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INTRODUCTION

Key Clinical Questions

  • image Why should we care about combat stress and related disorders?

  • image How do you define cultural competence regarding military service members, veterans, and their families?

  • image What are the medical problems associated with military service and deployment stress?

  • image How would you describe point-of-care strategies to improve the care of military service members, veterans, and their families?

  • image What resources are available to provide information, support, and access needed by military service members, veterans, and those who care for them and about them?

An estimated 2.7 million American military members have served in Operation Enduring Freedom (OEF) in Afghanistan or Operation Iraqi Freedom (OIF) and/or Operation New Dawn (OND) in Iraq since the first of these began in 2001. As of November 2006, these conflicts have exceeded the duration of World War II. The attention rightly paid to the less than 1% of Americans who have served in OEF/OIF/OND should also alert the public that there are 22 million living American veterans and, conservatively estimated, an additional 33 million dependents potentially eligible for Department of Veterans Affairs (VA) benefits. Approximately one in every five Americans is a Service Member, a veteran, or a dependent. Of key importance, fewer than one in three veterans uses VA health services in any given year and, among these, most are also receiving at least some of their health care elsewhere. Thus, the majority of veterans and virtually all their dependents receive health care outside of VA. Hospitalists need to be alert to the fact that as many as 20% of their patients is a service member, a veteran, and/or a dependent.

More than 60% of those who have served in Afghanistan or Iraq have already had at least one episode of VA care. Among these VA’s Public Health Office reports that, as of March 31, 2015:

  • 12% of those serving in these operations are women.

  • 76% of the military forces are 35 years of age or younger.

  • 61% were active duty (AD) component members, and 39% were the Reserve component (RC) including Reservists and National Guard Members.

Active duty component members have the support of a strong military community due to their serving a continuous “hitch” on a military base. The RC “Citizen Soldiers,” however, move back and forth between military and veteran status. They may live hundreds of miles from the nearest military community and thousands of miles from the troops with whom they are deployed. Spouses may be the only person in their workplace who has had a wife or husband deployed in the military. Their children may be the only ones in their school to have a parent serving overseas.

The nature of our volunteer military requires multiple deployments per member. Each time a military member deploys, the individual’s risk of developing a postdeployment mental health problem increases. When a service member deploys, a family serves too and there ...

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