Art Therapy Services to Support Veterans' Transition to Civilian Life: The Studio and the Gallery

The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. Copyright 2004 Massachusetts Medical Society

We sought to investigate longitudinal trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans. We determined the prevalence and predictors of mental health diagnoses among 289,328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008 using national VA data. Of 289,328 Iraq and Afghanistan veterans, 106,726 (36.9%) received mental health diagnoses; 62,929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and 50 432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7 times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders. Greater combat exposure was associated with higher risk for PTSD. Mental health diagnoses increased substantially after the start of the Iraq War among specific subgroups of returned veterans entering VA health care. Early targeted interventions may prevent chronic mental illness.

The ability to make sense of events in one's life has held a central role in theories of adaptation to adversity. However, there are few rigorous studies on the role of meaning in adjustment, and those that have been conducted have focused predominantly on direct personal trauma. The authors examined the predictors and long-term consequences of Americans' searching for and finding meaning in a widespread cultural upheaval--the terrorist attacks of September 11, 2001--among a national probability sample of U.S. adults (N=931). Searching for meaning at 2 months post-9/11 was predicted by demographics and high acute stress response. In contrast, finding meaning was predicted primarily by demographics and specific early coping strategies. Whereas searching for meaning predicted greater posttraumatic stress (PTS) symptoms across the following 2 years, finding meaning predicted lower PTS symptoms, even after controlling for pre-9/11 mental health, exposure to 9/11, and acute stress response. Mediation analyses suggest that finding meaning supported adjustment by reducing fears of future terrorism. Results highlight the role of meaning in adjustment following collective traumas that shatter people's fundamental assumptions about security and invulnerability.