Combat-related mental health disorders: the case for resiliency in the long war

More US military service members have been deployed since 9/11 than in the previous 40 years. A greater number of these deployed service members are surviving, which has increased the incidence of combat-related mental health disorders among veterans of "The Long War." The societal cost of caring for veterans with such disorders is expected to surpass that of the Global War on Terror, which is estimated at $600 billion. Because the prospect of stopping all deployment is remote, standardized prevention and treatment methods must be used to eliminate these "invisible wounds of war." It is imperative that high-quality, evidence-based, and cost-effective treatments--pharmaceutical and nonpharmaceutical--be developed. Although no approved medication currently exists for the prevention of posttraumatic stress disorder, the blood pressure medication propranolol has shown promise in erasing the behavioral expression of fear memory and may be useful for preventing more severe emotional disorders. In addition, a nonpharmaceutical method known as stress inoculation training is ideally suited to military populations and should be incorporated into military training programs. Furthermore, osteopathic physicians can improve resilience in the communities they serve by considering the dynamic of body, mind, and spirit in their patients. Applying these methods, teaching self-regulation traits, and removing barriers to care will build resiliency among service personnel for The Long War.