. "4 PRELIMINARY FINDINGS." Returning Home from Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press, 2010.
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Returning Home from Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and their Families
Affairs (VA) in 2005 defined polytrauma as “injury to the brain in addition to other body parts or systems resulting in physical, cognitive, psychological, or psychosocial impairments and functional disability” (VA, 2005). Since then, its definition has been expanded to include concurrent injury to two or more body parts or systems that results in cognitive, physical, psychologic, or other psychosocial impairments (VA, 2009b).
Many military personnel returning from OEF and OIF appear to have more complex and emotional trauma than has been seen in past wars (Friedemann-Sanchez et al., 2008). That observation may be due, in part, to an improved chance of survival because of the widespread use of body armor, improved battlefield medical response, and advances in aeromedical evacuation. Polytrauma patients in particular have complex rehabilitation needs, including addressing and treating for pain, TBI, PTSD, and other comorbid conditions to facilitate readjustment (Sayer et al., 2009). Although TBI, amputations, PTSD, and major depression are distinct postcombat health outcomes, they cause overlapping long-term, possibly lifelong, effects on people’s lives. People affected by those types of combat-related injuries and mental health disorders tend to report poorer health and impaired function in many life activities than people who do not suffer those types of injuries. Moreover, physical injuries and mental health disorders often require treatment by multiple health-care services for an extended period. The problem of polytrauma and the associated lifelong, recurring comorbid conditions, such as PTSD and chronic pain, requires the development of integrated approaches to clinical care that can replace traditional treatment systems that focus on isolated problems (Belanger et al., 2005; Gironda et al., 2009).
Those injuries also have the potential to affect family life even if the injured service members recover fully. For example, family members may need to relocate if the proper treatment facilities are not available close to home (Cozza et al., 2005). Injuries that result in long-term changes in behavior or abilities can seriously challenge marriages, thrusting the spouse into a caregiving role, increasing the risk of depression and other psychologic problems, and increasing the likelihood of divorce (Blais and Boisvert, 2005; Calhoun et al., 2002).
The committee has decided, in this preliminary report, to focus on the most serious health, psychologic, and social outcomes related to OEF and OIF service. Those outcomes and possible readjustment needs associated with them are discussed below.
Traumatic Brain Injury and Related Blast Injuries
Throughout OEF and OIF, explosive devices have become more powerful, their detonation systems more creative, and their additives more devastating. TBI2 is the most common injury among those wounded in OEF and OIF and is a significant cause of mortality and morbidity. In 2003–2007, the Military Health System (MHS) recorded that 43,779 patients had a diagnosis of TBI (CRS, 2009). The estimates vary: some studies have found that about 10–20% of veterans returning from OEF and OIF have TBI (Elder and Cristian, 2009; Tanielian and Jaycox, 2008), and others have found that TBI accounts for up to one-third of all battlefield injuries (Meyer et al., 2008). Although penetrating brain injuries are easily identified, closed TBI is more common and, when mild, can go unnoticed. A concern for troops, veterans, and their
Brain injuries may be categorized as mild, moderate, or severe (see Silver et al., 2005); the Defense and Veterans Brain Injury Center in collaboration with the Armed Forces Health Surveillance Center publishes the annual incidence of brain injury by severity and by branch of military (DOD, 2009).