Date: March 26, 2013



Evidence-Based Diagnostics and Therapies and Long-Term Forecasts of Needs Among Steps Necessary to Ease Iraq and Afghanistan Service Members' Readjustment to Post-Deployment Life


WASHINGTON -- To improve the ability of military service members and their families to readjust well to post-deployment life, the U.S. departments of Defense and Veterans Affairs should ensure that their systems have sufficient capacity to provide timely and adequate care to service members, veterans, and family members, and boost efforts to reduce the stigma associated with getting care for mental health and substance abuse problems, says a new report from the Institute of Medicine.  DOD and VA also should ensure that they are using diagnostic tools and therapies that are in line with the latest medical evidence.  In addition, the departments should complete work as soon as possible on a combined, interoperable electronic health record that will help service members and veterans more easily navigate the services offered by each department and ease the transition from one to the other.  


To better serve the needs of the full range of military personnel and families, DOD and VA need to take into account the increasing diversity of this population as the number of women in the armed forces rises and nontraditional families become increasingly common.  DOD should intensify its efforts to eliminate sexual harassment and assault, a problem that affects a significant percentage of current and former female service members and can have lingering emotional and health consequences, the report says, and the department should add criteria to commanding officers' performance reviews that assess how well they deal with harassment and assault.  DOD also should ensure that its support programs address the needs of the full range of families, which increasingly include unmarried partners, same-sex couples, single parents, and stepfamilies.  Support services have largely focused on married, heterosexual couples and their children.


In addition, the report reiterates the call the committee made in its 2010 interim report for the Veterans Health Administration (VHA) to conduct forecasts of the amount and types of resources necessary to meet the needs of veterans and their families in the next 30 years or more, when demand for health care and disability compensation is likely to peak based on trends from previous wars.  VHA produces some forecasts of health needs, but these projections should be conducted annually in a way similar to those done for Social Security and Medicare, and the results should be made publicly available.


"Although several federal agencies are actively trying to address the support needs of current and former service members deployed to Iraq and Afghanistan as well as their families, the response has been slow and has not matched the magnitude of this population's requirements as many cope with a complex set of health, economic, and other challenges," said committee chair George Rutherford, Salvatore Pablo Lucia Professor and vice chair, department of epidemiology and biostatistics; and director, prevention and public health group, Global Health Sciences, University of California, San Francisco.  "The number of people affected, the influx of returning personnel as the conflicts wind down, and the potential long-term consequences of their service heighten the urgency of putting the appropriate knowledge and resources in place to make re-entry into post-deployment life as easy as possible."


More than 2.2 million troops have served in the wars in Iraq and Afghanistan, which have resulted in more than 48,000 injuries and 6,600 deaths.  These troops include greater percentages of women, parents of young children, and reserve and National Guard troops than in previous conflicts.  Moreover, many of these individuals have served longer deployments with shorter intervals at home between missions.  Although the majority has readjusted well to post-deployment life, a large minority -- 44 percent -- has reported difficulties since returning home.


Significant percentages of personnel deployed to Iraq and Afghanistan have suffered traumatic brain injuries (TBI), and many have shown symptoms of post-traumatic stress disorder, depression, and substance misuse or abuse.  In many ways, DOD and VA health care providers are at the forefront of providing evidence-based care for TBI and psychological health problems.  But the tool that DOD uses to assess cognitive function after a head injury has no clear scientific evidence basis to assure its effectiveness, the committee noted.  VA includes Acceptance and Commitment Therapy among its first-line treatments for depression although the therapy lacks sufficient evidence.  Research shows that restricting access to lethal weapons prevents suicides, but even if a service member is at risk for suicide, DOD policy prohibits restricting that individual's access to privately owned weapons.


Due to limited access to data and the scarcity of research focusing on economic, social, and other impacts of deployment on military service members and their families, the committee was unable to answer many questions about the readjustment needs of this population and the status and effectiveness of support programs.  A large array of relevant data are being collected by several federal departments and agencies, and if it were possible to fully link and integrate this data, the aggregated information could be comprehensively analyzed to answer many key questions about readjustment, the committee said.  However, numerous barriers hinder access to this data, the committee found, such as unclear procedures and steps for making data requests. 


DOD, VA, and other federal agencies should develop clear procedures for linking and sharing data that detail the information they have available and spell out all the requirements and steps researchers will need to follow to access it.  Safeguarding the privacy and confidentiality of such data is paramount, and privacy experts will need to be involved in the effort to link the information.


The report was requested by Congress and sponsored by the U.S. Department of Defense.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  A committee roster follows.



Christine Stencel, Senior Media Relations Officer

Office of News and Public Information

202-334-2138; e-mail


Pre-publication copies of Returning Home From Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families are available from the National Academies Press on the Internet at or by calling tel. 202-334-3313 or 1-800-624-6242. Additional information is available at  Reporters may obtain a copy from the Office of News and Public Information (contacts listed above). 



Board on the Health of Select Populations


Committee on the Initial Assessment of Readjustment Needs of Military Personnel, Veterans,

and Their Families



George W. Rutherford, M.D., A.M. (chair)

Salvatore Pablo Lucia Professor and Vice Chair

Department of Epidemiology and Biostatistics, and


Prevention and Public Health Group

Global Health Sciences

University of California

San Francisco


Margarita Alegria, Ph.D.
Department of Psychiatry
Harvard Medical School, and
Center for Multicultural Mental Health Research
Cambridge Health Alliance


Jeffrey J. Bazarian, M.D., M.P.H.

Associate Professor
Departments of Emergency Medicine and Neurology
University of Rochester Medical Center
Rochester, N.Y.


Dan G. Blazer, M.D., Ph.D.
J.P. Gibbons Professor of Psychiatry
Duke University Medical Center
Durham, N.C.


Kathleen M. Carroll, Ph.D.


Department of Psychiatry
Division of Substance Abuse
Yale University
West Haven, Conn.


Ibolja Cernak, M.D., M.E., M.H.S., Ph.D.

Canadian Military and Veterans' Clinical Rehabilitation Medicine

Faculty of Rehabilitation Medicine

University of Alberta

Edmonton, Canada


John D. Corrigan, Ph.D.
Professor and Director
Division of Rehabilitation Psychology
Department of Physical Medicine and Rehabilitation
Ohio State University


E. Jane Costello, Ph.D.

Department of Psychiatry and Behavioral Sciences
Duke University School of Medicine
Durham, N.C.


Sureyya S. Dikmen, Ph.D.

Department of Rehabilitation Medicine
University of Washington


Naihua Duan, Ph.D.

Professor of Biostatistics
Department of Psychiatry
Columbia University Medical Center
New York City


Ryan D. Edwards, Ph.D.
Associate Professor of Economics
Queens College;

Associate Professor

Graduate Center City University of New York; and
Research Associate
National Bureau of Economic Research
New York City


Christine Eibner, Ph.D.

RAND Corp.
Arlington, Va.


Norah Feeny, Ph.D.

Department of Psychological Sciences
Case Western Reserve University


Sandro Galea, M.D., Dr.P.H.
Gelman Professor and Chair
Department of Epidemiology

Mailman School of Public Health
Columbia University
New York City


Gregory C. Gray, M.D., M.P.H.

Professor and Chair
Department of Environmental and Global Health
College of Public Health and Health Professions, and


Global Pathogens Laboratory
University of Florida


Kenneth W. Kizer, M.D., M.P.H.
Distinguished Professor
School of Medicine and Betty Irene Moore School of Nursing, and
Institute for Population Health Improvement
University of California



Meredith Kleykamp, Ph.D.

Assistant Professor
Department of Sociology

University of Maryland

College Park


Janice L. Krupnick, Ph.D. 
Professor of Psychiatry, and

Trauma and Loss Program
Georgetown University
Washington, D.C.


Richard A. Kulka, Ph.D.
Group Vice President of Survey Research
Abt Associates Inc.
Durham, N.C.


Bennett L. Leventhal, M.D.

Deputy Director
Nathan Kline Institute for Psychiatric Research
New York City;


Department of Disability and Human Development

University of Illinois, Chicago; and

Irving B. Harris Professor Emeritus

University of Chicago



Alair MacLean, Ph.D.
Associate Professor
Department of Sociology
Washington State University
Vancouver, Canada


Frances M. Murphy, M.D., M.P.H.

Independent Health Care Consultant
Silver Spring, Md.


Samuel J. Potolicchio, M.D.
Professor of Neurology
George Washington University Medical Center
Washington, D.C.


Scott L. Rauch, M.D.
Partners Psychiatry and Mental Health;
President and Psychiatrist in Chief
McLean Hospital; and
Professor of Psychiatry
Harvard Medical School


William E. Schlenger, Ph.D.
Principal Scientist
Abt Associates Inc.
Durham, N.C.


Tyler Smith, Ph.D.

Associate Professor

Department of Community Health
School of Health and Human Services

National University Technology and Health Sciences Center

San Diego


S. V. Subramanian, Ph.D.

Professor of Population Health and Geography,

Department of Society, Human Development and Health
Harvard School of Public Health


Shelly M. MacDermid Wadsworth, Ph.D.
Professor of Human Development and Family Studies; 

Center for Families; and

Military Family Research Institute
Purdue University
West Lafayette, Ind.


Albert W. Wu, M.D., M.P.H.
Professor and Diretor

Center for Health Services and Outcomes Research

Department of Health Policy and Management
Bloomberg School of Public Health
Johns Hopkins University




Laura Aiuppa, M.S.

Study Director


Carolyn Fulco, M.S.