Jay Kopelman - From Baghdad to America: Life Lessons from a Dog Named Lava

Im including some of the forms and studies that I cite in the book.

1. Post-Deployment Health Assessment (PDHA)

   The form soldiers are asked to complete on returning from active duty.

2. Post-Deployment Health Re-Assessments (PDHRA)

   The form soldiers are asked to complete three to six months after returning from active duty.

3. Mental Health Needs of Soldiers Increase Several Months

   After Returning from Iraq War
   A press release describing findings in the 2007 study
   published in the Journal of the
   American Medical Association .

4. An Achievable Vision

   A summary of the highly-cited Pentagon Report on mental health and the Armed Forces.

5. Combat Duty in Iraq and Afghanistan, Mental Health

   Problems, and Barriers to Care
   The seminal report on the mental health of members of the
   Army and Marine Corps involved in combat operations in
   Iraq and Afghanistan, published in 2004.

CHICAGOCompared to initial screening upon returning from the Iraq war, U.S. soldiers report increased mental health concerns and needs several months after their return for problems such as post-traumatic stress disorder and depression, according to a study in the November 14 issue of The Journal of the American Medical Association (JAMA) .

Our previous article described the Department of Defenses (DoD) screening efforts to identify mental health concerns among soldiers and Marines as they return from Iraq and Afghanistan using the Post-Deployment Health Assessment (PDHA). However, the article also raised concerns that mental health problems might be missed because of the early timing of this screening. It cited preliminary data showing that soldiers were more likely to indicate mental health distress several months after return than upon their immediate return. Based on these preliminary data, the DoD initiated a second screening similar to the first, to occur 3 to 6 months after return from deployment, the authors write.

Charles S. Milliken, M.D., of Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel Command, Silver Spring, Md., and colleagues analyzed the mental health responses of the first cohort of soldiers (n = 88,235) to complete both the initial screening and the new later screening, with a median (midpoint) of six months between the two assessments. Both screenings included a self-report questionnaire and a brief interview with a clinician.

The researchers found that soldiers reported more mental health concerns, such as post-traumatic stress disorder (PTSD), major depression or alcohol misuse during the later screening. Of the 88,235 soldiers, 3,925 (4.4 percent) were referred for mental health care during the initial screening and 10,288 (11.7 percent) were referred during the later screening. Combined data from both screenings showed that the clinicians identified 20.3 percent of active and 42.4 percent of reserve soldiers as needing referral or already being under care for mental health problems.

Among active component soldiers, use of mental health services increased substantially following the later screening, especially within 30 days of the assessment. The majority of all soldiers who accessed mental health care (74 percent, n = 9,074) had not been identified as needing referral.

Concerns about interpersonal conflict increased four-fold between the two screenings. Soldiers frequently reported alcohol concerns, yet very few were referred to alcohol treatment. Although soldiers were much more likely to report PTSD symptoms on the later screening instrument, 49 percent to 59 percent of those who had PTSD symptoms identified on the initial screen improved by the time they took the later screen, suggesting that the increase was due to new symptoms being reported.