INVITED COMMENTARY 299 NCMJ vol. 76, no. 5 ncmedicaljournal.com This commentary describes the prevalence of mental health problems affecting military service members and veterans in North Carolina and the rest of the nation, with a special emphasis on those who served in the recent wars in Iraq and Afghanistan. Approximately 1.9 million of these veterans have become eligible for Veterans Affairs health care since 2002, and an estimated 1.16 million veterans have registered for this care. T he recent succession of military conflicts—Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND)—represents the longest sustained military operation in United States history. Since the inception of these operations, over 2 million vet- erans have deployed, with an average of over 1 deployment per service member [1]. Table 1 gives data on the number of active-duty soldiers, reserve soldiers, National Guard sol- diers, and veterans in North Carolina and nationwide. Combat operations have been characterized by use of improvised explosive devices (IEDs) by guerilla insur- gents, multiple and extended deployments, high utilization of the National Guard, an all-volunteer military force, and increased injury survival rates due to advances in battlefield medical care [2-4]. Rates of observed mental health condi- tions among post-9/11 service members have challenged mental health resources across the Department of Defense (DoD), Veterans Health Administration (VHA), and com- munity systems, requiring significant enhancement and expansion. Incidence, Prevalence, and Base Rates Approximately 1.9 million OEF/OIF/OND veterans have become eligible for Veterans Affairs (VA) health care since 2002. Of these, an estimated 1.16 million veterans have reg- istered for VA health care. As of December 2014, 57.2% (662,722) received at least a provisional mental health diag- nosis, with the most common conditions being post-trau- matic stress disorder (PTSD; 55%), depressive disorders (45%), and anxiety disorders other than PTSD (43%) [5]. Other studies have found a 23% prevalence of PTSD among OEF/OIF/OND veterans [6] and high rates of adjustment and substance use disorders (SUDs) [7, 8]. A 2015 meta- analysis by Kelsall and colleagues revealed a significantly greater incidence of SUDs among OEF/OIF/OND veterans compared with a matched non-deployed sample [9]. In fact, the number of veterans presenting for VA care with PTSD and a comorbid SUD has increased by 76% since 2008 [10, 11]. Rates of general reintegration difficulties among post-9/11 service members range from 45% among non-VHA users to 62% among users of VHA health care offerings [12]. Within the Veterans Integrated Service Network 6 (VISN 6) catch- ment area—which encompasses North Carolina, Virginia, and portions of West Virginia—30,214 OEF/OIF/OND vet- erans sought care specifically for PTSD between October 1, 2001 and December 31, 2014 [13]. Among these veterans, 60.5% presented to North Carolina–based VHA facilities. The OEF/OIF/OND conflicts and combat methods have also resulted in a high incidence of traumatic brain injury (TBI). According to a 2013 report from the Department of Veterans Affairs, from 2007–2013, a total of 185,437 veterans self-reported a history of TBI on a brief screening instrument [14]. The Defense and Veterans Brain Injury Center (DVBIC) recently reported that there have been 327,299 TBI cases among service members since 2000 [15], with 5,912 cases Mental Health Among Military Personnel and Veterans Treven Pickett, David Rothman, Eric F. Crawford, Mira Brancu, John A. Fairbank, Harold S. Kudler Electronically published November 13, 2015. Address correspondence to Dr. Treven Pickett, Psychology Section (116B), Mental Health Service, McGuire VA Medical Center, 1201 Broad Rock Blvd, Richmond, VA 23249 (treven.pickett@va.gov). N C Med J. 2015;76(5):299-306. ©2015 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved. 0029-2559/2015/76505 table 1. Number of Soldiers in North Carolina Compared to the Country as a Whole Nationwide Numbers Active-duty soldiers 1,382,400 [74] Reserve soldiers 834,700 [74] National Guard soldiers 459,600 [75] OEF/OIF/OND veterans 1,906,754 [5] North Carolina/VISN 6 Total active-duty soldiers in North Carolina 116,000 [68] Total reserve/National Guard soldiers in 22,000 [68] North Carolina Total number of veterans in North Carolina 766,000 [68] Total number of OEF/OIF veterans in VISN 6 95,077 [5] Note. OEF, Operation Enduring Freedom; OIF, Operation Iraqi Freedom; OND, Operation New Dawn; VISN 6, Veterans Integrated Service Network 6.