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      Discapacidad militar: revisión de recursos psicosociales en los ejércitos de nuestro entorno Translated title: Military disability: review of psychosocial resources in the armies of our environment

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          Abstract

          RESUMEN El avance legislativo y social respecto a los derechos e igualdad de oportunidades de las personas con discapacidad, no excluye a los contextos militares. Estados Unidos, Francia, Reino Unido o España, han desarrollado instrumentos para garantizar la protección legal, administrativa y económica de los militares con discapacidad, pero los proyectos y programas de recuperación social parecen insuficientes, por lo que este trabajo se centra en el objetivo de revisar los recursos psicosociales disponibles en los ejércitos de nuestro entorno. Los resultados muestran que la mayor parte de los estudios revisados se centran en la recuperación de militares con trastorno de estrés postraumático (TEPT), aunque también se recogen trabajos con lesionados medulares o con daño cerebral. Las temáticas abordadas, con relación al apoyo psicosocial y los recursos disponibles, se enfocan a la empleabilidad, las compensaciones económicas, los tratamientos y los factores que favorecen la integración social. Destacan los estudios sobre: (1) los beneficios aportados por los programas de empleo con apoyo para la salud, la integración social y la autoestima, (2) el uso de perros de servicio, que mejoran la calidad de vida y la producción laboral, y (3) los programas de deporte, que mejoran la autoestima y la calidad de vida, y favorecen el crecimiento postraumático. Como conclusión, se apunta la necesidad de establecer programas de recuperación integral, no solamente sanitaria, sino también psicosocial. Los militares y veteranos con discapacidad deben ser informados y asesorados acerca de los recursos que tienen a su disposición, pero también acompañados en la transición a la vida civil, iniciando proyectos laborales, sociales, deportivos y de ocio, que favorezcan su calidad de vida, su autoestima y su recuperación.

          Translated abstract

          SUMMARY The legislative and social progress regarding the rights and equal opportunities of people with disabilities does not exclude military contexts. The United States, France, the United Kingdom and Spain have developed instruments to guarantee legal, administrative, and economic protection for military personnel with disabilities, although social recovery projects and programs seem insufficient. Therefore, this bibliographic review focuses on the objective of reviewing the psychosocial resources available in the Armies of our environment. The results show that most of the studies reviewed focus on the recovery of military personnel with post-traumatic stress disorder (PTSD), although there are also studies on spinal cord injury or brain damage. The topics addressed, in relation to psychosocial support and available resources, focus on employability, economic compensation, treatments and factors that favour social integration. Of note are studies on: (1) the benefits brought by supported employment programs, for health, social integration, and self-esteem, (2) the use of service dogs, that improve quality of life and work production, and (3) sports programs, which improve self-esteem and quality of life, and favour post traumatic growth. In conclusion, the need to establish comprehensive recovery programs, not only health, but also psychosocial, is pointed out. Military personnel and veterans with disabilities should be informed and advised about the resources available to them, and accompanied in the transition to civilian life, initiating work, social, sports and leisure projects that favour their quality of life, self-esteem, and recovery.

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          Most cited references67

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          Mindfulness-Based Stress Reduction for Posttraumatic Stress Disorder Among Veterans: A Randomized Clinical Trial.

          Mindfulness-based interventions may be acceptable to veterans who have poor adherence to existing evidence-based treatments for posttraumatic stress disorder (PTSD).
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            The efficacy of recommended treatments for veterans with PTSD: A metaregression analysis.

            Soldiers and veterans diagnosed with PTSD benefit less from psychotherapy than non-military populations. The current meta-analysis identified treatment predictors for traumatised soldiers and veterans, using data from studies examining guideline recommended interventions, namely: EMDR, exposure, cognitive, cognitive restructuring, cognitive processing, trauma-focused cognitive behavioural, and stress management therapies. A systematic search identified 57 eligible studies reporting on 69 treated samples. Exposure therapy and cognitive processing therapy were more effective than EMDR and stress management therapy. Group-only therapy formats performed worse compared with individual-only formats, or a combination of both formats. After controlling for study design variables, EMDR no longer negatively predicted treatment outcome. The number of trauma-focused sessions, unlike the total number of psychotherapy sessions, positively predicted treatment outcome. We found a relationship between PTSD pretreatment severity levels and treatment outcome, indicating lower treatment gains at low and high PTSD severity levels compared with moderate severity levels. Demographic variables did not influence treatment outcome. Consequently, soldiers and veterans are best served using exposure interventions to target PTSD. Our results did not support a group-only therapy format. Recommended interventions appear less effective at relatively low and high patient PTSD severity levels. Future high-quality studies are needed to determine the efficacy of EMDR.
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              Deployment-related psychiatric and behavioral conditions and their association with functional disability in OEF/OIF/OND veterans.

              Understanding the factors that influence veterans' functional outcome after deployment is critical to provide appropriately targeted care. Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) have been related to disability, but other psychiatric and behavioral conditions are not as well examined. We investigated the impact of deployment-related psychiatric and behavioral conditions on disability among 255 OEF/OIF/OND service members and veterans. Structured clinical interviews assessed TBI and the psychiatric conditions of depression, PTSD, anxiety, and substance use. Self-report questionnaires assessed disability and the behavioral conditions of sleep disturbance and pain. Over 90% of participants had a psychiatric and/or behavioral condition, with approximately half presenting with ≥ 3 conditions. Exploratory factor analysis revealed 4 clinically relevant psychiatric and behavioral factors which accounted for 76.9% of the variance: (a) depression, PTSD, and military mTBI (deployment trauma factor); (b) pain and sleep (somatic factor); (c) anxiety disorders, other than PTSD (anxiety factor); and (d) substance abuse or dependence (substance use factor). Individuals with the conditions comprising the deployment trauma factor were more likely to be substantially disabled than individuals with depression and PTSD, but no military mTBI, OR = 3.52; 95% CI [1.09, 11.37]. Depression, PTSD, and a history of military mTBI may comprise an especially harmful combination associated with high risk for substantial disability.
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                Author and article information

                Journal
                sm
                Sanidad Militar
                Sanid. Mil.
                Ministerio de Defensa (Madrid, Madrid, Spain )
                1887-8571
                September 2022
                : 78
                : 3
                : 159-171
                Affiliations
                [1] Madrid orgnameUniversidad Complutense de Madrid orgdiv1Centro Universitario Villanueva Spain
                Article
                S1887-85712022000300006 S1887-8571(22)07800300006
                10.4321/s1887-85712022000300006
                0f584611-3474-4cda-9b62-65912dc1aa06

                http://creativecommons.org/licenses/by/4.0/

                History
                : 14 February 2022
                : 30 November 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 68, Pages: 13
                Product

                SciELO Spain

                Categories
                Artículo Original

                apoyo psicosocial,post-traumatic stress disorder,psychosocial support,military personnel with disabilities,veterans,trastorno por estrés postraumático,militares con discapacidad,veteranos

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