Invisible Wounds of War. Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery

Since 2001, 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom OEFOIF in Afghanistan and Iraq. Evidence suggests the psychological toll of these deployments may be disproportionately high compared with the physical injuries of combat. Concerns have been most recently centered on two combat-related injuries in particular post-traumatic stress disorder and traumatic brain injury. Many recent reports have referred to these as the signature wounds of the Afghanistan and Iraq conflicts. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other service members, family members, and society in general. All three conditions affect mood, thoughts, and behavior yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. RAND conducted a comprehensive study of the post-deployment health-related needs associated with post-traumatic stress disorder, major depression, and traumatic brain injury among OEFOIF veterans, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need. This monograph presents the results of that study. These results should be of interest to mental health treatment providers health policy makers, particularly those charged with caring for our nations veterans and U.S. service men and women, their families, and the concerned public.