Invisible Wounds

Predicting the Immediate and Long-Term Consequences of Mental Health Problems in Veterans of Operation Enduring Freedom and Operation Iraqi Freedom

by Benjamin Karney, Rajeev Ramchand, Karen Chan Osilla, Leah B. Caldarone, Rachel M. Burns

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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 may be disproportionately high compared with the physical injuries of combat. Research has focused primarily on three conditions: post-traumatic stress disorder (PTSD), depression, and traumatic brain injury (TBI). Karney et al. review the empirical literature on these three conditions, focusing on research that supports projections about the likely outcomes for OEF/OIF veterans and their families. These include an increased risk of suicide, substance abuse, and cardiovascular disease. Mental health conditions among veterans are also associated with reduced work productivity and future job prospects and may be a precursor to homelessness. Post-combat mental health disorders also affect servicemembers' spouses and children: For example, each of the three disorders has been linked to intimate partner violence and divorce. The authors also emphasize that it is common for veterans with one of the three conditions — PTSD, depression, or TBI — to also develop another of the three, and such individuals tend to experience more severe symptoms, poorer treatment outcomes, and more disability in social and occupation function. Karney et al. conclude with two series of recommendations: one for future research, and one for policy and interventions to mitigate the consequences of post-combat mental health conditions.

Table of Contents

  • Chapter One


  • Chapter Two

    Prevalence of Mental Health Problems in Returning Service Members

  • Chapter Three

    Theoretical Perspectives on the Consequences of Mental Health Disorders

  • Chapter Four

    Comorbidity and Other Mental Health Problems

  • Chapter Five


  • Chapter Six

    Physical Health and Mortality

  • Chapter Seven

    Substance Use Disorders

  • Chapter Eight

    Labor-Market Outcomes: Employment and Productivity

  • Chapter Nine


  • Chapter Ten

    Marriage, Parenting, and Child Outcomes

  • Chapter Eleven

    Conclusions and Recommendations

This work was funded by a grant from the Iraq Afghanistan Deployment Impact Fund, which is administered by the California Community Foundation. 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).

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