| Summary: | Post-traumatic stress disorder (PTSD) and other psychological health issues have emerged as a
signature pathology of combat operations in Iraq and Afghanistan. However, the full continuum of
care in the U.S. military for PTSD and related disorders is reported to be insufficient to meet the
current and future needs of service members and their beneficiaries. The influence of external factors
such as pre-traumatic risk factors and the availability of unit-level and enterprise-level resilience
resources on eventual mental health outcomes have been previously considered individually, but not
together in an enterprise-wide context. Although systems thinking has been applied to transform
general health care systems in the United States and recommended for the military health system,
there has been limited application of such ideas to the military health care system at large.
This thesis expands on previous systems thinking work to transform health care systems in
the United States by building a multi-level, dynamic model of the military psychological health
enterprise from accession and deployment to future psychological health screening and treatment.
The model demonstrates the relationships between stress, resilience and external unit-level and
enterprise-level resources, and the influence of pre-traumatic risk factors, effectiveness of predeployment
resilience resources and the availability of psychological health treatment in theater are
evaluated using sensitivity analyses in order to formulate recommendations for upstream initiatives
to improve downstream health outcomes.
Increasing participation in pre-deployment resilience training and increasing unit support would
have the largest effect on decreasing the number of service members predicted to develop symptoms
of PTSD. Thus, it is recommended that the military consider fitting potential at-risk service members
to resilience training, developing concurrent strategic short-term and long-term operational policymaking
processes, and linking accession data to health outcomes to inform future psychological
health policy creation.
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