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Out of the Shadows

Out of the Shadows: The Health and Well-Being of Private Contractors Working in Conflict Environments

Molly Dunigan
Carrie M. Farmer
Rachel M. Burns
Alison Hawks
Claude Messan Setodji
Copyright Date: 2013
Published by: RAND Corporation
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  • Book Info
    Out of the Shadows
    Book Description:

    Private contractors have been deployed extensively around the globe for the past decade and may be exposed to many of the stressors that are known to have physical and mental health implications for military personnel. Results from a RAND survey offer preliminary findings about the mental and physical health of contractors, their deployment experiences, and their access to and use of health care resources.

    eISBN: 978-0-8330-8235-0
    Subjects: Psychology, History, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-viii)
  4. Figures
    (pp. ix-x)
  5. Tables
    (pp. xi-xii)
  6. Summary
    (pp. xiii-xx)
  7. Acknowledgments
    (pp. xxi-xxii)
  8. Abbreviations
    (pp. xxiii-xxiv)
  9. CHAPTER ONE Introduction
    (pp. 1-12)

    Private contractors have been deployed extensively over the past decade to support U.S. and coalition operations in both Iraq and Afghanistan, at times outnumbering U.S. troops in these theaters. Although contractor deployments have received a substantial amount of media, scholarly, and government attention throughout this period, contractors are often referred to in the literature as a “shadow force” (see, for instance, Isenberg, 2008), operating below the radar or in the shadows of their military counterparts. Nonetheless, contractors support numerous other entities beyond U.S. and allied forces in Iraq, Afghanistan, and elsewhere around the globe, including foreign governments, nongovernmental organizations (NGOs),...

  10. CHAPTER TWO The Health Status of Contractors Who Are Deployed to Conflict Environments Is Not Well Understood: A Review of the Literature
    (pp. 13-24)

    Much has been written on military and security privatization, but very little is known about the experiences of individual contractors deployed to conflict environments. Media coverage and popular writing on contractors tend to focus on three main themes: lack of government oversight, contractor waste and fraud, and regulation of contractors (see, e.g., Pelton, 2007; Scahill, 2007). Academic scholarship on the topic tends to fall into three broad categories: the theoretical implications of outsourcing as an abrogation of state sovereignty, issues of accountability and regulation, and civilmilitary relations and contractors’ effects on the military (Avant, 2005; Chesterman, 2010–2011; Cotton et...

  11. CHAPTER THREE What Are the Deployment Experiences of Contractors?
    (pp. 25-38)

    As discussed in Chapter Two, deployment experiences likely to play a role in shaping the health and well-being of contractors. Combat exposure, for instance, has been linked to PTSD, depression, and physical health problems in research on the health of U.S. military personnel (Hoge, Auchterlonie, and Milliken, 2006; Seal et al., 2009). Again, due to the fact that contractors are deployed to theaters of conflict alongside military forces, it is reasonable to examine the extent to which these variables play a role in contractor health and well-being.

    It was crucial to gain a more solid understanding of how contractors in...

  12. CHAPTER FOUR What Is the Mental Health Status of Contractors Who Work in Conflict Environments?
    (pp. 39-46)

    As noted in Chapter Two, the wars in Iraq and Afghanistan have brought significant attention to the effects of combat on the mental health of military personnel. In the United States, the prevalence of PTSD among returning service members is estimated at 5–20 percent (Ramchand et al., 2010); rates are reportedly lower in the United Kingdom, with cohort studies reporting a PTSD prevalence of 4 percent among UK military personnel who have deployed to Iraq or Afghanistan (Hotopf et al., 2006; Iversen et al., 2009) and 7 percent among UK military personnel with combat exposure (Fear et al., 2010)....

  13. CHAPTER FIVE What Other Health Issues Affect Contractors Who Work in Conflict Environments?
    (pp. 47-56)

    As Chapter Four demonstrates, our survey respondents were screened on multiple measures of mental health and well-being. However, the literature reviewed in Chapter Two indicates potential links between a number ofphysicalhealth issues and contractor deployments. Burn pits, for instance, are thought to pose a risk of serious respiratory problems, while IEDs encountered by contractors working on convoys or elsewhere have caused life-changing physical injuries and even death (Drummond, 2012; Pratt, 2011; Zajac, 2013).

    In an effort to further explore the extent to which physical health problems affect the contractor population, this chapter explores the responses to three questions...

  14. CHAPTER SIX To What Extent Do Contractors Access Health Care, and What Are the Barriers to Receiving Health Care?
    (pp. 57-70)

    In this chapter, we present findings from the survey that describe contractors’ perceived access to and reported use of physical and mental health care, as well as reported barriers to receiving mental health care, in particular. We describe differences in perceived access and utilization by citizenship and health status (e.g., self-reported physical health problems, probable mental health problems) and also discuss findings on the perceived availability of company-provided resources for stress and mental health.

    Because contractors in general, like those in our sample, represent different countries and work for a variety of companies on contracts funded by different sources, there...

  15. CHAPTER SEVEN Conclusions and Policy Recommendations
    (pp. 71-80)

    In an effort to fill the void of empirical research detailing the prevalence of mental and physical health problems among contractors working in conflict environments, this report described the results of the largest survey to date of contractors deployed to a theater of conflict between 2011 and 2013. The aim was to examine their deployment experiences, mental and physical health, and access to health care. The study produced a number of findings with potentially important policy implications.

    The analysis in Chapter Three of the deployment experiences of contractors in the sample showed that contractors’ reported deployment prepardness and combat exposure...

  16. APPENDIX A Additional Data Tables
    (pp. 81-88)
  17. APPENDIX B Sensitivity Analyses
    (pp. 89-106)
  18. References
    (pp. 107-116)