The risk of developing PTSD after exposure to a traumatic event depends on many factors, including sex, age, ethnicity, sexual orientation, education attainment, intelligence quotient, annual income, childhood behavioral problems, prior exposure to a traumatic event, and a family history of psychologic disorders. Known risk factors for PTSD in military populations include experiencing combat, being wounded or injured, witnessing death, serving on graves registration duty or handling remains, being taken captive or tortured, experiencing unpredictable and uncontrollable stressful exposure, and experiencing sexual harassment or assault. Severe combat stressors include an increased number of unpredictable insurgent attacks in the form of suicide and car bombs, improvised explosive devices, sniper fire, and rocket-propelled grenades, which all increase the risk of being wounded or killed and thereby exacerbate the psychologic stress. Higher rates of PTSD and depression are associated with longer deployments, multiple deployments, and greater time away from base camp. Conversely, protective factors for PTSD include good leadership, unit support, and training, all of which may help promote positive mental health and well-being during deployment and thus reduce the risk for PTSD.

The current military population is all volunteer and has more women and racial or ethnic minorities than the military population in the Vietnam War or the 1990–1991 Gulf War. More National Guard and reservists have been deployed than in prior conflicts.


The National Defense Authorization Act for Fiscal Year 2010, reflecting congressional concern about the number of service members and veterans who were at risk for or had received a diagnosis of PTSD, required the Secretary of Defense, in consultation with the Secretary of Veterans Affairs, to sponsor this study of PTSD programs in the Department of Defense (DoD) and the Department of Veterans Affairs (VA). This report is the first of the two mandated in the legislation; the committee’s statement of task is shown in Box S-1.

This phase 1 report is based on an extensive literature search, including government documents and data; two public information-gathering sessions with presentations from representatives of the DoD, the VA, veterans’ organizations, and individual service members and veterans who had PTSD; meetings with a variety of mental health providers and with PTSD patients and their families at U.S. Army base Fort Hood in Killeen, Texas; and information from the Veterans Health Administration provided in response to the committee’s request. The committee was unable to obtain comparable information from the DoD in time to include it in this phase 1 report. The

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