mTBI, PTSD and Stress (Catch All)

[davidbfpo]

Hat tip to Leah Farrell (via Twitter) for this pointer - to a vivid, hard to read personal account of PTSD by an Australian soldier, who joined as a private and became a general. From the sub-title:

Major General John Cantwell fought in Iraq in 1991 and again in 2006. In 2010 he commanded the Australian troops in Afghanistan. Upon his return, he was in the running to be the Chief of Army – instead, he found himself in a psychiatric ward.

Link:http://www.smh.com.au/lifestyle/casu...917-2612i.html

We've seen similar references and I do wonder what the impact upon each national society will be of ex-veterans who think this:

I seethe at the indifference of most Australians to the efforts of our troops overseas.

I know there are some biker SWC members, so:

Bizarrely, I can ride a motorcycle without having these foolish panic attacks. I have no idea why.

Finally:

I understand that I am on a long journey of recovery, but I know also that I will complete that journey, someday. I am determined to get better. I will beat this thing.

A book is due out next month:

Exit Wounds: One Australian's War on Terror by Major General John Cantwell (with Greg Bearup), published by MUP on October 1.

Link to publisher:https://estore.mup.com.au/items/9780522861785 and no trace on Amazon.

[davidbfpo]

Introductory remarks have been edited slightly:

Daniel Somers was a veteran of Operation Iraqi Freedom... Daniel suffered greatly from PTSD and had been diagnosed with traumatic brain injury and several other war-related conditions. On June 10, 2013, Daniel wrote the following letter to his family before taking his life. Daniel was 30 years old. His wife and family have given permission to publish it.

Link:http://gawker.com/i-am-sorry-that-it...ium=socialflow

He refers to twenty-two military suicides daily. I tried to identify a thread on PTSD and suicide, but my search failed, so dropped in here.

[ganulv]

[Somers] refers to twenty-two military suicides daily. I tried to identify a thread on PTSD and suicide, but my search failed, so dropped in here.

I looked around the Web for a few minutes and came upon the following from a 2011 report:

[T]he VA estimates that a veteran dies by suicide every 80 minutes.*

That is eighteen veteran suicides daily, so a bit lower than Mr. Somers’s figure, but still, for perspective:

[A]lthough only 1% percent of Americans have served in the military, former service members represent 20% percent of suicides in the United States.†

-------
* Harrell, Margaret C., and Nancy Berglass. Losing the battle: the challenge of military suicide. Policy brief. Center for a New American Security, October 2011: p. 1.
† ibid.

[davidbfpo]

Ganulv,

I understand that the suicide rate amongst ex-UK servicemen is high too. Another SWC member I think referred to more committing suicide after the Falklands War (1982) than were killed in the conflict.

[ganulv]

Ganulv,

I understand that the suicide rate amongst ex-UK servicemen is high too. Another SWC member I think referred to more committing suicide after the Falklands War (1982) than killed in the conflict.

The figures from the 2011 report are particularly striking to me in light of the conditions associated with increased risk of suicide which preclude an individual from military service in the U.S. See here for the conditions listed under the headings of Disorders with psychotic features; Neurotic, anxiety, mood, somatoform, dissociative, or factitious disorders; and Personality, conduct, and behavior disorders, amongst others.

[jmm99]

Does the comparison of 20% of suicides being vets vs. 1% of the population being vets have any materiality (weight, significance) ? You judge.

The data in the CNAS study (see notes 2 & 3) come from Facts about Veteran Suicide (VHA, updated April 2011); also from whence:

30,000 - 32,000 US deaths from suicide per year among the population overall (Centers for Disease Control and Prevention)

Approximately:

20 percent are Veterans (National Violent Death Reporting System).

18 deaths from suicide per day are Veterans (National Violent Death Reporting System).

Taking 32,000 (all US suicides) x 20% (vets) = 6400 / 365 days = 17.5. Pretty simple - and also pretty simplistic.

Consider this one, A "Suicide Epidemic Among Veterans"? (2008); first for some background on the death stats:

Veteran status has been part of the standard death certificate since 1939. The National Vital Statistics System, however, is a terribly decentralized system in which the states voluntarily participate. The federal government is a subscriber to that data and pays for it on a per record basis through grant agreements with the states. That data element, veteran status, has never been collated at the federal level. So while the data exists on an existential level it might as well not exist in any practical sense.

Only a minority of states supply vet data. Obviously, this is an area where Big Data would be useful - Come on NSA !

In order to exert some control over the study, one might look beyond vet & non-vet to age and gender classes. The "Suicide Epidemic" article looks to those distinctions, based on 2004 data from two public use databases managed by the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control (this and that).

First take the 2004 data for all US suicides by age (per 100,000):

15-19 years, 8.2; 20-24 years, 12.4; 25-34 years, 12.6; 35-44 years, 15.0; 45-54 years, 16.5; 55-64 years, 13.8; 65-74 years, 12.3; 75-84 years, 16.3; and 85+ years, 16.4.

The rates for vets vary all over the place - 17 to 32 per 100,000.

Second, take the data for males (per 100,000):

15-19 years,12.6; 20-24 years, 20.8; 25-34 years, 20.3; 35-44 years, 23.0; 45-54 years, 24.7; 55-64 years, 22.0; 65-74 years, 22.5; 75-84 years, 34.8; and 85+ years, 45.0.

and, third, the 2004 data for white males (per 100,000):

15-19 years, 13.5; 20-24 years, 22.0; 25-34 years, 21.7; 35-44 years, 25.6; 45-54 years, 27.5; 55-64 years, 23.9; 65-74 years, 24.1; 75-84 years, 37.0; and 85+ years, 48.3.

So, for the 20-24 years cohort, we see for 2004: 12.4 (all); 20.8 (males); and 22.0 (white males). Looking at all 20-24 years males, over a number of database years:

1979 -- 26.5
1980 -- 26.8
1981 -- 25.7
1982 -- 25.2
1983 -- 24.0
...
1993 -- 26.5
1994 -- 28.0
1995 -- 27.0
..
2002 -- 20.8
2003 -- 20.2
2004 -- 20.8

The salient point - compare apples with apples.

Next up, JAMA, Post-service Mortality Among Vietnam Veterans (1987):

The post-service mortality (through December 1983) of a cohort of 9324 US Army veterans who served in Vietnam was compared with that of 8989 Vietnam-era Army veterans who served in Korea, Germany, or the United States. Over the entire follow-up period, total mortality in Vietnam veterans was 17% higher than for other veterans. The excess mortality occurred mainly in the first five years after discharge from active duty (rate ratio, 1.45; 95% confidence interval, 1.08 to 1.96) and involved motor vehicle accidents, suicide, homicide, and accidental poisonings. Thereafter, mortality among Vietnam veterans was similar to that of other Vietnam-era veterans, except for drug-related deaths, which continued to be elevated. An unexpected finding was a deficit in deaths from diseases of the circulatory system among Vietnam veterans. The excess in post-service mortality due to external causes among Vietnam veterans is similar to that found among men returning from combat areas after World War II and the Korean War.

From this study, we can conclude that the critical period for in-theatre personnel (for motor vehicle accidents, suicide, homicide, and accidental poisonings) is the first five years post-theatre.

Similar findings for deaths among Australian vets and non-vets, in the later period starting 15 to 20 years post service, are found in Mortality of National Service Vietnam Veterans (1997), including:

Suicide, which has been of particular interest in Vietnam veterans, was not significantly elevated, with a relative risk of 1.13.

This is an area where one should make haste slowly.

Regards

Mike

[ganulv]

In sum, you are suggesting that veteran/non-veteran suicide rates be compared by be age/race/sex combinations?

[jmm99]

and also that the variations over time be kept in mind. For example, the data for the 20-24 years male cohort has a variation from 20.2 (2003) to 28.0 (1994).

To also make it clear, I don't dispute that in-theatre vets (vs. out-of-theatre vets) have higher risk factors, especially in the earlier years after discharge; though my beliefs in that regard are very much influenced by anecdotal evidence (my dad, WWII combat in an assault rifle company). We just shouldn't get carried away with how "high" those risk factors are.

Regards

Mike

[ganulv]

and also that the variations over time be kept in mind. For example, the data for the 20-24 years male cohort has a variation from 20.2 (2003) to 28.0 (1994).

IIRC, Boomers have shown a higher suicide rate than those born before or after. I wonder how/if that ties into service in Vietnam.

[jmm99]

Suicide Among Adults Aged 35–64 Years — United States, 1999–2010.

Which first - chicken or egg ?

Regards

Mike

[SWJ Blog]

Leader-Imposed Stress

Entry Excerpt:



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Read the full post and make any comments at the SWJ Blog.
This forum is a feed only and is closed to user comments.

[davidbfpo]

Pre-broadcast publicity for tomorrow's BBC Panorama on this issue, so some UK papers have picked up the story:

In 2012 seven serving soldiers were confirmed to have killed themselves, while a further 14 died in suspected suicides but inquests had yet to be held, the Ministry of Defence have confirmed. But as the Government does not record suicides among former soldiers, the number of feared much higher.

An investigation by the BBC's Panorama found at least 29 veterans also took their own lives last year, bringing the total number of suicides to 50 compared with 40 soldiers who died in action in Afghanistan during the same period.

Link:http://www.telegraph.co.uk/news/ukne...s-suggest.html

Link to BBC summary:http://www.bbc.co.uk/news/uk-23259865

[ganulv]

How much does culture matter for P.T.S.D.? by David J. Morris

There is quite a bit of compare-and-contrast of British and American P.T.S.D. rates in the piece. Excerpts:

In [Ben Shephard’s] provocative book, “A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century,” he describes a historical cycle that governs the treatment of war stress: “the problem is at first denied, then exaggerated, then understood, and finally, forgotten.”*

One of the largest studies done on combat-related P.T.S.D., published in The Lancet at the height of the Iraq War, reported that around four per cent of British veterans had been diagnosed with the disorder. A meta-analysis of studies on American veterans deployed to Iraq found that the rate of P.T.S.D. diagnosis ranges from 1.4 to thirty-one per cent, although the range is typically between ten to seventeen per cent. In a 2010 study published in The British Journal of Psychiatry, Neil Greenberg, of the Academic Centre for Defence Mental Health, at King’s College London, found an incidence rate of 3.4 per cent.

*Shephard’s is not an original insight, but it is worth restating. One of my favorite anthropologists, W.H.R. Rivers, was publicly discussing what we now know as P.T.S.D. almost a century ago.

[davidbfpo]

'Commander Salamander' has added a commentary on the USNI blogsite, within which he comments on PTSD, alongside why service leadership fails to offer leadership:

Compared with other countries, the United States diagnoses PTSD cases at improbably high rates. Recent PTSD rates in the U.S. have reached as high as 30%, according to the Congressional Budget Office. By contrast, only 2% of Danish soldiers deployed to Afghanistan (and, per capita, the Danes have done as much fighting as anyone) are diagnosed with significant PTSD symptoms, according to a study published in December in Psychological Science. One consequence of high rates of PTSD diagnosis is that the treatment is too often conducted outside a military environment. Soldiers are deprived of what traditionally has been the best medicine: talking to other soldiers.

GBR, DNK, EST, CAN, NLD, AUS all fought relatively caveat free with us in AFG, especially DNK. That is a fair comparison. Either we argue that the average American servicemember is less hardy than your average Dane, that the Danes don’t care about their soldiers, or that there is something wrong with our reporting and classification system. I vote for #3.

Link:http://blog.usni.org/2013/08/19/2013...28USNI+Blog%29

[Red Rat]

A straw poll of some two dozen serving officers at my current location revealed that while we had all come across suicides among serving and retired peers and subordinates, all of them appeared to have been linked to non-PTSD issues.

This ad hoc military judgement panel felt that the relentless focus on PTSD was obscuring a larger issue of mental health in the round and while there was awareness of some people who had suffered with PTSD, these were very much the exception; more prevalent were people with stress, depression and other mental health issues.

certainly the UK often recruits (especially the combat arms) from a strata of society where disrupted backgrounds are the norm, military life is in itself very disruptive and then on discharge we return personnel inevitably back from whence they came.

[davidbfpo]

This thread was originally called White Paper: PTSD and mTBI. It has now been renamed mTBI, PTSD and Stress (Catch All).

Today I have merged in eight similar threads, all had been closed. There remain a small number of threads on PTSD / Stress, most are in the RFI arena and have been left alone.

IHMO this thread should be viewed alongside: How soldiers deal with the job of killing:http://council.smallwarsjournal.com/...ad.php?t=13523 and How LE & others deal with the job of killing and death: http://council.smallwarsjournal.com/showthread.php?t=15164

[davidbfpo]

A short article 'When the brain is the battlefield' in The Spectator, in a health supplement:http://health.spectator.co.uk/when-t...-armed-forces/

A couple of "take away" points: 4% of all those the UK deployed to Afghanistan and Iraq come back with PTSD; 7% for those in direct combat and 40% with disorders do not seek help.

The UK public expect 90% return with physical or mental health problems.

Yes, this article was the catalyst to re-open this thread and merge smaller ones in (see above Post).

[davidbfpo]

A long article from Huffington Post, the actual title is: These Elite Troops Spent 15 Years At War. This Program Tries To Prepare Their Minds And Bodies For The Next 15.
Link:http://www.huffingtonpost.com/entry/...b0018f9cb991d0