Joint
Mental Health
Advisory
Team 7 (J-MHAT 7)
Operation
Enduring
Freedom
2010
Afghanistan
22 February 2011 Office
of
The
Surgeon
General United States Army
Medical
Command
and
Office
of
the Command Surgeon
HQ,
USCENTCOM and
Office
of
the Command Surgeon
US
Forces
Afghanistan (USFOR-A)
The results and opinions presented in this report are those
of
the Joint Mental Health AdvisoryTeam 7 members and do not necessarily represent official policy or position
of
the Department
of
Defense.
1
1.
EXECUTIVE SUMMARy .................................................................................................... 4
1.1
Introduction ................................................................................................................. 4 1.2
Key
Findings: Army .................................................................................................... 4
1.3Key
Findings: Marines ............................................................................................... 6
1.4
Key
Findings
from
Behavioral
Health
Personnel ......................................................... 7
2.
BACKGROUND ................................................................................................................. 9
2.1
Mission
and
Background ............................................................................................ 9 2.2 Sampling Strategy ...................................................................................................... 9 2.3 Comparison Groups ...................................................................................................
10
2.4 Analytical Strategy
and
Verification
of Results
...........................................................
11
2.5
Focus
Groups ............................................................................................................
11
3.
CONCEPTUAL OVERViEW .............................................................................................
13
3.1
Service Member Combat
&
Well-Being
Model
...........................................................
13
4.
SOLDIER
REPORT:
SAMPLE CHARACTERISTICS .......................................................
15
5.
SOLDIER
REPORT:
WELL-BEING
INDICES
....................................................................
17
5.1
Morale .......................................................................................................................
17
5.2
Behavioral Health: Acute Stress, Depression
and
Anxiety .........................................
18
5.3 Suicide Ideation .........................................................................................................
19
5.4 Concussion (mTBI) ....................................................................................................
20
5.5
Pain
Medications .......................................................................................................
22
5.6
Medications for Sleep
and
Mental
Health Problems ...................................................
22
5.7 Factors Impacting Sleep Disturbance
and
Work Performance ...................................
23
6.
SOLDIER
REPORT: RISK
FACTORS...............................................................................
25
6.1
Combat Experiences .................................................................................................
25
6.2 Relationship Problems ...............................................................................................
26
6.3 OPTEMPO Factors: Months
Deployed
......................................................................
28
6.4 OPTEMPO Factors: Multiple Deployments ................................................................
28
6.5 Deployment Concerns ...............................................................................................
30
7.
SOLDIER
REPORT:
RESILIENCE
FACTORS
..................................................................
31
7.1
Unit Factors ...............................................................................................................
31
7.2
Stigma .......................................................................................................................
32
7.3
Barriers
to
Care .........................................................................................................
33
7.4
Training .....................................................................................................................
34
8.
SOLDIER
FOCUS
GROUP
SUMMARY
............................................................................
36
8.1
Methods.....................................................................................................................
37
8.2
Results ......................................................................................................................
38
8.3
Themes Emerging
from
Focus
Groups .....................................................................
.40
9.
SOLDIER
REPORT:
DISCUSSION
AND
RECOMMENDATIONS ....................................
50
9.1
Overview of Findings .................................................................................................
50
9.2 Evaluating Support
and
Sustainment
Units
................................................................
54
10.
MARINE
REPORT:
SAMPLE CHARACTERISTICS .....................................................
55
11.
MARINE REPORT:
BEHAVIORAL
HEALTH
................................................................
57 11.1
Morale .......................................................................................................................
57
11.2
Behavioral Health: Acute Stress, Depression
and
Anxiety .........................................
58
11.3
Suicidal Ideation ........................................................................................................
59
11.4 Interpersonal Adjustment
and
Work Functioning ........................................................
60
11.5
Concussion (mTBI) ....................................................................................................
61
11.6
Pain
Medications .......................................................................................................
62
11.7
Medications for Sleep
andMental
Health Problems ...................................................
63
11.8 Sleep Problems .........................................................................................................
63
12.
MARINE REPORT: RISK FACTORS
............................................................................
64
2
12.1
Combat Experiences .................................................................................................
64
12.2 Relationship Problems ...............................................................................................65 12.3 OPTEMPO Factors: Months Deployed ......................................................................66 12.4 OPTEMPO Factors: Multiple Deployments ................................................................
67
12.5 Deployment Concerns ...............................................................................................69
13.
MARINE REPORT: RESILIENCE FACTORS ...............................................................
71
13.1
Unit Factors ...............................................................................................................
71
13.2 Stigma .......................................................................................................................
72
13.3 Barriers to Care .........................................................................................................
72
13.4 Training .....................................................................................................................
73
13.5 Positive Impact of Deployment ..................................................................................
74
14.
MARINE REPORT: DiSCUSSiON ................................................................................
76
14.1
Overview of Findings .................................................................................................
76
14.2 Factors Related to Resilience ..................................................................................
77
15.
BEHAVIORAL HEALTHCARE SYSTEM ASSESSMENT ..............................................
81
15.1
ATO Behavioral Health
(BH)
Overview .................
".""",."
........................................
81
15.2 Behavioral Health (BH) Staffing
and
Distribution........................................................
81
15.3 Behavioral Health Survey Results ..............................................................................
84
16.
Theater Suicide Review ................................................................................................
92
16.1
Demographics......... ................................................................................................
92 17.
JOINT DISCUSSION AND RECOMMENDATIONS .......................................................
93
17.1
Nature of Recommendations versus Considerations .................................................
93
17.2 Increasing Behavioral Health Coordination and Training ...........................................93 17.3 Concussive Event Management ................................................................................
94
17.4 Tele-Mental Health ....................................................................................................
96
17.5 Sleep Discipline .........................................................................................................
97
17.6 Support Evaluation of Other Populations ...................................................................97
18.
STATUS
OF
MHAT
VI
RECOMMENDATIONS .............................................................98 APPENDIX
A:
REFERENCES ..................................................................................................
99
APPENDIX
B:
NAVY/MARINE DOCTRINE
AND
IMPLEMENTATION IMPLICATIONS .........
102
APPENDIX
C:
mTBI CLINIC OVERViEW ...............................................................................105 APPENDIX
D:
BEHAVIORAL HEALTH SURVEY RESULTS ..................................................107 APPENDIX
E:
BEHAVIORAL HEALTH FOCUS GROUPS .....................................................
11
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12. MARINE REPORT: RISK FACTORS for Field study of troops serving in Afghanistan
Joint Mental Health Advisory Team 7 report on Operation Enduring Freedom 2010, Afghanistan.
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