The Forgotten Ones: A Military Veteran’s Report on Stress’s Effects

15 min read · 3 sections

Abandoned and broken, our veterans are facing a burgeoning health crisis.

Veterans are in the grips of a national health crisis, caused in part by toxic stress induced brain injury. Despite billions spent by the federal government, rates of suicide, homelessness, and substance abuse either rise or stay flat in the veteran population. Here, we will briefly discuss the pathogenesis causing this, and the integrative medical therapies available to combat this epic problem.

The Changing Landscape of Warfare

The United States is committed to a prolonged state of armed conflict, which has created a crisis for veterans. The crucial issue of mental healthcare for veterans is more important than ever before due to the considerable number of veterans returning from combat missions who have experienced episodes of PTSD and other mental health conditions.

More than 1.5 million of the 5.5 million veterans seen in VA hospitals had a mental health diagnosis in 2016.1 This represents about a 31% increase since 2004.

The changing nature of warfare increases the chance for injuries that affect mental health. Veterans also face significant challenges upon returning home. These are just a couple of reasons why PTSD Diagnoses are on the rise.2

The potential negative effects of mental health issues, such as suicide, affect the more than 107,000 veterans who are homeless on any given night. Alarming numbers of veterans die by suicide each day, which makes the response to veteran mental health needs more urgent with each passing day.3

In their landmark study, Schoebaum and Kessler examined common mental health disorders among Army participants and whether the disorder developed prior to entering the Army. 4

Based upon the results from the Army Study to Assess Risk and Resilience in Service members (Army STARRS), they found that the most common disorders for Army participants were ADHD and intermittent explosive disorders—both mental health predictors for suicide and accidental death. The prevalence of the theses disorders is higher among Army soldiers compared to civilian populations of the same age and sex.4

Below is an excerpt from the Report on Section 593 of the National Defense Authorization Act for Fiscal Year 2016:5

“Prospective members of the Armed Forces are screened at the time of accession for both currently present, and histories of, physical and mental conditions that may be disqualifying for accession. The Department of Defense (DoD), specifically the United States Military Entrance Processing Command (USMEPCOM), has processes in place to conduct these screenings and to identify individuals who do not meet the standards outlined in Department of Defense Instruction (DoDI) 6130.03 “Medical Standards for Appointment, Enlistment, or Induction in the Military Services,” dated April 28, 2010. Each of these screening steps in the Military Entrance Processing Station (MEPS) examination process is detailed in the Attachment of this report.”

“These Medical Standards require screening for learning, psychiatric, and behavioral issues inclusive with screenings for all physical systems (e.g., neck, eyes, spine) and other conditions (neurologic and sleep disorders). If, at the time of this screening, a physical or mental condition is identified that may be disqualifying, the prospective member can be referred for additional assessment by a medical specialist consultant prior to a final medical qualification decision being made by USMEPCOM. Not all applicants are referred. If the MEPS provider has enough information to make the medical qualification decision, a consult is not necessary. The consultants never make the qualification decision; they just provide medical information regarding the applicant, and the MEPS medical provider, as the DoD authority for this decision, can independently medically qualify or disqualify the applicant based on their clinical judgment.”

This passage clearly states MEPS screens military recruits for mental health disorders upon enlistment. Simply put, the overwhelming incidence of mental health injury among veterans is a direct result of their military experience.

War & Stress by the Numbers

  • The military employs over 1.3 million men and women.
  • According to the Rand Corporation, there have been a total of 1.4 million combat deployment years to Iraq and Afghanistan from 2001 to 2018. 6 This includes individuals with multiple deployments.
  • According to The United States War Dogs Association, Inc., there was 1.6 million combat deployment years to Vietnam when the Department of Defense (DoD) had 2.7 million active-duty members.7

In their book The Three Trillion Dollar War: The True Cost of the Iraq Conflict, economists Joseph E. Stiglitz and Linda J. Bilmes state gross estimates of treating veterans with PTSD will reach over $950 billion, exceeding the total cost of war.8

Stiglitz, a Nobel Laurate in Economics, explains that the Veteran Administration’s (VA) estimates are grossly underestimated due to both an increase in VA claims since 2005 and the inability of the VA to foresee the full spectrum of medical conditions veterans suffer as a byproduct of PTSD.8

Stiglitz further states “Historically, the cost of caring for war veterans rises for several decades and peaks 30 to 40 years or more after a conflict. This will be especially true for veterans of the current wars, who are already utilizing VA medical services and applying for disability benefits at much higher rates than in previous wars.”8

Veteran talking with psychologist

Veterans in Distress

One of the reasons there is a veteran mental health crisis is because veterans are overwhelmingly diagnosed with mood and anxiety disorders due to trauma, and doctors overlook brain damage due toxic effects of stress over time.

Being a member of the U.S. military comes with the burden of many stressors that go unrecognized, such as extended time periods away from family, long hours on night schedules, and stressful training environments. Most U.S. military personnel will suffer some type of injury in their career, with the army citing 2,500 injuries for every 1,000 soldiers.17

U.S. military personnel are expected to maintain professional advancement, often with limited advancement opportunities, resulting in automatic discharge if they fail to advance. This is referred to as higher tenure. According to the Census Bureau, there are 23,000 active duty members living on SNAP benefits (formerly known as food stamps).18

Active-duty military members are not the only ones who are impacted by the demands of the military. According to a U.S. Census Bureau report from 2015, military supervisors have the highest divorce rates among any career.19

This is just a fraction of the stress active-duty personnel live with, not including deployments to combat zones, which are often 6 months to a year in duration. Although each of the stressors individually may not cause the toxic effects of stress, together they can create a cascading additive effect.

Sources

  1. Shane, L. & Kime, P. (2016). New VA finds 20 veterans commit suicide each day. Military Times.
  2. Garbelman, J. (2012). Crisis intervention issues in the veteran population. Milwaukee, MN: VAMC.
  3. Phillips, D. (2016). Suicide rate among veterans has risen sharply since 2001. The New York Times.
  4. Schoebaum, M., Kessler, R., et al. (2014). Predictors of suicide and accident death in the Army Study to Assess Risk and resilience in Servicemembers (Army STARRS), Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry, 71(5), 493-503.
  5. Department of Defense (DoD). (2016). Report on Section 593 of the National Defense Authorization Act for Fiscal Year 2016, Report on Preliminary Mental Health Screening for Individuals Becoming Members of the Armed Forces.
  6. Baiocchi, D. & Rand Corporation. (2013). Measuring Army deployments to Iraq and Afghanistan.
  7. The United States War Dogs Association, Inc. Vietnam statistics.
  8. Stiglitz, J.E. & Bilmes, L.J. (2008). The Three Trillion Dollar War: The True Cost of the Iraq Conflict. New York, NY: W.W. Norton & Company, Inc.
  9. Watson Institute, International & Public Affairs, Brown University. (2015). Costs of War.
  10. U.S. Department of Housing and Urban Development, Office of Community Planning and Development. (2018). The 2018 Annual Homeless Assessment Report (AHAR) to Congress.
  11. Metraux, S. & Szymkowiak, D. (October 2017). VA National Center on Homelessness Among Veterans Research Brief: Rural Homelessness among Veterans: What do we know?
  12. John. J. & USC Suzanne Dworak-Peck School of Social Work. (2012). Shedding light on America’s homeless veterans.
  13. Kang, H.K., Natelson, B.H., Mahan, C.M., Lee, K.Y., Murphy, F.M. (2003). Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans. American Journal of Epidemiology 157(2), 141-148.
  14. U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention. (2019). 2019 National Veteran Suicide Prevention Annual Report.
  15. U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention (2018). VA National Suicide Data Report 2005-2016.
  16. Hester, R.D. (2017). Lack of access to mental health services contributing to the high suicide rates among veterans. International Journal of Mental Health Systems 11, 47.
  17. McNulty, V. & U.S. Army Center for Health Promotion and Preventive Medicine. (2009) Injuries: the modern military epidemic.
  18. Merina, D. (2017). When active-duty service members struggle to feed their families.
  19. Morris, R. (2017). Divorce rates by job industry: military vets and baby boomers.
  20. McEwen, B.S. (2017). Neurobiological and systemic effects of chronic stress. New York, NY: Laboratory of Neuroendocrinology, The Rockefeller University.
  21. Lucille, H. (2016). General adaptation syndrome (GAS) stages.
  22. Lazarus, R.S. & Folkman, S. (1984). Stress, Appraisal, and Coping. New York, NY: Springer Publishing Company.
  23. Kim, E.J., Pellman, B., & Kim, J.J. (2015). Stress effects on the hippocampus: a critical review. Learning & Memory 22(9), 411-416.
  24. Lowy, M.T., Gault, L., & Yamamoto, B.K. (1993). Adrenalectomy attenuates stress-induced elevations in extracellular glutamate concentrations in the hippocampus. Journal of Neurochemistry 61(5), 1957-1960.
  25. Rogers, J.C. & De Brito, S.A. (2016). Cortical and subcortical gray matter volume in youths with conduct problems: a meta-analysis. JAMA Psychiatry 73(1), 64-72.
  26. Tomoda, A., Suzuki, H., Rabi, K., Sheu, Y.S., Polcari, A., & teacher, M.H. (2009). Reduced prefrontal cortical gray matter volume in young adults exposed to harsh corporal punishment. NeuroImage 47(2), T66-71.
  27. Geuze, E., Westenberg H.G., Heinecke, A., de Kloet, C.S., Goebel, R., & Vermetten, E. (2008). Thinner prefrontal cortex in veterans with posttraumatic stress disorder. NeuroImage 41(3), 675-81.
  28. Chen, S., Xia, W., Li, L., Liu, J., He, Z., Zhang, Z., et al. (2006). Gray matter density reduction in the insula in fire survivors with posttraumatic stress disorder: a voxel-based morphometric study. Psychiatry Researh 146(1), 65–72.
  29. Violanti, J. M., Andrew, M. E., Burchfiel, C. M., Dorn, J., Hartley, T., & Miller, D. B. (2006). Posttraumatic stress symptoms and subclinical cardiovascular disease in police officers. International Journal of Stress Management, 13(4), 541–554.
  30. Raison, C.L., Capuron, L., & Miller, A.H. (2006). Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends in Immunology 27(1), 24-31.
  31. McEwen, B.S. (1999). Stress and hippocampal plasticity. Annual Review of Neuroscience 22, 105-122.
  32. McEwen, B.S. (2016). Stress-induced remodeling of hippocampal CA3 pyramidal neurons. Brain Research 1645, 50-54.
  33. Dhabhar, F.S., Saul, A.N., Daugherty, C., Holmes, T.H., Bouley, D.M., Oberyszn, T.M. (2010). Short-term stress enhances cellular immunity and increases early resistance to squamous cell carcinoma. Brain, Behavior, and Immunity 24(1), 127–137.
  34. Treccani G, Musazzi L, Perego C, et al. (2014). Stress and corticosterone increase the readily releasable pool of glutamate vesicles in synaptic terminals of prefrontal and frontal cortex. Molecular Psychiatry. 19(4), 433–443.
  35. Picard, M., McEwen, B.S., Epel, E.S., & Sandi, C. (2018). An energetic view of stress: focus on mitochondria. Frontiers in Neuroendocrinology 49, 72-85.
  36. Ramirez, S., Gomez-Valades, A.G., Schneeberger, M., Varela, L., et al. (2017). Mitochondrial dynamics mediated by mitofusin 1 is required for POMC neuron glucose-sensing and insulin release control. Cell Metabolism 25, 1390–1399.
  37. Bowden, C., Cheetham, S.C, Lowther, S., Katona, C.L., Crompton, M.R., & Horton, R.W. (1997). Reduced dopamine turnover in the basal ganglia of depressed suicides. Brain Research 769(1), 135-140.
  38. Jie, F., Yin, G., Yang, W., Yang, M., Gao, S., Lv, J., & Li, B. (2018). Stress in regulation of GABA amygdala system and relevance to neuropsychiatric diseases. Frontiers in Neuroscience 12, 562.
  39. Mombereau, C., Kaupmann, K., Froestl, W., Sansig, G., van der Putten, H., & Cryan, J.F. (2004). Genetic and pharmacological evidence of a role for GABA(B) receptors in the modulation of anxiety- and antidepressant-like behavior. Neuropyschopharmacology 29(6), 1050-1062.
  40. Mombereau, C., Kaupmann, K., Gassmann, M., Bettler, B., van der Putten, H., & Cryan, J.F. (2005) Altered anxiety and depression-related behaviour in mice lacking GABAB(2) receptor subunits. NeuroReport 16(3), 307-310.
  41. McEwen, B.S. (2010). The brain is the central organ of stress and adaptation. NeuroImage 47(3), 911-913.
  42. Phillips, L.J., McGorry, P.D., Garner, B., Thompson, K.N., Pantelis, C., Wood, S.J., &Berger, G. (2006). Stress, the hippocampus and the hypothalamic‐pituitary‐adrenal axis: implications for the development of psychotic disorders. Australian and New Zealand Journal of Psychiatry 40(9), 725–741.
  43. Abedelmalek, S., Souissi, N., Chtourou, H., Denguezli, M., Aouichaoui, C., Ajina, M., Aloui, A., Dogui, M., Haddouk, S., & Tabka, Z. (2013). Effects of partial sleep deprivation on proinflammatory cytokines, growth hormone, and steroid hormone concentrations during repeated brief sprint interval exercise. Chronobiology International 30(4), 502-509.
  44. Felton, S.Y. & Felten, D.L. (1994). Neural-immune interaction. Progress in Brain Research 100, 157-162.
  45. Segerstrom, S.C. & Miller, G.E. (2004). Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychological Bulletin 130(4), 601-630.
  46. Kiecolt-Glaser, J.K. & Glaser, R. (1988). Methodological issues in behavioral immunology research with humans. Brain, Behavior, and Immunity 2(1), 67-78.
  47. Lui, H., Li, X., Wang, Y., Song, Y., & Liu, J. (2018). The hippocampus underlies the association between self-esteem and physical health. Scientific Reports 8.
  48. Bremner, J.D., Randall, P., Scott, T.M., Bronen, R.A., Seibyl, J.P., Southwick, S.M., Delaney, R.C., McCarthy, G., Charney, D.S., & Innis, R.B. (1995). MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder. American Journal of Psychiatry 152(7), 973-981.
  49. Banasr, M. & Duman, R.S. (2008). Glial loss in the prefrontal cortex is sufficient to induce depressive-like behaviors. Biological Psychiatry 64(10), 863-870.
  50. Bergland, C. (2014). Chronic stress can damage brain structure and connectivity.
  51. Van Wingen, G.A., Geuze, E., Caan, M.W., Kozicz, T., Olabarriaga, S.D., Vermetten, E., & Fernandez, G. (2012). Persistent and reversible consequences of combat stress on the mesofrontal circuit and cognition. Proceedings of the National Academy of Sciences of the United States of America 109(38), 15508-13.
  52. Williams, J. The amygdala: definition, role, & function.
  53. Rauch, S.L., Shin, L.M., & Phelps, E.A. (2006). Neurocircuitry models of posttraumatic stress disorder and extinction: human neuroimaging research—past, present, and future. Biological Psychiatry 60(4), 376-382.
  54. Park, A.T., Leonard, J.A., Saxler, P.K., Cyr, A.B., Gabrieli, J.D., & Mackey, A.P. (2018). Amygdala–medial prefrontal cortex connectivity relates to stress and mental health in early childhood. Social Cognitive and Affective Neuroscience 13(4), 430-439.
  55. Johns Hopkins Medicine. The effects of sleep deprivation.
  56. Lepola, U., Koponen, H., & Leinonen, E. (1994). Sleep in panic disorders. Journal of Psychosomatic Research 38(Suppl 1), 105-111.
  57. Colvoen, P.J., Masino, T., Drummond, S.P., Myers, U.S., Angkaw, A.C., & Norman, S.B. (2015). Obstructive sleep apnea and posttraumatic stress disorder among OEF/OIF/OND veterans. Journal of Clinical Sleep Medicine 11(5), 513–518.
  58. Tavernier, R. & Willoughby, T. (2014). Bidirectional associations between sleep (quality and duration) and psychosocial functioning across the university years. Developmental Psychology 50(3), 674-682.
  59. U.S. National Library of Medicine, Genetics Home Reference (2019). What is epigenetics?
  60. Lee, R.S., Tamashiro, K.L., Yang, X., Purcell, R.H., Harvey, A., Willour, V.L., Huo, Y., Rongione, M., Wand, G.S., & Potash, J.B. (2010). Chronic corticosterone exposure increases expression and decreases deoxyribonucleic acid methylation of Fkbp5 in mice. Endocrinology 151(9), 4332-4343.
  61. Smith, A.K., Conneely, K.N., Kilaru, V., Mercer, K.B., Weiss, T.E., Bradley, B., Tang, Y., Gillespie, C.F., Cubells, J.F. & Ressler, K.J. (2011). Differential immune system DNA methylation and cytokine regulation in post-traumatic stress disorder. American Journal of Medical Genetics. 156B(6), 700-708.
  62. Koenen, K.C., Uddin, M., Chang, S.C., Aiello, A.E., Wildman, D.E., Goldmann, E., & Galea, S. (2011). SLC6A4 methylation modifies the effect of the number of traumatic events on risk for posttraumatic stress disorder. Depression and Anxiety 28(8), 639-647.
  63. Koenen, K.C., Uddin, M., Chang, S.C., Aiello, A.E., Wildman, D.E., Goldmann, E., & Galea, S. (2011). SLC6A4 methylation modifies the effect of the number of traumatic events on risk for posttraumatic stress disorder. Depression and Anxiety 28(8), 639-647.
  64. Rusieckim J.A., Chen, L., Srikantan, V., Zhang, L., Yan, L., Polin, M.L., & Baccarelli, A. (2012). DNA methylation in repetitive elements and post- traumatic stress disorder: a case-control study of US military service members. Epigenomics, 4(1), 29-40.
  65. Uddin, M., Galea, S., Chang, S.C., Koenen, K.C., Goldmann, E., Wildman, D.E., & Aiello, A.E. (2013). Epigenetic signatures may explain the relationship between socioeconomic position and risk of mental illness: preliminary findings from an urban community-based sample. Biodemography and Social Biology 59(1), 68-84.
  66. Haghighi, F., Xin, Y., Chanrion, B., O’Donnell, A.H., Ge, Y., Dwork, A.J., Arango, V., & Mann, J.J. (2014). Increased DNA methylation in the suicide brain. Dialogues in Clinical Neuroscience 16(3), 430-438.
  67. Hoge, C.W., McGurk, D., Thomas, J.L., Cox, A.L., Engel, C.C., & Castro, C.A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. The New England Journal of Medicine 358, 453-463.
  68. Terrio, H., Brenner, L.A., Ivins, B.J., Cho, J.M., Helmick, K., Schwab, K., Scally, K., Bretthauer, R., & Warden, D. (2009). Traumatic brain injury screening: preliminary findings in a US Army Brigade Combat Team. Journal of Head Trauma Rehabilitation 24(1), 14-23.
  69. Fish, L. & Scharre, P. (2018). Protecting warfighters from blast injury.
  70. Bryant, R.A. & Harvey, A.G. (1999). Postconcussive symptoms and posttraumatic stress disorder after mild traumatic brain injury. The Journal of Nervous and Mental Disease 187(5), 302-305.
  71. Soika, P., Stalnacke, B.M., Bjornstig, U., & Karlsson, K. (2006). One-year follow-up of patients with mild traumatic brain injury: occurrence of post-traumatic stress-related symptoms at follow-up and serum levels of cortisol, S-100B and neuron-specific enolase in acute phase. Brain Injury, 613-620.
  72. Ponsford, J., Cameron, P., Fitzgerald, M., Grant, M., Mikocka-Walus, A. (2011). Long-term outcomes after uncomplicated mild traumatic brain comparison with trauma controls. Journal of Neurotrauma 28(6), 937-946.
  73. Kashluba, S., Paniak, C., Blake, T., Reyolds, S., Toller-Lobe, G, & Nagy, J. (2004). A longitudinal, controlled study of patient complaints following treated mild traumatic brain injury. Clinical Neuropsychology 19(6), 805-816.
  74. Lannsjö M., af Geijerstam, J.L., Johansson, U., Bring, J., & Borg, J. (2009). Prevalence and structure of symptoms at 3 months after mild traumatic brain injury in a national cohort. Brain Injury 23(3), 213-219.
  75. Lundin, A., de Boussard, C., Edman, G., & Borg, J. (2006). Symptoms and disability until 3 months after mild TBI. Brain Injury 20(8), 799-806.
  76. Stålnacke, B.M. (2007). Community integration, social support and life satisfaction in relation to symptoms 3 years after mild traumatic brain injury. Brain Injury 21(9), 933-942.
  77. Jakola, A.S., Müller, K., Larsen, M., Waterloo, K., Romner, B.,  & Ingebrigtsen, T. (2007). Five-year outcome after mild head injury: a prospective controlled study. Acta Neurologica Scandinavica 115(6), 398-402.
  78. Zumstein, M.A., Moser, M., Mottini, M., Ott, S.R., Sadowski-Cron, C., Radanov, B.P. Zimmermann, H., & Exadaktylos, A. (2011). Long-term outcome in patients with mild traumatic brain injury: a prospective observational study. Journal of Trauma 71(1), 120-127.
  79. Andersson, E.E., Bedics, B.K., & Falkmer, T. (2011). Mild traumatic brain injuries: a 10-year follow-up. Journal of Rehabilitative Medicine 43(4) 323-329.
  80. Yaffe, K., Vittinghoff, E., Lindquist, K., Barnes, D., Covinsky, K.E., Neylan, T., Kluse, M., & Marmar, C. (2010). Post-traumatic stress disorder and risk of dementia among US veterans. JAMA Psychiatry 67(6), 608-613.
  81. Flegal, K.M., Carroll, M.D., Ogden, C.L., & Curtin, L.R. (2010). Prevalence and trends in obesity among US adults, 1999-2008. The Journal of the American Medical Association 303(3), 235-241.
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