Subitled, Invisible Wounds of War. Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, this monograph features 27 contributing researchers. Published by the RAND Corporation, it is funded by a grant from the Iraq Afghanistan Deployment Impact Fund. The study was conducted under the joint auspices of the Center for Military Health Policy Research, a RAND Health Center, and the Forces and Resources Policy Center of the National Security Research Division of the RAND Corporation.
The work deserves our full attention as it delineates and explains the economic, human, medical, political, public health, and social consequences of injuries suffered by returning veterans of US involvement in 8 years of continuous conflict in Afghanistan and Iraq. The introduction defines the three kinds of invisible wounds affecting thousands of the 1.64 million American troops deployed in Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom (Iraq) since 2001. These combat related injuries are post traumatic stress disorder (PTSD), major depression, and traumatic brain injury (TBI). Upwards of 26% of returning troops may have mental health concerns, including drug and alcohol dependency, homelessness, and suicide.

The monograph analyses numerous studies of these issues, both governmental and non-governmental, and RAND has conducted its own study. The data collection is recent: from April 2007 to January 2008. RAND estimates that approximately 300.000 persons currently suffer from PTSD or major depression; in addition, 320,000 veterans may have experienced TBI during deployment.

The recommendations include evidence based care at the VA level, the state and community level, and on site in Afghanistan and Iraq. Adequate care would pay for itself and save money in the long run by improving productivity and reducing medical and mortality costs for members of the US armed forces.


One veteran  expresses why he hesitated to seek professional help: "In my battalion, if you go to see mental health, you're the weak guy, the weak gal. I took leave to see a counselor based on everything I went through over there. My unit doesn't have knowledge, but my commander said I have PTSD...there's a stigma. A brand new guy goes over at 18, comes back feeling 40. He worries about promotion. They still view it negatively, going to see a mental health care provider." (p. 333)
Finally, returning soldiers with untreated mental illness may negatively affect their spouses, children, and families into the next generation. Consequently, this pioneering  study of war's effect on mental health contributes to informed debate and offers important solutions to a continuing problem of the US volunteer military.


WInner of the Association of American Publishers 2008 PROSE Award in Clinical Medicine category. The monograph is available free on the RAND Corp. internet site. See links for information on editors Terri Tanielian and Lisa H. Jaycox.


RAND Corporation

Place Published

Santa Monica, Calif.




Terri Tanielian & Lisa H. Jaycox

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