Post-Deployment Stress:What You Should Know, What You Can Do

Almost everyone who has spent time in Iraq or Afghanistanhas experienced something very stressful. Studies of militarypersonnel deployed to these areas find that traumaticexperiences—such as being attacked or ambushed, havingto handle or uncover human remains, and knowing someonewho was seriously injured or killed—are common. If you hadsimilar experiences when you were in Iraq or Afghanistan,you are not alone.

Feelings, you might feel:SadHopelessWorthlessParanoidAnxiousGuiltyAngry

Behaviors, you might:Avoid situations that trigger flashbacksof your traumatic experiencesNot want to socializeHave low energyUse drugs or drink too much

veryone reacts differently to this kind of stress. But many returning militarymembers have thoughts, feelings, andbehaviors like these:

Thoughts, you might:Be forgetful and have troubleconcentratingRelive bad memories of traumaticeventsHave thoughts of death or suicide

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You may have these same kinds ofthoughts and feelings. It’s important for you to know that these are normalreactions to abnormal events and thatmany military personnel have felt thesame way.

However, these thoughts, feelings, andbehaviors can also mean that you havemore serious problems, including post-traumatic stress disorder (PTSD), traumaticbrain injury (TBI), depression, or a

combination of these. Fortunately, there are lots of ways to get support if you need it. This booklet containsinformation you can use now or later to help you understand and cope withthe problems you face.

Military OneSource1-800-342-9647https://www.militaryonesource.com

Department of Defense (DoD) PTSD and TBI Quick Factshttp://www.pdhealth.mil/downloads/TBI_PTSD_Final04232007.pdf

National Alliance on Mental Illness (NAMI)1-800-950-NAMIhttp://www.nami.org/veterans

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Photo Courtesy of U.S. Army

Kelly, a member of the Army NationalGuard, was deployed in Afghanistan for a year and has just returned home. Sinceher return, she has been having troublesleeping, is angry all the time, avoidstalking about her war experiences, andhas nightmares about them, includingseeing a friend die in a car bombing.These problems are making it hard for her to do her work as a loan officer for amortgage company.

Kelly is having symptoms like thosecaused by post-traumatic stress disorder(PTSD), a condition that people have afterexperiencing a disturbing event. Combatexperiences—such as being shot at,handling dead bodies, or knowingsomeone who was killed—can triggerPTSD.

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What Is Post-Traumatic Stress Disorder (PTSD)?

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Reliving the event. You feel that you are experiencing the event again—oftenwith the same fear and shock you hadwhen it took place. These kinds offlashbacks can be triggered by loudnoises, seeing a traffic accident, or evenwatching a news report.

Avoiding situations that remind you of the event. You try to avoid places orexperiences that bring back memories of your terrible experience.

Feeling numb. It seems like you don’thave any feelings, and you may loseinterest in relationships and activities.

Feeling on edge. You get angry orannoyed very easily and you have a hardtime sleeping, or you may overreact whensomething startles you.

Symptoms of PTSD can include:

If you have such symptoms and they are affecting youractivities at home or duties at your job, it may help for you totalk to someone at your local doctor’s office or clinic. You can

also call Military OneSource for confidential informationabout getting help: 1-800-342-9647

The Veterans Affairs (VA) National Center for PTSD

http://www.ncptsd.va.gov/ncmain/ncdocs/manuals/GuideforMilitary.pdf

http://www.ncptsd.va.gov/ncmain/ncdocs/videos/emv_newwarr_vets.html

Armyhttp://chppm-www.apgea.army.mil/deployment/Guides/RedeploymentTri-Fold/Deployment_Related_Stress.pdf

Marineshttp://www.usmc-mccs.org/cosc/63619-usmc.pdf

American Psychiatric Associationhttp://www.healthyminds.org/multimedia/ptsd.pdf

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Jason is a private first class in the MarineCorps who was deployed to Iraq for eightmonths, where he was exposed to animprovised explosive device (IED) blast.None of the IED’s parts hit Jason, but hehas frequent headaches that get worseevery day, has trouble with hiscoordination, and gets easily confused.Jason is frustrated because he can’t helphis two sons with their homework andhas started to drink a lot every night.

Jason’s feelings and behavior could meanthat he has traumatic brain injury (TBI). TBIcan be caused when something hits aperson’s head very hard or whensomething goes through the skull andenters the brain. Even the blast wavesalone from an IED can cause TBI.

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What Is Traumatic Brain Injury (TBI)?

If you had a blow or shock to your head and you have one ormore of these symptoms, you could be suffering from thelong-term consequences of TBI. If the symptoms persist, itmay help for you to talk to someone at your local doctor’soffice or clinic. You can also call Military OneSource for

confidential information about getting help: 1-800-342-9647

Defense and Veterans Brain Injury Center1-800-870-9244http://www.dvbic.org/

National Center for Injury Prevention and Control information on TBIhttp://www.cdc.gov/ncipc/tbi/tbibook.pdf

Department of Veterans Affairshttp://www.va.gov/environagents/docs/TBI-handout-patients.pdf

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Traumatic brain injury can cause problemslong after the injury actually happens.Symptoms can include:

Constant headachesConfusionLight headedness or dizzinessChanges in mood or behaviorTrouble remembering or concentratingRepeated nausea or vomitingProblems with seeing or hearing.

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Antonio is a sergeant in the Army and hasjust returned from a 15-monthdeployment in Iraq. He is excited to behome especially since he has a one-year-old daughter who was born while he wasin Iraq. But he often feels depressed andsad, and he doesn’t have much interest inplaying with his new daughter or three-year-old son. His wife is worried becausehe doesn’t want to be with other people.

Antonio has many of the commonsymptoms of depression. Depression caninterfere with your ability to work, sleep,eat, interact with others, and enjoy doingthings that you used to like. Depressioncan also have long-term chronic effectsthat make it hard for you to function andkeep you from feeling good.

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What Is Depression?

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Here are some of the most common signsof depression:

Feeling hopeless, sad, or “empty” mostof the timeLosing interest or pleasure in activitiesthat you used to enjoyLacking energy or feeling very tired Thinking about death or suicide

Having ongoing physical problems—such as headaches, stomach problems,and pain—that don’t get better evenwhen they have been treated.

If you have these kinds of symptoms and they are affectingyour activities at home or duties at work, it may help for youto talk to someone at your local doctor’s office or clinic. You

can also call Military OneSource for confidential informationabout getting help: 1-800-342-9647

Department of Defense https://www.qmo.amedd.army.mil/depress/Web%20Depression%20Brochure.doc

Uniformed Services University of the Health Sciences depression fact sheethttp://www.usuhs.mil/psy/CourageToCarePatientFamilyDepressionFactSheet.pdf

National Institute of Mental Health information on depressionhttp://www.nimh.nih.gov/health/publications/depression/nimhdepression.pdf

Families for Depression Awarenesshttp://familyaware.org/admk/wellnessguide.pdf

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Being part of or seeing shocking eventscan cause PTSD, TBI, or depression, so it ispossible to have more than one of theseproblems at the same time. Be sure todescribe all of the symptoms you arehaving to someone at your local doctor’soffice or clinic, or call Military OneSource(1-800-342-9647). Treatment for combinedproblems may be different fromtreatment for just one of them.

SUBSTANCE USE AND ABUSEPTSD, TBI, or depression can affect many parts of your life. Like Jason, youmay find yourself drinking or using drugsto deal with your problems. This mighthelp you escape for a little while, butalcohol or drugs can actually make your problems worse.

It’s often hard to know when alcohol ordrug use is becoming a problem. Here aresome signs to look for:

You feel guilty about your alcohol ordrug useYour family and friends comment onhow much you are drinkingYour drinking or drug use makes ithard to live up to your responsibilitiesat home or at workYou need more alcohol or drugs to getthe same effectYou have tried to cut down on youruse but can’t.

If you think you have an alcohol or drugproblem, you should see your health careprovider for help.

HELPING YOURSELF MAKE THETRANSITIONThe transition from deployment to homeis hard for everyone, and many othermilitary personnel are having problemslike the ones described above.

You have many ways to get help—someof them listed in this booklet. There arealso some simple things that you can doimmediately.

USE THE RESOURCES AVAILABLE TO YOUThe military is committed tosupporting the health, well-being, andjob performance of military personnel.Use the many organizations whosegoal is to help you make a smoothtransition from deployment to home.They can suggest ways to cope withsymptoms of PTSD, TBI, and depressionand to get you back on track faster.

TAKE CARE OF YOURSELFExercise and eat well (stay away fromjunk food).Get enough sleep by keeping a regularsleep schedule and avoiding vigorousexercise before bed.Stay away from alcohol, tobacco, and caffeine.

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Combined Problems

Substance Abuse and Mental Health Services Administration1-800-662-HELPhttp://getfit.samhsa.gov/Drugs/http://getfit.samhsa.gov/Alcohol/

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Think about the things you like to do,and do them.Set realistic goals and don’t take onmore than you can handle. If you find it hard to tackle large problems,break them into smaller ones. Thenstart with the small tasks that are most important.If you have experienced brain trauma,it is important to avoid vigorousphysical activities that would lead tofurther injury and to avoid alcohol,caffeine, pseudoephedrine (Sudafed),and heavy use of sleep aids that canput more stress on your brain.If you are having memory problems,carry a notebook or set a regularroutine for what you do.

PAY ATTENTION TO YOUR FEELINGSIf you have a flashback or nightmare,remind yourself of where you are andthat you are safe. Possibly get up, move around, and talk to someone. Tell your doctor or someone close toyou about it.

Manage your anger by walking awayfrom situations that make you angry or by talking things over with peoplewho have made you angry.If you are feeling depressed and arethinking about hurting yourself, ask for help from a family member orhealth care provider or call theNational Suicide Prevention Lifeline (1-800-273-TALK). If you needimmediate help, call 911.

TALK WITH OTHERSIf you are having any of the problemsdescribed in this booklet, it’s important for you to discuss them with other people and to think about getting help.

Health Care Providers. You can talk inprivate with a health care provider, suchas a doctor, nurse, psychologist, or othermental health professional. They knowhow to treat common post-deploymentproblems related to PTSD, TBI, anddepression. Make an appointmentspecifically to discuss your symptoms.

To help a health care provider understandand treat your symptoms, take a list ofquestions and concerns with you to your appointment. As you go through the list together, take notes so that youcan remember the provider’s advice. Itcan also be useful to take someone youtrust with you to this appointment to help you remember important parts ofthe discussion.

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Don’t feel like you’ve got only one chanceto ask a health care provider for help. After your first appointment, set upanother appointment so that you and theprovider can follow up on your progress. If you decide to meet with a mentalhealth professional, you may meet on a regular basis (likely once a week) untilyour symptoms improve.

Your Family. Your spouse or significantother and other family members canprovide important support. You may not want to talk with them about yourproblems because you’re worried that you will be a burden. But often the bestthing you can do for your family is to talkopenly about your thoughts, feelings, and actions. You can work together tomove forward.

You may talk to your loved ones aboutpractical issues, such as schedulingappointments or how to keep track ofyour symptoms, but you can also talk to them about other concerns related toPTSD, TBI, or depression. It may be helpfulto set aside a time every day to check inwith the people you care about, forexample, in the morning before your daybegins or before going to sleep at night.

Children. Children are usuallycomfortable with routines, so they mayhave a hard time with the changes thatoccur when you come home and noticethat you are acting differently. Dependingon their age, they may have questionsand concerns. It is often more scary forchildren when they feel kept in the dark,so if your child asks about your symptoms,you can explain some of how you’refeeling in a way that they will understand.

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Children need to know that it’s okay toask questions. As with other familymembers, think about scheduling aregular time with your children to checkin. Reassure them that someone willalways be available to take care of themwhile you get the help you need.

Church or Religious Leaders. Somepeople feel that religious leaders or elderscan offer helpful advice. Set up a timewith a church or religious leader whomyou trust to discuss your symptoms, anduse their advice to complement the helpyou are getting from health care providersand family.

Other Veterans. It can be helpful toconnect with people who have servedwith you or who have had similarexperiences. Your local VA may have anetwork you can use to contact otherservice members, or you can connectwith others online at the VeteranRecovery Web site through the U.S.Department of Veterans Affairs.

BE PATIENT WITH YOURSELFDon’t expect improvement overnight.You are more likely to feel a little betterevery day.It may help to increase activity slowly.

Military OneSource1-800-342-9647https://www.militaryonesource.com

Department of Veterans Affairs, Veteran Recoveryhttp://www.veteranrecovery.med.va.gov/

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Most people who are in treatment getbetter. Treatment can improve your life inmany ways. It can lead to better physicalhealth and job performance. It can alsoimprove your family relationships.

There are many ways to treat thesymptoms you are having and to makeyou feel more like yourself. The kind oftreatment and how long you’ll receive it will differ for every individual, but thesooner you take action to deal with post-deployment stress, the sooner you willbe able to feel better and move on withyour life.

Learning About Symptoms. Symptomsrelated to PTSD, TBI, and depression are common, but not everyoneexperiences post-deployment stress inthe same way. Use this booklet and theresources listed here to learn how torecognize symptoms that can be treatedby a health care provider.

Learning About Treatment. If you have identified thoughts, feelings, and behaviors that are part of post-deployment stress, you might want to learn more about how to get help. Your health care provider will tailortreatment to meet your needs. Forexample, treatment might involvediscussions with a health care provider in person, medications, or both. Thisbooklet and the resources listed in it give you more information aboutavailable treatments.

Getting Treatment. If you have concernsabout getting care for a personal oremotional problem, you can talk tosomeone at Military OneSource (1-800-342-9647) or at a Veteran’s Center. Call 1-800-905-4675 (Eastern) or 1-866-496-8838 (Pacific) to get contact information for the Veteran’sCenter nearest you. Your call will beconfidential and will not be shared with military authorities.

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Treatment

Military OneSource: Confidential information, support, and counseling available free to military personnel (regardless of activation status) and their families1-800-342-9647https://www.militaryonesource.com

Vet Centers: Confidential readjustment counseling for combat veterans and their families1-800-905-4675 (Eastern) or 1-866-496-8838 (Pacific)http://www.vetcenter.va.gov/

To get more copies of these and other materials, and to find links to more than 20 helpful resourceshttp://veterans.rand.org

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If you want to get care, your entry to themedical system may depend on yourcurrent military status:

If you are on active duty, you can godirectly to your unit’s military medicalprovider. You can contact a mentalhealth provider through your normalTRICARE channels. You can specifyeither a civilian or military provider,though there may be wait times forthe next available appointment.If you served in a theater of combatoperations after November 11, 1998and have since left the military, youmay be eligible to receive care for upto five years following discharge at alocal VA medical treatment center. Youcan call 1-877-222-8387 or go tohttp://www.va.gov/directory for more assistance. If it has been morethan five years since you left the

service, then you may still be eligiblefor care at the VA.If you are a Reservist or in the NationalGuard, contact your unit or a unit nearyou to find out about local resources.You can find out about treatmentoptions at your local VA medicaltreatment center (call 1-877-222-8387or go to http://www.va.gov/directory).You can also contact MilitaryOneSource (1-800-342-9647) to learnabout benefits you may be eligible forthrough TRICARE Reserve. Finally, if youare using your civilian health insurance,contact your insurer to get moreinformation about mental health care covered by your plan.

CP-534 (3/08) Cover Photo Courtesy of U.S. Department of Defense

RAND is a nonprofit institution that helps improve policy anddecisionmaking through research and analysis.

Note: Persons shown in the images throughout this booklet arefor illustrative purposes only and are not associated with any ofthe psychological and cognitive problems presented.