Since October 2001, approximately 1.64 million U.S. troops have deployed as part of Operation Enduring Freedom (OEF, Afghanistan) and Operation Iraqi Freedom (OIF, Iraq). These operations have employed smaller forces and (notwithstanding episodes of intense combat) have produced casualty rates of killed or wounded that are historically lower than in earlier prolonged conflicts, such as Vietnam and Korea. However, casualties of a different kind—invisible wounds, such as mental health conditions and cognitive impairments resulting from deployment experiences—are just beginning to emerge. Recent reports and increasing media attention have prompted intense scrutiny and examination of these injuries. As a...

This chapter provides a thumbnail sketch of the conflicts in Afghanistan and Iraq. The first section describes the composition of the U.S. forces by demographic components and organizational affiliations in the Active and Reserve Components. The second section places the conflicts in perspective, comparing them with other wars the United States has fought. The third section shows the history of troop deployments in the war on terrorism and arrays those deployments against significant events that have occurred in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). The third section also discusses the casualties for ground forces sustained in Iraq—...

As Kessler (2000) has noted: “Any assessment of the societal impact of a disorder must begin with a consideration of prevalence” (p. 4). By critically reviewing the current epidemiological studies on post-traumatic stress disorder (PTSD), depression, and traumatic brain injury (TBI) following deployment to Afghanistan and Iraq, we aim specifically to address several questions of both scientific and political importance, including: How widespread are mental health and cognitive conditions in the military currently? How do rates of mental health and cognitive conditions differ among troops deployed to Afghanistan, those deployed to Iraq, and nondeployed troops? How long do conditions and...

RAND conducted a large population-based survey on individuals previously deployed as part of Operation Enduring Freedom or Operation Iraqi Freedom (OEF/OIF) to address several gaps in the existing literature concerning the prevalence and correlates of mental health conditions and traumatic brain injury (TBI) stemming from service in OEF/OIF. As reported in Chapter Three, research on the prevalence of post-traumatic stress disorder (PTSD) and major depression has typically focused on active duty Army personnel and has largely neglected several types of servicemembers deployed in OEF/OIF. For example, although Air Force and Navy personnel account for 38 percent of the deployed force,...

Although there is an emerging consensus that mental health and cognitive conditions stemming from service in Afghanistan and Iraq are likely to have severe and broad consequences if left untreated, allocating resources toward particular treatments and interventions requires a detailed understanding of what the consequences of these problems are likely to be. For example, if it can be reasonably assumed that servicemembers will manifest any mental health or cognitive conditions immediately upon return from deployment, then initial assessments will be sufficient to identify those who may require extra support. In contrast, if there are reasons to expect delayed reactions to...

The previous part of this monograph (see Part III) described the consequences associated with deployment-related post-traumatic stress disorder (PTSD), major depression, and traumatic brain injury (TBI). In this chapter, we evaluate the costs associated with these conditions. Prior analyses of the costs associated with the conflicts in Afghanistan and Iraq have typically used standard accounting methodologies to project the costs that accrue to the government (Bilmes, 2007; Bilmes and Stiglitz, 2006; Goldberg, 2007), typically taking a per-person cost figure from existing data, multiplying by the projected population, and inflating over time with trend factors. These studies have focused on the...

How can we best provide services for military personnel who are suffering from mental health and cognitive problems? The answer to that question is the focus of Chapter Seven.

We examine the health care services available to military servicemembers who have returned from Afghanistan and Iraq with post-traumatic stress disorder or depression, or who have suffered a traumatic brain injury during their deployment.

We also examine gaps in these services, with the goal of supporting efforts to meet the mental health and cognitive needs of returning OEF/OIF servicemembers and veterans. We consider two kinds of service gaps:gaps in access...

Throughout its history, the United States has striven to recruit, prepare, and sustain an armed force with the capacity and capability to defend the nation. The Department of Defense (DoD), through the Secretary of Defense and the Services, bears the responsibility for ensuring that the force is ready and deployable to conduct and support military operations.

The nation has committed not only to compensating military servicemembers for their duty but also to addressing and providing compensation, benefits, and medical care for any Service-connected injuries and disabilities. For those who suffer injuries but remain on active duty, benefits and medical care...