Invisible Wounds of War


Jun 1, 2008

This commentary originally appeared on Voices of Tomorrow on June 1, 2008.

When I joined the Army in 2000, war seemed like a remote possibility. But on 9/11, it was no longer a question of whether I would go to war, only where and when. I was part of the initial invasion of Iraq as a soldier in the 101st Airborne Division, and as an Arabic linguist, I was one of the few soldiers who could communicate with Iraqis.

I also learned that we are not alone. According to a recent RAND Corporation study about these "Invisible Wounds of War," 18.5 percent of Operation Enduring Freedom and Operation Iraqi Freedom veterans are suffering from PTSD or depression and need appropriate treatment, and 19.5 percent report experiencing a TBI during deployment.

While most soldiers with mild TBIs recover fully, some suffer long-term cognitive deficits. Those with moderate to severe TBIs often have some type of life-long impairments. Being exposed to an explosion can easily cause both PTSD and TBI, and 7.3 percent of those in the RAND study have, like my husband, a mental health condition and TBI.

However, despite efforts to increase health services capacity within the Department of Defense and Department of Veterans Affairs, there remains a large gap between the need for mental health services and their use. The RAND study showed that only 53 percent of returning troops that met the criteria for current PTSD or major depression sought help in the past year. Some of this stems from personal and cultural factors, like being afraid that seeking help will hurt careers. But lack of provider availability also plays a role: returning service members may face long wait times for appointments.

There are also gaps in quality. According to the RAND study, slightly more than half of returning service members who sought care for their PTSD or depression received minimally adequate treatment. Fewer received high-quality care.

I began working at RAND, a non-profit research institution, where I was able to apply my analytic skills to research on national security and defense-related issues.

Recently I worked as part of the study team on the RAND "Invisible Wounds of War" study. The study provides policymakers an objective assessment and overview of issues facing returning veterans with these conditions as well as recommendations for confronting them. The study gives families like mine the knowledge that we are not alone in facing these challenges, and points us toward evidence-based treatments.

However, this will require nationwide, system-level changes. The RAND report includes four major recommendations:

Increase the group of providers who are trained and certified to deliver proven care so that capacity is adequate for current and future needs. Change policies to encourage active duty personnel and veterans to seek needed care. Deliver proven, evidence-based care to service members and veterans in all settings. Invest in research to close information gaps in the health care system and plan effectively. Taken together, the RAND recommendations suggest a national approach to closing gaps in access and quality care for veterans. All veterans should have access to, and feel comfortable seeking, evidence-based care. The decision makers in government now have a place to start in order to offer them to future generations of veterans.

Kayla Williams is a Project Associate with the RAND Corporation. The study discussed in this article was conducted by the RAND Corporation and published in April 2008. Kayla served as one of 31 researchers on this study, contributing her analytic skills to the team examining the systems of care for those suffering from traumatic brain injuries. More details, the full report, and resources for veterans and their families are available at

This is the abbreviated version of an op-ed that appeared in Voices of Tomorrow and can be found at

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Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.