Committee on Treatment of Posttraumatic Stress Disorder's Books

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations

Final Assessment

By: Institute of Medicine,Board on the Health of Select Populations,Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder

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Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations

Final Assessment

By: Institute of Medicine,Board on the Health of Select Populations,Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is one of the signature injuries of the U.S. conflicts in Afghanistan and Iraq, but it affects veterans of all eras. It is estimated that 7-20% of service members and veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom may have the disorder. PTSD is characterized by a combination of mental health symptoms - re-experiencing of a traumatic event, avoidance of trauma-associated stimuli, adverse alterations in thoughts and mood, and hyperarousal - that last at least 1 month and impair functioning. PTSD can be lifelong and pervade all aspects of a service member's or veteran's life, including mental and physical health, family and social relationships, and employment. It is often concurrent with other health problems, such as depression, traumatic brain injury, chronic pain, substance abuse disorder, and intimate partner violence. The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide a spectrum of programs and services to screen for, diagnose, treat for, and rehabilitate service members and veterans who have or are at risk for PTSD. The 2010 National Defense Authorization Act asked the Institute of Medicine to assess those PTSD programs and services in two phases. The Phase 1 study, Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment, focused on data gathering. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment is the report of the second phase of the study. This report analyzes the data received in Phase 1 specifically to determine the rates of success for each program or method. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment considers what a successful PTSD management system is and whether and how such a system is being implemented by DoD and VA. This includes an assessment of what care is given and to whom, how effectiveness is measured, what types of mental health care providers are available, what influences whether a service member or veteran seeks care, and what are the costs associated with that care. This report focuses on the opportunities and challenges that DoD and VA face in developing, implementing, and evaluating services and programs in the context of achieving a high-performing system to care for service members and veterans who have PTSD. The report also identifies where gaps or new emphases might be addressed to improve prevention of, screening for, diagnosis of, and treatment and rehabilitation for the disorder. The findings and recommendations of Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment will encourage DoD and VA to increase their efforts in moving toward a high-performing, comprehensive, integrated PTSD management strategy that addresses the needs of current and future service members, veterans, and their families.

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262

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National Academies Press

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ISBN 10

0309301769

ISBN 13

9780309301763

Treatment of Posttraumatic Stress Disorder

An Assessment of the Evidence

By: Institute of Medicine,Board on Population Health and Public Health Practice,Committee on Treatment of Posttraumatic Stress Disorder

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Treatment of Posttraumatic Stress Disorder

An Assessment of the Evidence

By: Institute of Medicine,Board on Population Health and Public Health Practice,Committee on Treatment of Posttraumatic Stress Disorder

Mental disorders, including posttraumatic stress disorder (PTSD), constitute an important health care need of veterans, especially those recently separated from service. Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence takes a systematic look the efficacy of pharmacologic and psychological treatment modalities for PTSD on behalf of the Department of Veterans Affairs. By reviewing existing studies in order to draw conclusions about the strength of evidence on several types of treatment, the Committee on the Treatment of Posttraumatic Stress Disorder found that many of these studies were faulty in design and performance, and that relatively few of these studies have been conducted in populations of veterans, despite suggestions that civilian and veteran populations respond differently to various types of treatment. The committee also notes that the evidence is scarce on the acceptability, efficacy, or generalizability of treatment in ethnic and cultural minorities, as few studies stratified results by ethnic background. Despite challenges in the consistency, quality, and depth of research, the committee found the evidence sufficient to conclude the efficacy of exposure therapies in treating PTSD. The committee found the evidence inadequate to determine efficacy of different types of pharmacotherapies, of three different psychotherapy modalities, and of psychotherapy delivered in group formats. The committee also made eight critical recommendations, some in response to the VA's questions related to recovery and the length and timing of PTSD treatment, and others addressing research methodology, gaps in evidence and funding issues.

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224

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National Academies Press

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ISBN 10

0309109264

ISBN 13

9780309109260

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations:

Initial Assessment

By: Committee on the Assessment of Ongoing Effects in the Treatment of Posttraumatic Stress Disorder,Board on the Health of Select Populations,Institute of Medicine

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Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations:

Initial Assessment

By: Committee on the Assessment of Ongoing Effects in the Treatment of Posttraumatic Stress Disorder,Board on the Health of Select Populations,Institute of Medicine

Prior to the military conflicts in Iraq and Afghanistan, wars and conflicts have been characterized by such injuries as infectious diseases and catastrophic gunshot wounds. However, the signature injuries sustained by United States military personnel in these most recent conflicts are blast wounds and the psychiatric consequences to combat, particularly posttraumatic stress disorder (PTSD), which affects an estimated 13 to 20 percent of U.S. service members who have fought in Iraq or Afghanistan since 2001. PTSD is triggered by a specific traumatic event - including combat - which leads to symptoms such as persistent re-experiencing of the event; emotional numbing or avoidance of thoughts, feelings, conversations, or places associated with the trauma; and hyperarousal, such as exaggerated startle responses or difficulty concentrating. As the U.S. reduces its military involvement in the Middle East, the Departments of Defense (DoD) and Veterans Affairs (VA) anticipate that increasing numbers of returning veterans will need PTSD services. As a result, Congress asked the DoD, in consultation with the VA, to sponsor an IOM study to assess both departments' PTSD treatment programs and services. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment is the first of two mandated reports examines some of the available programs to prevent, diagnose, treat, and rehabilitate those who have PTSD and encourages further research that can help to improve PTSD care.

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396

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National Academies Press

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ISBN 10

0309387744

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9780309387743

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations

Final Assessment

By: Institute of Medicine,Board on the Health of Select Populations,Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder

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Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations

Final Assessment

By: Institute of Medicine,Board on the Health of Select Populations,Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder

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National Academies Press

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ISBN 10

0309301769

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9780309301763

Treatment of Posttraumatic Stress Disorder

An Assessment of the Evidence

By: Institute of Medicine,Board on Population Health and Public Health Practice,Committee on Treatment of Posttraumatic Stress Disorder

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Treatment of Posttraumatic Stress Disorder

An Assessment of the Evidence

By: Institute of Medicine,Board on Population Health and Public Health Practice,Committee on Treatment of Posttraumatic Stress Disorder

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ISBN 10

0309109264

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9780309109260

Posttraumatic Stress Disorder

Diagnosis and Assessment

By: Institute of Medicine,Board on Population Health and Public Health Practice,Committee on Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress,Subcommittee on Posttraumatic Stress Disorder

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Posttraumatic Stress Disorder

Diagnosis and Assessment

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.

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National Academies Press

Published Date

ISBN 10

0309102073

ISBN 13

9780309102070

Returning Home from Iraq and Afghanistan

Assessment of Readjustment Needs of Veterans, Service Members, and Their Families

By: Institute of Medicine,Board on the Health of Select Populations,Committee on the Assessment of Readjustment Needs of Military Personnel, Veterans, and Their Families

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Returning Home from Iraq and Afghanistan

Assessment of Readjustment Needs of Veterans, Service Members, and Their Families

By: Institute of Medicine,Board on the Health of Select Populations,Committee on the Assessment of Readjustment Needs of Military Personnel, Veterans, and Their Families

As of December 2012, Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq have resulted in the deployment of about 2.2 million troops; there have been 2,222 US fatalities in OEF and Operation New Dawn (OND)1 and 4,422 in OIF. The numbers of wounded US troops exceed 16,000 in Afghanistan and 32,000 in Iraq. In addition to deaths and morbidity, the operations have unforeseen consequences that are yet to be fully understood. In contrast with previous conflicts, the all-volunteer military has experienced numerous deployments of individual service members; has seen increased deployments of women, parents of young children, and reserve and National Guard troops; and in some cases has been subject to longer deployments and shorter times at home between deployments. Numerous reports in the popular press have made the public aware of issues that have pointed to the difficulty of military personnel in readjusting after returning from Iraq and Afghanistan. Many of those who have served in OEF and OIF readjust with few difficulties, but others have problems in readjusting to home, reconnecting with family members, finding employment, and returning to school. In response to the return of large numbers of veterans from Iraq and Afghanistan with physical-health and mental-health problems and to the growing readjustment needs of active duty service members, veterans, and their family members, Congress included Section 1661 of the National Defense Authorization Act for fiscal year 2008. That section required the secretary of defense, in consultation with the secretary of veterans affairs, to enter into an agreement with the National Academies for a study of the physical-health, mental-health, and other readjustment needs of members and former members of the armed forces who were deployed in OIF or OEF, their families, and their communities as a result of such deployment. The study consisted of two phases. The Phase 1 task was to conduct a preliminary assessment. The Phase 2 task was to provide a comprehensive assessment of the physical, psychologic, social, and economic effects of deployment on and identification of gaps in care for members and former members, their families, and their communities. The Phase 1 report was completed in March 2010 and delivered to the Department of Defense (DOD), the Department of Veterans Affairs (VA), and the relevant committees of the House of Representatives and the Senate. The secretaries of DOD and VA responded to the Phase 1 report in September 2010. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families fulfills the requirement for Phase 2.

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795

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National Academies Press

Published Date

ISBN 10

0309264278

ISBN 13

9780309264273

PTSD Compensation and Military Service

By: National Research Council,Institute of Medicine,Board on Behavioral, Cognitive, and Sensory Sciences,Board on Military and Veterans Health,Committee on Veterans' Compensation for Posttraumatic Stress Disorder

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PTSD Compensation and Military Service

The scars of war take many forms: the limb lost, the illness brought on by a battlefield exposure, and, for some, the psychological toll of encountering an extremely traumatic event. PTSD Compensation and Military Service presents a thorough assessment of how the U.S. Department of Veterans Affairs evaluates veterans with possible posttraumatic stress disorder and determines the level of disability support to which they are entitled. The book presents a history of mental health disability compensation of military personnel and reviews the current compensation and pension examination procedure and disability determination methodology. It offers a number of recommendations for changes that would improve the fairness, consistency, and scientific foundation of this vital program. This book will be of interest and importance to policy makers, veterans affairs groups, the armed forces, health care organizations, and veterans themselves.

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263

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National Academies Press

Published Date

ISBN 10

0309105528

ISBN 13

9780309105521

Improving the Quality of Health Care for Mental and Substance-Use Conditions

By: Institute of Medicine,Board on Health Care Services,Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders

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Improving the Quality of Health Care for Mental and Substance-Use Conditions

By: Institute of Medicine,Board on Health Care Services,Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders

Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€"for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€"use conditions will benefit from this guide to achieving better care.

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529

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National Academies Press

Published Date

ISBN 10

0309100445

ISBN 13

9780309100441

Provision of Mental Health Counseling Services Under TRICARE

By: Institute of Medicine,Board on the Health of Select Populations,Committee on the Qualifications of Professionals Providing Mental Health Counseling Services Under TRICARE

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Provision of Mental Health Counseling Services Under TRICARE

By: Institute of Medicine,Board on the Health of Select Populations,Committee on the Qualifications of Professionals Providing Mental Health Counseling Services Under TRICARE

In this book, the IOM makes recommendations for permitting independent practice for mental health counselors treating patients within TRICARE-the DOD's health care benefits program. This would change current policy, which requires all counselors to practice under a physician's supervision without regard to their education, training, licensure or experience.

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351

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National Academies Press

Published Date

ISBN 10

0309157196

ISBN 13

9780309157193

Evaluation of the Department of Veterans Affairs Mental Health Services

By: National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Care Services,Committee to Evaluate the Department of Veterans Affairs Mental Health Services

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Evaluation of the Department of Veterans Affairs Mental Health Services

Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq. Shortly after troops started returning from their deployments, some active-duty service members and veterans began experiencing mental health problems. Given the stressors associated with war, it is not surprising that some service members developed such mental health conditions as posttraumatic stress disorder, depression, and substance use disorder. Subsequent epidemiologic studies conducted on military and veteran populations that served in the operations in Afghanistan and Iraq provided scientific evidence that those who fought were in fact being diagnosed with mental illnesses and experiencing mental healthâ€"related outcomesâ€"in particular, suicideâ€"at a higher rate than the general population. This report provides a comprehensive assessment of the quality, capacity, and access to mental health care services for veterans who served in the Armed Forces in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn. It includes an analysis of not only the quality and capacity of mental health care services within the Department of Veterans Affairs, but also barriers faced by patients in utilizing those services.

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467

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National Academies Press

Published Date

ISBN 10

0309466601

ISBN 13

9780309466608

Selected Health Conditions and Likelihood of Improvement with Treatment

By: National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Care Services,Committee on Identifying Disabling Medical Conditions Likely to Improve with Treatment

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Selected Health Conditions and Likelihood of Improvement with Treatment

The Social Security Administration (SSA) administers two programs that provide disability benefits: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. SSDI provides disability benefits to people (under the full retirement age) who are no longer able to work because of a disabling medical condition. SSI provides income assistance for disabled, blind, and aged people who have limited income and resources regardless of their prior participation in the labor force. Both programs share a common disability determination process administered by SSA and state agencies as well as a common definition of disability for adults: "the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." Disabled workers might receive either SSDI benefits or SSI payments, or both, depending on their recent work history and current income and assets. Disabled workers might also receive benefits from other public programs such as workers' compensation, which insures against work-related illness or injuries occurring on the job, but those other programs have their own definitions and eligibility criteria. Selected Health Conditions and Likelihood of Improvement with Treatment identifies and defines the professionally accepted, standard measurements of outcomes improvement for medical conditions. This report also identifies specific, long-lasting medical conditions for adults in the categories of mental health disorders, cancers, and musculoskeletal disorders. Specifically, these conditions are disabling for a length of time, but typically don't result in permanently disabling limitations; are responsive to treatment; and after a specific length of time of treatment, improve to the point at which the conditions are no longer disabling.

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319

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National Academies Press

Published Date

ISBN 10

0309670950

ISBN 13

9780309670951

The Mental Health and Substance Use Workforce for Older Adults

In Whose Hands?

By: Institute of Medicine,Board on Health Care Services,Committee on the Mental Health Workforce for Geriatric Populations

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The Mental Health and Substance Use Workforce for Older Adults

In Whose Hands?

By: Institute of Medicine,Board on Health Care Services,Committee on the Mental Health Workforce for Geriatric Populations

At least 5.6 million to 8 million-nearly one in five-older adults in America have one or more mental health and substance use conditions, which present unique challenges for their care. With the number of adults age 65 and older projected to soar from 40.3 million in 2010 to 72.1 million by 2030, the aging of America holds profound consequences for the nation. For decades, policymakers have been warned that the nation's health care workforce is ill-equipped to care for a rapidly growing and increasingly diverse population. In the specific disciplines of mental health and substance use, there have been similar warnings about serious workforce shortages, insufficient workforce diversity, and lack of basic competence and core knowledge in key areas. Following its 2008 report highlighting the urgency of expanding and strengthening the geriatric health care workforce, the IOM was asked by the Department of Health and Human Services to undertake a complementary study on the geriatric mental health and substance use workforce. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? assesses the needs of this population and the workforce that serves it. The breadth and magnitude of inadequate workforce training and personnel shortages have grown to such proportions, says the committee, that no single approach, nor a few isolated changes in disparate federal agencies or programs, can adequately address the issue. Overcoming these challenges will require focused and coordinated action by all.

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396

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National Academies Press

Published Date

ISBN 10

0309256658

ISBN 13

9780309256650

Book's by Committee on Treatment of Posttraumatic Stress Disorder

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations

Treatment of Posttraumatic Stress Disorder

Treatment of Posttraumatic Stress Disorder

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations:

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations:

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations

Treatment of Posttraumatic Stress Disorder

Treatment of Posttraumatic Stress Disorder

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder

Returning Home from Iraq and Afghanistan

Returning Home from Iraq and Afghanistan

PTSD Compensation and Military Service

PTSD Compensation and Military Service

Improving the Quality of Health Care for Mental and Substance-Use Conditions

Improving the Quality of Health Care for Mental and Substance-Use Conditions

Provision of Mental Health Counseling Services Under TRICARE

Provision of Mental Health Counseling Services Under TRICARE

Evaluation of the Department of Veterans Affairs Mental Health Services

Evaluation of the Department of Veterans Affairs Mental Health Services

Selected Health Conditions and Likelihood of Improvement with Treatment

Selected Health Conditions and Likelihood of Improvement with Treatment

The Mental Health and Substance Use Workforce for Older Adults

The Mental Health and Substance Use Workforce for Older Adults

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