Approximately 2.7 million U.S. troops have deployed in support of Operation Iraqi Freedom or Operation Enduring Freedom since fiscal year 2002. The rate of mental health diagnoses among active-duty service members increased approximately 65 percent between 2001 and 2011. During this time period, 936,283 service members were diagnosed with at least one mental health disorder. Twenty-six percent of these service members were diagnosed with adjustment disorders, 17 percent with depressive disorders, 10 percent with anxiety disorders not including posttraumatic stress disorder (PTSD), and 6 percent with PTSD. Alcohol and substance use disorders made up 17 percent of diagnoses. During this same time period of 2001 to 2011, the incidence rate of PTSD grew by 656.5 percent, faster than that of all other mental health diagnoses.
In response to the increase in service members returning from conflicts in Iraq and Afghanistan with psychological health problems, several research organizations within the Department of Defense (DoD) began to examine where improvements could be made to the continuum of care of psychological health disorders including with regards to prevention, diagnosis and treatment. In fiscal year 2014 alone, DoD managed approximately $700 million dollars for military psychological health research (unofficial estimate).
The current military psychological health research paradigm was largely shaped by the 2012 executive order “Improving Access to Mental Health Services for Veterans, Service Members, and Military Families.” The executive order charged DoD, along with the Departments of Veterans Affairs (VA), Health and Human Services (HHS), and Education, to improve coordinated research of PTSD and traumatic brain injury (TBI) through development of the National Research Action Plan (PDF) (NRAP). Since the release of the NRAP and similar reports by the The National Academies of Sciences, Engineering, and Medicineand DoD, as well as mental health strategies such as the DoD/VA Integrated Mental Health Strategy (IMHS) (PDF), areas of research focus have included improving access and quality of mental health and substance abuse services for service members and their families, prevention of suicide, early diagnosis and treatment of mental health disorders, better coordination of care among providers and services, and integration of family members into military mental health care.
As research in these areas continues to broaden, DoD has the opportunity to be on the cutting edge of mental health research. Within the Military Health System (MHS), there are opportunities to test alternative treatment delivery methods and systems of care in order to improve access, quality and continuity of care for service members and their families. Telehealth interventions (e.g., phone and web-based treatments) and models of mental health treatment such as collaborative care can be evaluated as part of large-scale clinical trials and effectiveness studies, with the aim of improving communication between providers and patients, increasing treatment adherence, and optimizing practitioner staffing in clinics.
DoD is focused on accelerating the translation of research findings into improvements in prevention, early diagnosis and treatment.
DoD continues to delegate funding specifically for the purpose of implementation science research to encourage research aimed at improving the system of care for military mental health services. Likewise, effective procedures for feeding information gleaned from research to providers and other researchers are crucial, as are reliable methods for synthesizing knowledge in order to effectively implement findings across the military health care system. Practice-based research networks are one tool to allow providers and researchers to collaborate in setting research priorities and determining what information gets integrated into clinical care.
Military Health System Research
Research specifically tailored to the needs of the MHS is focused on the areas of the research continuum that are implementation-ready and immediately useful to providers.
DoD and VA worked together to collaboratively develop an approach to strategically identify research that is effective and should be translated into practice. This model, the “Interagency Research Continuum Approach,” is outlined in the NRAP (PDF) and organizes studies along the following progression: foundational science; epidemiology; etiology; prevention and screening; treatment (which has been combined here with follow-up care); and implementation (services) research. This approach facilitates analysis of gaps and identification of future areas of focus, as well as indicating key areas that are most immediately actionable.