Military programs to prevent combat-related psychological disorders need improvement

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ANN ARBOR—Despite numerous resilience and prevention programs to address the psychological health of military veterans and their families, many are not effective, according to a new report issued by the Institute of Medicine.

Kenneth Warner, a professor at the University of Michigan School of Public Health and chair of the committee that wrote the report for the U.S. Department of Defense, said the military should develop, track and evaluate programs based on scientific evidence to ensure their effectiveness. In addition, more frequent evaluations of programs are needed.

"Increasing rates of mental health problems among service members and the related psychological toll on families point to an urgent need to prevent and mitigate these conditions," said Warner, the Avedis Donabedian Distinguished University Professor of Public Health at U-M. "DOD should rigorously evaluate any new programs that are developed to do so, because we remain uncertain about which approaches work and which ones are ineffective."

From 2000 to 2011, more than 900,000 current or former service members were diagnosed with a psychological condition. Such diagnoses increased by about 62 percent among active-duty service members during approximately the same time-frame.

Adjustment disorders, such as feeling stressed or hopeless, made up 26 percent of the diagnoses; depression, 17 percent; and anxiety disorders (excluding post-traumatic stress disorder), 10 percent. PTSD accounted for 6 percent, while alcohol and substance abuse made up 17 percent.

In response to the surge of veterans returning from Iraq and Afghanistan with various problems, Congress required DOD to study the physical and mental health and other readjustment needs of returning soldiers. The IOM conducted the 2013 report "Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members and Their Families."

This new report, "Preventing Psychological Disorders in Service Members and Their Families, an Assessment of Programs," is a follow-up to examine the quality and evidence base of DOD programs designed to prevent negative psychological health outcomes among service members and their families, and to identify appropriate performance measures for such programs.

Although DOD has adopted numerous resilience and prevention programs, gaps exist in the evidence supporting their effectiveness. For example, the committee was unable to identify any evidence-based programs to prevent domestic abuse across DOD services.

Though the services use a number of interventions to prevent sexual assaults, a DOD review found that components needed to measure their effectiveness are missing. Furthermore, DOD does not systematically consider cost-effectiveness to ensure that resources are directed to programs that see the greatest results per dollar spent.

Certain strategies with strong evidence of effectiveness are underused, the committee said, such as restricting access to personal firearms to prevent suicide or homicide in domestic violence cases or placing restrictions on the sale of alcohol to reduce substance misuse. In place of these proven approaches, the committee typically found unsubstantiated interventions such as campaigns, Internet tools or in-person events, which may be effective but are seldom evaluated.

DOD has many family-focused prevention programs, but here, too, there are gaps in the evidence supporting their effectiveness, the report showed. It recommends that DOD implement comprehensive, well-supported programs to prevent psychological health problems in the families of service members, targeting risks and vulnerabilities such as family violence, substance abuse and stress reaction.

The report was sponsored by the U.S. Department of Defense. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector and the public.

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