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Providing care to OIF/OEF veterans

Providing care to OIF/OEF veterans. Steve McCutcheon, PhD Matthew Jakupcak, PhD VA Puget Sound Healthcare System, Seattle Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine. Acknowledgments. Miles McFall, PhD Director, Psychology Service

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Providing care to OIF/OEF veterans

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  1. Providing care to OIF/OEF veterans Steve McCutcheon, PhD Matthew Jakupcak, PhD VA Puget Sound Healthcare System, Seattle Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine

  2. Acknowledgments Miles McFall, PhD Director, Psychology Service Director, PTSD Patient Care Line VA Puget Sound Health Care System

  3. Workshop overview • Basic epidemiology and patient characteristics • A model of integrated care for OIF/OEF veterans • Federal and State collaboration in Washington State • An integrated model of primary stepped care at VA Puget Sound, Seattle • Adapting evidence-based PTSD treatments in secondary prevention efforts for OIF/OEF veterans

  4. Faces of the war • James • Avoidance and withdrawal • Gary • Vigilance and control

  5. Facts about the war

  6. War in Southwest AsiaPopulation Statistics • Over 1,000,000 military personnel deployed to Southwestern Theater of Operation • 505,366 veterans have left active duty (as of 12/31/05) • 43% active duty troops • 57% Reserve and National Guard VHA Office of Public Health and Environmental Hazards, February 14, 2006

  7. War in Southwest AsiaHuman Costs • 2,513 Americans killed (2/7/06) • 17,096 officially wounded (2/7/06) • 50,000 – 250,000 civilians killed (Nov. 2004)

  8. Top 10 Causes of OIF Deaths3/19/2003 – 11/30/2004

  9. Increasing Survival Rate of Injured Soldiers WWII: 23% of injured combatants died Vietnam: 17% of injured combatants died Iraq/Afghanistan: 9% of injured combatants die As many US soldiers have been injured in combat thus far in Iraq/Afghanistan as were in the Revolutionary War, the War of 1812 or the first 5 years of the Vietnam War Gawande A. Casualties of War—Military Care for the Wounded from Iraq and Afghanistan. NEJM 351(24): 2471-2475.

  10. Combat Exposure for OIF SoldiersHoge et al. (2004)

  11. Service utilization

  12. Perceived Barriers to Mental Health CarePositive Screen CasesHoge et al. (2004)

  13. Utilization of Mental Services Active Duty Personnel • Only 23% of positive screen active duty Army/USMC personnel sought mental health care in past year1 • 35% soldiers in a population-based study sought mental health services in first year after demobilization2 1Hoge et. Al. 2004 2Hoge et. Al. 2004

  14. Utilization of VA Services 29% (144,424) have sought VA care nationally (12/31/05) • 32% of separated active duty • 26% for reserve component • Represents 3% of all vets seen in VA VHA Office of Public Health and Environmental Hazards, February 14, 2006

  15. Utilization of VA ServicesCharacteristics of Patients • 87% male; 13% female • Age 20-29 = 53%; age 30-39 = 23% • ARMY = 66%, USAF = 13%, USMC = 11%, USN = 10% • Active duty = 49%, Reserve Component = 51% VHA Office of Public Health and Environmental Hazards, February 14, 2006

  16. Clinical characteristics

  17. Medical Diagnoses (N = 144,424) Musculoskeletal 40% Mental disorders 32% Digestive System 30% Ill Defined Symptoms 30% Nervous system 28% Respiratory 17% Injury/Poisoning 16% VHA Office of Public Health and Environmental Hazards, February 14, 2006

  18. Spectrum of Post-Deployment Mental Disorders (N = 46,571) Disorder N % PTSD 20,638 44% Drug Abuse 17,768 38% Depression 14,317 31% Neurotic Disorders 11,481 25% Affective Psychosis 7,460 16% Alcohol Dependence 3,116 7% Acute Stress Reaction 1,327 3% VHA Office of Public Health and Environmental Hazards, February 14, 2006

  19. Prevalence of Mental Disorders by War ZoneStrict Diagnostic Criteria

  20. Outcomes for Symptom Screening (Iraq)Liberal Criteria

  21. Health Risk Screening OutcomesDemobilization Sites • Alcohol = 33% • Hostility = 22.8% • Suicide ideation/risk = 1.1% - 4.1% • Interpersonal Aggression/Domestic Violence = 2.1% - 2.2% • Tobacco Use = 50% (25% - 44% want to quit)

  22. Health Risk BehaviorsVAPSHCS Clinic Sample (n = 144)

  23. Post-Deployment Readjustment ReactionsFunctional Limitations • Unemployment • Financial deficits (lacking money management skills) • Homelessness • Phobias about driving • “Reunion stress” (over-controlling, detached, intimacy problems) • Marital conflict, parenting concerns and family reintegration problems (including divorce, DV, and infidelity)

  24. Post-Deployment Readjustment ReactionsProminent Arousal Symptoms • Disturbed sleep and dreaming • Easily startled • Irritability and anger • Hypervigilance (discomfort in crowds)

  25. Post-Deployment Readjustment ReactionsCommon Themes and Concerns • “Addiction” to CNN war coverage • Worry about friends still deployed overseas • Miss excitement of combat, urges to return • Worries about re-deployment

  26. Traumatic Brain Injury • cognitive problems (e.g., impaired memory, attention, or executive function) • headaches • sensitivity to light or noise • dizziness or nausea • irritability, impulsivity, poor frustration tolerance • depression • insomnia • TBI can cause impaired or lost sensory function (e.g., eyesight), mobility, and ability to perform basic activities of daily living

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