTSD and/or Major
  Depression
• 320,000 OIF/OEF Veterans with TBI
• RAND Survey 2008

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Scope of Problem

• NOT Knowledgeable about MH warning signs
• 49 Soldiers
• 52 Military Spouses
• Treatment options for MH Ignorance
• 59 Soldiers
• 66 Military Spouses
• 10 have sought treatment STIGMA prevents MH
  Care
• APA Harris Interactive Survey 2008

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PTSD
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Diagnosis of PTSD

• The individual experienced or witnessed an event
  that involved actual or threatened death or
  serious injury, and felt very afraid or
  helpless.
• Traumatic events can include a wide variety of
  different experiences
• military troops involved in combat
• victims and rescue workers involved in natural
  disasters
• victims and rescue workers involved in man-made
  disasters
• sexual assault or other violent crimes
• domestic violence
• physical and/or sexual abuse
• immigrants fleeing violence in their homeland
• Torture
• MVAs

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Impact of PTSD

• Individuals may AVOID certain triggers or
  reminders of the trauma and may experience
  EMOTIONAL NUMBING (and/or distance themselves
  from others).
• They may try to avoid
• activities
• places
• thoughts
• people

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Traumatic Brain Injury
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What Is A Traumatic Brain Injury?

• External force applied to the head
• Disruption of brain function
• Alteration of consciousness
• incomplete memory of the event
• dazed or confused
• loss of consciousness

Adapted from ACRM Special Task Force on TBI
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Blast Injury

• Incidence of TBI in med evac patients with blast
  injuries at Walter Reed 60
• 64 of all military-related TBI from blast
• OIF/OEF 33 of all battle injuries TBI
• Past war-wounded 14-20 TBI
• ? Modern warfare ? TBI risk 2X greater

Warren Lux, MD, Presentation _at_ BIAT, August,
2005 Deputy Director, Defense of Veterans Brain
Injury Center
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Impact of TBI

• Attention/Concentration
• Speed of Mental Processing
• Learning/Information Retrieval
• Executive Functions (e. g., Planning, Problem
  Solving, Self Monitoring) May see judgment
  problems, apathy, inappropriate behaviors

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Psychological/Psychiatric and Psychosocial
Changes after TBI

• Personality
• Increased/Decreased Activation
• Episodic Dyscontrol Irritability
• Psychiatric
• Mood Disturbance
• Psychosis
• Psychosocial
• Work Status
• Relationships with others

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Public Health Impact OIF/OEF
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Post Deployment Mental Health Its not just PTSD
and/or TBI

• Job loss
• Family dissolution
• Homelessness
• Violence towards others
• Incarceration
• Suicide

• Alcohol Abuse
• Narcotic addiction
• Major Depression
• Military Sexual Trauma

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Effects on Relationships

• 1. Social anxiety
• 2. Angry outbursts
• 3. Emotional unavailability
• 4. Sleep disturbance
• 5. Difficulty managing family roles and
  responsibilities

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Relationship Impact

• 20 of married Iraq troops are planning a divorce
• 2/3 of Married or Cohabitating Veterans report
  Family Adjustment Issues
• Iraq and Afghanistan Veterans of America

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Impact on Families

• Domestic Violence
• Childhood Abuse
• Substance Abuse
• Parent with MH/TBI and associated
  socioeconomic/legal issues

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What To Do, and How To Do It

• Community Awareness
• Military Forces members, Veterans, and their
  families
• Employers
• School
• Faith Based Organizations
• State Non-Profit Agencies
• Health Care Providers
• Coordination of Available Services
• 2-1-1 West Central Texas Experience