Injuries create challenges for returning veterans and their employers
Thousands re-entering civilian workforce; PTSD among conditions to watch for
By the time most United States forces return home from active duty in the Middle East, more than 2 million military personnel will have been deployed in that part of the world. Many of those who have seen combat will have little difficulty returning to their civilian lives but, for some, reentering home life and the working world will be challenging to both the returning employee and his employer as they deal with the emotional impact of combat and injury.
As in past post-war periods in the United States, most employers are uncertain how to help returning veterans integrate back into the workforce. Occupational health nurses are positioned to be of great help in this process, one veterans health professional says, but only if they know how.
"[Wounded or combat-traumatized veterans] are not going to tell you things because they're not going to trust you," says Michael J. Wagner, PhD, Colonel (Retired) USAR, executive director and chairman of the Military, Veteran and Family Assistance Foundation (MVFA). MVFA is a nonprofit organization that provides services and resources beyond the budgetary and mission capabilities of the Department of Defense, the Department of Veterans Affairs, and other national, state, and local veterans' agencies.
"So, how do you treat them compared to other employees?" Wagner asks. "How does it [combat and injury] impact their work?"
Emotional signs can surface later
While the military screens many combat veterans for mental health issues at the time of discharge, those results might not be truly accurate markers of the emotional toll of combat service, according to Thomas A. Grieger, MD. Grieger and colleagues at the Uniformed Services University of the Health Sciences (USU), the nation's only federal medical school, have found that the emotional impact of injury deepens in the first year after evacuation from combat.
"The biggest punch line on the article is that of all things examined at initial evaluation (at one month post discharge), including exposures and length of service, presence of [post-traumatic stress disorder] PTSD and depression, none are predictive of PTSD and depression at seven months," says Grieger. "The one thing that was indicative was a high level of physical complaints initially."
Grieger's study is the first to examine emotional injury in soldiers seriously wounded or injured in combat in Iraq or Afghanistan. It indicates a correlation between self-reported physical problems and psychiatric disorders.
The findings came from the screening of more than 600 soldiers who were the most severely wounded of those receiving combat injuries from March 2003 to September 2004. Of these soldiers, 243 completed assessments at the one-, four-, and seven-month time frame after being injured. The rates of PTSD and depression were 4% at one month, 12 % at four months, and 19 % at seven months.
What does this mean to an occupational health nurse who has combat veterans working in his or her organization?
"[Occupational health nurses] should be aware that if they have patients who have a large number of severe physical complaints following such exposures to combat, that would warrant a medical evaluation to determine if PTSD or depression is present," says Grieger. "Also, they should be aware that treatment of the mental health conditions might alleviate physical complaints." (See box on Symptoms of PTSD below.)
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Symptoms of post-traumatic stress disorder (PTSD) Re-experiencing the trauma through painful, intrusive memories and recollections; suffering from nightmares and flashbacks. Reminders intensify the symptoms. Developing behaviors and attitudes that cause the person to avoid people, places, and things that may cause him/her to remember the trauma. The person may become emotionally numb with feelings of alienation from people, even those with whom the person had previously maintained a close bond. This can include family members, friends, and associates. Developing symptoms of irritability, impatience, anxiety, and depression. He/she may have a "short fuse" and is quick to become enraged with little provocation. Developing sleep problems and an ongoing feeling of hypervigilance and distrust. Experiencing problems with attention and concentration. Experiencing physical reactions like heart palpitations or sweating when reminded of the trauma. |
A study that appeared in the New England Journal of Medicine in 2004 found the following in military personnel serving in Iraq who met screening criteria for major depression, anxiety, or PTSD:
- only 78% acknowledged a problem;
- just 43% indicated an interest in receiving help;
- only 40% had received help from any professional within the previous year;
- only 27% had received help from a mental health professional within the past year.
Reasons they gave for not seeking help included fear that they would appear weak; difficulty getting time off for therapy; doubt that mental health treatment would work; and feeling embarrassed. And as Wagner pointed out, more than one-third said they did not trust mental health professionals.
Grieger's findings, "Posttraumatic Stress Disorder and Depression in Battle-Injured Soldiers" appear in the October 2006 issue of The American Journal of Psychiatry.
For more information:
Michael J. Wagner, PhD, Colonel (Retired) USAR, executive director and chairman, Military, Veteran and Family Assistance Foundation. Address: 5930 Royal Lane, Suite 353, Dallas, TX 75230. Phone: (214) 987-9247. Email: [email protected].
Thomas A. Grieger, MD, Uniformed Services University of the Health Sciences, Department of Psychiatry, Bethesda, MD. Phone: (301) 295-9475.
Hoge CW, et al. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 2004;351:13-22.
Hartwig RP. When Johnny comes marching home: Injured veterans returning from war present unique challenges for insurers. 2006;online. Insurance Information Institute, New York, NY. Available at www.iii.org.
By the time most United States forces return home from active duty in the Middle East, more than 2 million military personnel will have been deployed in that part of the world.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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