January 31, 2009

Statistics, Effects and the Realities of Multiple Deployments

Collage of images taken by U.S. military in Ir...
Image via Wikipedia
If you found this site looking for combat PTSD statistics you have hit the jackpot! Please take your time and read the post, vote in the poll and I encourage you to give your feedback. I will respond later with the results in another article.

I finally found the data that I have been looking for. I have been scouring the internet for raw statistics on how many deployments soldiers have been on. I actually found it by not looking for it. I was checking out the website Veterans for America (VFA) and came across some reports on the strains on the Guard units fighting in Iraq and Afghanistan.

For our WWI and WWII vets it was to suffer in silence, for our Korean and Vietnam vets the denial of such suffering, and for my generation of Desert Storm vets the myth of the "Jarhead" movie as a common experience and of the denial of the Gulf War Syndrome (which was recently acknowledged by the US government) and now with our modern veterans, the effects and realities of multiple deployments.

Preliminary self-reported rates of PTSD from OIF and OEF have reached 15% already according to Hoge et al. (with a 15-40% lifetime rate after combat; Hoge and Castro, 2005 para. 2) and we continue to have naysayers saying the problem could not be as bad as we say it is. How many times have our veterans been on the receiving end of this same kind of generational denial and recrimination?
Rand (2008b) reports,
[O]f the 1.64 million service members who had been deployed for OEF/OIF as of October 2007, we estimate that approximately 300,000 individuals currently suffer from PTSD or major depression and that 320,000 individuals experienced a probable TBI during deployment (p. xxi).
These figures taken with the above place estimate levels of PTSD today in soldiers and veterans of our nations modern wars at 23%.

The data on multiple tours was quite disturbing, due the fact that soldiers and veterans who have more than one deployment have significantly higher rates of mental health problems. Quoted directly from the horses mouth, the Mental Health Advisory Team (MHAT) V, the military's own research arm reports,
Soldiers on multiple deployments report low morale, more mental health problems, and more stress-related work problems. Soldiers on their third/fourth deployment are at particular risk of reporting mental health problems (MHAT V, 2008, Sec. 2.2.2, No. 8).
VFA reported on October 8, 2008 that 1,321,019 soldiers had been deployed to wars abroad, 796,483 (60%) had been deployed once, and that 469,095 soldiers had been deployed 2 to 3 times (36%), and 55,441 (4%) had been deployed 4 to 6 times. With multiple tours our modern veterans will become exponentially more vulnerable to join the ranks of the walking wounded.

In the monograph, a truncated report, titled “Invisible Wounds of War,” recently published by Rand (2008a),
Early evidence suggests that the psychological toll of these deployments—many involving prolonged exposure to combat-related stress over multiple rotations—may be disproportionately high compared with the physical injuries of combat. Concerns have been most recently centered on two combat related injuries in particular: posttraumatic stress disorder and traumatic brain injury. Many recent reports have referred to these as the signature wounds of the Afghanistan and Iraq conflicts. With the increasing concern about the incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise (p. iii).
The report adds,
The pace of the deployments in these current conflicts is unprecedented in the history of the all-volunteer force (Belasco, 2007; Bruner, 2006). Not only is a higher proportion of the armed forces being deployed, but deployments have been longer, redeployment to combat has been common, and breaks between deployments have been infrequent (Hosek, Kavanagh, and Miller, 2006). At the same time, episodes of intense combat notwithstanding, these conflicts have produced casualty rates of killed or wounded that are historically lower than in earlier prolonged conflicts, such as Vietnam and Korea. Advances in both medical technology and body armor mean that more servicemembers are surviving experiences that would have led to death in prior wars (Regan, 2004; Warden, 2006). However, casualties of a different kind—invisible wounds, such as mental health conditions and cognitive impairments resulting from deployment experiences—are just beginning to emerge (p. 2).
The Psychiatric Times reports a “gathering storm” due to the estimate that 70% of soldiers and veterans will not seek help from federal agencies (DoD or the VA), placing an undue strain on private facilities and practitioners. With this in mind the public sector of mental health has little to no preparation for the oncoming onslaught of help seeking veterans and soldiers.

At the website VA Watchdog, a reprint story on a Massachusetts commission found that veterans were not “receiving adequate treatment and readjustment assistance.” A summation of a member of the commission, state Rep. Harold P. Naughton,
said the public also should understand that the operational tempo of the current wars has exposed troops to combat for upward of 200 days at a time, far longer periods of uninterrupted combat exposure than most troops experienced in World War II or Vietnam (VAWatchdog.org).
The much reported mental health screening process during processing from combat duty has little to no effect on reporting the actual numbers of soldiers who have received psychological damage.
More than 50% of those referred for a mental health reason were documented to receive follow-up care although less than 10% of all service members who received mental health treatment were referred through the screening program (Hoge, Auchterlonie, and Milliken, 2006, p. 1023).
Hoge et al. (2006) goes on to ponder the reasons for such high numbers of non-diagnosed veterans,
This study shows that approximately one third of OIF veterans accessed mental health services in their first year after deployment, 12% per year received a diagnosis of a mental health problem, and an additional 23% per year were seen in mental health clinics but did not receive a diagnosis. It is not clear why there was such high use of mental health services without a mental illness diagnosis (p. 1030).
Hmmmmm, let me take a wild stab at it. Take it from a combat veteran who had attempted to receive help for PTSD through the combative VA system 7 times over 15 years. The systemic denial of veterans benefits has a strong bureaucratic resistance to give any compensable diagnosis coupled with “protecting the budget.”

Compounding the issue for veterans and soldiers receiving help for mental health issues is the stigma attached to such help. Stereotypical views within the military culture still hold a pervasive foothold in the minds of soldiers as to the nature and problem of psychological wounds.
Similarly, Hoge et al. [2004] found that of the soldiers and Marines who met the criteria for being diagnosed with a mental health problem, only 38 to 45% indicated an interest in receiving help: furthermore, within the previous year, only 23 to 40% reported actually receiving professional help (Brit, Greene-Shortridge, and Thomas, 2007, p. 1).
I witnessed this mentality of denial when looking into the eyes of my primary care and mental health personnel as I cycled through suicidal ideation, several episodes of psychosis, severe depression, addiction, homelessness, unemployability and complete disengagements from reality, society and loved ones. Proof positive of this phenomenon, quoted from the infamous email from a VA hospital’s PTSD program coordinator, Norma Perez,
Given that we are having more and more compensation seeking veteran, I’d like to suggest that you refrain from giving a diagnoses of PTSD straight out. consider a diagnosis of Adjustment Disorder, R/O [rule out] PTSD (Citizens for Responsibility and Ethics in Washington).
Repeated deployments will have unforeseen consequences for our veterans and soldiers. Never before in the history of warfare have we exposed our soldiers to such prolonged combat and sustained redeployments with little to no down time needed for decompressing stressed out psyches. Combine this with the governments slow to respond, cavalier attitudes and dismissal of the magnitude and scope of the problem, our veterans and soldiers suffer in silence and when the killing, death and deprivation becomes to much to bare, they take their own lives in alarming rates.

It is perplexing to realize that we keep having to do the same thing over and over again with the issues that our veterans encounter. To educate the public of the plight our veterans face on a daily basis, while combating the governments complete denial, as our veterans die each day.


  1. Scott,
    How does childhood trauma parallel the trauma experienced by veterans? What is the treatment protocol for healing? If a veteran heals the childhood trauma is it possible for the veteran to better deal with combat trauma?

  2. Scott, I am a three time operation Iraqi freedom vet, who is also working on a Masters degree in Social Work(M.S.W.) in order to help other Vets who suffer from PTSD. I hope to see you in the field as a social worker treating Vets along side myself. Lord knows we need more Vets to get involved.

    Sgt. William Rodriguez


  3. Welcome home SGT R, I will see you on the front lines of the oncoming tsunami of Combat PTSD.

  4. First & Foremost, I would like to offer my utmost gratitude to every U.S. veteran and their families. It is because of YOU that this country remains second to none. May God continue to bless you all.

    Additionally, although I am not personally a vet, my family has a long line of vets. I am a clinician who has been researching the effects of war on our veterans. I am aghast that, for a myriad of reasons, our vets are experiencing difficulties accessing mental health services for post-war injuries. As a result, our heroes are self-medicating with substances. I founded a not-for-profit agency called Hope for Tomorrow that has opened a long-term residential program for 22-24 vets. This program is called U.S. VETCare. Hope for Tomorrow's web site is: www.hopefortomorrow.net Point being, if you hear of a honorably discharged veteran that needs help (Illinois), please let them know about U.S. VETCare. 630-966-9000. Once again, thank you for making America the best nation in the world.

  5. I have just finished my 5th and last deployment as a national guar soldier.I voluntereed for 4 of them thinking it was my responsability.I did Noble Eagle 2,OEF Afghanistan,Bosnia-Kosovo,and back to back Iraq tours.I was diagnosed chronic PTSD on my firstIraq deployment when in hind site I now see that since Afghanistan I have suffered quietly.Each time I have come home I have struggled with "fitting" back in depression and finding a job.The easy answer has been to go back to what I know....and that has almost killed me now.I have not processed things from the first deployment and cant even get started.I was in therapy overseas and it worked good but at the VA I did not feel comfortable with the therapist that was assigned to me...I know I need to go back into therapy but not sure it will be with the VA.My other Drs have been great though.

  6. Hello Scott,

    My name is Margit. I am an Army wife, a college student, and a devout American. It devAstates me to know that our soldiers are faced not only with physical perils, but emotional ones as well. I understand that there is no single cure; we can only treat the symptoms. And in most cases, it is only after the home life of a diagnosed soldier's life has been drastically affected.
    I am writing a paper for a college English class. The assignment was to choose a debatable topic, and support your claim. Since I love my life as an Army wife, and the military itself, I chose "Should Psychological Pre-screening be Incorporated into the Military Induction Process?" My thought pattern behind this is purely psychologically based and by no means is censoring in bias. Essentially, I want to advocate for pre-deployment education with the major topic being... are soldiers with adverse backgrounds (child abuse, broken homes, sexual abuse, etc.) more likely to suffer from PTSD? Through previous Psych research, I have found that any individual facing repetitive abuses is more likely to be scarred from that abuse than an individual whose abuse occurred less frequently. We know PTSD is a psychological reaction to severe emotional trauma. If the in-coming military personnel has faced earlier recurring emotional and/or psychological trauma, wouldn't it follow that he or she would be more likely suffer from PTSD? If that is the case (which my preliminary research has shown IS the case) wouldn't it be in the best interests of the military, the VA, the government, and most especially the soldier and his/her family, to "pre-treat" the earlier wounds? Counseling the soldier pre-deployment may help that soldier develop coping mechanisms and open them to the self-realization that "something's not right", earlier.
    Now, with all of that being said, as I mentioned, I need to advocate for my belief (and I do hope that I have not offended anyone in my statements as that is not my intention).
    Part of my debate is to discuss the value of pre-screening. In doing so, I must show how PTSD affects the soldier, the family, and society. I would love your feedback, and with your permission, may I cite from your paper “The Modern Combat Veteran: Dissociative Posttraumatic Stress Disorder & Influences on Criminality”?

  7. Hi. I am currently a under grad student who is pursuing a degree in human services. I will get my Master's in Professional Mental Health Counseling and then move on to get my Dr. in Psychology. I have a deep burning desire to give back to the men and women who have so bravely fought for my country and suffer from this very real and painful mental illness. I would love to do further research and find ways that do not involve meds to help these guys and gals combat this and overcome it. There has to be a way... somewhere, we just have to continue to get public awareness out so that we can apply to the governmen to get grants for research etc so this thing can be cured or at least dealt with better than what it is currently being done.

  8. Anonymous, thank you for passion and continued educational pursuit to help our returning veterans. I would suggest looking to a phase-oriented treatment process using multiple treatments from medications to appropriate therapies depending on the clients needs.

  9. I want to salute your site for posting your sources. I have read the stats on your site on many other sites but they do not state the source of the data. Thank you!!!!

    I actively work with returning veterans with on the spot support and to advocate for educating the masses on the symptoms of PTSD and TBI.

    1. I ran into the same problem and decided to do the leg work on it, it took several months. Thank you for recognizing it!

  10. My husband did two tours. One in iraq and one in afganastan. He suffers from tbi and ptsd. i really never knew alot about this issue until i really saw how much it was effecting both our lives and i begun to really start to worry. He was discharged general under honerable condtitions because when he was diagnosed they placced him on tons of prescription drugs- xanax, seroquill, clonopin, (spelling) and many others. The medicine was not working for him made him a zombie and get bad nightmares he tried to stay with it but then made a chioce to try medical marijuanna. he tried it and it seemed to help alot. but then he got discharged for a hot test due to the marijuanna. Since then he is just not the same he loved the military but has so many scares too. i want him to have the right help but i dont know where to start. he doesnt have any medical insurance or anything cause he has not been able to revice any from the va. He has 2 purple hearts and many awards from his tours but due to one day trying to self medicate his life was changed and i feel he is stuck now. I just want to see him happy. Please help. We live in colorado if anyone has suggestions on where to start.

    1. In the top right hand on this blog you will find a link Family of Vet, they are supporters of veterans and caregivers. I have worked with them for the last several years and highly recommend this organization. You may want to volunteer and begin to network with others who live the same life you. They can help with how to apply for benefits and support you in the process. Also, in the top of this blog you will find a links for resources, tips and articles on veteran issues. Additionally join my Facebook page linked above for support and questions on understanding your PTSD veteran.

  11. Thanks for the statistics and for sharing these facts with us. I was specifically looking for info on PTSD and how it coincides with prolonged deployments overseas. I am writing a Policy Proposal for one of my classes and will be using this topic for my research paper also. Great article. I appreciate it.
    Also thank you to all my fellow vets for your service.
    -OIF1&2 Veteran....SGT Alameda


Please share your comments, stories and information. Thank you. ~ Scott Lee