In response to growing national concern about the number of veterans who might be at risk for posttraumatic stress disorder (PTSD) as a result of their military service, the Department of Veterans Affairs (VA) asked the Institute of Medicine (IOM) to conduct a study on the diagnosis and assessment of, and treatment and compensation for PTSD. An existing IOM committee, the Committee on Gulf War and Health: Physiologic, Psychologic and Psychosocial Effects of Deployment-Related Stress, was asked to conduct the diagnosis, assessment, and treatment aspects of the study because its expertise was well-suited to the task. The committee was specifically tasked to review the scientific and medical literature related to the diagnosis and assessment of PTSD, and to review PTSD treatments (including psychotherapy and pharmacotherapy) and their efficacy. In addition, the committee was given a series of specific questions from VA regarding diagnosis, assessment, treatment, and compensation. Posttraumatic Stress Disorder is a brief elaboration of the committee's responses to VA's questions, not a detailed discussion of the procedures and tools that might be used in the diagnosis and assessment of PTSD. The committee decided to approach its task by separating diagnosis and assessment from treatment and preparing two reports. This first report focuses on diagnosis and assessment of PTSD. Given VA's request for the report to be completed within 6 months, the committee elected to rely primarily on reviews and other well-documented sources. A second report of this committee will focus on treatment for PTSD; it will be issued in December 2006. A separate committee, the Committee on Veterans' Compensation for Post Traumatic Stress Disorder, has been established to conduct the compensation study; its report is expected to be issued in December 2006.

Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Early evidence suggests that the psychological toll of these deployments -- many involving prolonged exposure to combat-related stress over multiple rotations -- may be disproportionately high compared with the physical injuries of combat. In the face of mounting public concern over post-deployment health care issues confronting OEF/OIF veterans, several task forces, independent review groups, and a Presidential Commission have been convened to examine the care of the war wounded and make recommendations. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. RAND conducted a comprehensive study of the post-deployment health-related needs associated with these three conditions among OEF/OIF veterans, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need. This monograph presents the results of our study, which should be of interest to mental health treatment providers; health policymakers, particularly those charged with caring for our nation's veterans; and U.S. service men and women, their families, and the concerned public. All the research products from this study are available at http://veterans.rand.org. Data collection for this study began in April 2007and concluded in January 2008. Specific activities included a critical reviewof the extant literature on the prevalence of post-traumatic stress disorder, major depression, and traumatic brain injury and their short- and long-term consequences; a population-based survey of service members and veterans who served in Afghanistan or Iraq to assess health status and symptoms, as well asutilization of and barriers to care; a review of existing programs to treat service members and veterans with the three conditions; focus groups withmilitary service members and their spouses; and the development of a microsimulation model to forecast the economic costs of these conditions overtime. Among our recommendations is that effective treatments documented in the scientific literature -- evidence-based care -- are available for PTSD and major depression. Delivery of such care to all veterans with PTSD or majordepression would pay for itself within two years, or even save money, by improving productivity and reducing medical and mortality costs. Such care may also be a cost-effective way to retain a ready and healthy military force for the future. However, to ensure that this care is delivered requires system-level changes across the Department of Defense, the Department of Veterans Affairs, and the U.S. health care system.

Fattori di rischio dei disturbi da stress post-traumatico: demografici, ambientali, genetici, neurocognitivi, biologici.

The Oklahoma City bombing, intentional crashing of airliners on September 11, 2001, and anthrax attacks in the fall of 2001 have made Americans acutely aware of the impacts of terrorism. These events and continued threats of terrorism have raised questions about the impact on the psychological health of the nation and how well the public health infrastructure is able to meet the psychological needs that will likely result. Preparing for the Psychological Consequences of Terrorism highlights some of the critical issues in responding to the psychological needs that result from terrorism and provides possible options for intervention. The committee offers an example for a public health strategy that may serve as a base from which plans to prevent and respond to the psychological consequences of a variety of terrorism events can be formulated. The report includes recommendations for the training and education of service providers, ensuring appropriate guidelines for the protection of service providers, and developing public health surveillance for preevent, event, and postevent factors related to psychological consequences.

Combat stress casualties are not necessarily higher in city operations than operations on other types of terrain. Commanders and NCOs need to have the skills to treat and prevent stress casualties and understand their implications for urban operations. The authors review the known precipitants of combat stress reaction, its battlefield treatment, and the preventive steps commanders can take to limit its extent and severity.

With “groundbreaking research on the psychology of resilience” (Adam Grant), a top expert on human trauma argues that we vastly overestimate how common PTSD is in and fail to recognize how resilient people really are. After 9/11, mental health professionals flocked to New York to handle what everyone assumed would be a flood of trauma cases. Oddly, the flood never came. In The End of Trauma, pioneering psychologist George A. Bonanno argues that we failed to predict the psychological response to 9/11 because most of what we understand about trauma is wrong. For starters, it’s not nearly as common as we think. In fact, people are overwhelmingly resilient to adversity. What we often interpret as PTSD are signs of a natural process of learning how to deal with a specific situation. We can cope far more effectively if we understand how this process works. Drawing on four decades of research, Bonanno explains what makes us resilient, why we sometimes aren’t, and how we can better handle traumatic stress. Hopeful and humane, The End of Trauma overturns everything we thought we knew about how people respond to hardship.