Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery

Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. 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: post-traumatic stress disorder and traumatic brain injury. With the increasing concern about the incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise.

The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet, these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it.

This monograph summarizes key findings and recommendations from a larger RAND document entitled Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery (Tanielian and Jaycox [Eds.], Santa Monica, Calif.: MG-720-CCF, 2008), a comprehensive study RAND conducted of the post-deployment health-related needs associated with the three conditions among OEF/OIF veterans; the health care system in place to meet those needs; gaps in the care system; and the costs of filling those gaps and providing quality health care to all those in need.

Readers desiring more details are referred to that document. Both monographs should be of interest to mental health treatment providers; health policymakers, particularly those charged with caring for our nation"s veterans; and U.S. service men and women, their families, and the concerned public. All the research products from this study are available at http://veterans.rand.org.