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Care of Military Service Members, Veterans, and Their Families

Edited by Stephen J. Cozza, M.D., Matthew N. Goldenberg, M.D., and Robert J. Ursano, M.D.

  • ISBN 978-1-58562-531-4
  • Item #62531

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Care of Military Service Members, Veterans, and Their Families serves a critical need, which has been highlighted by recent reported rates of combat-related stress disorders and traumatic brain injury, as well as increases in suicide rates among service members and veterans over the past decade and the distress and challenges faced by their children and families. More than 2.5 million Americans currently serve in the U.S. military on active duty, in the Reserves, or in the National Guard, and more than 20 million civilians are veterans. Although patients are viewed here in the context of military service, they seek health care in military, veteran, and civilian settings, and their mental health concerns are as diverse as those encountered in the civilian population. This book is designed for clinicians in all care settings and provides thorough coverage of U.S. military structures and cultures across the armed services, as well as detailed material on the particular mental health challenges faced by service members and their families.

  • A full overview of the military lifestyle is provided, including the life cycle of the military (recruitment to retirement), service subcultures (Navy, Army, Marines, Air Force, and Reserve and Guard components), challenges of military life for service members and families (moves, deployments, etc.), and military mental health. Material on military culture provides insight for practitioners who may not be familiar with this population.
  • The book focuses on collaborative care, particularly between the military health care system and the Veterans Administration, providing clinicians with strategies to mitigate stigma and other barriers to care through mental health service delivery in primary care settings.
  • The incidence of traumatic brain injury among service members has increased because of the use of improvised explosive devices, and an entire chapter is devoted to diagnosing and treating these injuries as well as educating patients and their families on the condition.
  • The families of service members face significant challenges, and several chapters are devoted to the needs of military children, the families of ill and injured service members and veterans, deployment-related care, and caring for the bereaved.

The book's comprehensive review of resources available to military service members, veterans, and families both ensures high-quality care and reduces the workload for treating physicians. Care of Military Service Members, Veterans, and Their Families is an authoritative and much-needed addition to the mental health literature.


  • Contributors
  • Dedication
  • Preface
  • Acknowledgments
  • PART I: Fundamentals for Treating Military Service Members, Veterans, and Families
  • chapter 1. An Introduction to Military Service
  • chapter 2. Understanding Military Families: Their Characteristics, Strengths, and Challenges
  • chapter 3. Military Children and Programs That Meet Their Needs
  • chapter 4. Military Health Care System and the U.S. Department of Veterans Affairs: An Overview
  • PART II: Military Service–Related Conditions and Interventions
  • chapter 5. Health Consequences of Military Service and Combat
  • chapter 6. Combat Stress Reactions and Psychiatric Disorders After Deployment
  • chapter 7. Substance Use Disorders
  • chapter 8. Care of Combat-Injured Service Members
  • chapter 9. Traumatic Brain Injury
  • chapter 10. Suicidal Thoughts and Behaviors in Military Service Members and Veterans
  • chapter 11. Collaborative Care: Mitigating Stigma and Other Barriers to Care Through Mental Health
  • Service Delivery in Primary Care Settings
  • PART III: Meeting the Needs of Military and Veteran Children and Families
  • chapter 12. Deployment-Related Care for Military Children and Families
  • chapter 13. Children and Families of Ill and Injured Service Members and Veterans
  • chapter 14. Caring for Bereaved Military Family Members
  • chapter 15. Building Resilience in Military Families
  • Index


    Alvi Azad, D.O., M.B.A., Maj USAF MC
    Paul Ban, Ph.D.
    Mia Bartoletti, Ph.D.
    Mark J. Bates, Ph.D.
    William R. Beardslee, M.D.
    David M. Benedek, M.D.
    William L. Brim, Psy.D.
    David E. Cabrera, Ph.D., LTC, USA, MSC
    Jesse Calohan, DNP, PMHNP-BC
    Judith Cohen, M.D.
    Christina Collins, M.S.
    Daniel W. Cox, Ph.D.
    Stephen J. Cozza, M.D.
    Justin Curry, Ph.D.
    Tricia D. Doud, Psy.D.
    Charles Engel, M.D., M.P.H.
    Michael Faran, M.D., Ph.D.
    Matthew N. Goldenberg, M.D.
    Jamie B. Grimes, M.D.
    Derrick Hamaoka, M.D., LtCol, USAF, MC, FS
    Jill Harrington-LaMorie, D.S.W., LCSW
    Patti L. Johnson, Ph.D.
    Larry G. Knauss, Ph.D.
    Gregory A. Leskin, Ph.D.
    Patricia Lester, M.D.
    Travis K. Lunasco, Psy.D., Maj, USAF, BSC
    Shelley MacDermid Wadsworth, Ph.D.
    James E. McCarroll, Ph.D., M.P.H.
    Kimberly S. Meyer, APRN
    DeAnna L. Mori, Ph.D.
    James A. Naifeh, M.D.
    Barbara L. Niles, Ph.D.
    Matthew K. Nock, Ph.D.
    Robert M. Perito Jr., M.D.
    Kris Peterson, M.D.
    Jeffrey E. Rhodes, D.Min.
    Elspeth Cameron Ritchie, M.D., M.P.H.
    William R. Saltzman, Ph.D.
    Patcho Santiago, M.D., M.P.H., CDR, USN, MC
    Paula P. Schnurr, Ph.D.
    Antonia V. Seligowski, B.A.
    Robert J. Ursano, M.D.
    Susan L. Van Ost, Ph.D.
    Harold Wain, Ph.D.
    Doug Zatzick, M.D.

About the Authors

Stephen J. Cozza, M.D., is a professor of psychiatry and associate director of the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Matthew N. Goldenberg, M.D., is a professor of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Robert J. Ursano, M.D., is director of the Center for the Study of Traumatic Stress, a professor of psychiatry and neuroscience, and chair of the Department of Psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Ambitious yet effective, scholarly yet jammed with practical tools, this comprehensive manual is a must-read for anyone providing medical, mental health, or pastoral care for military service members, veterans, or their families. Its chapter authors include top leaders in thought, research, and practice, and their subjects span the entire spectrum of war-related distress and dysfunction, from physical and brain injuries to social, cultural, and spiritual challenges of many kinds. This book will be a valuable reference for many years to come.—William P. Nash, M.D., CAPT, MC, USN (Retired); Boston VA Research Institute; former director, Marine Corps Combat and Operational Stress Control programs

From the values of military culture, to frequent moves and separations, to the stressors of the deployment cycle, Service members and their families face a unique context of influence on their well-being and mental health. This edited text brings together experts in these contextual factors and military mental health to highlight the latest science in ways that provide practical suggestions for the practitioners who serve these individuals. Armed with the knowledge in this book, clinicians will be in a much better position to ask the right questions and provide the most effective resources and support for military families.—Sonja V. Batten, Ph.D., Department of Veterans Affairs Central Office and Uniformed Services University of the Health Sciences

Care of Military Service Members, Veterans, and Their Families is a comprehensive and authoritative guide to understanding and caring for the 1% who have served our nation. Just as important, it addresses the needs of the family members who serve and sacrifice along with them. Nearly half of veterans and the vast majority of their family members will receive their health care from civilian health care providers. Every clinician must be informed and prepared to recognize and address the special challenges faced by service members and their families. At a time when the smallest percentage of Americans in our history serve in our armed forces, it is too easy for their commitment and sacrifice to be unrecognized and misunderstood. As a community, we must commit to raising awareness and providing the informed and competent care that service members and their families have earned. This well written text is a 'must read' for every member of our civilian health care community.—Paula K. Rauch, M.D., Director, Family Program, The Red Sox Foundation and Massachusetts General Hospital Home Base Program

This is a timely and compassionate book. In a succinct but comprehensive manner, the book offers a guide for those providing care to our nation's service members and their families, and a roadmap for understanding military culture and the military healthcare system. The book is a compendium of current knowledge on a range of practice-related issues including psychiatric and substance use disorders, combat injuries and bereavement, suicidal thoughts and behaviors, and deployment-related adjustment challenges.—Abigail Gewirtz, Ph.D., L.P., Associate Professor, Dept. of Family Social Science & Institute of Child Development, University of Minnesota

One out of every five Americans is either a Service Member, a Veteran or a family member yet few clinicians routinely ask patients 'Have you or someone close to you served in the military?' This reflects provider insecurity about what to do with the answer as well as profound reticence inherent in military culture. Cozza, Goldenberg, and Ursano's Care of Military Service Members, Veterans and Their Families, written by experts spanning the military/VA/community continuum of care, provides a field manual for taking, making sense of and acting upon a military history in clinical settings. After more than a decade of war, this book should be required reading for every health care professional in America.—Harold Kudler, M.D., Duke University, Durham, North Carolina

Like a tight rank of polished and well trained troops, Care of Military Service Members, Veterans, and Their Families stands out and stands alone as the go-to, indefatigable resource for all matters military. This definitive, insightful, and timely resource informs and inspires the reader about the phenomena of the military, the military member, and the military family. The authors offer an in-depth, comprehensive, but balanced and compassionate perspective, all the while, honoring those service members who serve and the families through whose tireless support, makes personal sacrifice possible.—Robert L. Koffman, M.D., MPH, Captain, Medical Corps, USN Senior Consultant Behavioral Health, National Intrepid Center of Excellence

Over the past 13 years, more than two million United States military service members have been deployed to combat operations overseas, primarily in Iraq and Afghanistan. In addition to over 6,000 deaths and several thousand combat injuries, several hundred thousand service members (and their families) continue to struggle with deployment-related readjustment and medical and mental health challenges. These recent operations and their sequelae are a reminder of the longstanding issues faced by military service members, veterans, and their families in the United States and worldwide from previous wars, in addition to newly returning veterans who present new challenges in healing the wounds associated with modern warfare. The recent conflicts have also inspired significant efforts to develop new knowledge regarding treatment approaches and new systems of prevention and care delivery that are better suited to effectively support service members and their families. However, more research, infrastructure changes, and resources are required to meet current and future needs.

This book is a timely and an important milestone in the literature on the care of military members, veterans, and their families. Its strength lies in the collective expertise of its authors and editors who have produced unified and clear messages, including the message that the health and well-being of military service members and veterans is closely linked to that of their family members. The body of information about military service, culture, families, and unique challenges (such as frequent separations, relocations and deployments, changes in family roles, stigma, access to care, and injuries and deaths), as well as about the many strengths of service members (such as a sense of pride and belonging, financial stability, role flexibility, family extendedness, and resilience) is a highlight of this book. The Department of Defense and related community-based partners have made impressive progress in research, interventions, and resources in the care of military families (e.g., Child and Youth Services, Family Readiness Groups, Military OneSource, and FOCUS [Families OverComing Under Stress]) that should be widely disseminated. This aspect of this volume will help community providers better understand the needs of their service member and veteran patients and their families and is a considerable contribution to the field.

The most important conceptual contributions of this book are outlined in three fundamental factors: that combat exposure impacts mental and physical health; that deployment/combat experiences of service members are closely linked to the health and well-being of their family members; and that the military is in constant flux due to change and transitioning of members between military and civilian communities. Constant change between military and civilian communities is particularly important among National Guard and Reserve members (who constitute close to one-half of the ready force). Military members/veterans who move to the civilian sector may live in areas where there is inadequate expertise specifically related to the needs of military members/veterans and their families. Thus, the health and care of military members, veterans, and families is a national and community concern, not just a concern for the Department of Defense or the Veterans Health Administration or a few agencies. This volume's conceptualization and focus is an excellent initial blueprint for the community to support these service members and veterans. Other strengths include the organization of this volume into three broad sections: Fundamentals for Treating Military Service Members, Veterans, and Families; Military Service-Related Conditions and Interventions; and Meeting the Needs of Military and Veteran Children and Families. This greatly helps in enhancing conceptual clarity, knowledge, and awareness for community providers with limited exposure to military members/veterans to effectively direct attention and resources toward addressing the needs of military members/veterans and their families. The chapters on Collaborative Care and Suicide in the second section are particularly impressive and informative.

The ambitiousness of this book is commendable, although there were clearly challenges in deciding what to include in this volume. The authors have negotiated this challenge quite well, striking a good balance between in-depth coverage of important topics, including theoretical and recent research advances, while also offering a lot of practical information and resources for providers. Potentially future editions of this book could expand by including an international perspective of the issues facing veterans so that we might benefit from research and practice in other parts of the world. Additional attention to the wide range of Veterans Health Administration services would be important as well (1).

The time of transition between the Department of Defense and civilian life as a veteran is one of opportunity in which returning service members can be screened, provided information about resources, and connected with services. Lack of basic needs, such as housing and employment support, can potentially exacerbate and contribute to readjustment challenges and should be addressed in conjunction with health care needs. Every Veterans Health Administration medical center has a seamless transition team that provides outreach, case management, and coordination services to support returning veterans and their families.

In summary, the experts who contributed to and edited this book have provided an important and much needed contribution to the field of military, veteran, and family care. This book will serve as an excellent resource for a wide range of medical and nonmedical service providers, increasing awareness of resources and new directions in meeting the unique needs of service members, veterans, and their families.—Dr. Brian Martis is Associate Chief and Chief Psychiatrist, Mental Health Service, VA Ann Arbor Healthcare System and Associate Professor of Psychiatry, University of Michigan Medical School

In short this book is a fabulous reference for psychiatrists, psychologists, individual and family therapists, and other clinicians who treat military members, veterans, and their families.—Annette M. Matthews, MD, Journal of Psychiatric Practice Vol. 20, No. 6, 11/12/2014

This is a great resource. The book flows seamlessly from topic to topic, making it easy to learn about the military world in a way that makes sense. I would recommend this to anyone preparing to or currently dealing with service members or veterans.—Sundeep S. Randhawa, M.D., Doody's Book Review

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