RECOMMENDATIONS

The committee acknowledges that the VA and the Department of Defense (DoD) have expended enormous effort and resources in attempts to address the numerous health issues related to veterans. The information obtained from those efforts, however, has not been sufficient to determine conclusively the origins, extent, and long-term implications of health problems associated with veterans’ participation in war. The difficulty in obtaining useful answers, as noted by numerous past Institute of Medicine committees and the present committee, is due largely to inadequacies in predeployment and postdeployment screening and medical examinations and to lack of recording of stressors to which deployed personnel are exposed.

The committee recommends that DoD conduct comprehensive, standardized predeployment and postdeployment evaluations of medical conditions, psychiatric symptoms and diagnoses, and psychosocial status and trauma history. Predeployment evaluation would serve two purposes. First, it would help to identify at-risk personnel who might benefit from targeted intervention programs during deployment—such as marital counseling, medication for psychiatric or other disorders, or psychologic counseling and therapy—which might eliminate or minimize future problems. Second, such evaluations would establish a baseline against which later health and psychosocial effects could be measured.

Postdeployment assessment would also serve two purposes. First, it would provide data that could be analyzed to determine the long-term consequences of deployment-related stress and its modifiers; the committee recommends that postdeployment assessments be made shortly after deployment and at regular intervals thereafter (such as every 5 years) to measure the health and psychosocial status of veterans as they age. Second, such assessments would allow VA and DoD to implement intervention programs to assist veterans in adjusting to postdeployment life. The initial assessment after deployment should also ask the veterans what situations, events, or conditions they found to be most stressful during deployment. Knowing which veterans experienced the most stress and recognizing the possible modifiers and consequences of that stress would enable VA and DoD to target prevention and intervention programs to those at greatest risk for adverse effects. The committee further recommends that any longitudinal assessments also be conducted in a representative group of nondeployed veterans to allow appropriate comparisons between deployed and nondeployed veterans regarding health and psychosocial effects.

REFERENCES

CDC (Centers for Disease Control and Prevention). 1988. Health status of Vietnam veterans. I. Psychosocial characteristics. The Centers for Disease Control Vietnam Experience Study. Journal of the American Medical Association 259(18):2701-2707.

Eisen SA, Kang HK, Murphy FM, Blanchard MS, Reda DJ, Henderson WG, Toomey R, Jackson LW, Alpern R, Parks BJ, Klimas N, Hall C, Pak HS, Hunter J, Karlinsky J, Battistone MJ, Lyons MJ. 2005. Gulf War veterans’ health: Medical evaluation of a U.S. cohort. Annals of Internal Medicine 142(11):881-890.

Goss Gilroy Inc. 1998. Health Study of Canadian Forces Personnel Involved in the 1991 Conflict in the Persian Gulf. Ottawa, Canada: Goss Gilroy Inc. Department of National Defence.



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