USA – Army Works to Expand Combat Stress Detection

WASHINGTON, July 22, 2010 – Since 2003, the Army medical community has worked feverishly to establish processes that will improve the speed at which post-traumatic stress among military members is diagnosed, the Army’s surgeon general said here today.

As many as 30 percent of troops redeploying from Iraq and Afghanistan could develop post-traumatic stress symptoms, and early detection is key to their treatment, Army Lt. Gen. Eric B. Schoomaker said in a roundtable discussion with reporters.

"Earlier wars have taught us that you need to be very aggressive and very close to the battle when treating and diagnosing psychological impacts of deployment and combat exposure," Schoomaker said. "You can actually create more problems for the individual soldier by delaying the treatment or evacuating them out of theater."

Some symptoms of post-traumatic stress, Schoomaker noted, are avoidance of people, a sense of internal panic, intrusive thoughts and sleep problems, as well as drug and alcohol abuse.

Soon after the start of Operation Iraqi Freedom, the Army began sending mental health advisory teams to Iraq and Afghanistan to study behavioral health among troops exposed to combat, the general said.

The battlefield teams‘ work enabled the military medical community to refine how behavioral and mental health issues among troops was distributed, Schoomaker said. The teams also helped to validate the mental health community’s efforts, he added.

Initial treatment for soldiers on the spot, rather than waiting until they redeploy, has proven to restore the majority of diagnosed troops to operational performance levels, the general said. It also contributes to long-term health, he said.

However, many troops still are returning home with post-traumatic stress, compounded by traumatic brain injuries, Schoomaker said. Until recently, he added, servicemembers exposed to battlefield violence or attacks had the option to seek immediate health care. But many troops, he said, weren’t coming forward for care.

"If you give the soldier the option of self-identifying, what we’ve learned the past couple of years is that soldiers won’t do that," he explained. "How many football players are willing to come off the field [voluntarily]? Many of our soldiers and Marines are the same way. They brush themselves off, try to recover from what’s going on, and they go back into the fight."

But now policies are in place that force soldiers to be evaluated based on certain events, Schoomaker said.

"We’re pushing our protocols aggressively down to the battlefield [level], and taking it out of the hands of the soldier and taking them out of the fight," he said. "If we report an attack …, then everybody within a 50-meter range of that event is going to take a knee. They don’t have a choice."

Research and data provided by the mental health teams has helped the Army to develop additional survey questions, and discover other causes of post-traumatic stress, Schoomaker said.

The Army began looking harder at deployment lengths and the amount of time troops had between deployments.

"Dwell time plays a very important role," Schoomaker said. Fewer than 24 months does not allow servicemembers enough time to restore to a "baseline level" of psychological health, he said.

"Short dwell [times] between deployments were contributing to some of the problems we’re seeing," Schoomaker said. "Before [troops] had time to reconnect with family, reconnect with their community and get back to a normal ground state, they were getting out the door again."

Over the years, military medical professionals also have determined that post-traumatic stress is a normal, treatable malady, the general said.

To illustrate a possible symptom of post-traumatic stress, Schoomaker cited the example of a soldier who may be nervous and "jumpy" at loud noises after a lengthy deployment. Such a reaction, he said, is much like someone who was in a car accident who afterward maybe quick to use the brakes in traffic.

"Jumping on the table when you hear a loud noise is not a sign that [a troop] has lost his mind," he said. "It’s a normal reaction to a stressful environment."

Last fall, the Army began transitioning mental health assessments within a unit’s deployment lifecycle, Schoomaker said. For years, soldiers have received pre- and -post deployment mental health screenings, he said. But they now receive additional screenings 90 to100 days after redeployment, the general said.

However, studies show that troops‘ post-traumatic-stress symptoms could be suppressed because they’re excited about returning home, Schoomaker said.

"What we are attempting to do is tie together what we know about soldiers‘ health, well being and mental issues, emotional issues before they deploy, the state of the family; any problems they may have before they deploy, what occurred to them in the deployment that may have triggered reaction, and then tie that to their return," the general said.

Schoomaker said returning soldiers now meet one-on-one with a counselor, which he said is well-received by the troops. The counseling sessions are conducted via video conference or in person, he said, noting that about 60 percent of soldiers say they’d rather do their interviews online.

"They find that having the screen and the video gives them what I call an electronic buffer," the general said. "It makes them more comfortable even talking about very intimate problems they may have."

This approach, along with the deployed mental health teams and the series of screenings has become standard now in the Army, Schoomaker said. These methods, he added, will help to ensure symptoms are found early and treated.

"Experience has taught us that if you can find these symptoms early, you can prevent the development … of post-traumatic stress," Schoomaker said. "If we find those symptoms early, we think that 95 percent of the people can be returned to [normal duty]."

U.S. Department of Defense
Office of the Assistant Secretary of Defense (Public Affairs)