Colonel Carl A. Castro Director, Military Operational Medicine Research Program
description
Transcript of Colonel Carl A. Castro Director, Military Operational Medicine Research Program
Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel
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Impact of Combat on the Mental Health and Well-Being of Soldiers and Marines
7 Things I Think I Know
Colonel Carl A. CastroDirector, Military Operational Medicine
Research Program
Smith College School for Social WorkCombat Stress: Understanding the Challenges,
Preparing for the Return Northampton, New Hampshire
26-28 June 2008
Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel
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• Born in Kansas City, Missouri• Enlisted as an infantryman in the U.S. Army at the age of 17• Obtain BA from Wichita State University and MA and PhD from the University of Colorado (major psychology)• Entered active duty as a psychologist in 1989• Served on deployments to Bosnia (1998), Kosovo (2000, 2002), and Iraq (2003, 2006)• Authored, co-authored around 100 publications• Promoted to colonel in FEB 2007• Serves on several NATO, TTCP panels• Just started a new job as Director of Military Operational Medicine, Fort Detrick, Maryland• Areas of research interest include:
- Impact of combat and operations on mental health and well-being of Soldiers and Families- Development of validated mental health training instrument and procedures to facilitate effective adaptation and growth- Junior Leader development and their role in facilitating mental health and well-being in subordinates
Biography of Colonel Castro
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1. Combat impacts the mental health and well-being of Soldiers and Marines.
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Prevalence of PTSD
% PTSD
5.0
14.6
02468
1012141618
Pre-OIF Post-OIF (3 months)n = 2,414 n = 3,781
• There is a 3-fold increase for U.S. Soldiers screening positive for PTSD when assessed 3 months after returning from a year in Iraq.
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% PTSD
18.8
29.7
19.9 17.7
7.8 9.7 8.1 9.5
05
10152025303540
Firefights High Combat Perceiveddanger
Dissociation
Yes vs. No
Firefights, high combat, high perceived danger, & dissociative experiences increased PTSD risk.
Combat-related Risk Factors & PTSD
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Anger and Aggressive Behaviors
Got angry with someone and kicked or smashed something, slammed the door, punched the wall, etc.
Got into a fight with someone and hit the person
Percent one or more times
Got angry with someone and yelled or shouted at them
Threatened someone with physical violence
22
40
46
81
19
36
42
77
11
31
37
75
0 20 40 60 80 100
pre-OIF
3 mth PostOIF12 mth PostOIF
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2. Not all Soldiers are at equal risk for mental health problems.
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Combat Experiences: Combat vs. Support
9%
6%
15%
53%
57%
57%
68%
21%
21%
42%
80%
90%
87%
87%
0% 20% 40% 60% 80% 100%Happened At Least Once
CombatCS/CSS
Hand-to-hand fighting
Got shot at
Was attacked or ambushed
Saw dead bodies
Knew somebody injured/killed
Killed enemy combatants
IED exploded nearby
• Soldiers in combat units experienced more combat-related events than Soldiers in combat support (CS) and combat service support (CSS).
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Mental Health Status By Unit Types
Any Behavioral Health Problem (PTSD, Depression or Anxiety)
14.49.9
7.5 6.7
16.8 16.7
6.1
13.4
0
10
20
30
40
Combat Arm
s
ENG/EODMP/M
I
Signal
Civil A
ffairs
Transp
ortatio
n
Support
Medica
l
Perc
ent S
cree
ning
Pos
itive
• Soldiers were more likely to screen positive for a mental health problem if they were in a combat arms unit, engineer, transportation, or support unit than Soldiers in other types of units.
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The Frontline in Iraq
• Soldiers were divided into low, medium and high combat based on frequency of combat events during the deployment.• Soldiers with higher levels of combat were more likely to screen positive for anxiety, depression, or PTSD, indicating that all Soldiers are NOT at the same level of risk for a mental health problem.
5 58
118 8
1417
12
2830
13
0
5
10
15
20
25
30
35
Anxiety Depression PTSD Any Mental HealthProblem
Perc
ent S
cree
ning
Pos
itive
Low Combat Medium Combat High Combat
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3. Leadership is important for maintaining Soldier mental health.
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Leadership and Mental Health
Adjusted R Square = .15 and the Chi Square is significant at the .01 level
• Soldiers with high perceptions of Leadership were less likely to screen positive for a mental problem (PTSD, Depression or Anxiety) compared to those Soldiers with low perceptions of leadership.
28
11
0
10
20
30
40
50
LowLeadership
HighLeadership
Percent Screened Positive for any mental health problem
20
5
36
17
0
10
20
30
40
50Low Combat/Low LeadershipLow Combat/High LeadershipHigh Combat/Low LeadershipHigh Combat/High Leadership
Percent Screened Positive for any mental health problem
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Battlemind Training as an Example
• Battlemind Training is mental health training focused on the development of skills, involving self-aid, buddy aid, and leadership.
• Battlemind Training involves:– Evidence-based: Built on findings from the Land Combat
Study. Validated through research.– Experience-Based: Uses examples that Soldiers can relate to.– Strengths-based: Builds on existing Soldier strengths and
skills – rejects a deficit or illness model.– Training: Focuses on skill development – not education.– Explanatory: Highlights conflicted/misunderstood reactions.– Team-based: Self awareness through helping buddy.– Action-Focused: Discusses specific actions to guide Soldier
behavior.
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4. Mental health training works.
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Soldier Attitudes: Training Utility
• Battlemind Training had high ratings.
50.559.4
48
35.745.5
33.623.4
29.1 26.6
0
20
40
60
80
100
The discussion mademe realize that I had
learned a lot from mydeploymentexperiences
The discussion wasuseful because I
realized my reactions tothe deployment were
normal
It was helpful to hearwhat others have to sayabout their experiences
in Iraq
% A
gree
Small BMTLarge BMTStress Ed
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Battlemind Training: PTSD & Depression
-4
-1
2
5
8
11
14
17
20
23
5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Combat Exposure: Events Experienced
PC
L C
hang
e S
core
Small BMT Stress Ed Large BMT
• Soldiers who received Battlemind Training (BMT) (p < .01) reported fewer PTSD symptoms at 3 months post-deployment compared to Soldiers who received the standard stress education training.
• Depression symptoms for Soldiers who received BMT were only marginally significantly lower than for Soldiers who received stress education (p < .10).
-2.0
0.0
2.0
4.0
6.0
8.0
10.0
5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Combat Exposure: Events Experienced
Dep
ress
ion
Cha
nge
Sco
re
BMT Stress Ed
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Battlemind Training: Stigma & Sleep
2.00
2.20
2.40
2.60
2.80
3.00
3.20
3.40
3.60
3.80
4.00
5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Combat Exposure: Events Experienced
Stig
ma
BMT Stress Ed
• Soldiers who received Battlemind training reported less psychological stigma at 3 months post-deployment compared to Soldiers who received the standard stress education training (p < .01).
• Soldiers who received Battlemind training also reported fewer sleep problems than Soldiers who received the standard stress education training (p < .01).
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Combat Exposure: Events Experienced
Pro
babi
lity
of S
leep
P
robl
ems
BMT Stress Ed
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Battlemind Training System: Deployment Cycle
AlertTransition to Post-Conflict
Battlemind AARPsychological Debriefing
Continuing the Transition Home
Battlemind Training II
PDHRA BattlemindBrief and DVD
Transitioning from Combat to Home
Post-Deployment Battlemind
Battlemind AARPsychological Debriefing
Pre-Deployment Battlemind For:LeadersJunior EnlistedHelping Professionals
Spouse/Couples Pre-Deployment Battlemind
Tough Facts about Combat
and what leaders can do to mitigate risk and build confidence
Battlemind Training ISpouse/Couples Post-Deployment Battlemind
Preparing for a Military Deployment
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5. Mental health “re-setting” following a year-long combat tour takes more than 12 months.
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High Performing Soldiers with Mental Health Symptoms Returning to Iraq
6.45.0
9.37.9 7.9
12.9
17.1
12.0
17.0
23.2
6.3
11.5
0
5
10
15
20
25
30
Depression Anxiety PTSD Any MHProblem
Perc
ent
pre-OIF3 mth Post OIF12 mth Post OIF
(Castro & Hoge, 2005)
• Soldiers’ mental health status does not “re-set” after 12 months following return from a combat tour.
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6. Longer and multiple deployments are likely to lead to more mental health issues.
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Soldier Multiple Deployments
• Soldiers deployed to Iraq more than once were more likely to screen positive for a mental health problem than first-time deployers.
15 1724 27
0
10
20
30
40
50
Acute Stress (PTSD scale) Any Mental Health Problem
Per
cent
Scr
eeni
ng P
ositi
ve
OIF First time DeployersOIF Multiple Deployers
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Soldier Deployment Length
• Soldiers deployed longer than 6 months were more likely to screen positive for a mental health problem than those deployed for 6 months or less.
12 1519 22
0
10
20
30
40
50
Acute Stress Any Mental Health Problem
Per
cent
Scr
eeni
ng P
ositi
ve Deployed 6 months or lessDeployed more than 6 months
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7. Every combat Soldier (and Marine) will face moral and ethical challenges.
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Torture should be allowed in order to gather important info about insurgents
Torture should be allowed if it will save the life of a Soldier/Marine
All non-combatants should be treated as insurgents
• Treatment of non-combatants and views on torture
24
39
44
17
38
25
36
41
17
47
0 20 40 60 80 100
Percent Agree/Strongly Agree
2006 OIFSoldiers
2006 OIFMarines
I would risk my own safety to help a non-combatant in danger
All non-combatants should be treated with dignity and respect
Battlefield Ethics: Attitudes
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Physically hit / kicked non-combatant when it was not necessary
Damaged / destroyed Iraqi property when it was not necessary
Insulted/cursed at non-combatants in their presence
Members of unit ignore ROEs in order to accomplish the mission
• Treatment of Noncombatants and ROEs
7
9
7
12
30
5
8
4
9
28
0 20 40 60 80 100
Percent Reporting One or More Times
2006 OIFSoldiers
2006 OIFMarinesMembers of unit modify ROEs in order to
accomplish the mission
Battlefield Ethics: Behaviors
Soldiers and Marines who report better officer leadership are more likely to follow the ROE.
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unnecessarily destroying private property
injuring or killing an innocent non-combatant
mistreatment of a non-combatant
violating ROEs
30
34
35
32
33
40
43
47
46
46
50
55
0 50 100
Percent Agree or Strongly Agree
2006 OIFSoldiers
2006 OIFMarines
stealing from a non-combatant
I would report a unit member for:
not following general orders
Battlefield Ethics: Reporting
“We prefer to handle things within the unit; would only turn someone in if it put the safety of unit members in jeopardy.”
---Junior NCO
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Received training that made it clear how I should behave toward non-combatants.
Training in proper treatment of non-combatants was adequate.
Received training in the proper treatment of non-combatants.
31
67
81
83
87
28
71
78
82
86
0 20 40 60 80 100Percent Agree or Strongly Agree
2006 OIFSoldiers
2006 OIFMarines
Encountered ethical situations in Iraq in which I did not know how to respond.
• Although Soldiers and Marines reported receiving adequate battlefield ethics training, over one quarter reported encountering situations in which they didn’t know how to respond.
NCOs and Officers in my unit made it clear not to mistreat non-combatants
Battlefield Ethics: Training
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• Soldiers who screened positive for a mental health problem or who had high levels of anger were twice as likely to engage in unethical behavior on the battlefield compared to those Soldiers who screened negative or who had low levels of anger.
• Soldiers with high levels of combat were more likely to engage in unethical behaviors than Soldiers with low levels of combat.
Physically hit / kicked non-combatant when it was not necessary
Insulted/cursed at non-combatants in their presence
7
16
40
3
7
25
0 20 40 60 80 100
Percent Reporting One or More Times
ScreenedNegative
ScreenedPositive
• The relationship between mental health and unethical behavior holds even when controlling for anger.
• These findings indicate the need to include Battlefield Ethics awareness in all mental health counseling and anger management courses.
Damaged and/or destroyed Iraqi private property when it was not necessary
Soldier Mental Health, Combat and Ethics
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Point of Contact
COL Carl CastroDirector, Military Operational Medicine Research
Program, Fort Detrick, [email protected]