New discoveries in military mental healthcare

Dr. Belding:
The goal is to make sure that we're taking care of the health and wellbeing of those war fighters so that way they're able to do their job. So I think as we start looking into even more of the complexity around these things, understanding that we're talking about a whole person. It's not just one injury, it's everything that's going on for them all at the same time. I think that's really going to push the science in really fascinating directions.

Meghan:
Welcome to this episode of Mindset. I'm your host, Meghan Good.

Brandon:
And I'm your host Brandon Buckner.

Meghan:
Today, we have a special episode with a round table of experts in military mental health. So Brandon, let's get started.

Brandon:
As our listeners may or may not know, we are right now in back-to-back months when we'll be hearing a lot on the topic of mental health. May is when we observe mental health awareness month, and June, especially for the VA, is when we observe post-traumatic stress disorder or PTSD awareness month. So it seems like the perfect time to explore this topic, but especially from the angle of military mental health care and new discoveries in the field. As we know, this is a really big story right now in our military community. Traumatic brain injury and PTSD are often referred to as the quote unquote invisible wounds of war. And in fact, military doctors consider concussions to be the signature wound of the conflicts in Iraq and Afghanistan. This is also a very big challenge for Leidos, because within the company, within our health group specifically, we have a lot of work going on to help our customers better understand these wounds of battle, work that seeks to advance the science of how we mitigate, diagnose and treat them.

Brandon:
So we've asked three of our colleagues on the show today to help answer the question, what are the latest discoveries in military mental health care? I'd like to start with Dr. Jennifer Belding, a San Diego based Leidos scientist who actually earned the company's most prestigious award in scientific innovation for her team's research on traumatic brain injury. Nice to have you on, Dr. Belding.

Dr. Belding:
Thanks for having me.

Brandon:
So we know our military community faces very unique mental health challenges, and obviously there is a strong feeling that we need to do more to care for any type of injury to our soldiers and their families. So Dr. Belding, as you look at this issue broadly, what's the biggest challenge you see?

Dr. Belding:
I think one of the biggest challenges we see is being able to know who needs or how prevalent these issues are and to know who needs that care, right? So to be able to understand how common these things are in our environment to be able to identify them when they happen so that way we can ensure that our war fighters and service members are getting the care that they need.

Brandon:
What are some ways that we can better understand this?

Dr. Belding:
So there's a lot of really great advances that are going on. A big piece of it is really using a variety of scientific approaches to be able to understand the scope. So for example, there are multiple groups that are conducting surveillance efforts, trying to identify when folks are deployed or when they come home. And when they're here in the U.S., how prevalent issues such as traumatic brain injury or post traumatic stress disorder or any of these other mental health conditions might be affecting folks. So for example, we know that in the past two decades, since 2000, over 400,000 service members have sustained a concussion or a more severe form of traumatic brain injury. And that's really a lot of folks. So we want to make sure that by understanding how common these issues are and how to track it, how to screen for it, that way we can ensure that those folks are getting the care that they need. We can keep them healthy. We can ensure they've got that wellbeing so that they're able to do the job that we need them to do, and that'll be valuable.

Brandon:
Wow. So 400,000 is obviously a lot of our soldiers, and it's obviously a very big challenge, a very important challenge. On the flip side of that coin, what would you say is the most promising new advance that you're seeing?

Dr. Belding:
Well, that's a great question. I think different people will give you different answers for sure. I would say given the work that I do, which specifically focuses on traumatic brain injury, which can result from something like exposure to a blast or an explosion during deployment, what we're starting to see is we're starting to see a shift towards really good efforts at trying to record the different exposures that people may have. So trying to create a record that sticks with service members. That way we can look back over time and say, here's what they've been exposed to, here's what might be influencing the care that they need. And getting that at the individual person level is going to be really helpful, not only when they're seeking care within the military health system, but ultimately, once they've finished their service, now they might be seeking care from the VA or elsewhere.

Dr. Belding:
There's a lot of different approaches to that. Some of them involve creating great equipment that service members can wear that measure how strong that blasts might be. Sometimes it's self-reported surveys that they fill out frequently. Sometimes we're looking at their medical record and trying to be able to identify here's when they had these different diagnoses.

Brandon:
Let's go now to Dr. Jessica Watrous, another San Diego based Leidos scientist. She is a clinical health psychologist by training and involved with several major programs, including the Wounded Warrior Recovery Project. Nice to have you on Dr. Watrous.

Dr. Watrous:
Thanks for having me.

Brandon:
Same question to you. As you look at this issue, what's the biggest challenge you see?

Dr. Watrous:
So I think from my perspective as a clinical health psychologist, one of the biggest challenges that we're facing in kind of addressing mental health concerns is actually that a lot of research in clinical work is happening in silos. So we have people that are addressing issues related to injury sometimes almost separately than they're addressing mental related issues. And so as a clinical psychologist, I'm particularly interested in that intersection between the two. And this is really relevant for, for example, service members that were injured during deployment or during combat. And so the biggest challenge is how do we get people interdisciplinary care? How are we ensuring that they have access to the physical and medical care that they need at the same time that they're also receiving kind of mental and behavioral health care that can improve their outcomes? So for me, I think that is where I would kind of say, there can be a stuck point both in healthcare and in research.

Brandon:
So on the flip side of that coin then, what are some of the most promising advances, exciting advances that you're seeing?

Dr. Watrous:
Yeah, I think the most promising advances actually have to do with addressing that specific challenge. And so, for me specifically, that is having the opportunity to work with researchers in other disciplines who are doing work that's directly related to the work that I'm doing. So for example, I am an expert in something like mental health, or I've done a lot of work in things like PTSD or substance use disorders. And I may know those things well, but what I know less about would be, for example, sleep physiology, and I've had the opportunity to work with some really amazing sleep physiologists. Chronic illness from a medical perspective is something that I don't have explicit training and background in and I've had great opportunities to work with nephrologists and cardiologists. And so really kind of addressing these issues from a multidisciplinary angle, one, so that we can understand them in that way, and two, hopefully so that we can kind of influence policy and improve healthcare from an interdisciplinary or multidisciplinary stance.

Brandon:
Let's go now to Robyn McCroy, also based in San Diego, a Leidos epidemiologist whose research throughout her career has focused on military, psychological, behavioral and physical health. The current portfolio she manages includes more than 90 active research studies. Nice to have you on Robyn.

Robyn:
Nice to be here.

Brandon:
Same question to you. As you look at this issue, what's the biggest challenge you see?

Robyn:
So, I think one of the biggest challenges for the military community is care seeking for mental health care problems and the stigma that's associated with it. The military has a strong culture that's grounded in toughness, strength, and self-reliance can certainly influence mental health care stigma. Past research has identified that almost half of military personnel with mental health symptoms feel that they would be seen as weak or that their leadership might treat them differently if they decided to seek help. But the good news is that the military has identified this as a major concern and has done quite a bit of work over the past decade to try to mitigate the stigma from a variety of programs and interventions. But I think in order to see a really big reduction in stigma, a large cultural shift is necessary, and cultural shifts take a long time.

Brandon:
And thank you for the issue of stigma, which we know is so important. Same follow-up question to you, Robyn. As the flip side of that coin, as you look at the most promising new advances, what comes to mind for you?

Robyn:
I think that there are really three big areas specifically related to early intervention, our understanding of the effects of therapies, and advancements in technology. And I think all of these are really related to changing the trajectory of mental health symptoms and mental health disorders. There's been a lot of work in mental illness interventions and therapies that can be used in mild or substantive cases that actually prevents symptoms. A number of clinical trials have indicated that the onset of common mental disorders like depression and anxiety can be delayed and in some cases even prevented from worsening. Another promising new advance is related to our understanding of the biology of mental health disorders and the effects of therapy. There is some ongoing research in the civilian sector regarding the relationship between depression, risk and biomarkers, such as cytokine levels in the bloodstream. Other researchers looking at how specific protein levels in the blood change and response to antidepressant therapy and people who are responding and not responding to treatment.

Robyn:
And I think the third advancement is related to technology, which has really opened a lot of doors for not only mental health treatment, but for researchers as well. Mobile devices like smartphones and tablets are giving patients and doctors new ways to access help and monitor progress. In addition to benefiting patients, these apps can also provide useful data to researchers. For example, we ask and collect data on symptoms over the course of time, and researchers can use that information to understand factors that lead to change. And some apps are starting to use the device's built in sensors to collect data on a user's typical behavior pattern and can detect deviations from this. Since people carry their phones wherever they go, the apps can collect valuable data that researchers can use to better understand mental health and wellbeing.

Meghan:
That's fascinating how it's, how the three of you, when you talk to you together, it's amazing the breadth and scope of the kind of work that you're pursuing, from Dr. Belding talking to us about traumatic brain injury and the impacts around different kinds of concussions, to then we talk through about how that ties in with clinical health and to how that actually gets performed and that the underlying research along the whole life cycle. Thank you all for sharing that. And I'd like to know a little bit more about what it is that you do, and what's really under the surface of the kinds of projects that you work on today. So, first to you, Jessica, can we talk about the efforts that you work on?

Dr. Watrous:
Absolutely. So I lead a multi-disciplinary team for our customers that includes social psychologists, a neuropsychologist, myself, a clinical health psychologist, and epidemiologist. And we work with a number of collaborators in a variety of different disciplines, both at our customer site and beyond, including in other services and at the VA. Our work is intended to focus on kind of some of these invisible consequences of military service and of war specifically. Our largest study is the Wounded Warrior Recovery Project, which is a long-term surveillance project of patient reported outcomes for service members that were injured during deployment. So a lot of the work focused on injury during deployment includes kind of objective medical records. And that's really, really important and that's useful to know about outcomes, but it tells us much less about how those service members would describe their ongoing functioning and kind of their quality of life.

Dr. Watrous:
And so from that, the Wounded Warrior Recovery Project was born. And to date, we have over 6,000 participants who complete assessment measures for us every six months and will do so for about 15 years. And those assessments focus on things like mental health, behavioral health, which includes things like physical activity and tobacco use, and then also long-term quality of life. And we can take that and kind of take a snapshot over time of how people are doing after an injury. And like I mentioned, our particular interest and my particular interest is what is the intersection between mental and physical health, because unfortunately experiencing an injury can place these individuals at risk for adverse outcomes in both the mental and the physical domain. So they may be at risk for things like PTSD and depression, but also things like chronic pain and increased risk of cardio metabolic diseases like diabetes or hypertension.

Dr. Watrous:
And so really understanding how these things are intersecting and understanding the role that people's emotional wellness is playing, how they're engaging in behaviors, like things like physical activity and substance use, and how those are all impacting long-term outcomes is a really important part of the work that we do. We've had the opportunity to work with collaborators, like I mentioned earlier, who are nephrologists and epidemiologists so we can start to understand this picture, not simply from a mental health domain and not simply from a medical domain, but really where are things kind of intersecting. And as the lead on this project, or one of the leads on this project, we kind of see all of the work across the entire, from participant recruitment and retention through the dissemination of this data at scientific conferences and in manuscripts.

Dr. Watrous:
We've had the opportunity to present at a variety of scientific and clinical conferences, which has been wonderful. And then we've published recently, most recently on issues related to things like low back pain, women's health, health behaviors in our population and in our sample. And so we're really focused on understanding the risks so that we can hopefully inform how to improve care and optimize outcomes for these individuals.

Meghan:
So Robyn, over to you for the same question. Can you give us a little bit more about the kinds of research programs you work on?

Robyn:
Yeah. So I'm going to focus on one specifically. This is the biggest project in my current contract portfolio, and it's a survey research effort that focuses on active duty, reserve guard, and veterans from all service branches. And this is actually the largest and longest running health study of military personnel. It began over 20 years ago and is actually expected to last until at least 2068. The study follows service members while they are in service and after they leave the military, including that important time around when they transition out of service. The study includes well over 200,000 individuals and the goal is to investigate the longterm health and wellbeing of service men and women to improve military readiness and protect the health of military personnel, veterans and their families. In addition to being the largest and the longest ongoing study, the research is adaptable and responsible. Our researchers and stakeholders suggest new topics and questions that can address emerging issues and capture information on how things are changing for this population.

Robyn:
And a little over 10 years ago, the study expanded its effort to include a separate survey for the spouses of service members enrolled in the study. Including the spouses, we not only have a better understanding of family factors that can improve service member resilience over time, but we can also explore risk and protective factors that influence family wellbeing. And going back to some of the three biggest advancements in mental health, early intervention, our increased understanding of the biology behind therapies and technological advancements, what these three things have in common is that they are all related to altering the trajectory of mental health problems. And this is where this program of research really shines. Because the study is longitudinal, the team can examine the trajectory of mental health disorders and military personnel and explore the multitude of factors that influence the course of illness and recovery. And the program is really further strengthened by its ability to connect survey data with additional data sources, such as medical records, pharmaceutical data, immunizations, deployment information, and also veterans affairs records after service members and families transition to civilian life.

Brandon:
Over to you, Dr. Belding.

Dr. Belding:
What we do on our team is we are trying to pull data from multiple different sources and compile it together to be able to come up with that really informative approach. So what we've done in the past is we've leveraged archival post-deployment health assessment and post-deployment health reassessment surveys. These are mandatory surveys that service members have to fill out when they're coming home from deployment and then about six months later. And on that three page survey, they tell us the different things that might've happened to them during deployment, they'll fill out a screener that would let us know if they might have sustained a probable concussion or more severe injury during their deployment. It also tells us a little bit about what symptoms that they reported seeking medical care for. So if they were in the Marine Corps and they had headaches, did they go see a corpsman to be able to get some Motrin to be able to help them with that?

Dr. Belding:
So we're getting that self-reported information. We're using a combination of that data with archival medical and career data. So what was their job in the military? What were they doing? What diagnoses did they seek care for? All of these different things. The research that we've published to date has really been looking at, it's been trying to identify with active duty enlisted Marines who might've been exposed to something that could have caused the traumatic brain injury during deployment. How are they doing afterwards? We've been able to group people into occupational categories that might be at more risk or less risk for certain kinds of blast exposure, so different things that they might be doing as part of their occupational duties that might increase their susceptibility to concussion. And so we've been able to show that there are some of these occupational differences, that some folks are more likely to sustain that concussion.

Dr. Belding:
And those same folks are more likely to be reporting neurological symptoms. Things like headaches, fatigue, memory lapses, all of these things, and being able to examine how long those things may persist. So they're reporting it when they come back from deployment, but are they still reporting it six months later? So by leveraging all of that archival data, we're looking at folks who have been deployed over a very long time, trying to get a really big scope. And that's one of the things that makes what we're doing unique compared to most other researchers in this field who are using very, very small samples. You're talking maybe 40 people or so. The data we work with is 181,000 people. And so we're getting a lot more data here. We're being able to leverage it in a lot of interesting ways. And I think that's something that's really innovative about the approach that we have. And the fact that we get that incredibly rich career data really helps us identify who's at risk so that way we can use that to inform how to mitigate that risk.

Meghan:
That's incredible, though, with the scale that you're talking at, and really where you start to see those sorts of trends. Has there been anything so far that's been surprising as you've been analyzing this volume of data?

Dr. Belding:
Yeah. Well, so there have been. I think I could give you the funny answer just because it cracks me up is we had to code all the different, people got to write what their occupation was during their deployment on an open-ended text box. So we had to code that, and those answers are absolutely hilarious. So there was a little bit of surprise there in terms of what we would read that our Marines were writing. But in terms of the actual innovative information, our research has really shown that there are these occupational differences, and that's something that really prompted the original investigation into these different kinds of blast exposure, because there were service members who were coming back from deployment, who were leaving these different tours of duty where they were repetitively exposed to these kinds of things. And they were reporting headaches and fatigue and memory lapses. They were saying that they had all these issues and they were the ones really pushing for that research.

Brandon:
So Dr. Belding, what are the big differences that you've discovered in someone who's suffered a concussion from a blast injury versus someone who's suffered a concussion from blunt trauma?

Dr. Belding:
One of the really interesting things about blasts is that it's a very complex event that happens, right? So you can imagine that somebody who has sustained a concussion or another form of traumatic brain injury, usually that comes from physically hitting your head against another surface. It could be the ground, it could be the wall, something else. Essentially, you get your bell rung. But with a blast, it's a little bit different because there's that pressure wave that comes through your head, reverberates around a little bit, and it's possible that the pressure wave alone might come with different consequences. And that same blast can also physically knock you off your feet so you still hit your head, but there might be some other element of that exposure that could be associated with different health outcomes. So in our work, what we've done is we've looked at not only who's susceptible to sustaining a concussion, which is usually determined based on whether or not they had a loss or alteration of consciousness.

Dr. Belding:
Did things go dark for them? Did they pass out? Did they feel dizzy? They saw stars, those kinds of things. So we look a little bit at who's more likely to sustain those concussions. And then, are there differences based on what might've caused that concussion between physical impact to the head and somebody who might've had blast exposure. So we refer to those as either blast induced concussions or impact induced concussions. And what our findings have shown is that when we're talking about these concussions that were sustained during deployment for active duty enlisted Marines, and again, we're talking about a lot of them here, are these folks more likely to have that loss or alteration of consciousness? And yes, that is more likely to happen after you're exposed to a blast compared to something like a car crash or a fall. Folks are more likely to have that loss or alteration of consciousness after a blast. But they also are more likely to report those neurological symptoms, things like headaches, memory, lapses, dizziness, or dim vision.

Dr. Belding:
And so they report those essentially right after it happens. They report those when they're coming back from deployment. But we also looked at are those symptoms more likely to persist over time. Are some folks still reporting those headaches up to six months later? Because if they're lasting for after three months, we call that post-concussive syndrome. And what we've shown in our research is that yes, blast induced concussions are associated with more of those persistent neurological symptoms over time. That research is coming out in a paper that was actually accepted this morning, which is really exciting for us.

Brandon:
Congratulations. So looking ahead, how much more is there to know and to understand about TBI and what are you most eager to study next?

Dr. Belding:
I feel like one of the great things about traumatic brain injury research in general is all of the different complexities that we have in the way that we think about these things. So it's really understanding what the different treatments might be. But in order to get to that point, we have to understand how prevalent these issues are, what differences there might be in the types of traumatic brain injuries that people sustain. So we look at blast versus impact, but there are other things that you can examine as well. What I'm particularly interested in seeing more of in the future is looking at the comorbidity or the co-occurrence of traumatic brain injury with these other things that often have happened, and PTSD is one example of that. So for instance, when you think about folks who are coming back from deployment, they might've had some sort of experience that was traumatic.

Dr. Belding:
Certainly being exposed to an improvised explosive device or seeing what may happen there is a traumatic event and it makes sense that folks might sustain that concussion as well as develop post traumatic stress disorder. And so really we're going to start seeing more and more of that research look at when those things are happening simultaneously, when they're happening separately, how distinct are those different conditions that people might have and if they are different in some way. If there's something about just having the concussion but not showing those signs and symptoms of PTSD, does that suggest that different treatment would be necessary? Because again, the goal is to make sure that we're taking care of the health and wellbeing of those war fighters, so that way they're able to do their job. So I think as we start looking into even more of the complexity around these things, understanding that we're talking about a whole person. It's not just one injury, it's everything that's going on for them all at the same time. I think that's really going to push the science in really fascinating directions.

Brandon:
Robyn, I'm really interested in this military family angle, perhaps an often overlooked angle to this story. How much of a push are you seeing to care for the family members of our veterans?

Robyn:
That's a great question. We're actually seeing quite a big push and I think that's because people are really understanding that the military personnel are veteran. They're not operating in isolation. What's going on with them is affecting their family members and their family members have an impact on them. And there's this great deal of interconnectedness between the two. And so, in addition to not only treating a family, treating a military person who is struggling, it's something where there's been shown to be a lot of success if the entire family is brought in.

Brandon:
Interesting. And then, Jessica, I was interested in what you mentioned about the intersection of physical and mental health. How much do we really know and how active is this area of research?

Dr. Watrous:
That is a great question. And what I would say is that sometimes our research just brings us more questions. So those relationships are incredibly complex and we can think about it from, we can kind of come up with an example of something that we sometimes see amongst our injured service personnel. And so you can imagine a situation where somebody is involved in a combat incident. Maybe they get hit by an IED or they're involved in a firefight and they suffer a pretty severe injury. And from that point on, the experience of that injury can be associated with physiological changes. At an almost cellular level, we can see changes in the mitochondria of cells and changes in kind of inflammation throughout the body, as a function of the injury and as a function of the psychological trauma. And those two things and combat injuries are almost impossible to pull apart. From there, we see this ongoing kind of cycle where physical, mental, and behavioral health are all kind of pulling on each other.

Dr. Watrous:
So in a worst case scenario, where somebody is struggling with something like chronic pain, and they're suffering from emotional distress, maybe this is PTSD, maybe it's depression, maybe it's both, they may engage in behaviors that can exacerbate those problems. So they may engage in substance use. They may isolate from friends and loved ones. And not only is that going to make the emotional distress a little bit worse, but it's also going to prevent them from kind of being able to engage in physical behaviors or medical appointments that can improve that aspect of things. And so, it is critical that we kind of understand how these things are all playing together, but it requires us to no longer rely on this idea that there is a separation between mind and body. For example, chronic pain is one of those things that we're seeing has a high, high rate of co-occurring with mental health problems.

Dr. Watrous:
And it's difficult sometimes to just be able to attribute pain to solely a physiological injury. There's a lot of reasons that people experience pain, and that doesn't make the pain any less real just because you can't point to a place on a scan and say that this is where your pain is coming from. It's complicated, it's complex, it's fascinating. In terms of how that work is ongoing in the injury sphere, luckily that is a very common take. And so, in pain, in injury, in chronic illness, people also often describe something called the bio-psycho-social model which kind of incorporates all of these different domains that may be impacting people. So I think that it has become a really dominant view of some of these issues, which is good, because we know that all of those things are playing a role when people are struggling, whether that be with mental or physical health issues.

Meghan:
It's so exciting to hear you describe where there's a lot of knowledge and where the discoveries are still happening. And it begs the question in my mind of what's next. Where's the next deep dive in these areas? Robyn, can you go first?

Robyn:
I think one of the new approaches that the team is really excited about is the use of GIS software, which is a mapping and spatial analytics technology that will allow us to analyze all types of geographic and spatial data. We know that location can greatly impact health and behavior in a lot of ways through factors like cultural and social norms, local policies or initiatives, and the availability of resources. And the military is really a great population to study best because all those civilians get to self-select where they live. Service members are often assigned to work and live in specific locations and this choice is often outside their control. So the team wants to use GIS technology to explore things like differences in mental health between urban and rural veterans and explore our community factors, such as crime rates, unemployment, and the military presence and how these might influence mental health in military families.

Robyn:
The team is also excited to explore innovative topics in their research, including suicide risk, women's health, discrimination, anger, sexual assault, harassment, and bullying among active duty members, how the team's continuing to grow in the recognition of the importance of protective factors for mental health, and to answer the question, what makes military members more resilient? And they're continuing to expand the study to include contextual factors, such as work climate, social support, and family wellbeing. The researchers are also interested to more deeply explore issues related to health disparities and health equity. The military offers a unique context to study health disparities because active duty members have equal access to care. So it will be interesting to identify which factors are associated with barriers to mental health care that are above and beyond access issues.

Meghan:
Thank you, Robyn. And over to you, Jessica. What's next? What's on the horizon for the research and the advances that you're seeing?

Dr. Watrous:
That's a great question. And I think listening to Robyn talk and listening to Robyn's discussion about things like stigma and access being huge issues, I think that remains something that we can also still address through research. So I think there's kind of a three-pronged approach in my head kind of what's next, not just for us, but broadly for improving mental health research and care in the military and for veterans. So first of all, there's a lot of work in implementation. And so implementation work is focused not solely on what is an effective treatment, but how do we effectively launch this in a broad way so that it's sustainable in whatever systems we're going to try to launch it? The good news is that clinical psychologists have been working to create evidence-based treatments for a lot of the issues that we see. Things like PTSD, depression, anxiety disorders, sleep problems, have treatments that are already in existence that work really well to address those issues.

Dr. Watrous:
So I think that there needs to be a continued effort from researchers, and we would like to contribute to this, to figure out ways to make sure that people have access to that. In regards to the stigma portion, I think that is a research question. I also think that it's kind of a personal issue where we just need to talk openly about these things. We need to do a good job of educating, not just ourselves, but our friends and our colleagues, about what mental health is and how do we know when we may seek therapy and are there options for us that could be really beneficial. So I think that is one domain of work. I think Robyn also touched on this issue of resilience. I think understanding that a significant portion of military personnel and veterans are doing very well, both from a mental health perspective and a physical health perspective.

Dr. Watrous:
And so understanding what's working, what's supporting them in that, what environmental factors are kind of supporting that and what personal factors are supporting that, so that we can think about ways that we can inform future intervention and prevention efforts based on how they're doing. And then, last would be really thinking about if there is a need for novel intervention and prevention strategies and doing kind of gold standard randomized clinical trials and finding out what works so that we can eventually kind of continue to inform the policy so that healthcare can continue to be improved and advocating for more resources.

Dr. Watrous:
Because one of the issues that does still exist within the DOD and broadly sometimes within the VA is that although stigma is an issue, we have seen strides forward in the last maybe five or 10 years where people are maybe more likely to seek out mental health care. But unfortunately, then we run into a problem where there may not be enough providers. And so, we need to be able to advocate for why this is so important for our service members and for our veterans, so that we can make sure that the resources are being dedicated so that people can access those sorts of resources when they need them.

Meghan:
Right. And certainly at the end of this, I think you said it very well, Jessica, earlier. It's about understanding all of these risks through your research so that you're improving care and outcomes and particularly those for our military veterans. That's so critical and important. Thank you for your time today, sharing what your research is and where it's going next.

Robyn:
You're welcome.

Dr. Watrous:
Yeah, you're welcome. And thank you for having me. This was great.

Meghan:
And thank you to our listeners. If you enjoyed this episode, please share with your colleagues and visit leidos.com/mindset.