Training Needs for the Treatment of Combat-Related Posttraumatic Stress Disorder: A Survey of Department

2006). Although the actual prevalence rate of PTSD will not be known for years to come, what is known is that military medicine has undertaken unprecedented efforts for screening, early intervention, and preven-tion of combat-stress conditions such as PTSD, as is readily evident from the forward deployment of the largest number of mental health (MH) providers in history as well as the mandatory predeployment and postdeployment assessments in the DoD. The level of combat exposure is the best predic-tor of combat-related PTSD; for veterans of the Vietnam War, low levels of combat exposure resulted in estimated PTSD rates of 19 % to 30 % (Oei, Lim, & Hennessy, 1990). As predicted from past battlefield lessons, there was a significant relationship between level of combat exposure and OIF returnees ’ screening positive for PTSD (Hoge et al., 2004; Hoge et al., 2006). At this writing, it is not uncommon to have service personnel returning for their second or third tours in Iraq, where combat exposure is widespread. A study conducted by the Walter Reed Army Institute found that despite the concern for the cumu-lative effect of operational and combat stress, there are stigmas and barriers to seeking MH treatment in DoD facilities (Hoge et al., 2004). Barriers identified In July 2004, a groundbreaking survey conductedby the Department of Defense (DoD) estimatedthat posttraumatic stress disorder (PTSD), the most disabling and predictable psychological out-come of warfare, affected 9 % to 25 % of returning Operation Iraqi Freedom (OIF) veterans and 5 % to 9 % of Operation Enduring Freedom (OEF) veterans, depending on the stringency of the diagnostic crite-ria (Hoge et al., 2004). Recent prevalence rates of postdeployment mental health problems (depression, anxiety, and PTSD) ranged between 16 % and 33% for OIF/OEF veterans, depending on the strictness of the diagnostic criteria; 35 % of OIF veterans sought mental-health treatment within 1 year o