Navigating the Road to Reintegration: Status and Continuing Support of the U.S. Air Force's Wounded Warriors.

The U.S. Air Force, wanting to gain greater insight into the well-being of its members who have sustained mental or physical injuries in combat or combat-related situations, including their quality of life and the challenges they will confront in their reintegration following separation or retirement, asked the RAND Corporation for assistance in gauging the current status of the Air Force's wounded warriors, including their use of and satisfaction with Air Force programs designed to serve them. This article presents the baseline findings from a longitudinal analysis of enrollees in the Air Force Wounded Warrior (AFW2) program who were receiving benefits or undergoing evaluation to receive benefits, the majority of whom had a primary administrative diagnosis of post-traumatic stress disorder (PTSD). A high proportion of the Airmen in the sample screened positive for PTSD (roughly 78 percent) and major depressive disorder (MDD) (roughly 75 percent); 69 percent screened positive for both. Although more than 90 percent of those in the sample who screened positive for PTSD or MDD were receiving treatment, about half indicated that there was at least one instance during the past year in which they desired mental health treatment but did not receive it. Participants reported concerns about stigma, confidentiality, and the quality of available treatment as barriers to receiving mental health care, though the current data do not link these concerns to a particular treatment setting. About 10 percent of Airmen reported a financial situation that could be considered as living in poverty based on U.S. Department of Health and Human Services' poverty guidelines. Similarly, close to 15 percent of those in the labor force could be considered unemployed. Reserve and National Guard Airmen evidenced heightened challenges across examined domains. Respondents were overall satisfied with the services they received from the AFW2 and Air Force Recovery Care Coordinator programs.

[1]  A. Peterson,et al.  Assessment and Treatment of Combat-Related PTSD in Returning War Veterans , 2011, Journal of Clinical Psychology in Medical Settings.

[2]  John P. Campbell,et al.  JOB SATISFACTION: ARE ALL THE PARTS THERE? , 1983 .

[3]  C. Paniak,et al.  A randomized trial of two treatments for mild traumatic brain injury. , 1998, Brain injury.

[4]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[5]  Amiram D. Vinokur,et al.  Effects of Recent and Past Stress on Mental Health: Coping with Unemployment Among Vietnam Veterans and Nonveterans1 , 1987 .

[6]  Robert E. Drake,et al.  Individual Placement and Support: An Evidence-Based Approach to Supported Employment , 2012 .

[7]  K. Seal,et al.  Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment. , 2011, Drug and alcohol dependence.

[8]  D. Edington,et al.  Analysis of the association between metabolic syndrome and disease in a workplace population over time. , 2010, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[9]  R J Rona,et al.  PTSD after deployment to Iraq: conflicting rates, conflicting claims , 2009, Psychological Medicine.

[10]  S. Guay,et al.  Exploring the links between posttraumatic stress disorder and social support: processes and potential research avenues. , 2006, Journal of traumatic stress.

[11]  D. Bradford Helping America's Homeless: Emergency Shelter or Affordable Housing? , 2002 .

[12]  R. Arvey,et al.  Work Centrality and Post-Award Work Behavior of Lottery Winners , 2004, The Journal of psychology.

[13]  M. Schmid,et al.  Specific effects of microRNAs on the plant transcriptome. , 2005, Developmental cell.

[14]  A Ehlers,et al.  Mind the gap: Improving the dissemination of CBT. , 2009, Behaviour research and therapy.

[15]  A. Beck,et al.  The empirical status of cognitive-behavioral therapy: a review of meta-analyses. , 2006, Clinical psychology review.

[16]  M. Valenstein,et al.  Prevalence and correlates of alcohol misuse among returning Afghanistan and Iraq veterans. , 2011, Addictive behaviors.

[17]  F. Norris,et al.  Longitudinal linkages between perceived social support and posttraumatic stress symptoms: sequential roles of social causation and social selection. , 2008, Journal of traumatic stress.

[18]  Dennis P. Culhane,et al.  Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data , 1998, American journal of community psychology.

[19]  K. Lahiri,et al.  Effects of Psychiatric Disorders on Labor Market Outcomes: A Latent Variable Approach Using Multiple Clinical Indicators , 2013, Health economics.

[20]  B Jennett,et al.  Epidemiology of head injury. , 1981, Archives of disease in childhood.

[21]  Mieke Verfaellie,et al.  Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: perspectives from cognitive neuroscience. , 2009, Clinical psychology review.

[22]  Terry L. Schell,et al.  Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: possible explanations. , 2010, Journal of traumatic stress.

[23]  S. Orr,et al.  Prospective study of posttraumatic stress disorder and depression following trauma. , 1998, The American journal of psychiatry.

[24]  Martha R. Burt,et al.  Helping America's Homeless: Emergency Shelter or Affordable Housing? , 2001 .

[25]  Olga V. Demler,et al.  Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[26]  Meredith Kleykamp Unemployment, earnings and enrollment among post 9/11 veterans. , 2013, Social science research.

[27]  B. Dohrenwend,et al.  The Psychological Risks of Vietnam for U.S. Veterans: A Revisit with New Data and Methods , 2006, Science.

[28]  Dawne Vogt,et al.  Mental health-related beliefs as a barrier to service use for military personnel and veterans: a review. , 2011, Psychiatric services.

[29]  S. Barnett,et al.  The role of military chaplains in mental health care of the deployed service member. , 2012, Military medicine.

[30]  Jeremy Arkes,et al.  Effects of Iraq/Afghanistan deployments on major depression and substance use disorder: analysis of active duty personnel in the US military. , 2012, American journal of public health.

[31]  David J Newman,et al.  Natural products as sources of new drugs over the period 1981-2002. , 2003, Journal of natural products.

[32]  Yehuda Baruch,et al.  Response Rate in Academic Studies — A Comparative Analysis , 1999 .

[33]  R. Rosenheck,et al.  A model of homelessness among male veterans of the Vietnam War generation. , 1994, The American journal of psychiatry.

[34]  Harold Alan Pincus,et al.  Care for veterans with mental and substance use disorders: good performance, but room to improve on many measures. , 2011, Health affairs.

[35]  J. Pankow,et al.  A graphical method for assessing risk factor threshold values using the generalized additive model: the multi-ethnic study of atherosclerosis , 2012, Health Services and Outcomes Research Methodology.

[36]  J. Skvoretz,et al.  Bearing the Burden: Deployment Stress Among Army National Guard Chaplains , 2012, Journal of health care chaplaincy.

[37]  Connie R. Wanberg,et al.  Job search and employment: a personality-motivational analysis and meta-analytic review. , 2001, The Journal of applied psychology.

[38]  T. Wills,et al.  Stress, social support, and the buffering hypothesis. , 1985, Psychological bulletin.

[39]  Coady B Lapierre,et al.  Posttraumatic stress and depression symptoms in soldiers returning from combat operations in Iraq and Afghanistan. , 2007, Journal of traumatic stress.

[40]  Keith R. Stowell,et al.  Principles and Practice of Psychiatric Rehabilitation: An Empirical Approach , 2008 .

[41]  Shannon M. Kehle,et al.  Early mental health treatment-seeking among U.S. National Guard soldiers deployed to Iraq. , 2010, Journal of traumatic stress.

[42]  T. Jacks,et al.  Somatic activation of the K-ras oncogene causes early onset lung cancer in mice , 2001, Nature.

[43]  C. Paniak,et al.  A randomized trial of two treatments for mild traumatic brain injury: 1 year follow-up. , 2000, Brain injury.

[44]  D. Weiss,et al.  Manual for the Minnesota Satisfaction Questionnaire. , 1967 .

[45]  J. Cook Employment barriers for persons with psychiatric disabilities: update of a report for the President's Commission. , 2006, Psychiatric services.

[46]  R. Kessler,et al.  The Impact of Psychiatric Disorders on Labor Market Outcomes , 1997 .

[47]  P. Thoits Conceptual, methodological, and theoretical problems in studying social support as a buffer against life stress. , 1982, Journal of health and social behavior.

[48]  Joan S. Tucker,et al.  Unprotected Sex Among Heterosexually Active Homeless Men: Results from a Multi-level Dyadic Analysis , 2013, AIDS and Behavior.

[49]  Glenn Roberts Principles and Practice of Psychiatric Rehabilitation : An Empirical Approach , 2007, British Journal of Psychiatry.

[50]  Leonore A. Herzenberg,et al.  Reversal of Paralysis and Reduced Inflammation from Peripheral Administration of β-Amyloid in TH1 and TH17 Versions of Experimental Autoimmune Encephalomyelitis , 2012, Science Translational Medicine.

[51]  D. Kivlahan,et al.  The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. , 1998, Archives of internal medicine.

[52]  Meredith Kleykamp Labor Market Outcomes among Veterans and Military Spouses , 2013 .

[53]  P. Jackson,et al.  Unemployment and Mental Health: Some British Studies , 1988 .

[54]  C. A. Morgan,et al.  Trauma-related symptoms in veterans of Operation Desert Storm: a 2-year follow-up. , 1995, The American journal of psychiatry.

[55]  M. Kolbe August, 2010 , 2010, The Lancet Neurology.

[56]  Terry L. Schell,et al.  All symptoms are not created equal: the prominent role of hyperarousal in the natural course of posttraumatic psychological distress. , 2004, Journal of abnormal psychology.

[57]  John D Corrigan,et al.  Substance use disorders and clinical management of traumatic brain injury and posttraumatic stress disorder. , 2008, JAMA.

[58]  B. Grant,et al.  Prevalence and Co-Occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders , 2004, Archives of general psychiatry.

[59]  Christopher H Warner,et al.  Importance of anonymity to encourage honest reporting in mental health screening after combat deployment. , 2011, Archives of general psychiatry.

[60]  Kathleen M. Wright,et al.  Timing of postcombat mental health assessments. , 2007 .

[61]  A. Colella,et al.  Disability and employment: New directions for industrial and organizational psychology. , 2011 .

[62]  Charles W Hoge,et al.  Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. , 2010, Archives of general psychiatry.

[63]  I. Anderson,et al.  Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. , 2000, Journal of affective disorders.

[64]  Joanne Davila,et al.  Excessive reassurance seeking, depression, and interpersonal rejection: a meta-analytic review. , 2008, Journal of abnormal psychology.

[65]  Connie R. Wanberg,et al.  Psychological and physical well-being during unemployment: a meta-analytic study. , 2005, The Journal of applied psychology.

[66]  J. E. Brazier,et al.  Validating the SF-36 health survey questionnaire: new outcome measure for primary care. , 1992, BMJ.

[67]  G. Bonanno Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? , 2008, The American psychologist.

[68]  C. Brewin,et al.  Considering PTSD for DSM‐5 , 2011, Depression and anxiety.

[69]  R. Rosen,et al.  Disseminating evidence-based treatments for PTSD in organizational settings: A high priority focus area. , 2009, Behaviour research and therapy.

[70]  D. Erickson,et al.  The Course of PTSD Symptoms Among Gulf War Veterans: A Growth Mixture Modeling Approach , 2004, Journal of traumatic stress.

[71]  R. Ruff,et al.  Mild traumatic brain injury in U.S. soldiers returning from Iraq. , 2008, The New England journal of medicine.

[72]  David,et al.  ASSESSING MARITAL QUALITY IN LONGITUDINAL AND LIFE COURSE STUDIES , 2017 .

[73]  L. Kazis,et al.  Social support, social selection and self-assessed health status: results from the veterans health study in the United States. , 1999, Social science & medicine.

[74]  Holger Russig,et al.  Epigenetic Transmission of the Impact of Early Stress Across Generations , 2010, Biological Psychiatry.

[75]  M. Sherman,et al.  Key Elements in Couples Therapy With Veterans With Combat-Related Posttraumatic Stress Disorder. , 2005 .

[76]  D. Blazer,et al.  A prospective study of depression following combat deployment in support of the wars in Iraq and Afghanistan. , 2010, American journal of public health.

[77]  W. Katon,et al.  Functional status in patients with chronic fatigue syndrome, other fatiguing illnesses, and healthy individuals. , 1996, The American journal of medicine.

[78]  Connie R. Wanberg,et al.  The individual experience of unemployment. , 2012, Annual review of psychology.

[79]  Robert A Rosenheck,et al.  Rates and risk factors for homelessness after successful housing in a sample of formerly homeless veterans. , 2008, Psychiatric services.

[80]  J. Cook,et al.  Scales for the measurement of some work attitudes and aspects of psychological well‐being , 1979 .

[81]  G. Bonanno,et al.  Resilience in the Face of Potential Trauma , 2005 .

[82]  D. Wade,et al.  Does routine follow up after head injury help? A randomised controlled trial. , 1997, Journal of neurology, neurosurgery, and psychiatry.

[83]  R. Kessler,et al.  Posttraumatic stress disorder: the burden to the individual and to society. , 2000, The Journal of clinical psychiatry.

[84]  Christopher R. Erbes,et al.  Intimate relationships among returning soldiers: the mediating and moderating roles of negative emotionality, PTSD symptoms, and alcohol problems. , 2010, Journal of traumatic stress.

[85]  Charles L. Hulin,et al.  Lessons From Industrial and Organizational Psychology , 2002 .

[86]  Thomas Ashby Wills,et al.  Measuring perceived and received social support. , 2000 .

[87]  D. Wade,et al.  Routine follow up after head injury: a second randomised controlled trial , 1998, Journal of neurology, neurosurgery, and psychiatry.

[88]  R. Neugebauer,et al.  A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders , 2005, European Archives of Psychiatry and Clinical Neuroscience.

[89]  D. Weiss,et al.  Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. , 2003, Psychological bulletin.

[90]  Besa Smith,et al.  Cigarette smoking and military deployment: a prospective evaluation. , 2008, American journal of preventive medicine.

[91]  Terence M Keane,et al.  Reducing the Burden of Mental Illness in Military Veterans , 2011, Perspectives on psychological science : a journal of the Association for Psychological Science.

[92]  R. Bradley,et al.  A multidimensional meta-analysis of psychotherapy for PTSD. , 2005, The American journal of psychiatry.

[93]  J. Yaffe,et al.  Factors affecting mental health service utilization among deployed military personnel. , 2012, Military medicine.

[94]  R. Kessler,et al.  Posttraumatic stress disorder in the National Comorbidity Survey. , 1995, Archives of general psychiatry.

[95]  C. Brewin,et al.  Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. , 2000, Journal of consulting and clinical psychology.

[96]  B. Gordon,et al.  Guidelines for the pharmacologic treatment of neurobehavioral sequelae of traumatic brain injury. , 2006, Journal of neurotrauma.

[97]  Lesley A Ross,et al.  The Impact of Speed of Processing Training on Cognitive and Everyday Functions. , 2007, The journals of gerontology. Series B, Psychological sciences and social sciences.

[98]  Erin C Dunn,et al.  The meaning and importance of employment to people in recovery from serious mental illness: results of a qualitative study. , 2008, Psychiatric rehabilitation journal.

[99]  B Chewning,et al.  Medication decision-making and management: a client-centered model. , 1996, Social science & medicine.

[100]  P. Schnurr,et al.  Longitudinal analysis of the relationship between symptoms and quality of life in veterans treated for posttraumatic stress disorder. , 2006, Journal of consulting and clinical psychology.

[101]  Gary R Bond,et al.  Supported employment: evidence for an evidence-based practice. , 2004, Psychiatric rehabilitation journal.

[102]  M. Shanahan,et al.  Pathways to Adulthood in Changing Societies: Variability and Mechanisms in Life Course Perspective , 2000 .

[103]  Charles W Hoge,et al.  Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. , 2004, The New England journal of medicine.

[104]  Charles W Hoge,et al.  Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. , 2007, JAMA.

[105]  D. Warden,et al.  Military TBI During the Iraq and Afghanistan Wars , 2006, The Journal of head trauma rehabilitation.

[106]  G. Morse Causes of Homelessness , 1992 .

[107]  Thomas W. Britt,et al.  Stigma, Negative Attitudes About Treatment, and Utilization of Mental Health Care Among Soldiers , 2011 .

[108]  C. Marmar,et al.  The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans. , 2010, Journal of traumatic stress.

[109]  A. Vinokur,et al.  Impact of the JOBS intervention on unemployed workers varying in risk for depression , 1995, American journal of community psychology.

[110]  R. Rosenheck,et al.  The civilian labor market experiences of Vietnam-era veterans: the influence of psychiatric disorders. , 2000, The journal of mental health policy and economics.

[111]  D. Klein,et al.  Psychosocial processes underlying the maintenance and persistence of depression: implications for understanding chronic depression. , 1999, Clinical psychology review.

[112]  D. Arciniegas,et al.  Mild traumatic brain injury: a neuropsychiatric approach to diagnosis, evaluation, and treatment , 2005, Neuropsychiatric disease and treatment.

[113]  Robert E Drake,et al.  Shared decision making and medication management in the recovery process. , 2006, Psychiatric services.

[114]  Jerome A Yesavage,et al.  VA Practice Patterns and Practice Guidelines for Treating Posttraumatic Stress Disorder , 2004, Journal of traumatic stress.

[115]  Janice Brown,et al.  Alcohol use and negative consequences among active duty military personnel. , 2011, Addictive behaviors.

[116]  E. Blanchard,et al.  Short-term follow-up of post-traumatic stress symptoms in motor vehicle accident victims. , 1995, Behaviour research and therapy.

[117]  A. Vinokur,et al.  From field experiments to program implementation: Assessing the potential outcomes of an experimental intervention program for unemployed persons , 1991, American journal of community psychology.

[118]  Marta R Prescott,et al.  Coincident posttraumatic stress disorder and depression predict alcohol abuse during and after deployment among Army National Guard soldiers. , 2012, Drug and alcohol dependence.

[119]  Robert A. Rosenheck,et al.  Employment Outcomes and PTSD Symptom Severity , 2005, Mental health services research.

[120]  Robert J Ursano,et al.  Posttraumatic stress disorder and depression in battle-injured soldiers. , 2006, The American journal of psychiatry.

[121]  D. Payne,et al.  Preliminary observations on polar body extrusion and pronuclear formation in human oocytes using time-lapse video cinematography. , 1997, Human reproduction.

[122]  C. Morin,et al.  Efficacy of cognitive-behavioral therapy for insomnia associated with traumatic brain injury: a single-case experimental design. , 2007, Archives of physical medicine and rehabilitation.

[123]  J. House,et al.  Social relationships and health. , 1988, Science.

[124]  H. Wagner,et al.  Financial well-being and postdeployment adjustment among Iraq and Afghanistan war veterans. , 2012, Military medicine.

[125]  A. Surís,et al.  Military Sexual Trauma , 2008, Trauma, violence & abuse.

[126]  J M Golding,et al.  Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. , 1997, The American journal of psychiatry.

[127]  B. Cooke Examining the Definition and Assessment of Social Support: A Resource for Individuals and Families. , 1988 .

[128]  J. Ponsford,et al.  Impact of early intervention on outcome following mild head injury in adults , 2002, Journal of neurology, neurosurgery, and psychiatry.

[129]  C. Latkin,et al.  A social network perspective on heroin and cocaine use among adults: evidence of bidirectional influences. , 2009, Addiction.

[130]  D. G. Campbell,et al.  Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions , 2007, Journal of General Internal Medicine.

[131]  B. Turner Center for a New American Security , 2014 .

[132]  Chris R Brewin,et al.  Systematic review of screening instruments for adults at risk of PTSD. , 2005, Journal of traumatic stress.

[133]  B. E. Hogan,et al.  Social support interventions: do they work? , 2002, Clinical psychology review.