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Commentary on MHAT-IV: Struggling to Reduce the Psychological Impact of War

G. V. (Sonny) Montgomery VA Medical Center, South Central MIRECC and University of Mississippi Medical Center, Jackson, judith.lyons{at}med.va.gov

Using data from varied surveys and focus groups, the U.S. military's fourth Mental Health Advisory Team report (MHAT-IV) quantifies the heavy burden of family separation, danger, exhaustion, and heartbreaking moral choices borne by combat troops. Recommendations put forth by MHAT-IV are already influencing training, deployment scheduling, and mental health policies. Such efforts to minimize war stress are commendable. MHAT-IV highlights that unit leadership may be key in reducing combat's impact on mental health. Determining ideal deployment length (both per deployment and cumulative) and interdeployment interval may involve factors not addressed by MHAT-IV. Additional variables for consideration in future assessments are suggested, including survivor guilt (particularly in relation to the suicide-prevention buddy system) and sexual trauma. The findings show that troops, behavioral health personnel, and chaplains each belong to somewhat different cultures. Current debates regarding military ethics indicate that optimally integrating these cultures will likely remain a challenge.

Key Words: MHAT-IV • combat stress • military medicine • deployment

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