Mental health and military Veterans — An invisible battlefront

By Denise Lana,

For those who are serving or have served in the military, mental health concerns are an often-overlooked issue. The military culture fosters the mindset that soldiers can’t be weak or ask for help, which lends credence to why many military members past and present are often hesitant to admit mental health issues.

For those who are serving or have served in the military, mental health concerns are an often-overlooked issue. The military culture fosters the mindset that soldiers can’t be weak or ask for help, which lends credence to why many military members past and present are often hesitant to admit mental health issues.  
Stressful events and life events like being separated from loved ones, death, combat, injury, natural disasters or physical or sexual abuse are often associated with depression. Additionally, military life is full of uncertainty, which can cause family members to experience high anxiety, depression, PTSD and long-term mental health and wellness injuries. 
According to several online military surveys, almost 25 percent of nearly 5,500 active-duty, non-deployed soldiers tested positive for a mental disorder of some kind, and 11 percent within that subgroup also tested positive for more than one illness. The prevalence of anxiety disorders in the military is estimated to be about 15 percent, the rate of major depression among soldiers is five times as high as civilians, and the rate of PTSD is nearly 15 times higher.
Many “invisible” mental disorders include the following. 

Anxiety
Some Veterans develop severe anxiety following a trauma or a life-threatening experience. For others, stressful life events — such as the transition from military to civilian life or difficult work situations — can cause anxiety disorders. 
Symptoms of anxiety include: 
• Feeling restless, jumpy or on edge
• Excessive worrying about everyday decisions
• Difficulty concentrating
• A racing heart or cold, clammy hands
• Trembling or twitching
• Having trouble catching your breath
• Feeling dizzy, nauseous, or lightheaded
• Difficulty sleeping

Bipolar
Bipolar disorder is not the result of a character flaw and people don’t bring it on themselves. Bipolar disorder tends to run in families and there is no single cause of bipolar disorder. Some Veterans experience an increase in their bipolar symptoms due to stressful events and challenging situations.
Symptoms of Bipolar disorder include:
• Noticeable swings in energy, mood, or hours of sleep needed
• Periods of unusually elevated, high energy lasting for at least several days
• An overly good mood followed by a long period of low, depressed mood

Depression
Depression affects 23 percent of active-duty military. 
Symptoms of depression include:
• Feelings of intense sadness or hopelessness
• Losing interest or pleasure in activities that one used to enjoy
• Feelings of guilt, unworthiness or low self-esteem
• Avoiding being around people

Military sexual trauma (MST) 
Refers to sexual assault or sexual harassment experienced during military service. Includes any sexual activity performed against one’s will or where “No” cannot be said.
• Being pressured or coerced into sexual activities, such as with threats of negative treatment if he or she refuses to cooperate or with promises of better treatment
• Sexual contact or activities without consent, including when he or she was asleep or intoxicated
• Being overpowered or physically forced to have sex
• Being touched or grabbed in a sexual way that makes one uncomfortable, including during “hazing” experiences
• Comments about one’s body or sexual activities that are found threatening
• Unwanted sexual advances that are found threatening

Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD) develops when someone experiences or witnesses a life-threatening event, and that person can’t shake the memories and emotions tied to the event. It can linger for months and years and can leave the person handicapped in ways unseen by the layperson.  
Veterans from WWI suffered shell shock from artillery bombardments. During WWII, the phrase “Combat Fatigue” was coined from soldiers being on the front line upwards of 240 days. Vietnam War PTSD, so rampant it was called “Vietnam Stress,” was brought on heavily due to lack of decompression time between active battles as well as lack of support and hostile treatment by the public when soldiers returned home from battle.  
Post-Traumatic Stress Disorder was finally recognized as a mental health diagnosis in 1980, but in the decades since, the military has still embodied the misconception of a “zero defects” service member. Research suggests that 11 to 20 percent of veterans experience PTSD each year. More than 30 percent of all Vietnam vets have had, or still have, PTSD.
PTSD signs and symptoms:
• Insomnia and nightmares
• Trouble concentrating
• Refusal to discuss the event or acting like it didn’t happen
• Reliving the event (flashbacks)
• Triggers brought on by seeing, hearing, or smelling something that reminds one of the traumatic event
• Fear of being around people or performing certain acts that are tied to the event (like driving if their convoy was bombed, or watching a movie about earthquakes if they experienced an earthquake)
• Easily startled at noises
• Paranoia, fear that the world is dangerous 
• Reluctance to trust others
• Guilt or shame 
• Substance abuse

Schizophrenia
A chronic and severe psychiatric disorder affecting approximately 120,000 Veterans receiving VA health care, according to a 2014 study. People affected with the disorder may experience hallucinations, delusions, difficulty feeling pleasure and trouble focusing or paying attention.
Signs and symptoms of schizophrenia:
• Hallucinations
• Delusions, such as feeling like one is being watched or followed when one is not
• Confused thinking
• Changes in feelings and behaviors
• Difficulty feeling and expressing positive emotions
• Reduced range of emotional expression, such as limited facial expressions or eye contact
• Difficulty getting out of the house, doing things with other people or pursuing goals such as going to work, attending school, or maintaining relationships
• Trouble concentrating or paying attention
• Memory loss or slow thinking

Substance Abuse Disorder (SUD)
Substance Abuse Disorder is usually triggered by mental health concerns or life stressors. When people are stressed, anxious, depressed, or overwhelmed, they may be more likely to have trouble controlling alcohol and drug use. SUD causes someone to have difficulty controlling his or her use of alcohol, drugs and other substances
Signs and symptoms include: 
• Increased urge to drink or to use drugs
• Inability to stop drinking or using drugs
• Drinking or using drugs in hazardous situations (for example, drinking and driving)
• Change in relationships due to drinking or drug use
• Feeling depressed or anxious about substance use
• Feeling sick and experiencing withdrawal symptoms when drinking or drug use stops
• Increased tolerance, which results in the need for more alcohol or stronger drugs to achieve the desired effect

Suicide
According to PBS.org, a study released in 2022 found that as many as 44 Veterans die on average per day from suicide — a 40 percent increase between 2015-20. In 2020, death by suicide increased by 25 percent. The study detailed stress factors particular to military life: high exposure to trauma — mental, physical, moral, and sexual — stress and burnout, the influence of the military’s dominant masculine culture, continued access to guns and the difficulty of reintegrating into civilian life.

Smoking
People who smoke are more likely than nonsmokers to have experienced anxiety, panic, stress, depression or suicidal thoughts. The challenges of quitting smoking can also lead to increased stress and anxiety. Quitting smoking can increase the effectiveness of medications used to treat mental health issues.

Traumatic Brain Injury (TBI)
Traumatic Brain Injury is caused by exposure to explosions, bullet penetration, vehicle accidents, physical abuse or trauma. Between 2000-17, the Department of Defense reported more than 375,000 diagnosed cases of TBI among members of the U.S. Armed Forces. This may increase risk for anxiety, depression and sleeping problems, and can involve serious long-term effects on thinking ability, memory, mood and mental focus.
Common symptoms of TBI may include:
• Headaches
• Blurred vision
• Hearing problems
• Difficulty speaking
• Dizziness

Confidential support options available 24/7/365
In an effort to reduce the stigma for military members and Veterans, the Department of Defense and the Department of Veterans Affairs, along with other mental health organizations, offer a variety of mental health support resources available to military service members, families, employees and Veterans. 
Mental health resource information listed below. 
Military Crisis Line: 800-273-8255 and press 1, www.veteranscrisisline.net or text 838255
Military Veteran Mental Health: www.mentalhealth.va.gov
Veteran general information: www.va.gov or call 800-827-1000
Homeless Veterans: 877-424-3838 or www.va.gov/homeless
Real Warriors Campaign: www.health.mil/RealWarriors 
Psychological Health Resource Center: www.health.mil/PHRC or 866-966-1020
Military One Source: www.militaryonesource.mil or 800-342-9647
Make the Connection: www.maketheconnection.net
Free Counseling for Vets: www.usvets.org or 877-548-7838