By virtue of their occupation, individuals in the military are at heightened risk for exposure to traumatic events. This has become particularly apparent in recent years, as the wars in Afghanistan and Iraq have contributed to drastic increases in the rates of PTSD, depression, and suicide among service members. There has also been a rise in the rates of traumatic brain injuries (TBI), as advances in protective equipment have increased the chances of survival from injuries that previously would have been fatal. This chapter focuses on risks and complicating factors that are particularly relevant to the military population, with emphasis on the relationship between PTSD and the potential long-term effects of mild TBI.

The high rates of exposure to trauma combined with the separation from loved ones during deployment, and the difficulty of readjusting to life following deployment (particularly for reserves), create a uniquely elevated risk of PTSD for service members. Alcohol and drug abuse are also common in the military population and can complicate the presentation of PTSD as well as increase risk for suicidal behavior. The ready access to weapons and training in how to use them are additional concerns for individuals with suicidal ideation, plans, or intent.

Further complicating the diagnosis and treatment of service members with mental illnesses is the fact that there is a major shortage of mental health staffing within the army. Other medical professionals within the army do not have extensive mental health training; thus access to qualified mental health professionals is a considerable problem.

That both PTSD and TBI could result from the same trauma is not surprising when one considers that the brain regions most vulnerable to TBI are also those associated with symptoms of PTSD (areas shaded in green).

Although this section has focused on the military population, it should be noted that TBI does, of course, occur in the civilian population as well.Interestingly, only 3–5% of civilians with mild TBI experience PPCS. In the military population, the estimate based on the current screening process is ten times that.