Being deployed to a war zone can result in numerous adverse psychological health conditions. It is well documented in the literature that there are high rates of psychological disorders among military personnel serving in Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom in Iraq as well as among the service members' families. For service members' families, the degree of hardship and negative consequences rises with the amount of the service members' exposure to traumatic or life-altering experiences. Adult and child members of the families of service members who experience wartime deployments have been found to be at increased risk for symptoms of psychological disorders and to be more likely to use mental health services.

In an effort to provide early recognition and early intervention that meet the psychological health needs of service members and their families, DOD currently screens for many of these conditions at numerous points during the military life cycle, and it is implementing structural interventions that support the improved integration of military line personnel, non-medical caregivers, and clinicians, such as RESPECT-Mil (Re-engineering Systems of Primary Care Treatment in the Military), embedded mental health providers, and the Patient-Centered Medical Home.

Preventing Psychological Disorders in Service Members and Their Families evaluates risk and protective factors in military and family populations and suggests that prevention strategies are needed at multiple levels - individual, interpersonal, institutional, community, and societal - in order to address the influence that these factors have on psychological health. This report reviews and critiques reintegration programs and prevention strategies for PTSD, depression, recovery support, and prevention of substance abuse, suicide, and interpersonal violence.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE ASSESSMENT OF RESILIENCY AND PREVENTION PROGRAMS FOR MENTAL AND BEHAVIORAL HEALTH IN SERVICE MEMBERS AND THEIR FAMILIES
• REVIEWERS
• PREFACE
• ACRONYMS
• SUMMARY
  • BACKGROUND
  • PREVENTION AND GOOD PSYCHOLOGICAL HEALTH
  • PSYCHOLOGICAL HEALTH IN THE MILITARY
  • PROGRAM EVIDENCE AND MEASUREMENT
  • FINDINGS AND RECOMMENDATIONS
  • EFFECTIVENESS AND COST-EFFECTIVENESS
  • RISK IDENTIFICATION AND INTERVENTION
  • MEASUREMENT AND EVALUATION
  • MILITARY FAMILIES
  • COMMUNITY CHARACTERISTICS AND INTERVENTIONS
• 1. INTRODUCTION
  • CHARGE TO THE COMMITTEE
  • COMMITTEE'S APPROACH TO ITS CHARGE
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. CONCEPTUAL FRAMEWORKS FOR REVIEWING EVIDENCE-BASED PREVENTION IN PSYCHOLOGICAL HEALTH
  • TERMINOLOGY
  • GOOD PSYCHOLOGICAL HEALTH
  • DEFINITION OF PREVENTION
  • MULTI-LEVEL PREVENTION AND THE SOCIAL ECOLOGICAL MODEL
  • APPLICATION OF PREVENTION FRAMEWORK TO PSYCHOLOGICAL HEALTH FOR MILITARY MEMBERS AND THEIR FAMILIES
  • PREVENTION WITHIN THE PHASES OF MILITARY EXPERIENCE
  • MEASUREMENT OF PREVENTION PROGRAMS
  • MODEL FOR PREVENTION PROGRAM DEVELOPMENT AND MEASUREMENT
  • CONCLUSION
  • REFERENCES
• 3. UNDERSTANDING PSYCHOLOGICAL HEALTH IN THE MILITARY
  • CHARACTERISTICS OF THE ARMED FORCES
  • PSYCHOLOGICAL HEALTH CONSEQUENCES OF DEPLOYMENT
  • PSYCHOLOGICAL HEALTH AMONG MILITARY FAMILIES
  • SCREENING AND SURVEILLANCE IN THE MILITARY
  • PSYCHOLOGICAL HEALTH SERVICES IN THE MILITARY
  • CONCLUSIONS
  • REFERENCES
• 4. EVIDENCE FOR DEPARTMENT OF DEFENSE INTERVENTIONS FOR PREVENTING PSYCHOLOGICAL DISORDERS
  • OVERVIEW OF DOD PREVENTION INTERVENTIONS
  • RESILIENCE-RELATED PROGRAMS
  • BOOT STRAP
  • POSTTRAUMATIC STRESS DISORDER
  • SUICIDE
  • SUBSTANCE USE DISORDERS
  • REINTEGRATION
  • MILITARY SEXUAL ASSAULT
  • FAMILY-FOCUSED PROGRAMS
  • CONCLUSIONS
  • REFERENCES
• 5. MEASUREMENT OF DEPARTMENT OF DEFENSE PREVENTION INTERVENTIONS RELATED TO PSYCHOLOGICAL HEALTH
  • STANDARDS FOR PERFORMANCE MEASUREMENT
  • SCOPE OF PREVENTION MEASUREMENT
  • MEASUREMENT IN THE MILITARY
  • WHAT SHOULD BE MEASURED
  • MEASURES IDENTIFIED IN REVIEW OF NATIONAL QUALITY INITIATIVES
  • CONCLUSION
  • REFERENCES
• 6. FINDINGS AND RECOMMENDATIONS
  • EFFECTIVENESS AND COST-EFFECTIVENESS
  • RISK IDENTIFICATION AND INTERVENTION
  • MEASUREMENT AND EVALUATION
  • MILITARY FAMILIES
  • COMMUNITY CHARACTERISTICS AND INTERVENTIONS
• APPENDIXES
  • A SUMMARY FROM RETURNING HOME FROM IRAQ AND AFGHANISTAN: ASSESSMENT OF READJUSTMENT NEEDS OF SERVICE MEMBERS AND THEIR FAMILIES
  • B INFORMATION-GATHERING MEETING AGENDA
  • C SUPPLEMENTAL HEALTH SCREENING QUESTIONNAIRE
  • D PRE-DEPLOYMENT HEALTH ASSESSMENT QUESTIONNAIRE
  • E POST-DEPLOYMENT HEALTH ASSESSMENT QUESTIONNAIRE
  • F POST-DEPLOYMENT HEALTH RE-ASSESSMENT QUESTIONNAIRE
  • G PROGRAM REVIEWS FROM SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES
  • H TABLE OF DOD PROGRAMS TO INCREASE RESILIENCE OR PREVENT PSYCHOLOGICAL HEALTH DISORDERS, AS IDENTIFIED BY RAND

This study was supported by Contract HHSP23320080007T between the National Academy of Sciences and the Department of Defense. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.