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Essays on Veterans

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The Transition of Iraqi and Afghanistan Veterans from Military to Civilian Life and The Challenges of Reconnecting to Society

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Reasons Why Maya Lin's Vietnam Veteran Memorial Won The Competition by The Monument Committee

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Honor to Veterans: a Tribute to Sacrifice and Service

What veterans day means to me, why is veterans day important, my pledge to our veterans: honoring sacrifice and commitment, veterans day: a reflection on honor and sacrifice, why is a veteran a hero, relevant topics.

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148 Veterans Essay Topics & Military Essay Ideas

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  • The U.S. Department of Veteran Affairs
  • The Paralyzed Veterans of America Case Study
  • Gaps in Equity Related to Mental Health Access for Veterans
  • Secrets to Living a Long Life: Narrated by 109 Years Old Veteran
  • Veterans in the Criminal Justice System
  • The Effect of Extra-Curricular Activities on the Academic Performance of Veteran Students
  • Veterans Court Designing: Three Crucial Stages
  • Covid-19 Effects on Treatment-Seeking Veterans The article under analysis is “The impact of the COVID-19 pandemic on treatment-seeking veterans in the UK with preexisting mental health difficulties…” by Hendrikx et al.
  • The Department of Veteran’s Affairs The United States Department of Veterans Affairs is a government agency that serves the needs of veterans and their families.
  • Mental Health Problems Among Veterans Some service members are at a high risk of mental health problems, including anxiety, depression, and post-traumatic stress disorders.
  • Veteran Health Administration Policy Analysis This policy analysis will attempt to identify alternatives to the existing veterans’ healthcare policy and evaluate them in terms of making healthcare more accessible.
  • The Vietnam Veterans Memorial Controversy A deep symbolic image for some and a questionable faceless wall for others – the Vietnam Veterans Memorial has become controversial since the layout was accepted.
  • Readjustment Counseling When Working With Veterans Readjustment counseling of veterans may range from simple guidance in employment or education to more complex instances of offering to counsel for those that experienced trauma.
  • Military Sexual Trauma: PTSD in Female Veterans The following paper suggests a literature review on the subject of post traumatic stress disorder associated with military sexual trauma in female veterans.
  • Veteran Employment: Problems Veterans Face after Returning Home Some veterans may find it difficult to adjust from a highly structured military environment to one where they must independently manage different challenges.
  • Cognitive Behavior Theory for Military Veteran Cognitive behavior theory is based on the idea that an individual is able to alter their behavior by interfering with their thought patterns.
  • Pot for Pain: Medical Marijuana for Veterans This paper argues the idea of medical marijuana for veterans should be encouraged by the US government and society only in cases where patients are under medical supervision.
  • The Main Methods of Conducting a Needs Assessment for Veterans The assigned article is a detailed analysis of the main methods to use in conducting a needs assessment for veterans.
  • Healthcare Marketing Analysis: Veterans Affairs Loma Linda Healthcare System – Diabetes Clinic The focal point of the paper is to evaluate and analyze the marketing strategy of Veterans Affairs (VA) Loma Linda Healthcare System – Diabetic Clinic.
  • Veterans Affairs Healthcare System: Marketing Research and Segmentation The main aim of the paper is to provide an analysis of the market with the Potential patients of Veterans Affairs Healthcare System.
  • Northport Department of Veteran Affairs There are many challenges that the Northport Department of Veteran Affairs (VA) faces. One challenge is that despite the numerous efforts.
  • Veterans’ Transition From the Military to Civilian Life This paper examines the main problems encountered by veterans during the transition from the military to civilian life, for example, social stigmas and drug abuse.
  • The Experience of Substance Abuse in Homeless Veterans The problem of homelessness often affects the most vulnerable segments of society, one of them being veterans. This particular group also experiences significant issues.
  • Health Care Policy for Veterans With Mental Illness The paper discusses The National Research Action Plan as the current policy designed in 2013 to improve the health services for veterans, service members, and their families.
  • Veterans After the Vietnam War The Vietnam War was one of the most important events in the 20th century, which made a considerable impact on the United States and its society.
  • The Problems of Substance Abuse in Homeless Veterans The problem of homelessness often affects the most vulnerable segments of society, among them veterans. This group also experiences excessive alcohol consumption.
  • Statue of Liberty and Vietnam Veterans Memorial The Statue of Liberty and the Vietnam Veterans Memorial have many differences but are not devoid of common messages that underline their significance.
  • Veterans Sacrificed Their Health for Us: Feature Release You wake up every morning and enjoy peaceful skies over your head. However, you do not think of those who provide this peace to you and your family.
  • American Homeless Veterans’ Needs: An Op-Ed Of every 10,000 American veterans, 21 experienced homelessness at the beginning of 2020. This number seems small to common citizens, but it is huge to veterans.
  • Wounded Veterans Do Not Receive Proper Care: News Release American veterans put their lives on the line to save us from enemies. However, when they return to civilian life, they find the transition difficult.
  • The Veteran Homelessness Issue Analysis While the official statistics on homeless veterans are relatively low, the statistics do not include veterans who experience financial struggles.
  • Homeless Veterans: Analysis of Cases To deal with the veterans’ mental health, the government, in conjunction with the healthcare system, is giving therapy to veterans to aid in combat PTSD and depression.
  • Civil War Veterans and Crime in America Podcast by Handley-Cousins and Earls explores how American society and its disabled soldiers coped with the perceptions of service, disability, and government responsibility.
  • Homeless Veterans in Ohio State This reportage will touch upon the problem of the low-income social group of homeless veterans. It is the duty of American society to provide them with the necessary support.
  • Programs and Needs for Homeless Veterans This study explores programs and services offered by different agencies in Houston, TX. The motivation is that veterans who return from missions abroad face numerous challenges.
  • The Veterans’ Needs Assessment The purpose of the veterans’ needs assessment is to address the concerns of military families regarding the assimilation of their family members into civilian life.
  • Prevalence of Combat Post-traumatic Stress Disorder Among Veterans The paper argues combative nature of military personnel contributes to the Post-traumatic Stress disorder experienced by officers.
  • Kolcaba’s Comfort Theory in Regard to Military Veterans With PTSD To sum up, if the experiment proves reliable and valid, the application for those who have PTSD may be improved or facilitated for everyday use.
  • Aggression and Substance Use Involvement Among Veterans: Treatment Strategies 180 veteran participants with a history of reported substance abuse and acts of aggressive behaviour towards partners and non-partners, were assigned to 3 groups and compared.
  • The Opioid Crisis in Veterans: The Delphi Method The Delphi method was used to generate a consensus on the best treatment measures for patients with opioid dependence.
  • The US Veterans: The Problem of Tobacco Smoking Although the rate of tobacco use among American veterans has been declining, those returning from Afghanistan and Iraq are smoking at an alarming rate.
  • Organizational Culture and Diversity: United States Army Veteran Rank For me, the most significant cultural identifiers are the United States Army Veteran rank, Texas as the home residence, and marital status.
  • Reducing the Incidence of Diabetes Mellitus and Diabetic Foot in the Veteran Population The research proposes to use a comprehensive education program to reduce the incidence of diabetes mellitus and diabetic foot in the Veteran population.
  • Effects of Combat on War Veterans In recent years, the long-lasting impacts of military war have become ruinous. In the U.S, cases of suicide in the Army have exceeded the pace of prevention in the general populace.
  • Organizational Quality Improvement Plan: Veterans Affairs Hospitals The role of Managed Care for Veterans Affairs is great due to the improvements implemented to manage the resources in this area properly.
  • Organizational Quality Improvement Plan for Veterans Affairs with Regard to Managed Care in the Community The Veteran Affairs (VA) health care organization deals with veterans that have been brought to the community hospitals.
  • Homeless Veterans Problem Analysis The purpose of this paper is to describe the main causes of this situation, to consider the approaches of different scientists to the problem, and to offer ways to solve it.
  • Social Service Barriers Among Homeless Veterans The goal is to gather information about the conditions under which homeless veterans have to live and define the main problems the chosen group of people faces regularly.
  • Social Policy Analysis: Stopping the Opioid Crisis in Veteran Population The problem of the opioid epidemic in the USA has been at the center of an ongoing discussion for years: veterans are twice as likely to die of opioid overdose as average citizens.
  • Discrimination and Harassment in Hiring a Veteran This paper will examine cases of discrimination and harassment in hiring a veteran, as well as the illegal dismissal of an employee to study the issue of labor relations.
  • Family Support to a Veteran With Depression Even the strongest soldiers become vulnerable to multiple health risks and behavioral changes, and depression is one of the problems military families face.
  • Mental Health Conditions Among Military Veterans The research will analyze whether the incidence of symptoms and their link to individuals’ experiences relate to their military service
  • Psychotherapy Treatment for Combat Veterans Suffering From PTSD The symptoms of PTSD based on combat experience include flashbacks, nightmares, tries to suppress the memories, irritability, hyperarousal, sleep disorders, numbing.
  • Veteran Pharmaceutical: Cause and Effect Due to the economic crunch being experienced all over America and the whole world at large, there has been a decline in profits for Veteran in the last few months.
  • Homeless War Veterans in America The problem of homelessness is increasing in the country. When the financial position of the country worsens, the number of homeless veterans increases.
  • Preferential Treatment of Not and Disabled Veterans Right from the beginning of the 21st century, there have been certain growth in movements promoting disability rights including that of disabled veterans.
  • Veterans Affairs Healthcare System The strengths of the VA healthcare system are focused on providing high-quality and low cost health care, giving an opportunity for patients to admire the benefits of the service.
  • Posttraumatic Stress Disorder in Combat Veterans The aim of this essay is to review briefly yet, comprehensively the recent advances in assessment and treatment of PTSD.
  • Soldier and Veteran Suicide Prevention Hearing People who work in the profession tend to encounter potentially severe stress throughout service, which can lead to mental issues.
  • Transition Experiences of First-Generation Latino Veterans This research project will investigate the lived experiences of first-generation Latino veterans who decided to stay in the US after military service.
  • Veterans’ Civilian Employment Experiences This paper offers a critique of the article based on the criteria established by O’Brien, Harris, Beckman, Reed, and Cook.
  • Senator Rubio on Veteran Urgent Access to Mental Healthcare Act The paper presents a mock interview with Marco Rubio, the U.S. Senator for the state of Florida. The interview refers to the Veteran Urgent Access to Mental Healthcare Act.
  • Opioid Crisis Effects on US Veterans The current research aims at seeking answers to several research questions, concerning the opioids crisis and its effect on veterans, to overcome problems.
  • Veteran Treatment and Florida’s State Strategies The accessibility of health management services has been an issue for numerous vulnerable groups in Miami, FL.
  • Student Veterans’ Experience: Photovoice Methodology Nikhil Tomar’s article discusses an analysis of the lived experience of student veterans that uses photovoice methodology.
  • Latino Veterans’ Transition to Civilian Life in the US It is proposed to investigate the dual transitioning of first-generation Latino migrants who are also former US military members.
  • Posttraumatic Stress Disorder in Military Veterans Both in the military and civilian life, people encounter traumatic occurrences that challenge their perception of the world or themselves.
  • Veteran Legal Institute’s History and Challenges The biggest accomplishment of the Veteran Legal Institute is the creation of a systematic, organized, and self-sustaining network for providing services to veterans.
  • United States Military Veteran Suicides and Causes Researchers have not agreed on the exact causes of suicide cases in the US military. Initially, it was assumed that deployment was a risk factor for this behavior.
  • Student Veterans and Academic Benefits The project reviews the main issues faced by U.S. veterans and shows how the Post-9/11 GI Bill aims to address them by offering financial assistance to student veterans.
  • Challenges in Veteran Mental Health Care The population of veterans in the US experiences a variety of difficulties upon returning to non-military life.
  • Suicide Among Veterans Issue The increase in suicide rates among veterans frightens and reveals the magnitude of mental challenges experienced by the group.
  • Business Plan of Veteran Fitness Center This paper outlines a business proposal for a fitness center in Sharjah for military veterans who do not have health coverage for physical fitness.
  • Co-Curricular Activities in Veteran Student Performance This paper discusses the effects of co-curriculum activities on the achievements of student veterans within the Armed Services Arts Partnership Program (ASAP) program.
  • Exploring and Storming Phase for Veterans with PTSD The paper addresses the peculiarities of the storming stage as applied to the therapeutic group designed for male combat veterans with PTSD.
  • Western Oahu Veterans Center: Budgeting Project Western Oahu Veterans Center is a local branch of the U.S. Department of Veterans Affairs, a government agency that aims to provide various types of aid to veterans of U.S. military service.
  • Veteran Student Performance: Co-Curricular Activities In this memo, the main goal is to choose a non-profit program that can be applied to veteran student performance and propose a program evaluation regarding an appropriate program theory.
  • Student Veterans on Campus: Issues and Benefits The present paper will review the problems faced by student veterans and describe the historical background of the Post-9/11 GI Bill that serves to solve some of these problems.
  • Military Veterans’ Mental Health Needs The topic of the study concerns the mental health needs of veterans who suffer different types of disorders as the result of their military service.
  • Veteran Student Performance and Activities This paper introduces an evaluation design plan to be applied to the Armed Services Arts Partnership program and the analysis of the effects of its co-curricular activities on student veterans.
  • American Veteran Homelessness & Advocacy Practice A study by Lusk, Staudt, and Moya (2012), shows that subjecting these veterans to constant gun violence causes emotional stress to them
  • War Veterans’ Mental Health as Social Issue This work discusses the current issue on the War Veterans returning home and not receiving proper mental health care due to a lack of professionals serving the Armed Forces.
  • Psychotherapy Group of Combat Veterans in Transition The group members are combat veterans with PTSD, and their behavior can be mind-boggling due to the group’s views on mental health and health issues.
  • Psychotherapeutic Intervention: Veterans with PTSD This group manual is written for a brief psychotherapeutic intervention developed for combat veterans with PTSD. The paper includes a description of the intervention, its major phases.
  • Veterans Administration Department: Organization Problems Today, not many organizations are ready to cooperate with veterans and offer them appropriate working and living conditions.
  • Health Policy Action: American Veterans’ Health The US healthcare system is now undergoing certain changes so it can be a perfect time for considerable and timely improvements.
  • Health Advocate: Veterans’ Health Problems The number of veterans in the United States is on the rise. These veterans and their families face a wide range of health problems.
  • Policy Action for Veterans’ Health Care When it comes to providing high-quality and affordable care for the US veterans, it is crucial to consider all aspects of this multi-faceted issue.
  • Veterans’ Post Traumatic Stress Disorder: How a Game Can Help? This research paper will analyze how veterans suffering from PTSD stand to benefit from the game Human versus Zombies by using the skills they learned in war.
  • Cutting Veterans Benefits: Does GI Joe Need Public Assistance
  • Why Corporations Should Not Hire Military Veterans
  • Veterans Administration Health Care in Pittsburgh
  • Chicago Veterans Attitudes and Characteristics
  • How Has the Health of Vietnam Veterans Been Affected by Their Service in Vietnam
  • Homeless Veterans Throughout the City of Los Angeles
  • Race and Older Age Mortality: Evidence From Union Army Veterans
  • Improving Veterans Access for Mental Health Care Using
  • The Mirror Therapy Treatment for the Amputee Veterans
  • Medical Care and Benefits for Wounded Military Veterans
  • The Veterans Affairs Compensation and Pension
  • Military Veterans and Neighborhood Racial Integration: Veterans Affairs Mortgage Lending
  • How Dogs Can Help Veterans Overcome Post-Traumatic Stress Disorder by Chris Collins
  • Immigration Reform, and Better Care for Veterans
  • Strategic Plan for Veterans at Veterans Affairs Facilities
  • Veterans and America’s History and Future
  • Removing Barriers for Mental Health Services for Veterans
  • After the Glory: The Struggles of Black Civil War Veterans
  • Veterans and Depression the Battle to Heal the Wounds of War
  • Increasing the Educational Benefits of War Veterans
  • Body Mass Index and Health Among Union Army Veterans: 1891-1905
  • Establishing the Academic Performance of Veterans in the Us Colleges
  • Individual Counseling Services for War Time Veterans
  • Homeless American Veterans: The Impact of War on Our Veterans
  • Are War Veterans Receiving the Benefits They Deserve
  • Improving Veterans Access for Care
  • Emerging Social Work Crisis for Veterans and Their Families Term Paper
  • Why Colleges Should Help Veterans
  • The Veterans Affairs Neuropathy Scale: A Reliable, Remote Polyneuropathy Exam
  • Declining Wealth and Work Among Male Veterans in the Health and Retirement Study
  • Specialty Courts for Veterans of the US Military
  • The Lost Generation: Hardships of WWI Veterans
  • Disabilities and Mental Illness of Veterans
  • Alcohol Use Among Veterans and the Military
  • America’s Military Veterans and Denying Aid
  • Remember the Forgotten Military Veterans of World War II
  • Injury Careers After Blast Exposure Among Combat Veterans Deployed to Iraq or Afghanistan
  • Traumatic Brain Injury and Firearm Use and Risk of Progressive Supranuclear Palsy Among Veterans
  • The Factors Affecting the Transition of Veterans From War to Civilian Life
  • Government Funding for Veterans With Prosthetics Within
  • Effective Treatment for Veterans With Post-Traumatic Stress Disorder
  • The Washington D.C. Vietnam Veterans Memorial
  • Detonating the Bomb: The Relationship of Post-Traumatic Stress Disorder in Vietnam and Iraq Veterans
  • Iraq and Afghanistan Veterans’ Post-Traumatic Stress Disorder Problems
  • Oxytocin Affects Spontaneous Neural Oscillations in Trauma-Exposed War Veterans
  • Social Chaos and Confusion of Children of Vietnam War Veterans
  • The Controversy and Impact of the Gulf War Syndrome on the Health of the United States Veterans
  • Promoting Social and Community Support for Veterans: Engaging the Public in Veterans’ Issues
  • The Importance of Military Preparedness in Maintaining National Security
  • Improving Mental Health Services for Military Spouses and Family Members
  • The Benefits of Service Dogs for Veterans with Disabilities or PTSD
  • Addressing Post-Traumatic Stress Disorder Among Military Personnel
  • Military Technology: Assessing the Ethical Implications of Advancements in Warfare
  • Military Veterans and Employment: Promoting Transition and Job Opportunities
  • Addressing Homelessness Among Veterans: Strategies for Prevention and Assistance
  • The Role of Military Intervention in Humanitarian Crises
  • Expanding Educational Opportunities and Scholarships for Veterans and Their Families
  • Pros and Cons of Implementing Compulsory Military Service in the US
  • Women in Combat Roles: Examining the Benefits and Challenges

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StudyCorgi. (2021, September 9). 148 Veterans Essay Topics & Military Essay Ideas. https://studycorgi.com/ideas/veterans-essay-topics/

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StudyCorgi . "148 Veterans Essay Topics & Military Essay Ideas." September 9, 2021. https://studycorgi.com/ideas/veterans-essay-topics/.

StudyCorgi . 2021. "148 Veterans Essay Topics & Military Essay Ideas." September 9, 2021. https://studycorgi.com/ideas/veterans-essay-topics/.

These essay examples and topics on Veterans were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

This essay topic collection was updated on January 9, 2024 .

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Key findings about america’s military veterans.

Key findings about America’s military veterans

This Veterans Day, Americans across the country will honor the service and sacrifice of U.S. military veterans. A recent Pew Research Center survey of veterans found that, for many who served in combat, their experiences strengthened them personally but also made the transition to civilian life difficult.

Here are key facts about veterans, drawn from that survey:

Post-9/11 veterans more likely to have been deployed, seen combat, experienced emotional trauma

Post-9/11 veterans are also more likely than their predecessors to bear some of the physical and psychological scars of combat. Roughly half (47%) of post-9/11 veterans say they had emotionally traumatic or distressing experiences related to their military service, compared with one-quarter of pre-9/11 veterans. About a third (35%) of post-9/11 veterans say they sought professional help to deal with those experiences, and a similar share say that – regardless of whether they have sought help – they think they have suffered from post-traumatic stress (PTS).

2 A majority of veterans say they have felt proud of their service since leaving the military. Roughly two-thirds of all veterans (68%) say, in the first few years after leaving the military, they frequently felt proud of their military service. An additional 22% say they sometimes felt proud, and 9% say they seldom or never felt this way. Pre-9/11 veterans are more likely to say they frequently felt proud of their service than are post-9/11 veterans (70% vs. 58%).

Most veterans say they would endorse the military as a career choice. Roughly eight-in-ten (79%) say they would advise a young person close to them to join the military. This includes large majorities of post-9/11 veterans, combat veterans and those who say they had emotionally traumatic experiences in the military.

About half of veterans say the military prepared them well for their transition to civilian life

Veterans who say they have suffered from PTS are much more likely to report experiencing these things than those who did not. Roughly six-in-ten (61%) say they had trouble paying their bills, about four-in-ten (42%) say they had trouble getting medical care for themselves or their families, and a similar share (41%) say they struggled with alcohol or substance abuse.

6 When it comes to employment, a majority of veterans say their military service was useful in giving them the skills and training they needed for a civilian job. About one-in-three veterans (29%) say it was very useful, and another 29% say it was fairly useful. There are significant differences by rank: While 78% of veterans who served as commissioned officers say their military service was useful, smaller shares of those who were noncommissioned officers (59%) or enlisted (54%) say the same.

Most post-9/11 veterans say having served in the military was an advantage when it came to finding their first post-military job – 35% say this helped a lot and 26% say it helped a little. Only about one-in-ten (9%) say having served in the military hurt their ability to get a job. Among veterans who looked for a job after leaving the military, 57% say they found one in less than six months, and an additional 21% say they had a job in less than a year.

About four-in-ten post-9/11 veterans say the government hasn't given them enough help

More broadly, 64% of veterans say the government has given them about as much help as it should have. Three-in-ten say the government has given them too little help. Post-9/11 veterans are more likely than those from previous eras to say the government has given them less help than it should have (43% vs. 27%).

8 Majorities of veterans say the wars in Iraq and Afghanistan were not worth fighting. Additional findings from the same survey show that about two-thirds of veterans (64%) say they think the war in Iraq was not worth fighting considering the costs versus the benefits to the United States, while 33% say it was. Similarly, a majority of veterans (58%) say the war in Afghanistan was not worth fighting. About four-in-ten (38%) say it was worth fighting.

Views differ significantly by party. Republican and Republican-leaning veterans are much more likely than veterans who identify with or lean toward the Democratic Party to say the wars in Iraq and Afghanistan were worth fighting: 45% of Republican veterans vs. 15% of Democratic veterans say the war in Iraq was worth fighting, while 46% of Republican veterans and 26% of Democratic veterans say the same about Afghanistan.

Views on U.S. military engagement in Syria are also more negative than positive. Among veterans, 42% say the campaign in Syria has been worth it, while 55% say it has not. (The survey was conducted entirely before President Donald Trump’s decision to remove U.S. troops from parts of Syria.)

9 A majority of Americans and veterans associate discipline and patriotism with veterans. Majorities among veterans (61%) and the general public (64%) say most Americans look up to people who have served in the military. And veterans see themselves as more disciplined (84%) and patriotic (71%) than those who have not served in the military. Most Americans agree with this: 67% of all adults say being disciplined better describes veterans than non-veterans, and 59% say the same about being patriotic.

About a third or more among veterans and the public say veterans are more hard-working than those who haven’t served. Still, when it comes to things like being tolerant and open to all groups, the public is less likely to see this as a trait associated with military service than veterans are themselves.

Veterans and the public associate being disciplined and patriotic with those who have served in the military

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The changing face of America’s veteran population

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About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

Essays on Veterans

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Why do we celebrate veterans day: honoring those who serve.

Why do we celebrate Veterans Day? Veterans Day, observed on November 11th each year, is a significant holiday in the United States that honors the brave men and women who have served in the armed forces. This day holds deep meaning and serves as a...

My Pledge to Our Veterans: Honoring Sacrifice and Service

Our veterans have dedicated their lives to protecting our nation, defending our freedoms, and upholding the values we hold dear. As a citizen, I am deeply grateful for their sacrifices and unwavering commitment. This essay serves as a reflection of my pledge to our veterans,...

The Issue Of Veteran Homelessness

Every day, men and women join the U.S. military forces to fight for our freedom and the availability to live our lives in the manner that we do. But, what happens when they retire from the military and return back to civilian life? The assumption...

  • Homelessness

Homelessness In California: Homeless Veterans

California has always had a problem with homelessness, during the 1980’s the number of homeless spiked throughout the United States with the estimated amount being over 200,000. Since then the number of homeless people has increased with California being the one with the largest amount...

Johnny Got His Gun by Dalton Trumbo: The Negative Consequences of War

In Dalton Trumbo’s Johnny Got His Gun, the casualties of World War One are expressed through the eyes of the main character, Joe Bonham. Joe loses his arms, legs, eyes, nose, mouth, and ears after a bomb drops on him while fighting in a war...

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The Nature of Trench Warfare and Its Different Forms

Trench Warfare – a phrase of perhaps the most notable feature of The Great War – has been etched on our consciousness through various accounts and photographs. At its core, trench warfare was seen as merely a short-term expedient, as within all previous conflicts “normality”...

  • Trench Warfare

Taxi Driver Movie Analysis: 1970's America Through the Eyes of a Broken Vietnam Veteran

In Martin Scorsese’s Taxi Driver, Robert De Niro plays Travis Bickle, a mentally disturbed Vietnam Veteran likely suffering from PTSD who spend his nights patrolling the crime ridden streets of a decaying New York City in his yellow cab. The film is commonly read as...

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Account of Courage of the Elderly Veterans

The word courage can be defined in many ways by many people. To some it means fearless or brave. How I define courage is someone who will risk their life for the people they love. To take action in a heartbeat without even thinking about...

The Aftermath and Care for Veterans in The Things They Carried 

Tim O'Brein's The Things They Carried, is an assortment of short stories that retell the experiences of the men of the Vietnam War's Alpha Company. O'Brien's understanding as an infantryman from 1968 to 1970 has given him an insiders viewpoint to the war, and it...

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Repaying the Vietnam War Veterans for Their Bravery

A relative who served in the Vietnam War informed me, “when [his brothers] got out of the service, PTSD (Post-Traumatic Stress) wasn’t even recognized at that time. And my brother had issues, and they locked him up in the institution,” (Hooyman). In Vietnam, PTSD, a...

Growing Homelessness and PTSD Among the Veteran Population

The United States has an ongoing homelessness problem that seems to be unfixable. Thousands of people without homes, jobs, and adequate health care. Among them is a percentage of homeless veterans who have fought for our freedoms and have sacrificed their lives for our country....

  • Mental Illness

Mistreatment and Negligence of Hmong and American Veterans

On their fiftieth anniversary, my grandmother clutched onto my grandfather’s arm tightly, giving him a sad, teary-eyed smile as memories of the past five decades flashed before her eyes, “Peb kam tsim nyob ntev” (Let’s live for a long time). My grandfather, Cha S. Yang,...

  • Grandfather

The Issue of Poverty Among Aging Veterans

Becoming a veteran means having to put your life on the line for your country. It comes with sacrifice, fear, and unfortunately sometimes mental illness. Many of the veterans returning home are faced with the harsh reality of unemployment due to many factors, including mental...

Vietnam War and Its Impact on Veterans

Vietnam fought for independence and won in 1954. The country then split into North Vietnam and South Vietnam and war broke out. The Vietnam War happened in November of 1955, and lasted a total of twenty years, ending in April of 1975. North Vietnam was...

  • Vietnam War

The Vatour A Worldwide Government Scientific Research Institute

The Department of Veterans Affairs (VA) is a cabinet-level department of the U. S. federal government that provides a service and benefit system with a primary focus on supporting and caring for all U. S. veterans (Top 25, 2018). The VA ranks in at #17...

  • Role of Government

Analysis Of A Therapeutic Approach For Treating A Veteran

Introduction The basis of this paper is to examine five episodes of tape reviews and analyze a therapeutic approach for treating a veteran coming back from Iraq 10 months ago, in which he appears to be suffering from PTSD and Alcohol Use Disorder (AUD). Episode...

Best topics on Veterans

1. Why Do We Celebrate Veterans Day: Honoring Those Who Serve

2. My Pledge to Our Veterans: Honoring Sacrifice and Service

3. The Issue Of Veteran Homelessness

4. Homelessness In California: Homeless Veterans

5. Johnny Got His Gun by Dalton Trumbo: The Negative Consequences of War

6. The Nature of Trench Warfare and Its Different Forms

7. Taxi Driver Movie Analysis: 1970’s America Through the Eyes of a Broken Vietnam Veteran

8. Account of Courage of the Elderly Veterans

9. The Aftermath and Care for Veterans in The Things They Carried 

10. Repaying the Vietnam War Veterans for Their Bravery

11. Growing Homelessness and PTSD Among the Veteran Population

12. Mistreatment and Negligence of Hmong and American Veterans

13. The Issue of Poverty Among Aging Veterans

14. Vietnam War and Its Impact on Veterans

15. The Vatour A Worldwide Government Scientific Research Institute

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The Historical Lens into the Past

The epochs of World War I and II unfurl a vast spectrum of  veterans essay ideas . The narratives are endless, from exploring the trench warfare horrors to the heroism displayed on Normandy’s beaches. Additionally, investigating the evolution of veterans’ affairs during these wars reveals intriguing societal shifts. The accounts of soldiers from varying ranks and regions open up a broad palette of perspectives, shedding light on the monumental global events that shaped history and the lives therein.

The Cold War Chapters in Veterans Essay Ideas

Transitioning into the Cold War, the Korean and Vietnam Wars present a contrasting picture of veterans’ experiences. Comparing the veterans’ reception to their coping mechanisms amidst the harsh war realities unveils profound essays awaiting exploration. The political undercurrents and differing public opinion of these wars offer ample material for discussion and analysis, accentuating the often complex and nuanced nature of  veterans day essay ideas  surrounding these historical events.

Persian Gulf to Present in Modern Warfare

The modern-day warfare veterans from the Persian Gulf, Iraq, and Afghanistan conflicts bring forth a blend of technological advancements and evolving military strategies. Delving into how these aspects impacted the veterans’ roles, mental health, and societal reintegration paves the way for engaging  veterans day essay ideas . A closer look can examine the shift in warfare tactics, the role of international politics, and the human cost involved, providing a broader canvas for understanding the contemporary military landscape.

The Humanitarian Stories of Valor and Sacrifice Veterans Essay Ideas 

Immersing in personal narratives of veterans unveils the human aspect of wars. Capturing their bravery, the camaraderie among comrades, and the bittersweet homecomings in your essays will surely resonate with readers. Moreover, the resilience displayed by veterans as they transition back into civilian life brings forth compelling  veterans essay ideas . Through their stories, the universal themes of perseverance, brotherhood, and the essence of humanity amidst the scourges of war are beautifully highlighted.

Families of Veterans 

The war’s impact extends beyond the battlefield, reaching the veterans’ families. Exploring the challenges and triumphs of military families provides a fresh perspective on  veterans essay ideas . The strong support systems, the emotional toll, and the unsung sacrifices these families make are a testament to the ripple effects of military service. Through exploring these narratives, students can gain a more comprehensive understanding of the far-reaching impacts of war.

Veterans and Post-Traumatic Stress Disorder 

Investigating the haunting specter of Post-Traumatic Stress Disorder (PTSD) among veterans and how societies have evolved in recognizing and addressing this issue can form the crux of an insightful essay. The continual struggle for proper mental health resources and societal support underscores the need for proactive measures. By exploring the intertwining paths of healing and advocacy, students can formulate well-rounded  veterans essay ideas  that encompass personal and systemic dimensions.

Veterans Essay Ideas that delve into the valorous deeds, sacrifice, and the life beyond the battlefield of our heroic soldiers.

Veterans Essay Ideas and Sociopolitical Lens 

Tracing the historical and current policies impacting veterans reveals the intricacies of their post-war life. Advocating for policy enhancements forms a persuasive essay angle. Understanding the legislative frameworks, the gaps in the system, and the efforts made by various stakeholders for veterans’ welfare presents an enriching avenue for discussion and argumentation within  veterans day essay ideas , offering students a chance to evaluate the existing infrastructures.

Veterans in Politics 

The political arena often sees veterans stepping in to effect change. Evaluating how their military experiences shape their political ideologies and actions offers a compelling  veterans day essay ideas  springboard. Their unique insights, shaped by real-world battlefields, often translate into a distinct stance on various socio-political issues. These nuances, when explored, can lead to compelling essays that unravel the impact of military service on political engagement and leadership.

Veterans and Activities

Veterans transitioning into activists paint a narrative of change and hope. Delving into their advocacy on various societal issues presents a rich vein of essay ideas. Their unique perspective often propels them towards addressing broader societal challenges, reflecting a transition from military service to civic engagement. Analyzing the issues championed by veteran activists presents an engaging exploration into how military experiences can foster a deep-seated desire for societal betterment.

Imaginative Veterans Essay Ideas

Crafting fictional narratives rooted in historical accuracies allows a creative exploration of  veterans essay ideas . Embark on a journey that interweaves factual events with imaginative storytelling. These creative renditions can breathe life into historical events, making the stories of veterans more relatable and engaging for readers. Moreover, it encourages a deeper reflection on the human experiences embedded within the tapestry of war and peace.

Crafting poetic essays that pay homage to veterans creates a riveting narrative. Let the rhythm of your words echo the veterans’ courage and resilience. The essence of heroism, sacrifice, and the emotional spectrum of military service can be beautifully captured through poetic expression. This form of expression can evoke a deeper emotional connection, fostering a nuanced appreciation for the sacrifices made by veterans.

Artistic Interpretations

Employing art and imagery in essays provides a visually engaging narrative, portraying veterans’ experiences and sacrifices in a captivating manner. Visual storytelling through drawings, paintings, or digital media, coupled with well-crafted prose, can create a powerful impact. Through this creative blend,  veterans day essay ideas  can come alive, illuminating the multifaceted experiences of veterans in a visually evocative manner.

Researching Veterans Day Essay Ideas 

Delving into primary sources like interviews, letters, and diaries can breathe life into your essays, providing authentic glimpses into the veterans’ world. These first-hand accounts offer an unfiltered view into the lives of veterans, providing a solid foundation for your essays. Furthermore, they allow for a more personalized exploration of  veterans essay ideas , enriching the narratives with authenticity and emotional depth.

Harnessing books, documentaries, and scholarly articles as secondary sources enriches your essays, grounding them in well-researched facts. These resources provide a structured framework, broadening your understanding and interpretation of various events and individual experiences. With a range of secondary sources, the breadth and depth of  veterans essay ideas  can significantly be enhanced, leading to more insightful and well-rounded essays.

Online Archives

Navigating online archives unveils a treasure trove of information, aiding in crafting well-informed  veterans essay ideas . Online archives provide a wealth of resources, including photographs, letters, and official documents that add a rich layer of context to your essays. These digital repositories allow you to traverse history from your fingertips, offering a wide array of material to make your  veterans essay ideas  more compelling and well-rounded.

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The veteran’s essay ideas  for your next academic project presents an enriching endeavor filled with explorations of history, humanity, and heroism. It beckons a deep dive into personal narratives, socio-political aspects, creative expressions, and meticulous research. The plethora of ideas discussed here will equip you with a robust framework, propelling you towards crafting essays that resonate with the readers and pay a heartfelt tribute to the brave veterans.

Your venture into this topic is not just an academic exercise but a tribute to the real-life heroes whose narratives are matched in the annals of history. With another task at Writing Metier , we have a team of expert military and history writers who will help you to achieve the best results in writing military essays. Order an essay on any topic from Writing Metier today.

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Laura Orta is an avid author on Writing Metier's blog. Before embarking on her writing career, she practiced media law in one of the local media. Aside from writing, she works as a private tutor to help students with their academic needs. Laura and her husband share their home near the ocean in northern Portugal with two extraordinary boys and a lifetime collection of books.

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Veterans Day Essay Sample

Veterans Day is a federal holiday in the United States, where we pay tribute to people who have served in our armed forces. On November 11th, Americans all across the country will take time out of their day to thank and recognize veterans. This day was established after World War I and formally introduced by Congress on June 4th, 1919 under President Woodrow Wilson’s proclamation. It is said that this date was chosen because it is also when an armistice agreement between Germany and the Allied powers went into effect ending what would be known as The Great War.

Essay Sample On Veterans Day

  • Thesis Statement – Veterans Day Essay
  • Introduction – Veterans Day Essay
  • Main Body – Veterans Day Essay
  • Conclusion – Veterans Day Essay
Thesis Statement – Veterans Day Essay Veterans Day is a special national holiday in the United States. Veterans Day has been officially celebrated on November 11 since it was set by President Dwight D. Eisenhower in 1954, but its roots go back to World War I and earlier. Introduction – Veterans Day Essay Veterans Day is celebrated by the different countries at a different time in the year as they get freedom from the countries which hegemony them. For example, the United States of America celebrates its Veterans Day on the 11th  of November when it gets complete freedom from the colonial rule of the British. The purpose behind this celebration is to pay a huge tribute to those who were the dominating figures of this battle of freedom in the past. The entire journey that is traveled by these freedom fighters by giving their lives to the country is commemorated with the utmost respect by the citizens of America and the President of the  United States of America say few words to the public regarding this freedom and contribution of the soldiers in saving the prestige of the country by setting it free from the bars of foreigners. cta_essay-sample_1 Main Body – Veterans Day Essay Veterans Day is really an astounding Day for any nation and cannot be forgotten at any level. Everyone who knows about the compromises and struggles of the freedom fighters can never involve in the pursuit of insulting any veteran leader. Even respect and tribute are given to them with the utmost feelings from the depth of heart. Although Veterans Days are very much significant in every country but still many ill practices are being committed on this day by the people like they are fighting with each other on small issues even on the holy veteran day. Every freedom fighter dream is country as a symbol of harmony and liberty which mostly laid the foundation of the USA. But this harmony is sometimes destroyed by many ill forces in the society which must be stopped doing this to manage the peace in the country. Situations like civil war should not arise in any country which can ruin the harmony between the citizens thereby putting all the development on the Back foot. As long as we do not understand the importance of the role that our ancestors played to set us free from the manacles of other people from different countries we cannot retain unity and harmony in the country. It is our responsibility to be the citizens of a nation to manage peace on every level whether it is economic peace, social peace, or political peace because these political, social, and economic upheavals can eat the real meaning of freedom. It is very crucial to understand the sacrifices of those who left their families to fight for freedom manage to fight in the war with an empty stomach and lost their lives at the end as well so that we can get freedom. The freedom that a country gets from its freedom fighter’s help cannot be wasted on the grounds of some personal small issues. We should try to manage out quarrels with mutual understanding rather than putting them in seriousness causing a lack of stability and anarchy in the country. This is not sufficient to talks about the achievements of the veterans only but at the same time, it is also crucial to talk about the success of our present generation in maintaining that freedom as well. Playing loud music and shouting the slogans of freedom is not merely the solution to see the grave reality of lacking harmony and deal with it. Some serious steps need to be taken on an urgent basis by the people and government of the country to develop the nations towards betterment and contribute to the development of this world as well. We must remember on the grounds of the practical reality that what were the reasons which push us towards the colonial rule and how can we avoid such things to happen again. Buy Customized Essay on Veterans Day At Cheapest Price Order Now Conclusion – Veterans Day Essay If we discuss the conclusion of the essay in a real sense then we will come to know that Veterans Day needs to be celebrated differently. Apart from doing celebrations by loud music and such other things we need to understand the importance of maintaining peace for a long period of time so that no external power can ever target our unity or take its benefit to rule over us again in the way as happened in the earlier case. We should not sound fool when celebrating our veteran’s day and must come up with new techniques that can enhance the bond between people of a nation to great extent. The three pillars which were the base of USA formation are Liberty, equality, and fraternity must not be forgotten by the countrymen at any cost. This is how peace and freedom can be managed for the long term without any external threat. Intellectual people of the different societies must ponder on this issue that how we can celebrate Veterans Day in a real sense by paying the actual tribute to our veterans by marinating the freedom they gave to us. Hire USA Experts for Veterans Day Essay Order Now

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Essays on Veterans

It is hard to admit it, but nowadays younger generation tends to forget about what veterans had to endure and their service to their respective nations, so being tasked with writing a veterans essay is a good way to make sure that veterans’ legacy is remembered. When we say veterans, we usually refer to war veterans – people who went through the war and participated in combat. Writing essays on veterans is a common assignment, which in no way undermines its significance. It is important to show our respect and express gratitude to people who fought for their country and fulfilled their duty to their land. When writing veterans essays, it's important to learn about a public attitude towards veterans in your country and check out governmental programs that help veterans – some samples of essays below delve into these topics. Take a look at veterans essay samples we provided and see if any of the ideas are relevant to your essay.

I have visited the Hampton VA Medical Center, which offers healthcare services to the veterans and their families. The medical center is located among the largest military retiree communities in the US. It offers a comprehensive primary and specialty care in medicine, surgery, and psychiatry to the people in southeastern...

Words: 1429

The combat and war experiences have a way of impacting people’s lives (Abbassi and Aslinia 45). There are those who are affected directly and others indirectly by the war. For the soldiers who participate actively in the combat face numerous challenges as loss of loved ones, colleagues, torture, and dreadful...

Words: 2944

Service Dogs and Their Benefits to Disabled Veterans Service dogs are trained on performing tasks that are aimed to benefit a person who has had a psychological and physical disability. They are mainly used for Post-Traumatic Stress Disorders therapy and have been proven to be of great benefit to the veterans....

Words: 1101

Service dogs are trained on performing tasks to for the benefit of a person who has a psychological, and physical disability. They are mainly used for PTSD therapy and have been proven to be of great benefit to the veterans. Post-Traumatic Stress Disorder (PTSD) are reactions that are brought by...

Words: 1022

As a Marine Corps veteran with a long career, one of my responsibilities at work involves becoming a psychologist, which has always intrigued me. I frequently come across individuals who need my assistance, and those in particular require psychological support. I've been making an effort to assist in the best...

The Veterans Health Administration's failure and caregiving problem The Veterans Health Administration's failure and caregiving problem may not be managed by raising the quantity of resources or by hiring more nurses and doctors. (Powell-Young, Baker & Hogan, 2006). Even though more resources might seem essential and crucial, they cannot provide...

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Clinical Manager Position (Veteran Affairs Department) Director of aid and veterans' affairs Job purpose: Monitor and supervise all tasks in the veterans affairs office, ensuring full compliance with state standards and legislation. Duties: It should be emphasized that the jobs listed here are the very minimum; extra responsibilities may be assigned. Creating and implementing...

Words: 1069

According to the University of Maryland University College's mission statement, its principal objective is to help veterans, working individuals, and their families who reside throughout the United States of America as well as throughout the rest of the world [1]. The university must create a distinctive and highly accessible computer...

Words: 4704

The federal state department of veteran affairs is a cabinet-level federal entity that provides comprehensive healthcare services to all qualifying military veterans at veteran medical centers and outpatient clinics. The clinics are spread across the country to help in the delivery of health care to veterans. It also gives special...

Words: 4231

The Things They Carried The book was written to remind readers of the preparedness of American soldiers during the Vietnam War. In this book, O’Brien discusses the types of items that soldiers led by First Lieutenant Jimmy Cross carried during the conflict. It describes the soldiers’ experiences on their way to...

Words: 2530

The management of the Veteran Affairs hospital failed to provide an enabling environment for the doctors and nurses to carry out their everyday responsibilities. It took the intervention of doctors who took matters into their own hands to save patients who had been admitted to the hospital. A successful firm must...

Words: 2416

The Americans with Disabilities Act The Americans with Disabilities Act has made significant progress in ensuring that people with a variety of disabilities, such as veterans, expectant moms, the blind, and even older workers, are accommodated. This bill's goal is to prevent these people from suffering unnecessary hardship while working (Oppix...

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Veteran and military mental health issues.

Catarina Inoue ; Evan Shawler ; Christopher H. Jordan ; Marlyn J. Moore ; Christopher A. Jackson .

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  • Continuing Education Activity

As the United States endures 2 decades of ongoing warfare, both the media and individuals with personal military connections have raised significant public and professional concerns about the mental health of veterans and service members. This activity reviews the assessment and management of mental health disorders affecting military personnel and veterans, mainly focusing on screening for military service and identifying risk factors unique to these populations. The subject matter delves into various prominent disorders, including posttraumatic stress disorder (PTSD), depression, suicidality, and substance use, providing insights into the crucial role of the interprofessional team in enhancing care for patients facing these challenges.

  • Describe the epidemiology and diagnostic features of PTSD and other mental health disorders prevalent in military populations.
  • Screen for mental health issues among active-duty personnel and veterans using appropriate assessment tools and techniques.
  • Identify risk factors unique to military personnel and veterans that may contribute to developing mental health disorders.
  • Summarize the management options offered by the interprofessional team to enhance the comprehensive care of military personnel and veterans facing mental health challenges.
  • Introduction

As the United States endures 2 decades of ongoing warfare, both the media and individuals with personal military connections have raised significant public and professional concerns about the mental health of veterans and service members. [1] The most widely publicized mental health challenges veterans and service members encounter are posttraumatic stress disorder (PTSD) and depression. Research indicates that approximately 14% to 16% of the US service members deployed to Afghanistan and Iraq have been affected by PTSD or depression. [2] [3]  Although these mental health concerns are prominently highlighted, it is crucial to acknowledge that other issues, such as suicide, traumatic brain injury (TBI), substance use disorder (SUD), and interpersonal violence, can be equally detrimental in this population. These challenges can have far-reaching consequences, significantly affecting service members and their families. [4]  Although combat and deployments are known to be associated with increased risks for these mental health conditions, general military service can also give rise to challenges. The presentation of these mental health concerns may not follow a specific timeline. However, there are particularly stressful periods for individuals and families, especially during periods of close proximity to combat or when transitioning from active military service. [5]

As per the recent reports released by the U.S. Census Bureau, there are around 18 million veterans and 2.1 million active-duty and reserve service members (https://www.census.gov/newsroom/press-releases/2020/veterans-report.html) in the United States. Since September 11, 2001, the deployment of 2.8 million active-duty American military personnel to Iraq, Afghanistan, and other areas has resulted in a growing number of combat veterans within the population. Over 6% of the US population has served or is currently serving in the military. Notably, this number also does not consider the significant number of relatives affected by military service. [6]  Healthcare providers can enhance the quality of care they provide patients and potentially save their lives by comprehending the relationship between military service and a patient's physical and mental well-being.

Posttraumatic Stress Disorder

PTSD was officially recognized and codified in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-3 in 1980, driven partly by the sociopolitical aftermath of the Vietnam War. However, its manifestations have been alluded to in different forms throughout history, with terms such as "soldier's heart" during the Civil War, "shell shock" in the First World War, and "combat fatigue" around the Vietnam War. The DSM criteria have remained primarily unchanged until the latest update in 2013. However, there is still ongoing debate regarding its classification. As a complex and constantly evolving combination of biological, psychological, and social factors, studying and diagnosing PTSD poses significant challenges. Although PTSD is commonly studied in individuals who have experienced war or natural disasters, its impact is not limited to specific groups and can affect anyone, including children. This disorder is commonly observed in individuals who have survived violent events such as assaults, disasters, terror attacks, and war. However, even secondhand exposure, such as learning that a close friend or family member experienced a violent threat or accident, can also lead to PTSD. Although many individuals may experience transient numbness or heightened emotions, nightmares, anxiety, and hypervigilance after exposure to trauma, these symptoms resolve within 1 month. However, in approximately 10% to 20% of cases, the symptoms may worsen and become persistent, causing significant impairment. [7]  PTSD is characterized by intrusive thoughts, flashbacks, and nightmares related to past trauma, leading to avoidance of reminders, hypervigilance, and sleep difficulties. Frequently, reliving the event can evoke a sense of threat as intense as the original trauma. PTSD symptoms can significantly disrupt interpersonal and occupational functioning and manifest in various ways, affecting psychological, emotional, physical, behavioral, and cognitive aspects. Military personnel can be exposed to an array of potentially traumatizing experiences. Military personnel deployed during wartime may witness severe injuries or violent deaths, which can occur suddenly and unpredictably. These events can impact not only intended targets but also others in the vicinity. Active-duty military members risk non-military-related traumas beyond the challenging deployment environment, such as interpersonal violence and physical or sexual abuse. Symptoms related to these traumas may be exacerbated in the deployed environment.

As a result of 2 decades of ongoing warfare in Afghanistan, there is a rising population of veterans seeking mental health treatment, with a significant portion having experienced combat and deployment. While caring for veterans, healthcare providers should consider the physical injuries they may have sustained during their service period and the emotional wounds they may be experiencing presently, including PTSD, acute stress disorder, and depression. Although depression does not garner the same level of attention as PTSD, this condition remains a prevalent mental health condition in the military. Research shows that depression is responsible for up to 9% of all ambulatory military health network appointments. The military environment can serve as a catalyst for the development and progression of depression. Factors such as separation from loved ones and support systems, the stressors of combat, and the experience of witnessing oneself and others in harm's way all contribute to an increased risk of depression in both active-duty and veteran populations. After deployments to Iraq or Afghanistan, military medical facilities witnessed an increase in diagnosed depression cases, rising from a baseline of 11.4% of members to a rate of 15%. [8] Given this high prevalence, providers have a critical responsibility to identify active-duty and veteran patients who may be suffering from depression. 

Major depression manifests through various symptoms, encompassing a depressed mood, loss of interest in activities, insomnia, weight loss or gain, psychomotor retardation, fatigue, reduced ability to concentrate, feelings of worthlessness, and thoughts of suicide. These symptoms dramatically affect the patient's capacity to operate at full potential. Although the array of symptoms is evident on paper, a patient's presentation can often be ambiguous. Surprisingly, it has been found that half of all patients suffering from depression are not correctly diagnosed by their general practitioner. [9]  Therefore, accurate screening, identifying, and following through with appropriate treatments is paramount, especially in the active-duty and veteran military population.

Veteran suicide rates have reached their highest level in recorded history, with over 6000 veterans dying by suicide annually. [10] Furthermore, overall suicide rates within the United States have increased by 30% between 1999 and 2016. According to a study conducted in 27 US states, it was estimated that veterans committed 17.8% of reported suicide cases. [11] Data published by the U.S. Department of Veterans Affairs (VA) in 2016 indicated that veteran suicide rates were 1.5 times higher than those of non-veterans. [12]  Research has shown that veterans are at significantly increased risk of suicide during their first year after leaving the military service. [13] [14]  In 2018, a Presidential Executive Order was signed to improve suicide prevention services for veterans during their transition to civilian life. Moreover, the Department of Defense (DoD) and VA have placed significant emphasis on suicide prevention due to the observed rise in fatal and non-fatal suicide attempts during the wars in Iraq and Afghanistan. [14]  The suicide rates in the U.S. Armed Forces doubled between 2000 and 2012. However, since then, there has not been any significant change in the annual rate of suicides, with approximately 19.74 deaths per 100,000 service members occurring each year. [15] [16]

Substance Use Disorders

Despite receiving public attention over recent decades, SUDs, including alcohol use, continue to be a problem among veterans and military members. In these populations, alcohol use is prevalent and is frequently utilized for stress relief and socializing. SUDs are associated with significant adverse medical, psychiatric, interpersonal, and occupational outcomes. A study conducted on military personnel revealed that approximately 30% of completed suicides and around 20% of deaths resulting from high-risk behavior were attributed to alcohol or drug use. In the general US population, alcohol is the fourth leading cause of preventable death, contributing to 31% of driving-related fatalities involving alcohol intoxication. [17]  According to the DSM-5, SUD is a group of behaviors that involve compulsive drug-seeking, which includes impaired control over drug use, dysfunctional social functioning due to drug use, and physiological changes resulting from drug consumption. Addiction represents the most severe stage of SUD in individuals, characterized by a loss of self-control that leads to compulsive drug-seeking behavior despite a desire to quit. [18] Substances encompass various categories, including legal drugs such as caffeine, nicotine, and alcohol; prescription medications such as opioids, sedatives or hypnotics, and stimulants; and illicit drugs such as marijuana, cocaine, methamphetamines, heroin, hallucinogens, and inhalants.

The etiology of PTSD remains partially understood, with progress in neuroscience and genetics contributing to its characterization as a biological, not solely a psychological, disease. Current research points to factors such as fear conditioning, neural circuit dysregulation, memory reconsolidation, genetics, and epigenetics, particularly the impact of childhood trauma on hypothalamic-pituitary-adrenal (HPA) axis regulation. Similar to other complex disorders, PTSD is believed to be highly polygenic and influenced by external exposures. [19]  Studies using magnetic resonance imaging have revealed differences in the size of anatomical structures in the brain, as well as variations in the levels of neurotransmitters when compared to healthy individuals. [20] [21]  Although the relationship between genetic predisposition, phenotype, and symptoms is still unclear, several measurable biomarkers can be utilized to determine the cause of PTSD. In addition, individual factors such as past trauma, belief systems, support networks, and other protective or exacerbating factors can impact one another in various ways. [7]

Several risk factors exist before, during, and after experiencing traumatic events. Childhood trauma places individuals at a higher risk of subsequently developing PTSD. [22] [23]  According to the VA, the most significant predictors of post-deployment PTSD are frequency and intensity of combat exposure. A comprehensive study conducted by the military of the United Kingdom revealed that several factors increase the risk of PTSD, which include lower rank, being unmarried, having a low level of education, being close to the enemy, experiencing low morale or unit social support, and being unaware of common psychological reactions upon returning home. [24] Similarly, a meta-analysis has identified certain risk factors that may already be present before experiencing trauma, which include being female, belonging to an ethnic minority group, having a lower level of education, being enlisted, serving in the Army, having a combat specialty, having undergone multiple deployments for longer periods, experiencing prior adverse life events, and having pre-existing psychological problems. The traumatic events involved in warfare include ongoing exposure to combat, firing a weapon, witnessing another getting wounded or killed, and other concurrent deployment-related stressors. Following the event, the absence of post-deployment psychological and social support increased the risk of PTSD. [25] [26]

Although there has been extensive research on major depressive disorder (MDD) for many years, its cause remains unclear. However, there is a definite connection between MDD and neurobiology. There is an ongoing debate about which markers and processes are the most critical in developing MDD in individuals. Patients with MDD have exhibited heightened responses to cortisol in the HPA axis, potentially explaining how stress becomes a significant risk factor. [27] Another hypothesis focuses on the neurocircuitry of emotions, specifically examining how dysfunction in the cortico-striato-pallido-thalamic circuitry could contribute to the emotional experiences of MDD. Neurophysiological imaging provides evidence supporting the hypothesis of neurocircuitry dysfunction. [28] As part of the neurocircuitry, neurotransmitters, such as serotonin, have been shown to regulate emotions in MDD. Studies have also explored how serotonin contributes to the neuroplasticity of the human brain. [29] As research progresses, more definitive answers about the etiology of MDD are expected to emerge.

Numerous factors can predispose individuals to MDD. Some common risk factors in the general population include unemployment, financial stress, female gender, and a personal or parental history of mental health concerns.

The military presents the following additional risk factors that providers should consider: [30]

  • Uniformed code of military justice actions (legal concerns)
  • Rank and promotion complications
  • Deployments
  • Combat exposure
  • Physical fitness concerns
  • Permanent changes of station (frequent relocations)
  • Command or leadership discord

Researchers studied veterans and service members to identify factors associated with military operations and suicide. The purpose was to pinpoint individuals who are vulnerable and provide them with early intervention. While serving in the military, members may encounter various stressors, including disciplinary actions, physical problems such as pain, conflicts with leadership, transferring duty stations, reductions in rank, or administrative separation from service. [31] [32]  Additional risks include comorbid conditions such as PTSD, MDD, and TBI. Military personnel may also experience worsened conditions due to exposure to combat, combat-related injuries, and access to lethal weapons. [33] [34] [15]  Although young men between the ages of 17 and 19 have the highest risk of suicide, research has shown that female veterans have up to 2.5 times greater risk compared to non-veteran counterparts. [35] [36]  Veterans who served in the Marines and Army and those with shorter service commitments of less than 2 years are at an increased risk. [35] Among veterans, those exposed to death or killing have notable associations with suicide, particularly if they witnessed another service member killed or wounded or if they were nearly killed or injured themselves in combat. [10] [37] For veterans, the risk of suicide is time-dependent, with the greatest danger occurring within 6 to 12 months after military separation. [5] [13]  

Military cohorts may have protective factors, including a sense of duty toward others, a sense of belonging or identity, strong interpersonal bonds, and access to healthcare. In particular, service members with family and friends to discuss their deployments with are unlikely to experience suicidal ideation (SI). Another protective factor is having a sense of purpose or control over one's life. [38]  Certain demographic features such as higher education, marriage, higher income, and active religious practice may also serve as buffers against suicidality. [32] [39] [40]  

Neuroscientific advances have significantly enhanced our understanding of drug effects on the brain. Addiction is now recognized as a chronic relapsing disorder triggered by repeat drug exposure in individuals vulnerable to genetics, development, and psychosocial conditions. These conditions encompass accessibility, drug use norms, and social support (or lack thereof). Drug use is fueled by the pharmacological effects of a substance, which result in rewarding experiences. The reinforcing effects of drug use heavily rely on dopamine signaling at the nucleus accumbens in the brain. Chronic exposure leads to glutamate-mediated adaptations in the striato-thalamo-cortical pathway, particularly in the prefrontal cortex at the orbitofrontal and anterior cingulate cortices. Another identified pathway is the limbic system, which comprises the amygdala and hippocampus. Drugs induce alterations in the extended amygdala, resulting in negative baseline emotional states that the drug temporarily alleviates. Counterintuitively, drug use is associated with blunted dopamine release in brain reward regions. The experience of using drugs does not live up to the anticipated reward triggered by conditioning to drug cues. Consequently, the substance leads to an increased drive to seek drugs and a reduced ability to regulate oneself due to its impact on the prefrontal cortex. [41]

Significant genetic influences contribute to SUDs, primarily within the dopaminergic system, affecting neurotransmission pathways. Other genetic influence points involve drug processing and metabolism. Research on gene-environment interactions has provided insights into potential mechanisms of how the environment influences substance use biology. Through epigenetic studies, changes in gene expression induced by drugs have been discovered that vary depending on the stage of the disease, specifically comparing substance initiation to chronic use. Ongoing studies investigate epigenetic mechanisms associated with substance use, such as methylation and microRNA. [18]

  • Epidemiology

Posttraumatic Stress Disorder

The prevalence of combat-induced PTSD is between 2% and 17% in US veterans. However, in other Western countries, during the same conflicts, the prevalence is lower and with a narrower range. This variability is multifactorial and influenced by the uniqueness of each theater of war and changes in diagnostic criteria over time. Each war exposes participants to varying intensities of combat and occurs in different sociopolitical contexts, from which troops are deployed and eventually returned. There are also notable differences between studies, including variations in sampling methods and measurement strategies, such as self-report versus structured interviews. In addition, delays in assessment after combat exposure, sometimes spanning years or decades, may potentially increase recall bias. The multifactorial, inherently subjective, and evolving nature of PTSD presents significant challenges in accurately defining its epidemiology. [26]

Major depression is the most prevalent mood disorder in the general population, with an estimated lifetime prevalence of up to 21%. For females, the lifetime incidence ranges as high as 25%, whereas for males, it can be as high as 12%. [42] [43] [44] Given the high lifetime incidence rates in the general population, the VA and DoD are keenly interested in examining those figures for active-duty members and veterans. Gulf War veterans have a risk of suffering from depression that is more than twice that of the general population. [45] Military members deployed to different conflict zones away from their families and exposed to various stressors face an increased risk of experiencing MDD. According to a report in 2012, 15% of troops who returned from deployment had symptoms consistent with MDD. [43]  

Before 2000, the suicide rates among military personnel and veterans were lower than those among civilians. However, these rates have increased over the last 20 years and exceed the current civilian rate. Within the military service, there are around 19.74 deaths per 100,000 members. In the US population, the age-adjusted suicide rate for individuals between the ages of 17 and 59 is approximately 16.8 per 100,000 members. [15]  Approximately 21 veterans die by suicide daily, representing an incidence 50% higher than the general US adult population. [46] [47] Concerns have escalated among female veterans as they have a 50% higher incidence of suicide than their civilian counterparts. [47]  

Changes to DSM criteria and the fact that not all veterans receive care through the VA make it challenging to determine the true prevalence of SUDs in veterans. As with the general population, SUDs are more common in male veterans (10.5% alcohol and 4.8% other drugs) than female veterans (4.8% alcohol and 2.4% other drugs). Unmarried individuals and veterans younger than 25 are at a higher risk for SUD. [48] This is believed to be due to military-specific experiences, such as deployment, combat, and the challenges of reintegrating into civilian life after separation. Mental health issues such as PTSD and depression are also associated with these stressors and may contribute to the development of SUD. Some individuals enlist in the military to leave their difficult home situations behind. A history of childhood trauma can also increase the likelihood of SUDs among veterans. [49]

In military and veteran populations, alcohol use disorders (AUDs) are the most prevalent SUDs. Based on the findings of the National Survey on Drug Use and Health, veterans were found to have a higher likelihood of consuming alcohol than non-veterans (56.6% compared to 50.8%, respectively) and engaging in heavy alcohol use (7.5% compared to 6.5%, respectively) over 1 month. Military personnel who experienced more combat had higher rates of problematic drinking than their peers. Specifically, they had heavy drinking rates of 26.8% and binge drinking rates of 54.8%, whereas other military personnel had rates of 17% and 45%, respectively. Smoking is more common in veterans than age-matched civilians (27% versus 21%, respectively). The rate of opioid prescriptions for veterans has been on the rise. Between 2001 and 2009, the percentage of VA opioid prescriptions increased from 17% to 24%. A diagnosis of PTSD (17.8%) or other mental health disorders (11.7%) significantly increased the likelihood of receiving an opioid prescription compared to those without such diagnoses (6.5%). Illicit drug use among veterans is comparable to civilians, with approximately 4% reported over 1 month. Among veterans, marijuana is the most commonly used illicit drug, with a usage rate of 3.5% over 1 month. This percentage is higher than the usage rate of other illegal drugs, which is only 1.7%. Notably, cannabis use disorders increased by 50% between 2002 and 2009 among VA patients. [17]

  • History and Physical

Assessment of Military Service

The foundations of a comprehensive mental health assessment remain unchanged when discussing mental health concerns with a service member or veteran. However, a challenge practitioners encounter is identifying military service in a patient's history. [50] Studies have shown that veterans and their families do not disclose their military service history to healthcare providers. Therefore, it is crucial to conduct screenings in community-based or private clinics. Evidence suggests that fewer than half of primary care and mental healthcare providers screen for services, indicating that veterans are unlikely to undergo screening for military-related conditions, such as PTSD. In 2013, the American Academy of Nursing initiated a national campaign in support of veterans and their families. [51] The "Have You Ever Served in the Military?" initiative emphasized the significance of screening for military service during initial encounters.

Some additional recommended questions that might be helpful to ask include:

  • "Have you or someone close to you ever served in the military?"
  • "During which period did you serve?"
  • "In which branch of the military did you serve?"
  • "What were your responsibilities during your time in the military?"
  • "Did you serve in a hostile or combat area?"
  • "Have you encountered enemy fire, witnessed combat, or experienced casualties?"
  • "Did you sustain any wounds or injuries or require hospitalization during service?"
  • "Were you exposed to noise, chemicals, gases, demolition of munitions, pesticides, or any other potentially hazardous substances during your service?"
  • "Have you ever used the VA for healthcare services?"

Certain individuals may encounter challenges in recognizing or openly discussing the emotional or cognitive aspects of PTSD. They may instead manifest symptoms through complaints related to physiological issues such as insomnia. Nevertheless, the diagnosis will rely on the patient's history, as not all patients exhibit physical exam findings. There are 8 criteria and 2 specifiers for PTSD, which should be comprehensively explored through history-taking, and they are outlined in the "Evaluation" section below. 

The foundation of a significant depression diagnosis lies in a patient's medical history. This should encompass a comprehensive course of the present illness, current symptoms and timeline, prior history of similar symptoms, factors that alleviate or aggravate the condition, the impact on daily living, and a thorough medical history, including psychiatric history. In addition, other categories to explore comprise family mental health history and social history, encompassing job or relationship stressors, as well as potential support structures. The same comprehensive medical history is essential to gather for military personnel and veterans. [52] Providers should contemplate incorporating screening for current or prior military service into patient questionnaires, as military members may not readily disclose their current or previous occupation. [51]

A pertinent physical exam is crucial for any encounter and holds equal importance for patients presenting with mental health concerns. For instance, patients experiencing depression often exhibit physical manifestations such as fatigue, insomnia, or weight changes. Examining any potential organic etiologies is crucial when dealing with individuals exhibiting somatic symptoms. Furthermore, healthcare providers must be open and willing to adjust their diagnosis if new symptoms or a more fitting cause becomes apparent.

To assess suicide risk in patients, it is crucial to obtain comprehensive medical histories. Specifically, clinicians should identify exacerbating and protective factors, focusing on modifiable intervention targets. [53] During the encounter, providers must inquire about prior suicide attempts, current and previous suicidal thoughts, and self-destructive behavior. Signs indicative of impending suicide include individuals making plans or taking actions toward self-harm, such as acquiring a firearm, drafting a will, bidding farewell to loved ones, giving away personal belongings, or leaving a suicide note. Individuals at risk might frequently mention thoughts of suicide or death, and they may seek assistance from their primary care provider or visit an emergency department in the weeks leading up to a suicide attempt. During these encounters, as patients might describe vague health problems, providers must be mindful and conduct a comprehensive mental health assessment beyond the chief complaint. Some at-risk individuals may have a family history of suicide, and the risk can be elevated around the anniversary of their family member’s death. Although the risk of suicide can escalate due to stress from sudden adverse life events, specific enduring issues, including disability, chronic pain, and mental health disorders, can also contribute to an increased risk of suicide. During a mental health assessment, clinicians need to pay attention to a patient's appearance, influence, judgment, and insight, and they should also check for signs of self-harm, such as rope burns or scars on the arms, wrists, or neck, on the patient's body. During the examination, healthcare providers may observe that some patients appear messy, unkempt, or unclean, experience anxiety or depression, or exhibit a lack of emotional responsiveness. Healthcare providers should be able to assess the patient's ability to manage stress and determine whether they have any difficulties while making decisions.  

SUDs are characterized by a pattern of drug use leading to distress or impairment. Diagnosis requires at least 2 of 11 symptoms, categorized under 4 groups, including impaired control, social impairment, risky use, and pharmacological effects, which occur over 1 year. Detailed criteria are mentioned in the "Evaluation" section below. After a positive screening (as discussed below), providers should conduct a comprehensive patient history and examination, including medical and mental health comorbidities, family history, and social background. Presentations may vary depending on the substance(s) an individual uses, and they may have incentives to minimize them. A mental status exam (MSE) may be helpful in the presence of psychiatric symptoms. This assesses appearance, behavior, speech, motor activity, mood and affect, perceptions, thought processes, thought content (including SI or homicidal ideation, hallucinations, and delusions), insight, judgment, and cognitive function. Providers should be alerted to the possibility of an SUD when abnormalities are detected, as they are frequently associated with such conditions. In SUDs, the MSE is typically normal, except during periods of intoxication, withdrawal, active psychosis, or cognitive impairment resulting from chronic substance use. In addition to the history and physical examination, a multidimensional assessment is essential to develop personalized and comprehensive management plans.

Consider the following factors during the assessment:

  • The pattern of substance use, treatment history, intoxication or withdrawal potential, and continued use potential
  • Emotional, behavioral, and cognitive conditions
  • Living environment
  • Employment and finances
  • Criminal justice involvement
  • Readiness to change

Alcohol consumption can have an impact on several organ systems and can lead to changes in behavior, mental health, and social interactions, even if these effects are not directly caused by drinking. Examples of these manifestations include:

  • Injuries from accidents or assault
  • Anxiety, depression, and suicidality
  • Concurrent use of other drugs
  • Central or peripheral neurological symptoms
  • Sleep disturbances
  • Hypertension
  • Cardiac disease
  • Electrolyte disturbances
  • Gastrointestinal symptoms, including reflux (GERD)
  • Bone marrow suppression
  • Macrocytosis
  • Malignancies, including oropharyngeal and gastrointestinal issues

Other substances are also associated with impaired function in nearly every organ system. Diseases may develop from direct toxicity, the method of administration, and high-risk behaviors related to use, such as needle sharing, unprotected sex, or poor hygiene. Possible physical indicators of SUDs include:

  • Unintended weight loss or gain
  • Scars (track marks) in injection drug use
  • Nasal mucosal atrophy or septum perforation in inhalational use
  • unsteady gait, slurred speech, pupil changes, conjunctival injection, eye tearing, rhinorrhea, odd behavior, tachycardia, and diaphoresis in cases of acute intoxication or withdrawal
  • Signs of medical comorbidities resulting from drug use (refer to the “Complications” section below)

Screening: PTSD screening serves multiple functions, with the primary one being risk assessment. This aids in identifying patients at risk of developing PTSD who may not fully meet the criteria yet, enabling them to be directed toward early prevention efforts. Screening also allows for earlier detection of acute and subthreshold cases or uncovering unidentified chronic PTSD patients. [54] The Primary Care PTSD Screen for DSM-5, or PC-PTSD-5, is a 5-item questionnaire with yes/no response options specifically designed for administration by primary care providers. This screening exhibits excellent diagnostic accuracy when compared to semistructured neuropsychiatric interviews. According to the study participants, a cutoff score of 3 or more was deemed the most sensitive, easily comprehensible, and bearable. [55] The PTSD Checklist for DSM-5, or PCL-5, is a 20-item self-administered questionnaire, which is helpful for screening, provisionally diagnosing, and monitoring symptom changes before and after the treatment. [56] The questionnaire employs a rating scale from 0 to 4 for each question; respondents can complete it in 5 to 10 minutes. Studies on veterans revealed probable PTSD can be indicated by a cutoff score ranging between 31 and 33 out of 80. [57] The questions are grouped into clusters corresponding to each DSM-5 diagnostic criteria B through E, allowing them to be used for provisional diagnosis in patients who meet the diagnostic rules. [56]

Diagnosis: The DSM-5 diagnostic criteria for adults are listed below.

  • Exposure to death (actual or threatened), serious injury, or sexual violence by:
  • Experiencing it directly
  • Witnessing it as it occurred to others firsthand
  • Learning that it happened to a close friend or family member
  • Experiencing repeated or extreme exposures to unpleasant details of the event(s), such as police officers repeatedly finding human remains.

Notably, exposure through media is not applicable unless it occurred as part of the patient's work.

  • Intrusion symptoms (more than 1):
  • Distressing memories of the event which are invasive, involuntary, and recurring
  • Recurrent nightmares about the event
  • Dissociative reactions, such as flashbacks, where the patient feels like they are reliving the event
  • Prolonged or intense psychological distress triggered by cues resembling some aspect of the event
  • Significant physiological responses to cues resembling some aspect of the event
  • Avoidance of trauma-related stimuli, as displayed by 1 or both of the following:
  • Efforts to avoid distressing memories or thoughts related to the trauma
  • Steps to avoid people, locations, topics, or situations that trigger painful recollections of the event
  • Negative mood or cognitions surrounding the event, as displayed by 2 or more of the following criteria:
  • Inability to recall significant features of the event, excluding other etiologies such as TBI and intoxication
  • Exaggerated or persistent pessimistic beliefs about the self, others, or the world
  • Distorted ideas about the cause or consequences of the trauma
  • Persistently negative emotional state, characterized by feelings of fear, anger, or shame
  • Detachment from others
  • Inability to experience positive emotions such as satisfaction, love, and happiness
  • Altered arousal and reactivity, as indicated by 2 or more of the following criteria: 
  • Irritability, despite minimal provocation, often expressed as angry outbursts or physical or verbal aggression
  • Engaging in recklessness or self-destructive behavior
  • Experiencing hypervigilance
  • Demonstrating a marked startle response
  • Difficulties in concentration
  • Experiencing insomnia
  • Criteria B through E must be present for longer than 1 month.
  • These symptoms must cause considerable distress or impairment in social, occupational, or other important functional domains. 
  • Substances or other medical conditions cannot cause symptoms.

The ideal approach to diagnosing PTSD involves utilizing multimethod assessments, considering the limitations of individual tools. This typically includes employing a self-report symptom severity measure, such as the PCL-5, in conjunction with a semistructured clinical interview. Research on biological measurements, such as heart rate, sweat gland activity, and neuroimaging, is still ongoing, and these methods are not yet widely accessible. Semistructured clinical interviews, most commonly the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), are conducted by trained interviewers, considered the "gold standard" for diagnosis. The advantage of using a semistructured clinical interview lies in its ability to clarify responses, thereby reducing the likelihood of misinterpretation of questions, exaggeration or minimization of symptoms, and inconsistent responses. [54] CAPS-5 consists of 30 items and can diagnose symptoms within the last week, month, or over a lifetime while also quantifying severity based on symptom frequency and intensity. The reliability and validity of CAPS-5 are well-established, even among veterans. [58]

Screening: Major depression is a common condition in the general population, but it is often underdiagnosed. To address this issue, the United States Preventive Services Task Force recommends depression screening for individuals 12 or older. As the youngest service members are 18 years old, it is highly recommended to conduct depression screening in the military community. At present, the Public Health Questionnaire (PHQ) instrument utilizes a 2-item (PHQ-2) and a 9-item (PHQ-9) to identify patients who require additional investigation efficiently. Even though PHQ-2 and PHQ-9 have similar sensitivities, the specificity of PHQ-9 is higher, with a range of 91% to 94% compared to PHQ-2's range of 78% to 92%. [59] Other screening tools for the primary care setting include the Beck Depression Inventory for Primary Care (BDI-PC) and the 5-item World Health Organization Well-Being Index (WHO-5). The BDI-PC has been utilized in over 7000 studies. The BDI-II, a variation of the BDI, is helpful as a severity scale. In the scoring of the BDI-II, a score of 0 to 13 indicates minimal depression, 14 to 19 corresponds to mild depression, 20 to 28 indicates moderate depression, and 29 to 63 indicates severe depression. [43]

Although still valuable as a severity tool, the BDI-II was found to have high sensitivity (over 90%) but lower specificity (59%) compared to the PHQ tools. [60] Screening does entail some risk of false positives, leading to unnecessary treatments. As an alternative, the WHO-5 is another user-friendly, self-administered questionnaire with a sensitivity of 86% and specificity of 81%. [61] These screening tests are crucial in initiating engagement with the depressed patient. Studies have demonstrated that implementing screening tools, such as patient questionnaires and early feedback, reduced the risk of persistent depression (summary relative risk of 0.87 with a 95% CI of 0.79 to 0.95). [52] Considering the prevalence of depression in the active-duty and veteran populations, screening tools are strongly recommended, as they have been shown to increase detection rates from 10% to 47%. [52] Early detection of the disorder has proven effective in reducing the duration of symptoms in our military population.

Diagnosis: According to DSM-5 criteria, MDD can be diagnosed when a patient experiences 1 or more MDDs. An MDD episode is defined as having 5 symptoms present during 2 weeks and a change in baseline functional status. In addition, a depressed mood or a loss of interest or pleasure in activities is necessary to confirm the diagnosis. The complete list of symptoms to consider in MDD includes depressed mood, loss of interest or pleasure in activities, weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feeling worthless or excessive guilt, decreased concentration, and thoughts of death or suicide. Physiological causes, SUDs, and other psychiatric disorders must be excluded.

Laboratory and imaging: Evaluations should be conducted at the provider's discretion, guided by the patient's history and physical examination. Common laboratories drawn in the initial evaluation of a patient with depressive symptoms include:

  • Complete blood count
  • Serum chemistry panel
  • Thyroid-stimulating hormone
  • Rapid plasma reagin
  • Human chorionic gonadotropin
  • Urine toxicology screen

Imaging is generally reserved for cases with suspicion of structural brain diseases. Further laboratory and neuroimaging evaluations should be guided by the findings in the patient's history and physical examination.

Although numerous resources are available for identifying those at elevated risk of suicide, most of these screening tools are ineffective in accurately predicting risks. These tools often exhibit low positive predictive values and high false-negative and high false-positive rates. [62]  Nonetheless, these questions have been proven not to increase a patient’s SI or behavior; therefore, screening ultimately presents no significant harm. [63] In contrast, patients may not feel comfortable admitting to suicidality without prompting and, therefore, may appreciate the opportunity to discuss their thoughts. Screening may also assist clinicians in directing additional investigations into patients' behavioral health. One widely accepted method is Item 9 on the PHQ-9 tool, which identifies suicide risk as mentioned below.

Item 9: "Over the past 2 weeks, how often have you been bothered by thoughts that you would be better off dead or of hurting yourself in some way?"

Responses: "Not at all," "Several days," "More than half the days," or "Nearly every day." [64]

Generally, patients who respond with high levels of SI are associated with a higher risk of death by suicide. [34] However, a significant constraint of the PHQ-9 is its many false-negative rates. One study found that 71.6% of suicidal deaths were by patients who endorsed "not at all" on Item 9. [62]  Although it has some limitations, the VA still suggests using it as a screening tool for suicidality with a weak recommendation.

Clinicians should conduct suicide risk evaluations on patients who screen positive. There are multiple analytic models and assessment tools for determining the future risks of suicide. These methods aid in standardizing the information gathered during the patient interviews. [65] However, as no single approach is sufficient to evaluate suicidal risks in these cases, healthcare providers should also conduct clinical interviews with patients to assess the risk instead of relying solely on assessment tools. [66]  

Screening: Although several alcohol-use screenings have been validated, none offer advantages over the single-item screening, Alcohol Use Disorders Identification Test (AUDIT), or AUDIT-Concise Test (AUDIT-C) in primary care settings. The AUDIT is the most effective test for identifying individuals who engage in high-risk, hazardous, or harmful drinking. Depending on the score cutoffs and criteria used, the test showed a sensitivity range of 51% to 97% and a specificity range of 78% to 96%. On the other hand, the CAGE questions were found to be most helpful in predicting AUDs and dependence. The questions showed a sensitivity range of 43% to 94% and a specificity range of 70% to 97%. Some single-item screening questions have been suggested. An example of a validated question is, “On a single occasion within the last 3 months, have you had 5 or more drinks containing alcohol?” An affirmative response for identifying problematic alcohol use in individuals was 62% sensitive and 93% specific.

The brevity, memorability, and lack of scoring make this screening easy to use. AUDIT is the most widely validated AUD screening, containing 10 items that take 2 to 3 minutes to complete. The screening questions assess the frequency, quantity, drinking occasions, impairment, dependence, harmful use, and concern from others. Scores range from 0 to 40, with a score of 8 or higher indicative of unhealthy alcohol use. The AUDIT-C questionnaire consists of 3 questions related to excessive alcohol consumption. Although it was proven primarily in male veterans, other studies validating its use in various populations are now being published. Studies show a sensitivity range of 54% to 98% and a specificity range of 57% to 93% for varying definitions of "heavy drinking." [67]

The AUDIT-C questions are as follows:

  • How often do you have a beverage containing alcohol?
  • How many drinks containing alcohol do you consume on a typical drinking day?
  • How often do you have 6 (male) or 4 (female) or more drinks on a single occasion?

CAGE is a series of 4 questions designed to detect SUDs and dependence according to DSM-4 criteria. This set of questionnaires is most helpful in identifying patients with severe problems when responses to 2 or more questions are positive. If the responses are positive, they should be supplemented with quantity and frequency questions. [67]  

The CAGE questions are as follows: 

  • Have you ever felt the need to C ut down on drinking?
  • Have others A nnoyed you by criticizing your drinking?
  • Have you ever felt G uilty about your drinking?
  • Have you ever needed to drink first thing in the morning to steady your nerves or get rid of a hangover ( E ye-opener)?

Diagnosis: DSM-5 diagnostic criteria are listed below. The presence of 2 to 3 symptoms is considered a mild SUD, 4 to 5 symptoms indicate a moderate SUD, and 6 or more symptoms indicate a severe SUD. [18]

Impaired control:

  • Taking the substance in more significant amounts or over a more extended period than intended.
  • Unsuccessful attempts or a persistent desire to reduce or regulate the use.
  • Spending excess time to obtain, use, or recover from the effects of the substance.
  • Experiencing solid cravings, intense desire, or urges for the substance can occur at any time.

Social impairment:

  • Inability to manage roles at work, school, or home due to significant interference caused by substance use.
  • Continued use of a substance despite experiencing recurrent social or interpersonal consequences exacerbated by the use.
  • Reduced participation in significant social, recreational, or occupational activities due to substance use.
  • Substance use in physically hazardous locations.
  • Continued substance use despite being aware of persistent physical or psychological consequences worsened by the drug.

Pharmacology:

  • Increasing the dosages of the substance to achieve the desired effect (tolerance).
  • Developing withdrawal symptoms, such as physical or psychological symptoms, which occur when substance intake is discontinued, or its dosage is decreased.

Laboratory tests such as urine, blood, sweat, hair, saliva, and breath tests exist for alcohol and other drugs, and they can detect recent substance use. Patients are more likely to answer use-related questions honestly when an objective measure has been accepted. However, as objective measures cannot quantify the frequency or dose(s) used, they may be of higher utility in monitoring abstinence. Basic screening tests exist for amphetamines, cocaine, cannabis, certain opioids, and phencyclidine. Except in emergencies, permission for obtaining a drug screening must be obtained. Although several alcohol-specific laboratory tests exist, they frequently require heavy and repetitive alcohol consumption to detect abnormalities, and most of them have varying degrees of non-specificity.

In the absence of other explanations, the following can aid in the assessment of unhealthy alcohol use:

  • Liver function tests: Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) can show elevated levels of hepatotoxicity. An AST:ALT ratio of 2:1 is more specific to alcohol-induced liver disease. In addition, bilirubin levels may be elevated, and albumin levels may be decreased in cases of liver damage.
  • Complete blood count: Chronic alcohol use can lead to anemia, pancytopenia, and macrocytosis, which can be observed in the blood count.
  • Gamma-glutamyltransferase (GGT): GGT is another enzyme primarily found in the liver and is often elevated with excessive alcohol use. The reference range for GGT is typically 8-40 units/L in females and 9-50 units/L in males.

The following tests are less commonly accessible:

  • Carbohydrate-deficient transferrin (CDT): A CDT level higher than 1.6% indicates prolonged and excessive alcohol consumption within approximately 2 weeks. Although CDT is fairly specific, it may also show elevated levels in some rare liver diseases, such as primary biliary cirrhosis.
  • Phosphatidylethanol (PEth): PEth is s specific marker for alcohol use. A value greater than 20 ng/dL is associated with moderate alcohol consumption, whereas values greater than 200 ng/dL typically indicate heavy alcohol consumption. [68] [67]
  • Treatment / Management

Treatment for PTSD should be initiated soon after diagnosis when symptoms have persisted for at least 4 weeks, although most patients present with the symptoms months or years later. First-line treatment primarily involves psychotherapy, while medications can be considered a reasonable alternative or adjunctive strategy based on patient preference or when psychotherapy is not accessible. 

Non-pharmacological therapies: Effective PTSD psychotherapies include exposure therapy, cognitive processing therapy (CPT), trauma-focused cognitive behavioral therapy (TF-CBT), and eye-movement desensitization and reprocessing (EMDR). Exposure therapy is rooted in emotional processing theory and seeks to correct a dysfunctional fear cognitive structure. CPT is trauma-specific and takes 12 weeks. This approach incorporates emotional processing and social cognitive theory elements, aiming to address and rectify distorted cognitions about the self and the world that may arise following trauma. [69] TF-CBT is a therapy that is a combination of exposure and cognitive techniques. [70] The type of therapy chosen depends on the patient's dominant symptoms, as those experiencing fear and avoidance tend to benefit from exposure techniques, whereas those with guilt and mistrust may benefit more from cognitive therapies. Interpersonal psychotherapy, initially designed for depression treatment, has demonstrated efficacy against PTSD as well, although it has received less research attention in comparison. [69]

Pharmacotherapy: Medications can be an effective option in reducing core PTSD symptoms. They are more effective against hyperarousal and mood symptoms and less effective for re-experiencing emotional numbing and avoidance symptoms. No medication class has demonstrated better suitability or tolerability than others. However, the largest and greatest number of trials have been conducted on selective serotonin reuptake inhibitors (SSRIs). Multiple randomized control trials found reduced PTSD symptoms with SSRIs compared to placebo. Venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), has shown effectiveness and tolerability in limited literature. [71] [72] Second-generation antipsychotics and an alpha-blocker antihypertensive, prazosin, are second-line treatments that effectively reduce symptoms. [73] The effectiveness of benzodiazepines remains a topic of debate, and expert consensus advises caution when considering their use. There is limited research coverage and no clear evidence of significant symptom reduction with tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and mood stabilizers.

Combination therapies: Some trials suggest that SSRIs, TF-CBT, and their combinations are roughly equivalent in effectiveness, with some advantages to psychotherapy for patient preference. There was improved adherence when patients were given their preferred treatment modality. [74] [75] A recent meta-analysis showed that multicomponent interventions were the most effective treatment approach. The same study found that psychotherapy, especially trauma-focused modalities, was effective for PTSD, comorbid anxiety, depression, and insomnia. Pharmacotherapies were less effective than psychotherapy for addressing PTSD symptoms and improving sleep. [73]

Treatment for MDD remains the same for both the general and military populations. Combinations of pharmacological and psychotherapies have been proven to be the most effective treatment strategy. [76]

Psychotherapy: Psychotherapy is a category of treatment options that involve talk sessions between the patient and the provider. Several types of psychotherapies include CBT, interpersonal psychotherapy, behavioral activation, problem-solving therapy, supportive psychotherapy, and psychodynamic psychotherapy. Although no specific type has been proven superior to another, CBT and Interpersonal Psychotherapy are often chosen as the first-line treatments due to the extensive body of research supporting the effectiveness of these methods. [77] [78] CBT involves the patient discussing practices, behaviors, and beliefs that must be changed or reinforced to help the patient.

Pharmacotherapy: Ongoing evidence supports the use of pharmacological agents in treating MDD. Available options include serotonin reuptake inhibitors (SRIs), SSRIs, MAOIs, SNRIs, and TCAs. Each class of medications works in slightly different ways and is beyond the scope of this article. The selection of the appropriate agent should be tailored to the individual patient's needs. Patient factors include comorbid conditions, clinical presentation, adverse effects, and previous medication use. [79] For instance, SSRIs are typically considered first-line for MDD; however, if a patient desires to quit smoking and lose weight, bupropion may be a more suitable choice due to its specific adverse effect profile and additional uses. Although more robust and more involved treatments, such as ketamine infusions, are available, they are typically reserved for refractory cases.

Electroconvulsive therapy (ECT): ECT involves an electric current to stimulate the brain into a generalized cerebral seizure. Although ECT is widely accepted as a productive and safe therapy, it is generally reserved for severe and resistant MDD cases. [80] ECT is less frequently used because of the stigma associated with the procedure created by popular media.

The VA and DoD recommend implementing a crisis response plan to assess SI and the individual's history of previous attempts as part of the treatment. Patients at imminent risk of suicide should be hospitalized, and a safety plan should be developed to ensure their well-being. [81] The provider and patient should discuss recent stressors and collaboratively identify behavioral, cognitive, or physical signs of crisis for the patients. In addition, patients should identify self-management skills to help them distract from distressing situations, reduce stress, and consider the protective factors in their lives. Clinicians should provide emergency resources, including medical and mental health providers and suicide lifelines (refer to the "Consultations" section below). Follow-up and appropriate referrals are essential for continued care. Finally, if the patient is in the military, the provider should inform the patient’s leadership to enact safety measures for protecting the patient and unit missions. Current regulations require that a member with suicidal behavior be placed on a duty limitation, which restricts them from entering exacerbating environments, such as deployment to remote locations. Hence, military medical services play a crucial role in treating suicidal patients. Detailed information can be found in the VA/DoD clinical practice guidelines (https://www.healthquality.va.gov/guidelines/MH).

Non-pharmacological therapies: Psychotherapy is the mainstay of SUD treatment. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is the first-aid strategy intended to intervene in unhealthy drinking before it progresses to AUD and offers immediate treatment for those who have already developed it. If further treatment or evaluation is necessary, patients should be provided with the option of longer-term management in either primary care or specialist settings. Evidence-based psychotherapy or behavioral interventions should be available, with short-term CBT being a common approach to identify and modify maladaptive thoughts and behaviors related to substance use. In addition, CBT can be beneficial in incentivizing abstinence, managing contingencies, and enhancing stress management skills. [17]

Patient-centered motivational interviewing aims to encourage patients to participate in treatment actively. Research has demonstrated that this approach can reduce weekly drinks consumed and alcohol dependence rates. [82] In those with comorbid PTSD, integrated therapies addressing both conditions have been developed. Studies indicate that adding trauma-focused interventions does not exacerbate substance use and, in many cases, may lead to a decrease in substance use. PTSD outcomes have shown improvement with integrated approaches in multiple randomized controlled trials. However, there is currently insufficient evidence to determine whether integrated treatment plans are superior to treating SUDs and PTSD separately but concurrently. [83]

Pharmacotherapy: Several pharmacotherapies have garnered support in managing SUDs, primarily by reducing cravings or withdrawal symptoms to incentivize abstinence or reduce barriers to quitting. [17] The 3 medications approved by the U.S. Food and Drug Administration (FDA) for AUDs include naltrexone, acamprosate, and disulfiram. The FDA approves methadone, buprenorphine, and naltrexone for opioid use disorders (OUDs). However, there are currently no off-label drugs to treat cocaine or marijuana use disorders. [84]

In addition to clinical interventions, veterans with SUDs can be introduced to self-help groups such as Alcoholics Anonymous or Narcotics Anonymous. These groups are generally free, widely available, and valuable for ongoing maintenance and engagement for those seeking abstinence. [17]

  • Differential Diagnosis

The diagnosis of PTSD involves considering a wide range of possible conditions, which can be made more complex by the presence of other psychiatric disorders. Some of these are discussed in the "Complications" section below. The following is a brief list that pertains specifically to adults:

  • Acute stress disorder: Acute stress disorder is diagnosed in individuals presenting with at least 9 of 14 symptoms in 5 categories (intrusion, negative mood, dissociation, avoidance, and arousal), which lasts between 3 days to 1 month after a trauma, and leads to functional impairment. Although most patients recover within this period, those who remain symptomatic even after 30 days are reclassified as having PTSD.
  • Adjustment disorders
  • Depressive disorders
  • Anxiety disorders: includes specific phobias, social anxiety disorder (social phobia), panic disorder, agoraphobia, and generalized anxiety disorder.
  • Substance use
  • Obsessive-compulsive disorder
  • Bereavement
  • Schizophrenia and other psychotic disorders 
  • Personality disorders, especially borderline personality disorder
  • Dissociative disorders
  • Conversion disorder

Although the complete differential diagnosis for MDD is extensive and goes beyond the scope of this article, 3 other conditions that must be considered before establishing this diagnosis are grief, adjustment disorder, and persistent depressive disorder (PDD). Grief typically occurs in response to the loss of a loved one. Patients experiencing grief often exhibit symptoms that overlap with depression, including decreased interest in activities, depressed mood, and thoughts about the deceased individual. [85] Auditory hallucinations are not uncommon in cases of grief. Adjustment disorder is characterized by a self-limited but out-of-proportion, emotional, or behavioral response to an acute stressor that does not meet the diagnostic criteria for another mental health disorder. Rates of adjustment disorder are considered equivalent or higher than MDD. [86] PDD shares many of the same symptoms and diagnostic criteria as MDD. The distinguishing characteristics lie within the timeline of each disorder. In MDD, symptoms must be present for at least 2 weeks, whereas in PDD, symptoms must persist for 2 years without a break of 2 months or more.

Differential diagnoses in SUDs depend on the specific substance involved and are numerous. Furthermore, for most other DSM-5 diagnoses, it is crucial to rule out substance-induced variants, as they can manifest similarly or trigger the onset of such disorders. Substance-related diagnoses include psychotic, bipolar, depressive, anxiety, obsessive-compulsive, related sleep disorders, sexual dysfunction, delirium, and neurocognitive disorders.

  • Treatment Planning

Military Command Exception to Health Insurance Portability and Accountability Act (HIPAA)

There is a significant stigma against seeking care for mental health disorders in the active-duty population, primarily due to the fear of potential repercussions on their military career. Although specific circumstances may necessitate notification of an active-duty patient's Commanding Officer, most routine mental health care does not. An upfront discussion between a provider and a patient regarding the limits of confidentiality is crucial to establishing a trusting and effective patient-provider relationship. Instances in which a medical provider must notify a patient's Commanding Officer include situations involving a severe risk of harm to the patient, others, or the mission. In these instances, the disclosure of otherwise protected health information is considered essential for national security and the patient's well-being. This exception helps prevent high-risk patients from being assigned to work duties that could limit their access to appropriate care and potentially place them in further harm's way until their condition is stabilized.

The prognosis for PTSD varies widely between individuals and can sometimes lead to a chronic condition. Approximately one-half of adults will experience recovery within 3 months, whereas another one-third may recover by 12 months. However, a significant minority of patients may remain symptomatic even after 10 years. Those who recover without treatment are more likely to do so within the first year. However, affected individuals may experience educational or occupational challenges, difficulties in intimate relationships, and reduced social support. [87] Nevertheless, current treatments have shown effectiveness in reducing symptoms and achieving remission. Treating all conditions concurrently for individuals with psychiatric comorbidities is generally recommended for better outcomes. [73]

MDD is variable, with less than half of cases resolving within 3 months of onset, compared to approximately 80% showing improvement within 12 months. MDDs falling under the severe specifier are associated with a higher risk of recurrence and can sometimes become a chronic condition requiring ongoing attention and maintenance. Studies have shown that patients who continued with pharmacotherapy for a minimum of 6 to 12 months following their first depressive episode experienced less risk of recurrence of symptoms than those who discontinued medication earlier (25% compared to 50%). Although remission is the ultimate goal, trials show that continued care and collaborative treatment programs reduce the prevalence and incidence of MDDs later in life. [88]

Patients who have experienced non-completed suicide attempts have a significantly increased risk for subsequent attempts. Although the risk of completed suicide is highest in the first year after an attempt, the danger can remain elevated for a decade. [89] [90] Several studies estimate that the risk of a repeat suicide attempt is approximately 5% to 10% over a timeframe ranging from 5 to 35 years. [91] Providers should screen for depression and SUDs, as they are correlated with completed suicides through an increased likelihood of further attempts. [92] [93]  

A significant study on VA patient-centered medical homes found that depression, severe mental illness (excluding PTSD), and SUDs were associated with an increased 1-year risk of hospitalization and death. The authors attributed the exemption for PTSD to the higher frequency of healthcare encounters in patients with PTSD. This supports the idea that mental illnesses, including SUDs, are associated with poor outcomes but can be somewhat relieved by access to care. [94]  In another study, veterans admitted into intensive PTSD programs were divided into 7 groups based on their substance use: no substance use, or use of alcohol, opiates, sedatives, cocaine, or marijuana alone, and use of multiple substances. Changes in non-substance use outcomes, including PTSD symptoms, violence, suicidality, medical problems, and employment before and after PTSD treatment, were compared, and the effect of abstinence on each group was evaluated. Although abstinence rates varied among the groups, it was consistently associated with improved outcomes, except for employment, in all the groups. [95]

  • Complications

Patients with PTSD are susceptible to a range of somatic and mental health comorbidities, and the direction and extent of overlap between these diagnoses are intricate. In a study involving OIF/OEF veterans with PTSD, it was found that compared to veterans without mental health conditions, those with PTSD had more medical diagnoses, with the most common being lumbosacral spine disease, headache, lower extremity joint problems, and hearing loss. [96] PTSD often co-occurs in patients with chronic pain, which, in turn, is associated with an increased risk of AUD. [97] Among obese VA patients, there is a correlation between obstructive sleep apnea and mood and anxiety disorders, with the strongest association found in PTSD and MDD. [98]

PTSD and AUD have been consistently linked over decades of research. Research demonstrated that men have a higher prevalence of AUD, whereas women have a higher prevalence of PTSD. However, individuals with either disorder are more likely to have the other. SUDs were 4 times more likely (with a rate of 55% to 75%) in Iraq and Afghanistan veterans with PTSD. [99] A 2018 review found no clear order of development between the two: some evidence suggests veterans with past trauma develop AUD, supporting a self-medication hypothesis. Other studies show that those with SUDs have more exposure to traumatic events and an increased risk of developing PTSD. [100] In both veteran and civilian samples, comorbid SUD/PTSD patients demonstrated poorer treatment responses, more severe substance use, social and legal problems, and higher rates of suicide attempts compared to those with either disorder alone. [101]

A study has shown that depression and PTSD are often connected, as 36% of patients with depression had positive PTSD screens. Individuals suffering from both depression and PTSD experience higher medical illness burdens, worse prognoses, lower social support, higher rates of suicidal ideation, and prolonged treatment needs compared to those with either condition alone. [102]  The study found that 57% of participants reported lifetime DSH, with 45% reporting DSH in the last 2 weeks. DSH was a significant predictor of SI, along with PTSD symptom severity. [103] PTSD is associated with higher rates of suicidal ideation independent of other psychiatric disorders. [104]  

TBI and PTSD are also known to have comorbidities and are the subject of extensive research. The most significant studies of Iraq and Afghanistan veterans show an overlap rate between 5% and 7% in these conditions. In individuals with mild TBI (mTBI), the frequency of PTSD ranges from 33% to 39%. As many as 23% of returning OIF/OEF veterans experienced TBI, with the vast majority classified as mild cases. However, even mTBI can result in somatic, cognitive, or behavioral changes that may complicate presenting PTSD symptoms. The effectiveness of treatments for mTBI or PTSD alone is still uncertain and requires further research. Furthermore, there is some concern that pharmacotherapies used for PTSD may exacerbate cognitive symptoms of the disorder. Cognitive limitations, impaired emotional regulation, impulse control, and pain resulting from TBI may also restrict the effectiveness of PTSD treatment and hinder patients' ability to engage in therapy actively. [105]

MDD is accompanied by a constellation of symptoms that can lead to further complications. Weight gain and fatigue are common symptoms of depression. Studies have shown an odds ratio of 1.18, indicating a link between depression and obesity. [106] Obesity is associated with many comorbidities, including heart disease, high blood pressure, and diabetes. MDD is also associated with an increased risk of suicide. Veterans are especially vulnerable, with over 6000 committing suicide yearly. [10] Issues with pain and SUDs are also much more prevalent in cases with MDD among veterans.

Suicide attempts and completions are traumatic events that can impact many people and lead to long-term concerns. Friends and family members may experience various emotions toward the patient, including anger, guilt, betrayal, anxiety, or helplessness. Post-suicide interventions can help family and friends understand suicide victims and reduce their inappropriate assumption of responsibility. [107] However, CBT for family members and friends has not shown clinically significant improvements in grief and depressive symptoms. [108] Nonetheless, monitoring the family, friends, and coworkers of the suicide victim can be beneficial in reducing the risks of PTSD, depression, and suicide. 

Psychiatric symptoms, including distress, often precede and exacerbate cravings in individuals with SUDs. The presence of comorbid psychiatric disorders can make SUDs more severe and challenging to treat. Among OEF/OIF veterans with SUDs, 82% to 93% had another co-occurring mental health disorder, and they were 3 to 4 times more likely to have PTSD or depression. Less than 1% of veterans had an isolated diagnosis of SUD. Veterans with dual diagnoses were more likely to experience homelessness and require disability benefits. They also tend to have lower quality of life, poorer relationships, and higher rates of aggression. [99] Interpersonal, legal, and professional consequences of alcohol use are twice as likely in binge drinkers compared to other drinkers (9% versus 4%). [17] Furthermore, those with SUDs have higher rates of medical comorbidities such as obesity, sleep disturbances, physical injury, and chronic pain. [109] Specific medical complications vary by the substance(s) used, routes of administration, and other factors, highlighting the need for thorough history-taking and a high index of suspicion.

Medical conditions potentially resulting from, and possibly indicating, SUD are listed below. [110]

  • Cardiovascular disease: Hypertension, cardiomyopathy, endocarditis, and heart failure 
  • Gastrointestinal disease: Pancreatitis, cirrhosis, chronic liver disease, and hepatitis B or C
  • Kidney failure
  • Central nervous system disease: Dementia, memory/attention impairment, cerebral vasculitis, intraparenchymal hemorrhage, stroke or TIA, and TBI
  • Pulmonary disease: Chronic obstructive lung disease, bronchospasm, pneumonia, hypersensitivity pneumonitis, and tuberculosis
  • Sexually transmitted infections
  • Impaired immunity
  • Bacterial infections
  • Pregnancy and birth complications
  • Consultations

Practitioners should be dedicated to understanding the unique challenges veterans and their families face and be familiar with available military resources. Making appropriate referrals is an essential aspect of providing continued care for veterans. There are various reasons to refer veterans to military or VA-related organizations, as they can benefit from treatment plans that involve providers and other veterans who understand their life experiences. The DoD and affiliated organizations offer programs to assist with various concerns that veterans may face.

Military OneSource is an excellent example that serves military members and their families, offering programs such as non-medical counseling, financial coaching, and employment resources. Coaching into Care is a valuable VA telephone service that connects veterans and their loved ones with relevant programs in local VA facilities or communities. The service provides free coaching from licensed psychologists and social workers to help veterans adjust to civilian life and seek appropriate treatment. Community peer groups can be a valuable tool when available.

If there are no local VA services available, veterans and family members can call the Vet Center Call Center, which provides 24-hour readjustment counseling from staff who are also combat veterans or family members of veterans. In moments of crisis, the VA offers the toll-free Veterans Crisis Line, which has trained responders, many of whom are veterans.

For active-duty patients and medical officers, familiarity with the "Military Command Exception" for disclosing protected health information (PHI) that would otherwise violate the HIPAA Privacy Rule is crucial. This exception requires medical personnel to notify a patient's Commanding Officer when a patient poses a severe risk of harm to self, others, or the mission. Medical personnel and Commanding Officers must consider a service member's fitness for duty when determining appropriate duty assignments and facilitating access to care for the individual.

  • Deterrence and Patient Education

The risk of developing PTSD and the effectiveness of treatments can be influenced by social support. However, it can be challenging for patients to admit to the effects of past traumas and initiate care. There may be a strong sense of fear, vulnerability, and confusion. PTSD affects physical and mental health in ways that are not always apparent. Thus, awareness of the signs and symptoms is essential. Patient buy-in and commitment to treatment courses, especially when addressing comorbid conditions, are crucial in reducing the illness burden for patients and their loved ones.

Military members are at risk of developing MDD, given risk exposures inherent to both the general population and military service. Despite the DoD’s renewed energy and devotion to providing members adequate access to care, the stigma around mental health remains. Military members and veterans report worrying about appearing weak or being overlooked for a position as reasons not to seek care. [43] Communicating the need to seek treatment in a judgment-free setting is crucial to patient follow-up. Support resources are available across the DoD and VA. Educating patients on accessing these resources is essential for promoting self-directed care. Utilizing social networks as a support system is also helpful in gaining patient buy-in for treatment programs. MDD is a significant concern within the active-duty and veteran populations. However, with proper screening, diagnosis, and treatment programs within the military's vast resource network, strides can be made in decreasing its prevalence.

Due to high rates of suicide among veterans, safety plans are mandated by the VA for those at risk. [12]  This commonly utilized tool outlines strategies for patients to manage and overcome recurring suicidal impulses. Safety plans have 6 hierarchical steps to mitigate suicide risk: [111]  

  • Step 1: Identify warning signs that indicate an impending suicidal crisis.
  • Step 2: Employ internal coping strategies (meditation, pleasant activities, or relaxation techniques).
  • Step 3: Reach out to social contacts or visit locations that are distractions.
  • Step 4: Contact a family member or friend for help
  • Step 5: Contact a professional or agency (Veterans’ Crisis Line or a therapist).
  • Step 6: Remove or reduce access to lethal means.

It is important to note that safety plans do not provide absolute protection for patients or clinicians, and even patients who agree to follow their safety plans may still be at high risk. Therefore, thorough evaluations and meaningful therapeutic interactions should be utilized, especially in cases involving impulsive patients.

The treatment of SUDs typically involves short-term therapy to identify and modify unhelpful thoughts and behaviors associated with substance use. For certain substances such as opioids, alcohol, and tobacco, medications can also be effectively used as part of the treatment approach. Other substances, including cocaine and marijuana, have no approved medications, making counseling the treatment's mainstay. The military and VA offer free counseling, including smoking cessation programs, which have been effective and shown to improve long-term outcomes. The treatment provided to patients can be individualized to address specific needs, help rebuild relationships with loved ones, and provide valuable life skills for veterans.

  • Enhancing Healthcare Team Outcomes

Diagnosing mental health disorders in military and veteran populations requires detailed history-taking. Still, in some cases, additional tests such as MSE, cognitive testing, and labs may be necessary to differentiate between various medical and psychiatric illnesses. Timely diagnosis and intervention are best achieved through interprofessional collaboration between healthcare providers and patients.

For the active-duty population, enlisted uniformed healthcare personnel with roles unique to the military medical environment, such as combat medics and hospital corpsmen, are often directly accessible to patients in the field and on the Homefront as the first point of contact for medical care. Enlisted healthcare personnel can serve as an extension of primary care providers and play a crucial role in screening populations at risk for mental health disorders.

Medics, Corpsmen, and primary care providers can often be the first to suspect conditions such as PTSD, depression, suicidality, SUDs, and comorbidities, allowing for timely identification and intervention. Nurses, medics, and corpsmen are vital in patient education and monitoring. They act as a crucial link among care teams. Social workers serve as outpatient counselors and are indispensable in addressing these disorders with pervasive social effects. Pharmacists should be consulted when utilizing pharmacotherapy, particularly in patients with comorbid medical and psychiatric conditions. Psychologists and psychiatrists play essential roles in guiding or providing care, especially for patients with high acuity or complexity, ensuring comprehensive and effective treatment approaches. For active-duty personnel, both patients and providers should be familiar with the "military command exception" to confidentiality and when notification of a patient's chain of command is required. This knowledge is critical for establishing patient-provider trust and ensuring the safety and well-being of the patient.

All treatment and intervention should involve the patient and, when appropriate, the family as part of the interprofessional treatment team, as social support plays a crucial role in both the pathogenesis and recovery of these disorders. Employing interprofessional methods will lead to better patient outcomes. 

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Disclosure: Catarina Inoue declares no relevant financial relationships with ineligible companies.

Disclosure: Evan Shawler declares no relevant financial relationships with ineligible companies.

Disclosure: Christopher Jordan declares no relevant financial relationships with ineligible companies.

Disclosure: Marlyn Moore declares no relevant financial relationships with ineligible companies.

Disclosure: Christopher Jackson declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

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Homeless Veterans in the United States Essay

A veteran is an individual who served in the Air Force or Navy, who has been set free under circumstances other than discreditable ones. Veteran may also be defined as someone possessing enough experience in some field (Culhane 9). This person usually has a direct disclosure to operations of military conflict.

Homelessness among veterans is an enormous setback that Americans are facing. There are a vast number of reasons as to why there is an alarming increase in the number of veterans (Eckholm 8). The veterans face a lot of problems including lack of basic needs like food and shelter; they are exposed to various types of diseases as well.

Homeless veterans and their families come across major challenges, drug addiction being one of them. This includes both those having problems with alcohol and those addicted to drug abuse (Culhane 1999).

According to a study done by Interagency Council on Homelessness, it was found out that forty nine percent of veterans had encountered problems with alcohol and thirty one percent had encountered problems related to drugs. As compared to homeless non-veterans’ alcohol and drug abuse was found to be more prevalent in homeless veterans.

Some of these veterans can not get jobs after leaving the forces. This is a major hindrance to stability among the veterans as they are not in a position to provide themselves with basic needs. The lack of jobs leads to idleness which is the major cause of the veterans’ addiction to drug abuse.

Others struggle psychologically with the war after their long term serving the nation. The psychological struggle they go through is chiefly due to the trauma they endure during their serving term. Lack of family support is also another challenge to the veterans (Culhane 21).

Veteran women undergo higher unemployment rate compared to males mainly due to the fact that women are less probable to attain employment that can generate them with enough money for their needs as well as for permanent housing. On getting back to the civilian life, women usually experience other challenges (Eckholm 8).

In case left untreated, these traumas will result into economic crises due to despair and emotional instability. Some of them include;

  • Substance abuse
  • Posttraumatic anxiety
  • Traumatic brain injury.
  • Military sexual trauma
  • Psychological trauma

On returning home, veterans deserve a considerable help so as to get back to their normal lives because they risk their lives for the sake of serving their nation. This calls for a good plan by the government as well as the whole community to work hand in hand to help them get back on their feet. Homelessness is an indication of one of the problems faced by veterans among others, shelter being the basic need for a human life; it is then a clear point of how veterans live a miserable life despite their devotion to fully serving the nation (Eckholm 8).

According to National Coalition for Homeless Veterans, two thousand Americans become homeless regularly. The alarming increase in the number of the homeless veterans is due to continuing war in Iraq and Afghanistan. In order to help the veterans re-enter the workforce as industrious citizens, it calls for professional preparation as well as compassionate services for the homeless veterans. This will in due course help veterans prevent employment (Rosenheck 22).

Employment is one of the ways of eliminating homelessness among veterans as they can manage to acquire permanent houses. This encompasses making available tools needed by the veterans to enhance their marketable talents. It is also encouraged to create an atmosphere where veterans can make their social as well as their personal skills stronger. A favorable environment will also provide the veterans with a chance to examine their skills in the real working world (Culhane 11).

Provided with tools and gaining the required skills, the veterans will be in position to cater for their needs as well as their health. The drug addicted veterans can be helped via organizing alcohol and drug rehabilitation programs as well as job training.

It is advised that the government should guarantee that the veterans get full support upon discharge so as to ensure that they become stable and are in a position to get the basis to start their civilian life (Culhane 11). It goes without saying that with job opportunities the veterans will be in a position to afford accommodation as well as other essential needs. The veterans are also advised to give support to other veterans so as to help the homeless veterans uplift their status.

It is found out that if homeless veterans were provided with enough experience as well as training, it would help to mitigate challenges like drug addiction and also other problems like homelessness as this will assist them in stabilizing economically. It is also recommended that counseling sessions are organized with an aim of encouraging the psychologically affected individuals along with the traumatized.

This will help them move from the distressed lives and be useful for the society (Rosenheck 22). The association should also help these homeless veterans in acquiring jobs that will give outcomes that are worthy to cater for their needs especially in acquiring homes.

Staying in touch with the family members also ought to be looked into in order to assist the veterans to have stability in their lives (Eckholm 8). As the homeless veterans devoted themselves fully to serve the nation during their term in the armed forces it should also be a duty to each of the citizens to ensure that they also dedicate themselves to helping them in their civilian lives.

In conclusion, homelessness among veterans ought to be taken care by both the government and the citizens at large in order to reduce the number of the homeless in the society. Various reforms should also be set aside to deal with challenges the homeless veterans are facing (Rosenheck 23).

These organizations should advocate the need to help the veterans through various ways like training and encouraging the traumatized. The veterans should be provided with vocational training as well as with the essential tools needed for them to market their acquired skills. With this kind of support the veterans will be independent. This will consequently reduce the quantity of the homeless veterans. It therefore needs the input of the whole nation to eradicate homelessness amongst the veterans.

Works Cited

Culhane Duke P., and Metraux Stephen. Risk Factors for Homeless Veterans. New York City and Philadelphia, 1999. Print.

Eckholm Edward. “Surge seen in Number of Homeless Veterans”. New York Times . 8 Nov. 2007: A 1. Print.

Rosenheck Beatrice R., and Frisman Leon. The Proportion of Veterans among Homeless Men. U. S.: University of Massachusetts, 1994. Print.

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IvyPanda. (2022, March 26). Homeless Veterans in the United States. https://ivypanda.com/essays/homeless-veterans-2/

"Homeless Veterans in the United States." IvyPanda , 26 Mar. 2022, ivypanda.com/essays/homeless-veterans-2/.

IvyPanda . (2022) 'Homeless Veterans in the United States'. 26 March.

IvyPanda . 2022. "Homeless Veterans in the United States." March 26, 2022. https://ivypanda.com/essays/homeless-veterans-2/.

1. IvyPanda . "Homeless Veterans in the United States." March 26, 2022. https://ivypanda.com/essays/homeless-veterans-2/.

Bibliography

IvyPanda . "Homeless Veterans in the United States." March 26, 2022. https://ivypanda.com/essays/homeless-veterans-2/.

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What is Presidents Day and how is it celebrated? What to know about the federal holiday

Many will have a day off on monday in honor of presidents day. consumers may take advantage of retail sales that proliferate on the federal holiday, but here's what to know about the history of it..

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Presidents Day is fast approaching, which may signal to many a relaxing three-day weekend and plenty of holiday sales and bargains .

But next to Independence Day, there may not exist another American holiday that is quite so patriotic.

While Presidents Day has come to be a commemoration of all the nation's 46 chief executives, both past and present, it wasn't always so broad . When it first came into existence – long before it was even federally recognized – the holiday was meant to celebrate just one man: George Washington.

How has the day grown from a simple celebration of the birthday of the first president of the United States? And why are we seeing all these ads for car and furniture sales on TV?

Here's what to know about Presidents Day and how it came to be:

When is Presidents Day 2024?

This year, Presidents Day is on Monday, Feb. 19.

The holiday is celebrated on the third Monday of every February because of a bill signed into law in 1968 by President Lyndon B. Johnson. Taking effect three years later, the Uniform Holiday Bill mandated that three holidays – Memorial Day, Presidents Day and Veterans Day – occur on Mondays to prevent midweek shutdowns and add long weekends to the federal calendar, according to Britannica .

Other holidays, including Labor Day and Martin Luther King Jr. Day , were also established to be celebrated on Mondays when they were first observed.

However, Veterans Day was returned to Nov. 11 in 1978 and continues to be commemorated on that day.

What does Presidents Day commemorate?

Presidents Day was initially established in 1879 to celebrate the birthday of the nation's first president, George Washington. In fact, the holiday was simply called Washington's Birthday, which is still how the federal government refers to it, the Department of State explains .

Following the death of the venerated American Revolution leader in 1799, Feb. 22, widely believed to be Washington's date of birth , became a perennial day of remembrance, according to History.com .

The day remained an unofficial observance for much of the 1800s until Sen. Stephen Wallace Dorsey of Arkansas proposed that it become a federal holiday. In 1879, President Rutherford B. Hayes signed it into law, according to History.com.

While initially being recognized only in Washington D.C., Washington's Birthday became a nationwide holiday in 1885. The first to celebrate the life of an individual American, Washington's Birthday was at the time one of only five federally-recognized holidays – the others being Christmas, New Year's, Thanksgiving and the Fourth of July.

However, most Americans today likely don't view the federal holiday as a commemoration of just one specific president. Presidents Day has since come to represent a day to recognize and celebrate all of the United States' commanders-in-chief, according to the U.S. Department of State .

When the Uniform Holiday Bill took effect in 1971, a provision was included to combine the celebration of Washington’s birthday with Abraham Lincoln's on Feb. 12, according to History.com. Because the new annual date always fell between Washington's and Lincoln's birthdays, Americans believed the day was intended to honor both presidents.

Interestingly, advertisers may have played a part in the shift to "Presidents Day."

Many businesses jumped at the opportunity to use the three-day weekend as a means to draw customers with Presidents Day sales and bargain at stores across the country, according to History.com.

How is the holiday celebrated?

Because Presidents Day is a federal holiday , most federal workers will have the day off .

Part of the reason Johnson made the day a uniform holiday was so Americans had a long weekend "to travel farther and see more of this beautiful land of ours," he wrote. As such, places like the Washington Monument in D.C. and Mount Rushmore in South Dakota – which bears the likenesses of Presidents Washington, Lincoln, Thomas Jefferson and Theodore Roosevelt – are bound to attract plenty of tourists.

Similar to Independence Day, the holiday is also viewed as a patriotic celebration . As opposed to July, February might not be the best time for backyard barbecues and fireworks, but reenactments, parades and other ceremonies are sure to take place in cities across the U.S.

Presidential places abound across the U.S.

Opinions on current and recent presidents may leave Americans divided, but we apparently love our leaders of old enough to name a lot of places after them.

In 2023, the U.S. Census Bureau pulled information from its databases showcasing presidential geographic facts about the nation's cities and states.

Perhaps unsurprisingly, the census data shows that as of 2020 , the U.S. is home to plenty of cities, counties and towns bearing presidential names. Specifically:

  • 94 places are named "Washington."
  • 72 places are named "Lincoln."
  • 67 places are named for Andrew Jackson, a controversial figure who owned slaves and forced thousands of Native Americans to march along the infamous Trail of Tears.

Contributing: Clare Mulroy

Eric Lagatta covers breaking and trending news for USA TODAY. Reach him at [email protected]

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House judiciary committee launches probe into cbs firing, seizing files of veteran reporter covering hunter biden’s laptop scandal.

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The House Judiciary Committee is calling CBS on the carpet over the firing of veteran reporter Catherine Herridge, who was probing the Hunter Biden laptop scandal, and the subsequent seizure of her personal records, The Post has learned.

In a scathing letter sent to CBS News President Ingrid Ciprian-Matthews on Friday — obtained exclusively by The Post — Rep. Jim Jordan, who chairs the committee, demanded the network reveal who at CBS or parent-company Paramount Global “made the decision to terminate” Herridge.

The committee said it also wants to know why her confidential files were “seized” as part of the termination.

Catherine Herridge

“The unprecedented actions of CBS News threaten to chill good journalism and ultimately weaken our nation’s commitment to a free press,” the letter stated.

Herridge — who is the middle of a First Amendment case being closely watched by journalists nationwide — was among just 20 CBS News staffers let go as part of a  larger purge of 800 employees at parent company Paramount Global.

A source with knowledge told The Post on Thursday that the network boxed up all Herridge’s personal belongings except for her notes and files and informed her that it would decide what — if anything — would be returned to her.

Jordan (R-Ohio) also requested a list of individuals who went through Herridge’s files, as well as any documents and communications relating to her documents.

The committee also seeks information on any individual from Paramount Global, CBS or CBS News accessed the confidential materials, “reviewed any of her confidential materials, copied or retained any of her confidential materials, or conducted any forensic examination of her confidential materials.”

The committee sent a letter to CBS News president Ingrid Ciprian-Matthews, demanding she turn over information on who handled Herridge's files at the network.

The committee gave Ciprian-Matthews a March 1 deadline “no later than 5 pm” to send in the information.

Herridge did not return requests for comment.

A CBS News spokesperson again refuted the characterization that the network confiscated Herridge’s private records.

“CBS News strongly denies any items were seized,” the rep said.

On Thursday, the CBS spokesperson insisted the network “respected [Herridge’s] request to not go through the files, and out of our concern for confidential sources, the office she occupied has remained secure since her departure.”

“We are prepared to pack up the rest of her files immediately on her behalf – with her representative present as she requested,” the network added.

The House probe comes amid uproar from employees who were first shocked the network would oust the journalist and equally stunned it retained her confidential files after she was let go.

“It’s so extraordinary,” a source familiar with the situation said, noting that the files — which are presumptively now the property of CBS News — most likely contain confidential material from Herridge’s stints at both Fox and CBS.

Herridge had encountered roadblocks in her coverage of the Hunter Biden's laptop story, The Post recently reported.

Herridge had encountered roadblocks from higher-ups  over her Hunter Biden coverage and had also clashed with Ciprian Matthews, a sharp-elbowed executive who was  investigated — and cleared — in 2021 over favoritism and discriminatory hiring and management practices,  as The Post previously reported.

“They never seize documents [when you’re let go],” a second source close to the network said. “They want to see what damaging documents she has.”

Rep. Jim Jordan sent a letter to CBS News on Friday that the House Judiciary Committee is launching a probe into CBS's seizure of Herridge's documents.

Sources feared CBS’s actions could have an impact on Herridge’s First Amendment case because her documents may contain privileged conversations she had with her lawyers or the identities of sources.

Herridge is under fire for not complying with US District Judge Christopher Cooper’s order to reveal how she learned about a federal probe into a Chinese American scientist who operated a graduate program in Virginia.

The journalist may soon be held in contempt of court for not divulging her source for an investigative piece she penned in 2017 when she worked for Fox News.

As a result, Herridge could be ordered to personally pay fines that could total as much as $5,000 a day.

Herridge is at the center of a First Amendment case, which could impact press freedom principles.

Insiders said that there are concerns that CBS could be subpoenaed to reveal her source’s identity, which would threaten free-press principles.

SAG-AFTRA, the union that represents CBS staffers, condemned the network for seizing Herridge’s notes and research from her office late Thursday.

“This action is deeply concerning to the union because it sets a dangerous precedent for all media professionals and threatens the very foundation of the First Amendment,” the union said in a statement to The Post.

The union added it has been in touch with CBS News and is hopeful the matter “will be resolved shortly.”

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