Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Early evidence suggests that the psychological toll of these deployments—many involving prolonged exposure to combat-related stress over multiple rotations—may be disproportionately high compared with the physical injuries of combat.

In the face of mounting public concern over post-deployment health care issues confronting OEF/OIF veterans, several task forces, independent review groups, and a President’s Commission have been convened to examine the care of the war wounded and make recommendations.

Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. Many recent reports have referred to these as the signature wounds of the Afghanistan and Iraq conflicts. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise.

The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it.

All the research products from this study are available at http://veterans.rand.org.

Data collection for this study began in April 2007 and concluded in January 2008. Specific activities included a critical review of the extant literature on the prevalence of post-traumatic stress disorder, major depression, and traumatic brain injury and their short- and long-term consequences; a population-based survey of servicemembers and veterans who served in Afghanistan or Iraq to assess health status and symptoms, as well as utilization of and barriers to care; a review of existing programs to treat servicemembers and veterans with post-traumatic stress disorder, major depression, and traumatic brain injury; focus groups with military servicemembers and their spouses; and the development of a microsimulation model to forecast the economic costs of these conditions over time.

Interviews with senior Office of the Secretary of Defense (OSD) and Service (Army, Navy, Air Force, Marine Corps) staff within the Department of Defense and within the Veterans Health Administration informed our efforts to document the treatment and support programs available to this population. Note, however, that the views expressed in this monograph do not reflect official policy or the position of the U.S. government or any of the institutions we included in our interviews.

This work was funded by a grant from the Iraq Afghanistan Deployment Impact Fund, which is administered by the California Community Foundation. The fund had no role in the design and conduct of this study; collection, management, analysis, or interpretation of data; or in the preparation of this document. The study was conducted jointly under the auspices of the Center for Military Health Policy Research, a RAND Health center, and the Forces and Resources Policy Center of the National Security Research Division (NSRD). The principal investigators are Terri Tanielian and Lisa H. Jaycox.  (Preface)

More information about RAND is available at www.rand.org.

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Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery
Edited by Terri Tanielian and Lisa H. Jaycox

Published 2008 by the RAND Corporation
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Contents

Part I: Introduction, Current Policy Context, and Historical Perspective

Chapter One:
Introduction

Chapter Two:
The Wars in Afghanistan and Iraq — An Overview

Part II: The Nature and Scope of the Problem

Chapter Three:
Prevalence of PTSD, Depression, and TBI Among Returning Servicemembers

Chapter Four:
Survey of Individuals Previously Deployed for OEF/OIF

Part III: Immediate and Long-Term Consequences of Post-Traumatic Stress Disorder, Depression, and Traumatic Brain Injury

Chapter Five:
Predicting the Immediate and Long-Term Consequences of Post-Traumatic Stress Disorder, Depression, and Traumatic Brain Injury in Veterans of Operation Enduring Freedom and Operation Iraqi Freedom

Part IV: Economic Consequences

Chapter Six:
The Cost of Post-Deployment Mental Health and Cognitive Conditions

Part V: Caring for the Invisible Wounds

Chapter Seven:
Systems of Care: Challenges and Opportunities to Improve Access to High-Quality Care

Part VI: Conclusions and Recommendations

Chapter Eight:
Treating the Invisible Wounds of War: Conclusions and Recommendations

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