Mental health disorders, particularly post-traumatic stress disorder or PTSD (an anxiety disorder triggered by a traumatic event), are often cited as conditions where the treatment will result in substantial future costs (Bass and Golding, 2012; Bilmes, 2013) if not treated. The total costs for treating veterans with PTSD during fiscal years 2004–09 at the Veterans Health Administration (VHA) was $1.42 billion (Bass and Golding, 2012). The total cost for treating active service members, reservists, and national guardsmen altogether is unreported. The average cost of treatment for PTSD per veteran in the VHA for the first year of treatment is $8300, whereas treatments for years 2, 3, and 4 are $4200, $3900, and $3800, respectively (Bass and Golding, 2012).
Accounting for and untangling the costs associated with PTSD and other mental illnesses associated with deployment are not easy tasks, nor is determining the total number of those diagnosed with PTSD. During the period of Oct. 2001 through Mar. 2011, military clinicians diagnosed PTSD as one of the more common diagnoses among service members, accounting for ≈75,000 cases (Golding, 2011). During the same period, the VHA diagnosed 187,000 overseas contingency operations (OCO) veterans with PTSD (Golding, 2011). For this period, 15,000 veterans were not treated for PTSD by the VHA system or the vet centers. While these calculations overlap, the total number is undetermined; however, the total number of veterans diagnosed with PTSD is somewhat less than 277,000 (Golding, 2011).
Over the past decade, the United States has deployed over 2.3 million service members to OCO, such as Iraq and Afghanistan, in the post-Sept. 11 “Global War on Terrorism” (Bass and Golding, 2012). In a study conducted in 2010, ≈27% of two million service members had been deployed more than once (Sayer et al., 2010).
Several studies suggest that as time since deployment to Operations Enduring and Iraqi Freedom (OEF/OIF) increases so, too, does the prevalence of poor mental health functioning among the U.S. service members (Falvo et al., 2012; Milliken et al., 2007; Seal et al., 2009; Thomas et al., 2010). Before deployment to Iraq and Afghanistan in support of the OEF/OIF, the U.S. service members reported baseline health functioning superior to that of the general U.S. population (Falvo et al., 2012; Smith et al., 2007). Following deployment, however, veterans reported they had poorer health (Falvo et al., 2012; Milliken et al., 2007; Sayer et al., 2010). In fact, the number of OEF/OIF veterans rating their overall health as fair or poor doubled 6 months after returning home as compared with their initial post deployment assessment (Falvo et al., 2012; Milliken et al., 2007). Studies have shown that the longer a veteran waits after redeployment to seek treatment, the worse his/her symptoms develop (Falvo et al., 2012). A worsening of functioning over time could lead to long-term disability and have numerous public health implications; for example, greater health care utilization and mortality would be especially problematic for this relatively young, working age population (Falvo et al., 2012).
Upon return from deployment, veterans often suffer with mental and physical challenges that interfere with their quality of life. Combat veterans, in general, often have a difficult time reintegrating into society and this is compounded when they are suffering with PTSD (Erickson, 2011). Veterans sometimes return as a different person, especially those who have served multiple deployments, and particularly if they have experienced, witnessed, or were confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (DSM-IV checklist as cited by DepressionD, 2013). Some veterans have changed in physical ways with physical wounds that can be seen and treated; others have psychological wounds that are invisible and sometimes much more difficult to diagnose and/or for the veteran to ask for help.
Despite the challenges veterans have in readjusting and transitioning from military life to civilian life, a little more than a million veterans and military service members have made the transition to campus life (NCSL, 2014). While all students have to adjust to campus life, student veterans have to balance a wide range of other challenges which range from coping with service related injuries, the lack of camaraderie and understanding among other students and faculty, difficulty obtaining academic credit for military training and experiences, concerns about targeted recruiting by for-profit institutions, and/or state residency requirements (NCSL, 2014). In 2012, veteran undergraduates made up ≈4% of the nation’s student body. Sixty-two percent of veterans are the first in their family to attend college, compared with 43% of nonmilitary students (McBain et al., 2012). The average age of student veterans enrolling in a four-year university is 33 years (McBain et al., 2012), of which 85% are 24 years of age, and 47% have families, either a spouse and/or children (NCSL, 2014). Females make up 27% of the veterans enrolled in postsecondary education; however, they only make up 10% to 12% of the total military personnel (NCSL, 2014).
Transition to college life can be difficult and challenging for traditional and nontraditional students. Bayram and Bilgel (2008) conducted a study to determine the correlations of depression, anxiety, and stress among university students. While using the Depression Anxiety and Stress Scale-42 (DASS-42), their results indicated depression, anxiety, and stress levels of moderate severity or higher were found in 25% to 47% of the respondents. First and second year students had higher depression, anxiety, and stress scores. Their study found an alarmingly high prevalence of issues of depression, anxiety, and stress among college students indicating a need for the development of prevention measures and support services for college students (Bayram and Bilgel, 2008).
The Center for Collegiate Mental Health’s 2015 report found in students’ self-report surveys of distress over a 6-year period that the average raw scores continue to increase for depression, generalized anxiety, and social anxiety. The level of academic distress also had a slight increase. Furthermore, the report found an increase in students seeking mental health services and a steady increase in self-harm (intentionally cut, burned, bruised, or otherwise injured themselves) among students who sought out services, with 32.9% of the students seriously considering suicide in 2015, compared with 23.8% in 2010 (Center for Collegiate Mental Health, 2016).
Gonzalez et al. (2011) conducted a study using therapeutic horticulture to assess changes in psychological distress and social participation in adults who were diagnosed with clinical depression. Therapeutic horticulture is a plant-based activity that includes participation in enjoyable activities, behavioral activation, and a moderate amount of physical activity in a pleasant, plant-based environment (Gonzalez et al., 2011). The study found that depression severity declined significantly after 4 weeks of therapeutic horticulture interventions and continued to decline in the following 4 weeks (Gonzalez et al., 2011).
The purpose of this study was to determine the effects of participation in particular greenhouse activities on depression, anxiety, and stress levels of students who served in the U.S. Armed Forces.
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