TY - BOOK AU - Institute of Medicine TI - Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment SN - DO - 10.17226/18724 PY - 2014 UR - https://nap.nationalacademies.org/catalog/18724/treatment-for-posttraumatic-stress-disorder-in-military-and-veteran-populations PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - 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. ER - TY - BOOK AU - Institute of Medicine TI - Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment SN - DO - 10.17226/13364 PY - 2012 UR - https://nap.nationalacademies.org/catalog/13364/treatment-for-posttraumatic-stress-disorder-in-military-and-veteran-populations PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - 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. ER - TY - BOOK AU - Institute of Medicine A2 - Stuart Bondurant A2 - Roberta Wedge TI - Combating Tobacco Use in Military and Veteran Populations SN - DO - 10.17226/12632 PY - 2009 UR - https://nap.nationalacademies.org/catalog/12632/combating-tobacco-use-in-military-and-veteran-populations PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - The health and economic costs of tobacco use in military and veteran populations are high. In 2007, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) requested that the Institute of Medicine (IOM) make recommendations on how to reduce tobacco initiation and encourage cessation in both military and veteran populations. In its 2009 report, Combating Tobacco in Military and Veteran Populations, the authoring committee concludes that to prevent tobacco initiation and encourage cessation, both DoD and VA should implement comprehensive tobacco-control programs. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine A2 - Linda Casola TI - Identifying and Managing Veteran Suicide Risk: Proceedings of a Workshop SN - DO - 10.17226/27195 PY - 2023 UR - https://nap.nationalacademies.org/catalog/27195/identifying-and-managing-veteran-suicide-risk-proceedings-of-a-workshop PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - On May 23, 2023, the National Academies of Sciences, Engineering, and Medicine Board on Behavioral, Cognitive, and Sensory Sciences hosted a workshop titled Current Practices and Challenges for Identifying and Managing Suicide Risk Among Veterans in Non-Department of Veterans Affairs (VA) Healthcare Systems to explore the landscape of veteran health care and suicide risk; consider strategies to identify veterans who receive their health care outside of the VHA; and identify best practices for suicide risk identification and care for VA-purchased care in community and at non-VA entities. This proceedings presents a summary of the presentation and discussion of the workshop. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine A2 - Laura Yoder TI - Community Interventions to Prevent Veteran Suicide: The Role of Social Determinants: Proceedings of a Virtual Symposium SN - DO - 10.17226/26638 PY - 2022 UR - https://nap.nationalacademies.org/catalog/26638/community-interventions-to-prevent-veteran-suicide-the-role-of-social PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine KW - Behavioral and Social Sciences AB - On March 28 and 29, 2022, the Board on Behavioral, Cognitive, and Sensory Sciences at the National Academies of Sciences, Engineering, and Medicine held a virtual symposium entitled Community Interventions to Prevent Veteran Suicide: The Role of Social Determinants to gain a better understanding of social determinants influencing the recent increase in suicide risk and how currently available practice guidelines can inform community-level preventive interventions, particularly those targeting veteran populations. Presenters and participants explored the relevant social, cultural, and economic factors driving changes in suicide risk among veterans and ways that current best practices for suicide prevention and treatment can be applied at the community level. This publication summarizes the presentations and discussion of the symposium. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine TI - Evaluation of the Department of Veterans Affairs Mental Health Services SN - DO - 10.17226/24915 PY - 2018 UR - https://nap.nationalacademies.org/catalog/24915/evaluation-of-the-department-of-veterans-affairs-mental-health-services PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - 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 health–related outcomes—in particular, suicide—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. ER - TY - BOOK TI - PY - UR - PB - The National Academies Press CY - Washington, DC LA - English ER - TY - BOOK AU - Institute of Medicine TI - Epidemiologic Studies of Veterans Exposed to Depleted Uranium: Feasibility and Design Issues SN - DO - 10.17226/12200 PY - 2008 UR - https://nap.nationalacademies.org/catalog/12200/epidemiologic-studies-of-veterans-exposed-to-depleted-uranium-feasibility-and PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine KW - Environment and Environmental Studies AB - Depleted uranium, a component of some weapons systems, has been in use by the U.S. military since the 1991 Gulf War. Military personnel have been exposed to depleted uranium as the result of friendly fire incidents, cleanup and salvage operations, and proximity to burning depleted uranium-containing tanks and ammunition. Under a Congressional mandate, the Department of Defense sought guidance from the Institute of Medicine in evaluating the feasibility and design of an epidemiologic study that would assess health outcomes of exposure to depleted uranium. The study committee examined several options to study health outcomes of depleted uranium exposure in military and veteran populations and concluded that it would be difficult to design a study to comprehensively assess depleted uranium-related health outcomes with currently available data. The committee further concluded that the option most likely to obtain useful information about depleted uranium-related health outcomes would be a prospective cohort study if future military operations involve exposure to depleted uranium. The book contains recommendations aimed at improving future epidemiologic studies and identifying current active-duty military personnel and veterans with potential DU exposure. ER - TY - BOOK TI - PY - UR - PB - The National Academies Press CY - Washington, DC LA - English ER - TY - BOOK AU - Institute of Medicine TI - Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence SN - DO - 10.17226/11955 PY - 2008 UR - https://nap.nationalacademies.org/catalog/11955/treatment-of-posttraumatic-stress-disorder-an-assessment-of-the-evidence PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - 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. ER - TY - BOOK AU - Institute of Medicine A2 - William F. Page TI - Epidemiology in Military and Veteran Populations: Proceedings of the Second Biennial Conference, March 7, 1990 SN - DO - 10.17226/1844 PY - 1991 UR - https://nap.nationalacademies.org/catalog/1844/epidemiology-in-military-and-veteran-populations-proceedings-of-the-second PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - This book contains papers presented at a conference which describe studies of a World War II hepatitis epidemic, a genetic analysis of substance use in veteran twins, hemorrhagic fever with renal syndrome, the psychological effects of military captivity, and dioxin in adipose tissue. Other papers discuss radiation risk studies in military populations and resources for epidemiologic research in Vietnam-era veterans. This volume should be of interest to epidemiologists, medical researchers, and others interested in public health. ER - TY - BOOK AU - Institute of Medicine AU - National Academies of Sciences, Engineering, and Medicine TI - Considerations for Designing an Epidemiologic Study for Multiple Sclerosis and Other Neurologic Disorders in Pre and Post 9/11 Gulf War Veterans SN - DO - 10.17226/21870 PY - 2015 UR - https://nap.nationalacademies.org/catalog/21870/considerations-for-designing-an-epidemiologic-study-for-multiple-sclerosis-and-other-neurologic-disorders-in-pre-and-post-911-gulf-war-veterans PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - In January 2015, the Institute of Medicine conducted a study to determine the incidence and prevalence, as well as the risk of developing multiple sclerosis (MS) and other neurologic diseases as a result of service in the 1990-1991 Persian Gulf and post 9/11 Global Operations theaters. The other neurologic diseases to be considered include: Parkinson’s disease, and brain cancers, as well as central nervous system abnormalities that are difficult to precisely diagnose. This report presents the committee’s data collection and findings. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine A2 - Ayshia Coletrane A2 - Alina B. Baciu TI - Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium–in Brief DO - 10.17226/27010 PY - 2023 UR - https://nap.nationalacademies.org/catalog/27010/exploring-policies-investments-and-case-making-for-longer-healthier-lives-for-all PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - A decade ago, two National Academies reports — U.S. Health in International Perspective: Shorter Lives, Poorer Health and For the Public's Health: Investing in a Healthier Future — made important recommendations regarding the nation's health and the policies and investments that shape it. They also aimed to raise alarm about the public's lack of awareness that the nation's unrivaled spending on health care is not matched by health outcomes and appears to be worsening.Although experts know what factors support longer and healthier lives and close health gaps along lines of race and ethnicity, the nation falls short in implementing policies around those factors or investing in needed system changes and interventions to address them (e.g., equitable education, poverty reduction). The National Academies' Roundtable on Population Health Improvement hosted a March 2023 symposium to explore innovative policies addressing poverty and other socio-economic factors and next steps toward more balanced spending on health.This proceedings document summarizes symposium discussions. ER - TY - BOOK AU - Institute of Medicine A2 - Lyla M. Hernandez A2 - Catharyn T. Liverman A2 - Merwyn R. Greenlick TI - National Center for Military Deployment Health Research SN - DO - 10.17226/9713 PY - 1999 UR - https://nap.nationalacademies.org/catalog/9713/national-center-for-military-deployment-health-research PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Concerns about the health of veterans of recent military conflicts have given rise to broader questions regarding the health consequences of service in any major military engagement. The Veterans Program Enhancement Act of 1998 directed the Secretary of Veterans Affairs to enter into an agreement with the National Academy of Sciences to help develop a plan for establishing' a national center (or centers) for the study of war-related illnesses and postdeployment health issues. In response to this legislation, the Department of Veterans Affairs (VA) asked the Institute of Medicine (IOM) to convene a committee of experts. The charge to the committee was to (1) assist the VA in developing a plan for establishing a national center (or centers) for the study of war-related illnesses and postdeployment health issues, and (2) assess preliminary VA plans and make recommendations regarding such efforts. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine A2 - Anna Nicholson A2 - Samantha N. Schumm A2 - Sarah H. Beachy TI - Training the Regenerative Medicine Workforce for the Future: Proceedings of a Workshop–in Brief DO - 10.17226/27013 PY - 2023 UR - https://nap.nationalacademies.org/catalog/27013/training-the-regenerative-medicine-workforce-for-the-future-proceedings-of PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Rapid growth in the regenerative medicine field is driving increased demand for skilled workers, highlighting the importance of considering how to shape the requisite workforce. The National Academies Forum on Regenerative Medicine hosted a November 2022 workshop to better understand gaps in workforce development and potential solutions, skillsets and other attributes needed for success in regenerative medicine, and incentives and disincentives for expanding the workforce. The workshop was intended to serve as an opportunity to catalyze engagement and development of the regenerative medicine workforce by exploring possibilities to expand participation. This proceedings document summarizes workshop discussions. ER - TY - BOOK AU - Institute of Medicine AU - Institute of Medicine TI - Informing the Future: Critical Issues in Health, Fifth Edition DO - 10.17226/12709 PY - 2009 UR - https://nap.nationalacademies.org/catalog/12709/informing-the-future-critical-issues-in-health-fifth-edition PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Today, perhaps more than ever, health care is a key item on the nation's agenda. Government policy makers, health professionals, scientists, industrial and civic leaders, patient advocates, and private citizens across the social spectrum are focusing on how best to obtain a high-quality health system that is efficient and affordable in its operation and that functions well for everyone. The Institute of Medicine (IOM) regularly considers this challenge from a variety of perspectives. Recent efforts have focused on improving the organization and operation of the nation's largest health agency; working to assess what diagnostic, therapeutic, and preventive services work best; gauging the overall health of the nation's population; and identifying ways to build an even stronger foundation of evidence-based medicine that effectively captures the promise of scientific discovery and technological innovation and enables doctors, nurses, and other health professionals to provide the right care for the right patient at the right time. The body of this book illustrates the work of IOM committees in selected, major areas in recent years, followed by a description of IOM's convening and collaborative activities and fellowship programs. The last section provides a comprehensive bibliography of IOM reports published since 2007. ER - TY - BOOK AU - Institute of Medicine TI - Gulf War and Health: Volume 6: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress SN - DO - 10.17226/11922 PY - 2008 UR - https://nap.nationalacademies.org/catalog/11922/gulf-war-and-health-volume-6-physiologic-psychologic-and-psychosocial PB - The National Academies Press CY - Washington, DC LA - English KW - Conflict and Security Issues KW - Health and Medicine AB - The sixth in a series of congressionally mandated reports on Gulf War veterans' health, this volume evaluates the health effects associated with stress. Since the launch of Operation Desert Storm in 1991, there has been growing concern about the physical and psychological health of Gulf War and other veterans. In the late 1990s, Congress responded by asking the National Academy of Sciences (NAS) to review and evaluate the scientific and medical literature regarding associations between illness and exposure to toxic agents, environmental or wartime hazards, and preventive medicines or vaccines in members of the armed forces who were exposed to such agents. Deployment to a war zone has a profound impact on the lives of troops and on their family members. There are a plethora of stressors associated with deployment, including constant vigilance against unexpected attack, difficulty distinguishing enemy combatants from civilians, concerns about survival, caring for the badly injured, and witnessing the death of a person. Less traumatic but more pervasive stressors include anxiety about home life, such as loss of a job and income, impacts on relationships, and absence from family. The focus of this report, by the Institute of Medicine (IOM) Committee on Gulf War and Health: Physiologic, and Psychosocial Effects of Deployment-Related Stress, is the long-term effects of deployment-related stress. Gulf War and Health: Volume 6. Physiologic, and Psychosocial Effects of Development Related Stress evaluates the scientific literature regarding association between deployment-related stressors and health effects, and provides meaningful recommendations to remedy this problem. ER - TY - BOOK AU - Institute of Medicine TI - Gulf War and Health: Treatment for Chronic Multisymptom Illness SN - DO - 10.17226/13539 PY - 2013 UR - https://nap.nationalacademies.org/catalog/13539/gulf-war-and-health-treatment-for-chronic-multisymptom-illness PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Chronic multisymptom illness (CMI) is a serious condition that imposes an enormous burden of suffering on our nation's veterans. Veterans who have CMI often have physical symptoms (such as fatigue, joint and muscle pain, and gastrointestinal symptoms) and cognitive symptoms (such as memory difficulties). For the purposes of this report, the committee defined CMI as the presence of a spectrum of chronic symptoms experienced for 6 months or longer in at least two of six categories—fatigue, mood, and cognition, musculoskeletal, gastrointestinal, respiratory, and neurologic—that may overlap with but are not fully captured by known syndromes (such as CFS, fibromyalgia, and IBS) or other diagnoses. Despite considerable efforts by researchers in the United States and elsewhere, there is no consensus among physicians, researchers, and others as to the cause of CMI. There is a growing belief that no specific causal factor or agent will be identified. Many thousands of Gulf War veterans1 who have CMI live with sometimes debilitating symptoms and seek an effective way to manage their symptoms. Estimates of the numbers of 1991 Gulf War veterans who have CMI range from 175,000 to 250,000 (about 25-35% of the 1991 Gulf War veteran population), and there is evidence that CMI in 1991 Gulf War veterans may not resolve over time. Preliminary data suggest that CMI is occurring in veterans of the Iraq and Afghanistan wars as well. In addition to summarizing the available scientific and medical literature regarding the best treatments for chronic multisymptom illness among Gulf War veterans, Gulf War and Health: Volume 9: Treatment for Chronic Multisymptom Illness recommends how best to disseminate this information throughout the VA to improve the care and benefits provided to veterans, recommends additional scientific studies and research initiatives to resolve areas of continuing scientific uncertainty and recommends such legislative or administrative action as the IOM deems appropriate in light of the results of its review. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine A2 - David A. Savitz A2 - Anne N. Styka TI - Assessment of Long-Term Health Effects of Antimalarial Drugs When Used for Prophylaxis SN - DO - 10.17226/25688 PY - 2020 UR - https://nap.nationalacademies.org/catalog/25688/assessment-of-long-term-health-effects-of-antimalarial-drugs-when-used-for-prophylaxis PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Among the many who serve in the United States Armed Forces and who are deployed to distant locations around the world, myriad health threats are encountered. In addition to those associated with the disruption of their home life and potential for combat, they may face distinctive disease threats that are specific to the locations to which they are deployed. U.S. forces have been deployed many times over the years to areas in which malaria is endemic, including in parts of Afghanistan and Iraq. Department of Defense (DoD) policy requires that antimalarial drugs be issued and regimens adhered to for deployments to malaria-endemic areas. Policies directing which should be used as first and as second-line agents have evolved over time based on new data regarding adverse events or precautions for specific underlying health conditions, areas of deployment, and other operational factors At the request of the Veterans Administration, Assessment of Long-Term Health Effects of Antimalarial Drugs When Used for Prophylaxis assesses the scientific evidence regarding the potential for long-term health effects resulting from the use of antimalarial drugs that were approved by FDA or used by U.S. service members for malaria prophylaxis, with a focus on mefloquine, tafenoquine, and other antimalarial drugs that have been used by DoD in the past 25 years. This report offers conclusions based on available evidence regarding associations of persistent or latent adverse events. ER - TY - BOOK AU - Institute of Medicine TI - Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families SN - DO - 10.17226/13499 PY - 2013 UR - https://nap.nationalacademies.org/catalog/13499/returning-home-from-iraq-and-afghanistan-assessment-of-readjustment-needs PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - 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. ER -