Mental Health Issues Affecting Veterans

The United States has gone through two continuous decades of war, and veterans have paid a tremendous toll on mental health. Post-traumatic stress disorder, depression and anxiety are highly publicized challenges, but traumatic brain injury, substance abuse, and suicide are also significant problems. If you or a loved one are a veteran, you may be overwhelmed as you begin to navigate the world outside the military, the world where you and your loved ones reside after your life of service.

It often takes time for a suffering person to recognize they are struggling, especially with wounds that are invisible to the naked eye. Sometimes family members see it first. The truth is, when one family member is suffering, even in silence, family and friends are also suffering. The situation is lonely for everyone involved. Fear of causing additional harm leads to an environment of “walking on eggshells”.

People who do not have a veteran in their life have never been exposed to the extreme impact of war-related illnesses. A huge portion of our population suffers from invisible wounds sustained during service. They are owed understanding and acknowledgment of an injury incurred while protecting the safety and security of our nation, whether that injury is physical, mental, or emotional.

It’s difficult to know how or where to begin to address a monumental issue like mental health. In the case of veterans, manifestations are numerous and varied. Knowledge is power. It is important for both veteran and loved ones to develop an awareness of the following:

Mental health issues and their causes commonly affecting veterans
Signs and symptoms of mental health issues
Characteristics of military personnel that could become barriers to seeking help
Unique issues faced by women in the military
Treatment modalities for the various issues
Where to find assistance

Some Statistics

War has a catastrophic effect on the health and well-being of a country. They cause higher rates of mortality and disability than any major disease. They destroy communities and families, and often disrupt the development of the social and economic fabric of nations.

The 2020 census reports approximately 18 million veterans and 2.1 million active-duty and reserve service members have been counted. Since September 11, 2021, 2.8 million active-duty American military personnel were deployed to Iraq, Afghanistan, and beyond. This led to burgeoning numbers of combat veterans in the population.

Greater than 6% of the United States population have served or now serve in the American military. This fails to address the number of family members affected. When a soldier serves, his family serves. When a soldier is in pain, his or her loved ones are also in pain.

Thirty-five percent of U.S. Veterans who incurred a physical or mental injury, illness, or wound while serving in the military post-2001 reported moderate to severe depression.

Veterans 18-25 were more likely to experience major depression. 46% of all respondents to the survey were taking anti-depressant medication.

We have a huge population of veterans in this country, and they are struggling and need help. Those numbers are only going to rise. Awareness is key when it comes to mental health challenges.

Asking for Help

Veterans can be very resistant to seeking support for mental health issues if they notice troublesome signs on their own. Additionally, family and loved ones generally feel their hands are tied if the veteran resists getting help on their own.

From the veteran’s perspective, his or her life of service, purpose, and mission is effectively over. For active-duty members, the fear of a mental health issue affecting his career is valid. That fear and stigma then carry over into post-military life, often brewing until life becomes unmanageable.

For these reasons, if a soldier does recognize that he or she is not the same as before and could use guidance, they will likely not divulge the whole story.

They will only share need-to-know facts about their symptoms with professionals. They will withhold information they think may affect their career or family. Often the information withheld is crucial to their treatment and diagnosis.
They will “suck it up” and ignore danger signs, often turning to drugs or alcohol to self-treat symptoms.
The veteran may be unaware that they are behaving differently, and feel reluctant to believe feedback from friends and loved ones.
They may be concerned about not being believed or being perceived as weak if they self-report.
They will likely not understand that seeking help reflects strength rather than weakness.
Single parents may choose not to report any troubling symptoms for fear of losing rights or access to their children, the most important thing in their lives.
They will be so overwhelmed by not having a specific point of contact for seeking help, they become paralyzed with inactivity.

Every one of these concerns has the potential to impact the mental, emotional, and financial stability of the veteran in profound ways. It’s very important for both families and health care professionals to understand these fears are not unfounded. Understanding and sensitivity will go a long way in the beginning stages of seeking help.

Signs and Symptoms of Depression

Depression isn’t temporary sadness or a blue mood. Depression hinders your ability to fully participate in your own life. It can be physically challenging to even get out of bed. You can’t talk yourself out of it, it won’t “pass”, and for some people, medication is necessary (at least temporarily) in order to recover.

Here are some of the most common symptoms of depression:

A sad, empty, or anxious mood that does not go away
Feelings of hopelessness
Irritability
Guilty, worthlessness, helplessness
Loss of interest and lack of pleasure
Fatigue and exhaustion
Talking and moving slowly
Restlessness
Difficulty concentrating, remembering, or making decisions
Difficulty sleeping or oversleeping
Appetite or weight changes
Aches, pains, digestive problems
Thoughts of death or suicide attempts

Untreated depression can lead to substance abuse or even suicide. This is why it’s so important to talk as openly as possible with your loved ones about symptoms of depression, whether you are the veteran or they are. Treatment saves lives.

Treatment for Depression

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy potentially helps you address emotional pain by finding positive actions that line up with your values. You are helped to recognize what matters most in your own life.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy is a short-term intervention helping you develop and hold on to positive thoughts about yourself, others, and the future

Interpersonal Therapy

Interpersonal Therapy helps to identify and work on relationship issues that may be the cause of depression and learn skills to help deal with problems in your relationship

Problem Solving Therapy

Problem Solving Therapy helps one recover from traumatic situations, and learn skills to improve daily life. These build coping mechanisms and help develop response plans in case of crisis

Behavioral Activation

Behavioral Activation helps one to understand that moods are connected to behaviors, and ways to improve your inner responses, and therefore behaviors

Addiction and Substance Abuse

One out of ten veterans who seek out help at the U.S. Veterans Administration meets the criteria for alcohol or drug dependence. And those are just the ones who seek out help.

Those with multiple deployments, combat exposure, and combat-related injuries are even more vulnerable to substance dependence. Anti-anxiety meds are often prescribed to those returning home from the military, and dependence and addiction can develop very easily; especially if the veteran has undiagnosed Depression or PTSD.

Signs of Substance Abuse or Dependency

Changes in physical appearance; lack of care towards grooming
Poor work performance, being chronically late
Losing interest in activities that used to bring joy
Becoming isolated or withdrawn
Changes in relationships; more arguing, or withdrawing completely
Becoming defensive when asked about their use of alcohol or drugs

Addiction is insidious. It sneaks up on the user, especially if the substance is a prescribed medication. If someone is numbing out to escape from feelings of depression, anxiety, or PTSD, the user may be completely unaware that they are abusing their substance of choice. They are just trying to feel “normal”.

If you or your loved one are struggling with substances, reach out for help as soon as possible. The longer the addiction carries on, the harder it is to recover. And if someone is masking depression or PTSD, that is all they are doing; masking the symptoms. Eventually, those struggles will catch up, and substance abuse will make it that much harder to deal with those core issues.

Traumatic Brain Injury (TBI)

Traumatic Brain Injury has been identified as the “signature wound” of the post 9/11 war. More than 410,000 service members have been diagnosed with TBI since 2001. Some of this is attributed to the high number of improvised explosive devices employed by Afghanistan and Iraqi enemy fighters.

TBI isn’t just attributed to troops who have been engaged in combat though. 80 to 85% of veterans tracked by the State Department have occurred stateside from training or traffic accidents. This may make a veteran hesitant to seek out help for any type of injury, physical or mental; the idea that since the injury wasn’t incurred during combat, it isn’t “valid”.

Long-Term Effects of TBI

Memory loss
Irritability
Depression
Anxiety
Insomnia

Women in the Military

11% of veterans from Afghanistan and Iraq military operations are women. The number continues to rise as women are the fastest-growing group of Veterans. There are 2 million female veterans in 2021. Women Soldiers face additional risk factors leading to mental health issues, including:

High risk for victimization and isolation during deployment. Forty percent of female veterans report sexual harassment during deployment.
Predominantly male-centered support systems upon leaving service, resulting in a much harder transition to home communities.
Women veterans are four times more at risk than men to be homeless after military service.
Post-Traumatic Stress Syndrome is closely linked to sexual assault. Nearly a third of female veterans report sexual assault during military service.

Post-Traumatic Stress Disorder (PTSD)

PTSD develops after exposure to a traumatic event that is beyond the everyday stressor. Accidents, personal assault, natural or man-made disasters, combat, and violence all are linked to PTSD. Half of adults will experience one significant trauma during a lifetime, but not everyone will develop PTSD.

65% of service members who received a combat injury exhibit signs of PTSD

Symptoms Of PTSD

Reliving the Event: Persistent, invasive thoughts can become a source of torment. These can be triggered by unexpected reminders that cause the person to experience the event as if it is still happening. Triggers show up unexpectedly and usually can’t be avoided. These can include sights, sounds, smells, and viewing scenes on television that are reminders of the event.

Avoiding Situations: People with PTSD may avoid situations that remind them of the event. Avoidance can take any form. This can include staying away from crowds, not viewing films or television related to war, or refusing to visit hospitals or medical facilities

Negative Views of People and Situations: Following trauma, a person may notice his entire worldview has changed. Some former optimists may no longer be unable to “see the good in things.” He or she may expect the worst outcome in any challenging situation, and question the motives of people trying to help.

Feeling on Edge: PTSD suffers often startle easily and be quick to explode in anger.

You or your loved one may need to seek out treatment for PTSD if you experience:

Anxiety, agitation, sleeplessness, or mood swings
Feeling as if there is no reason to live
Feeling excessive guilt, shame, or sense of failure
Rage or anger
Engaging in risky activities without thinking
Losing interest in hobbies, work, or school
Increasing alcohol or drug misuse
Neglecting personal welfare; a deteriorating physical appearance
Withdrawing from family and friends
Showing violent behavior, like punching a hole in the wall or getting into fights
Giving away prized possessions
Getting affairs in order, tying up loose ends, or writing a will

Treatment for PTSD

When you see signs of self-harm, it’s your cue to offer help. Addressing a difficult issue requires that you have a plan and resources. After all, the topic of self-harm may be just the start of an emotional outpouring.

Cognitive Processing And Prolonged Exposure

Patients are assisted to confront their fears. They are assisted to gradually approach their memories and fearful situations. It’s normal to avoid anything reminiscent of experienced trauma, but this avoidance generally reinforces their fear. By facing reminders of the trauma, the patient can learn that the memories and cues themselves are not dangerous and do not need to be avoided.

Eye Movement Desensitization Reprocessing (EMDR)

EMDR therapy focuses directly on the memory and is intended to change the way that the memory is stored in the brain, thus reducing and eliminating the problematic symptoms.

While clients briefly focus on the trauma memory and simultaneously experience bilateral stimulation (BLS), the vividness and emotion of the memory are reduced.

Suicide

Suicide is a very real concern amongst veterans. Nearly 25% of suicide victims in the U.S. are veterans. Veterans with substance abuse issues are twice as likely to commit suicide. Male veterans are 1.5 times more likely to commit suicide, and females are 2.5 times more likely. Older Veterans are even more at risk; 58% of veteran suicides occur in veterans above the age of 55.

These numbers are sobering. If you or your loved one are struggling with suicidal thoughts, please reach out for help.

Reaching Out

Asking for help is difficult for many people, but it is uniquely difficult for those who have served in the military. There is stigma and shame for showing “weakness”, even if no one in their vicinity sees it as such. If you suspect that your loved one is feeling suicidal (or depression, anxiety, or struggling with substances) after returning from deployment there are things you can do to support them:

Ask:

“Are you thinking about killing yourself?” It’s not an easy question but studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts.

Keep Them Safe:

Reducing a suicidal person’s access to highly lethal items or places is an important part of suicide prevention. While this is not always easy, asking if the at-risk person has a plan and removing or disabling the lethal means can make a difference.

Be There:

Listen carefully and learn what the individual is thinking and feeling. Research suggests acknowledging and talking about suicide may in fact reduce rather than increase suicidal thoughts.

Help Them Connect:

Save the National Suicide Prevention Lifeline number (1-800-273-TALK) and the Crisis Text Line (741741) in your phone so they’re there if you need them. You can also help make a connection with a trusted individual like a family member, friend, spiritual advisor, or mental health professional.

Stay Connected:

Staying in touch after a crisis or after being discharged from care can make a difference. The number of suicide deaths goes down when someone follows up with the at-risk person.

If you are a veteran struggling with a mental health issue, talk to someone you trust. Do it today. Don’t wait another hour. Reach out to a friend, loved one, health care provider, or your local VA. You are not alone in this.

If you have a loved one who is a Veteran and is struggling, ask him or her if they are okay. If they brush you off, find a time to ask again. And again. There are no easy answers and accessing services may take multiple calls. Don’t give up. Do not allow your loved one to give up either.

The VA helpline can direct veterans and families alike. It’s a crucial beginning.

There is help, there is hope, and there is recovery.

Sources

Office of Research & Development: Mental health. (2021). U.S. Department of Veterans Affairs. https://www.research.va.gov/topics/mental_health.cfm
Traumatic Brain Injury (TBI). (2021). Office of Research & Development. https://www.research.va.gov/topics/tbi.cfm
Military.com. (2020, February 3). Still Misunderstood: How Traumatic Brain Injuries Affect America’s Veterans. https://www.military.com/daily-news/2020/02/03/still-misunderstood-how-traumatic-brain-injuries-affect-americas-veterans.html
U.S. Department of Veterans Affairs & U.S. Department of Veterans Affairs. (2020). VA and DOD Launch Long-Term Impact of Military-related Brain Injury Consortium (LIMBIC). Defense Media Network. https://www.defensemedianetwork.com/stories/va-and-dod-launch-long-term-impact-of-military-related-brain-injury-consortium-limbic-tbi-traumatic-brain-injury/
Statista. (2020, November 3). Share of U.S. veterans bothered by various problems as of 2020, by frequency. https://www.statista.com/statistics/1102225/problems-bothering-us-veterans-type-frequency/
Veteran and Military Mental Health Issues. (2020). National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK572092/
VA.gov | Veterans Affairs. (2020). U.S. Department of Veterans Affairs. https://www.mentalhealth.va.gov/depression/treatment.asp
War Related Illness and Injury Study Center. (2020). U.S. Department of Veterans Affairs. https://www.warrelatedillness.va.gov/warrelatedillness/education/healthconditions/traumatic-brain-injury.asp
PTSD: National Center for PTSD. (2020). VA.Gov | Veterans Affairs. https://www.ptsd.va.gov/understand/what/ptsd_basics.asp
Crisis & Suicidal Signs – Veterans Crisis Line. (2020). Veterans Crisis Line. https://www.veteranscrisisline.net/education/signs-of-crisis
NIMH » 5 Action Steps for Helping Someone in Emotional Pain. (2020). National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/5-action-steps-for-helping-someone-in-emotional-pain
Eye Movement Desensitization and Reprocessing (EMDR) Therapy. (2020). American Psychological Association. https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing

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