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YONGSAN GARRISON, South Korea — With an increasing number of soldiers rotating to or from South Korea to combat zones — and therefore more exposed to triggers of acute stress disorder or post-traumatic stress disorder — military medical officials here say they’re focusing on both preventive and treatment programs.

2nd Infantry Brigade soldiers deploying to Iraq later this summer, for example, already should be getting information on coping strategies and possible symptoms. Unit commanders and senior noncommissioned officers are the key link in getting information to soldiers, medical officials said, because military educational and treatment programs are in place.

The systems focus “not just on medical interventions but helping in terms of some of the social distress or other problems people are experiencing,” said Maj. Sheila Adams, the chief of social work at Yongsan Garrison’s 121st General Hospital and the social work consultant to the 18th Medical Command. “It’s really outlined in terms of trying to intervene and developing a comprehensive treatment plan.”

Before units deploy, mental health experts in South Korea are meeting extensively with unit leaders to brief them on stress reactions in an effort to pre-empt any problems, Adams said. The leadership is given specific tips on both trying to prevent and — if necessary — to begin addressing problems.

Unique to South Korea, said Maj. Geoffrey Gabriel, the acting chief of psychiatry at the 121st General Hospital, is the ability and willingness of general medical officers at outlying camps to refer possible stress-related cases to experts at Yongsan.

The 121st also plans to hold a two-day summit of medical personnel in South Korea in coming weeks specifically to address stress disorders. And the hospital plans to start a “stress management group” for soldiers and leaders at bases here.

“At least from the psychiatric standpoint, the Army is really responding to this,” Gabriel said.

Though by no means a new disorder, PTSD first was codified in the early 1980s and added to the Diagnostic and Statistical Manual of Mental Disorders, which the military uses as its guide for mental health issues.

Persons exposed to life-threatening or shocking events can experience a range of symptoms, from mild temporary reactions to Complex PTSD. Stress disorders have clear biological and psychological symptoms and very specific diagnoses, mental health professionals said.

According to the National Center for Post-Traumatic Stress Disorder, “about 30 percent of the men and women who have spent time in war zones experience PTSD. An additional 20-25 percent have had partial PTSD at some point in their lives.”

A national study of American civilians conducted in 1995 estimated that the lifetime prevalence of PTSD was 5 percent in men and 10 percent in women.

The numbers peaked with more than half of all male Vietnam veterans and almost half of all female Vietnam veterans having experienced “clinically serious stress reaction symptoms.” Studies estimate the numbers at 8 percent of Gulf War I veterans; no data is yet available for the current Iraq conflict, officials said.

The center was founded in 1989 within the Veterans Administration [now called the Department of Veterans Affairs] in response to a congressional mandate to address the needs of military veterans. The center works closely with scholars and clinicians from the National Institutes of Health, the Department of Defense and academic researchers.

The center’s site also includes “The Iraq War Clinician Guide, 2nd Edition,” which details the different circumstances, military policies and potential stressors being faced by soldiers now deployed.

That guide details post-battle debriefings under a system called PIES: Proximity — Immediacy — Expectancy — Simplicity.

“Early intervention is provided close to a soldier’s unit, as soon as possible,” the clinician’s guide says. “Soldiers are told that their experience is normal and they can expect to return to their unit shortly. They are also provided simple interventions to counteract ‘fatigue’ [e.g., “three hots and a cot”].

“The point here is that soldiers who experience severe war-zone stress reactions likely will have received some sort of special care. On the other hand, it is without question stigmatizing for soldiers to share fear and doubt and to reveal signs of reduced capacity. This is especially true in the modern, all volunteer, military, with many soldiers looking to advance their careers.”

Thus, the clinician’s guide states, some veterans who don’t exhibit signs of PTSD until later “will have suffered silently and may still feel a great need not to show vulnerability because of shame.”

Medical officials at the 121st Hospital agree there are many things that can be done while on deployment to help counter development of stress-related disorders.

In addition to the “three hots and a cot,” Adams and Gabriel said, things as simple as talking with other unit members or chaplains after an engagement could help. Again, they said, the willingness and cooperation of unit commanders and NCOs to acknowledge potential cases would be crucial in early detection and treatment.

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