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Summer 2010 Vol. 10 Number 2



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Air Force squadron returns home after deployment in support of Operation Iraqi Freedom, photo courtesy U.S. Department of Defense

Coming Home

Easing the Transition for a New Generation of Veterans

As long as there have been wars, veterans returning home often have struggled to readjust to civilian life. But the wars in Iraq and Afghanistan are placing very different burdens on this generation of U.S. service members. Frequently, today's forces are deployed multiple times to dangerous war zones, exposing them to numerous stressors that might lead to post-traumatic stress disorder, depression, and a number of other psychiatric disorders. In addition, many veterans suffer from brain injuries and the long-lasting pathological conditions associated with such injuries.

All of these factors prompted Congress to ask the Institute of Medicine to re-evaluate how to help veterans and their families return to life after war. A preliminary report of the IOM's two-phase study identifies their most pressing needs; the second phase will examine additional studies now under way and provide more detailed findings and recommendations.

Anecdotal accounts from health care providers and service members indicate an overwhelming demand for mental health services, the report says, with long wait times for those seeking help. The departments of Defense and Veterans Affairs need to ensure there are enough providers available and in locations where they are most needed. Equally important is the need for DOD to develop policies that encourage service members to seek treatment.

Traumatic brain injury (TBI) has become known as the signature injury for veterans of the Iraq and Afghanistan wars. The VA has established a comprehensive system of treating these injuries initially, but the effects of TBI can persist for many decades. The department should sponsor research to determine how to develop protocols for long-term management of TBI and multiple traumas.

In fact, the highest demand for veteran support services will occur in the decades ahead. The report notes that requests for care and compensation by veterans of previous wars did not peak until 30 years or more after their service ended. To ensure that the nation is equipped, the VA should expand the role of its actuary -- and Congress should appropriate funds -- for annual long-term forecasts of costs associated with health and disability benefits for this population.

And to ease the immediate transition from war zone to civilian life, DOD should conduct a formal assessment of third-location decompression, which involves being sent for a number of weeks to an interim place before returning home. Veterans from other nations have reportedly found it helpful, but there is little formal research on the practice. --  Molly Galvin & Christine Stencel


Returning Home From Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Committee on the Initial Assessment of Readjustment Needs of Military Personnel, Veterans, and Their Families, Board on the Health of Select Populations, Institute of Medicine (2010; 192 pp.; ISBN 0-309-14763-8; available from the National Academies Press; tel. 1-800-624-6242; $43.25 plus $5.00 shipping for single copies).

The committee was chaired by George W. Rutherford, Salvatore Pablo Lucia Professor and vice chair, department of epidemiology and biostatistics; and director, prevention and public health group, Global Health Sciences, University of California, San Francisco. The study was funded by the U.S. Department of Defense.



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Copyright 2010 by the National Academy of Sciences