Contemporary Issues in Psychology and the Military: Mental Health Outcomes and Treatments

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Abstract

This integrated literature review examines articles published in the past five years relating to psychology in the military. Articles were considered based on their relevance to four psychology domains, including contemporary issues, physiological psychology, substance abuse and addiction, and personality theories and counseling. Within these domains, several keys issues are explored, especially with regard to mental health concerns for active duty service members and veterans. In particular, PTSD, TBI, SUDs, and other mental health factors were examined from multiple paradigms to consider the causative factors, functional impacts, and potential treatments as these problems are increasingly prevalent in the military population. In general, it appears that these problems are more common in military settings due to the interaction between individual factors, such as personal history, and military experiences. Military experiences are critical as they can include the acute injury or chronic stress that may immediately or insidiously contribute to problems such as TBI, PTSD, or SUDs. Military experiences are also relevant in terms of the reasons for pursuing or neglecting to seek mental health services and what services are currently available. Overall, the current research is an excellent foundation moving forward and more research should be conducted to more thoroughly examine the relations between all of these disorders, develop better treatments, improve help-seeking and treatment retention, and find preventative approaches. â€ƒ
The purpose of this integrated literature review is to consider the various issues psychologists need to address concerning the military in modern society. This is approached by examining four different subject domains in psychology and the relevant research in each of those areas, followed with an integrative analysis of those four areas to better understand current issues and establish directions for future research. The first domain is that of contemporary issues in psychology and focuses on the range of large-scale issues the military must deal with such as TBI, PTSD, mental health, suicide, substance abuse, and difficulties service members face when trying to reintegrate into society. The second domain, physiological psychology, delves further into some of these areas, especially with regard to the way the brain changes because of the acute and chronic stresses and damages service members experience. The third domain, substance abuse and addiction, examines current concerns with substance use problems among service members including the pathways by which these problems develop and the range of drugs which are presently being used and abused. The fourth domain, personality and counseling theories, discusses relevant treatment for some of these areas exploring effective and ineffective strategies as well as factors impacting help seeking. Taken together, this research provides a broad view of contemporary problems psychologists need to address, but also highlights critical gaps in current knowledge that should be explored sooner than later for the benefit of all service members.
As the U.S. military has evolved, so to have the issues it must face. While external enemies used to be the primary concern, domestic issues impacting active-duty members and veterans have become increasingly important and warrant further exploration. The issues often relate to pervasive, severe, and chronic consequences that veterans must deal with immediately after service and sometimes for the rest of their lives. These problems, discussed in more detail below, include traumatic brain injury (TBI), substance use disorders (SUD), post-traumatic stress disorder (PTSD), suicide, and reintegration into society. As the current research shows, these problems tend to interact, with many veterans struggling with more than just one of these problems, often necessitating intensive treatment approaches with less than optimal outcomes.
One of the most recent hot topics in military psychology and medicine is the occurrence of traumatic brain injury (TBI; Gubata et al., 2013). TBI refers to damage to any portion of the brain resulting from physical injury and this can happen for many reasons in the military. In civilian life, the most common causes of TBI include vehicular accidents, falls, and assault. In the military, all of these factors remain, but soldiers often face increased risk of TBI from projectile damage (i.e. bullets or fragments penetrating skull) and blast damage (i.e. explosions). In the past, such injuries were often fatal, but as medicine continues to improve in the development of life saving techniques, increasing numbers of veterans are surviving these injuries but suffering lasting and debilitating brain damage. The research by Gubata and colleagues (2013) examines how frequently this is occurring among active duty military members by reviewing all military records for the Army and Marine Corps over a five-year period. The research specifically examined all individuals seeking any kind of disability evaluation, comparing those with TBI with those suffering any other kind of disabling injury. This created a sample of over 17,000 service members, with about one-sixth being diagnosed with TBI, although this proportion gradually increased over the five-year period. Using logistic regression analyses the authors identified several significant risk factors. Being Caucasian, male, over the age of 30, and a reserve member were all factors that increased the risk of developing TBI. A critical finding is that approximately 9 out of 10 TBI disability cases resulted in retirement while only 2 out of 3 other cases resulted in retirement. Furthermore, those with TBI were also commonly diagnosed with PTSD and were much more likely than other service members to suffer dementia. Ultimately, this study is unique in its ability to access full data for two populations; however, the use of only disability findings may seriously understate the prevalence and consequences of TBI, especially more mild forms which may go undiagnosed and untreated.
Another issue that has always been significant in the military but is gaining increased attention in modern society is the abuse of alcohol and drugs by soldiers and veterans (Seal et al., 2010). Being a service member can be one of the most stressful and difficult jobs in the world but often the grueling pace of life prevents time to process and cope with those stressors. This is believed to be one reason why many soldiers and veterans resort to substance use to mentally survive their various circumstances. While this problem had been shoved under the rug in the past, it is receiving increasing attention in recent decades and the research conducted by Seal and colleagues (2010) is one example of this change. In their research, these authors accessed data from 500,000 thousand veterans of the Iraq and Afghanistan conflicts who were being enrolled in treatment at a VA center. This data included demographic details, military history, and mental health history, especially pertaining to diagnoses of depression, anxiety, adjustment disorders, and PTSD as well as data on alcohol use disorders (AUD) and other drug use disorders (DUD). Within the sample, approximately 10% struggled with an AUD and half as many struggled with a DUD. In addition, a sizeable number of veterans (3%) struggled with both of these problems simultaneously. The authors analyzed this data with logistic regression analyses, to determine the relative risk by which any of these factors predicted AUD and DUD. These regression analyses indicated that any mental health disorder significantly increased the risk of developing AUD or DUD, and that different disorders had different risk factors. Adjustment and anxiety disorders were least impactful, increasing the risk by 100-200% while depression and PTSD were much more impactful, increasing the risk by 300-400%. Looking at the raw numbers, two out of three individuals struggling with AUD or DUD were also diagnosed with PTSD, and half were diagnosed with depression, while at least a third had other mental health diagnoses. Other risk factors included being male and being younger, such that younger males were much more likely to have AUD and DUD. While this study was massive and collected extensive data from those seeking treatment, it may understate the severity and prevalence of the problem among service members, especially since many may struggle with these problems but not seek treatment.
One common thread between the research on TBI by Gubata and colleagues (2013) and the research on AUD and DUD by Seal and colleagues (2010) is the high comorbidity of PTSD among those military members. Research by Hourani, Williams, Bray, and Kandel (2014) further examines the presence, risk factors for and consequences of PTSD among military members. One unique contribution of this study is the emphasis on gender differences in PTSD among military members, which is especially important since PTSD occurs much more often among civilian women and it is important to determine if this remains consistent in military populations. Towards this goal, the authors collected survey data from 25,000 active duty service members, with about 2.5 males for each female in the sample. The surveys were lengthy and assessed PTSD, depression, anxiety disorders, alcohol problems, tobacco problems, substance use problems, stress levels, history of abuse, and combat experiences. PTSD was

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