Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward

David Forbes¹, David Pedlar², Amy B Adler³, Clare Bennett⁴, Richard Bryant^{1

5}, Walter Busuttil⁶, John Cooper¹, Mark C Creamer¹, Nicola T Fear^{7

8}, Neil Greenberg⁷, Alexandra Heber^{9

10}, Mark Hinton¹, Mal Hopwood¹, Rakesh Jetly¹¹, Ellie Lawrence-Wood¹², Alexander McFarlane^{1

12}, Olivia Metcalf¹, Meaghan O'Donnell¹, Andrea Phelps¹, J Don Richardson^{13

14}, Nicole Sadler¹, Paula P Schnurr^{15

16}, Marie-Louise Sharp⁷, James M Thompson^{9

17}, Robert J Ursano¹⁸, Miranda Van Hooff¹², Darryl Wade¹, Simon Wessely⁷

Affiliations

¹ a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia.
² b Canadian Institute for Military and Veteran Health Research , Kingston , ON, Canada.
³ c Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research , Silver Spring , MD , USA.
⁴ d New Zealand Defence Force , Wellington , New Zealand.
⁵ e School of Psychology , University of New South Wales , Sydney , Australia.
⁶ f Combat Stress , Surrey , UK.
⁷ g King's Centre for Military Health Research, King's College London , London , UK.
⁸ h Academic Centre for Military Mental Health Research , London , UK.
⁹ i Veterans Affairs Canada , Charlottetown , Canada.
¹⁰ j Department of Psychiatry , University of Ottawa , Ottawa , Canada.
¹¹ k Directorate of Mental Health , Canadian Armed Forces , Ottawa , Canada.
¹² l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia.
¹³ m Department of Psychiatry , Western University , London , Canada.
¹⁴ n McDonald/Franklin OSI Research Centre , London , Canada.
¹⁵ o National Center for PTSD , White River Junction , VT , USA.
¹⁶ p Department of Psychiatry , Geisel School of Medicine , Hanover , NH , USA.
¹⁷ q Department of Public Health Sciences , Queen's University , Kingston , ON , Canada.
¹⁸ r Center for the Study of Traumatic Stress, Department of Psychiatry , Uniformed Services University School of Medicine , Bethesda , MD , USA.

PMID: 31043106
DOI: 10.1080/09540261.2019.1595545

Review

Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward

David Forbes et al. Int Rev Psychiatry. 2019 Feb.

. 2019 Feb;31(1):95-110.

doi: 10.1080/09540261.2019.1595545. Epub 2019 May 2.

Authors

Affiliations

¹ a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia.
² b Canadian Institute for Military and Veteran Health Research , Kingston , ON, Canada.
³ c Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research , Silver Spring , MD , USA.
⁴ d New Zealand Defence Force , Wellington , New Zealand.
⁵ e School of Psychology , University of New South Wales , Sydney , Australia.
⁶ f Combat Stress , Surrey , UK.
⁷ g King's Centre for Military Health Research, King's College London , London , UK.
⁸ h Academic Centre for Military Mental Health Research , London , UK.
⁹ i Veterans Affairs Canada , Charlottetown , Canada.
¹⁰ j Department of Psychiatry , University of Ottawa , Ottawa , Canada.
¹¹ k Directorate of Mental Health , Canadian Armed Forces , Ottawa , Canada.
¹² l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia.
¹³ m Department of Psychiatry , Western University , London , Canada.
¹⁴ n McDonald/Franklin OSI Research Centre , London , Canada.
¹⁵ o National Center for PTSD , White River Junction , VT , USA.
¹⁶ p Department of Psychiatry , Geisel School of Medicine , Hanover , NH , USA.
¹⁷ q Department of Public Health Sciences , Queen's University , Kingston , ON , Canada.
¹⁸ r Center for the Study of Traumatic Stress, Department of Psychiatry , Uniformed Services University School of Medicine , Bethesda , MD , USA.

PMID: 31043106
DOI: 10.1080/09540261.2019.1595545

Abstract

Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with the development of PTSD in this population, considers issues relating to engagement in treatment, and discusses the empirical support for best practice evidence-based treatment. The paper goes on to explore the challenges in those areas, with particular reference to treatment engagement and barriers to care, as well as treatment non-response. The final section addresses innovative solutions to these challenges through improvements in agreed terminology and definitions, strategies to increase engagement, early identification approaches, understanding predictors of treatment outcome, and innovations in treatment. Treatment innovations include enhancing existing treatments, emerging non-trauma-focused interventions, novel pharmacotherapy, personalized medicine approaches, advancing functional outcomes, family intervention and support, and attention to physical health.

Keywords: PTSD; military; trauma; treatment; veteran.

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Comment in

Understanding military combat mental health.
Bricknell MC, Williamson V, Wessely S. Bricknell MC, et al. Occup Med (Lond). 2020 Jun 20;70(4):216-218. doi: 10.1093/occmed/kqaa037. Occup Med (Lond). 2020. PMID: 32562492 No abstract available.

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Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward

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Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward

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