The Minds and Hearts of Soldiers, Sailors, Airmen, Marines and their Families
by Robert J. Ursano, M.D.
Professor and Chair, Department of Psychiatry
and Director, Center for the Study of Traumatic Stress
Uniformed Services University School of Medicine

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Over 200,000 of today’s military are presently deployed in the war against terrorism in Iraq and Afghanistan. We often forget that this deployment is but one of many for our military and their families, a community often seen as a part of but apart from the rest of the nation. On the home front deployment is also a part of response to natural disasters. For Hurricane Katrina, the military deployed 72,000 forces including 50,000 National Guard as well as Navy ships and helicopters. Deployments abroad as well as deployments at home affect our nation’s families and soldiers across the country.

Whether in the extreme environments of combat or peacekeeping or on humanitarian missions, the stress of such work can be great. Soldiers and their families exhibit resilience in abundance. But military men, women and their families also experience apprehension with departure for these missions, stress from the added responsibilities and new family roles during deployment as one parent must now be caretaker and parent. And there is even stress in reuniting after long periods apart and refinding each other and new jobs and occupations, and for some anticipating redeployment in the not distant future. For some few, soldiers and families must also deal with serious injuries and loss of loved ones – events that alter lives forever. But we must not forget that resilience is also part of mental health.

Most people exposed to combat and other high stress environments will show great resilience over time. For others however the psychological and behavioral responses can include sleep problems, changes in smoking or drinking, depression and posttraumatic stress disorder. Approaches for enhancing the mental health of the military population are the same as for the general population: prevention though education and public education initiatives such as this month’s Mental Health Awareness Month; timely intervention through early identification of problems and treatment involving medications and/or therapy, and follow up short-term or long-term if needed. Military mental health care providers are deployed in Iraq and elsewhere to assist troops in theatre. Effective treatments are available for the disorders that our military may develop. For PTSD and depression in particular, both medication and psychotherapy have been shown to be very effective. Often family members play an important role in helping loved ones seek care.

A recent study of 300,000 troops returning from Iraq and Afghanistan revealed that around 20% reported mental health concerns and one-third accessed mental health services in the first year home. Of those, 12% were found to have a mental health problem. Those exposed to the most combat and risk to their life are at greatest risk of mental health problems on return. Early identification and help-seeking in large numbers is good news, but we do not know the mental health effects on families and the degree to which they are seeking and receiving treatment.

Military communities prepare soldiers and their families for the kinds of challenges they will encounter and offer many resources for family support. These range from wives’ support groups to community health centers and programs on military bases. Families at home, as well as returning soldiers, have access to confidential 800 help lines that offer mental health screening, assessment and referral. Military hospitals provide care to soldiers through Departments of Psychiatry, Psychology and Social Work, and reach out to families that are affected by injury and trauma. The military also conducts research on mental health issues to better understand and mitigate post-traumatic stress and related mental disorders.

The Uniformed Services University of the Health Sciences, our nation’s federal medical school, features a health communication campaign, Courage to Care. Courage to Care consists of electronic fact sheets that are disseminated to military personnel, healthcare providers and families around the world. The fact sheets provide information about the emotional issues of the deployment cycle for healthcare providers and the military family. Courage to Care embodies a culture of heart and mind that characterizes the strength and commitment of our military community.

We encourage all families impacted by the special stressors of military life and duty to take care of themselves, to seek help for mental health problems and to be proud of their resilience as individuals, families and communities.