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Biomedical subjects

R J Koshes

Publications and source records attributed to R J Koshes.

18 recordsLinked to original sources
PubMed1995

Homosexuality and the military.

OBJECTIVE: Homosexuality has remained a focus of military concern despite society's increasing acceptance of homosexual men and women and evidence that homosexuals have served and currently serve in the U.S. armed forces. President Clinton has stated a determination to end discrimination against homosexuals in the military and reverse the exclusionary policy on homosexuals serving in the armed forces. The authors review the history of the policy of the U.S. military to exclude homosexuals from serving in the armed forces. METHOD: The data for this study were drawn from military archives and court cases that have shaped U.S. policy excluding homosexuals from serving in the armed forces. The three main arguments are addressed: 1) homosexuality is a mental disorder rendering a person unstable, 2) homosexual service members are a source of poor morale for military units, and 3) homosexual service members are poor security risks. RESULTS: Considerable evidence demonstrates that homosexuals in the military pose no documented threat to national security and show no evidence of poor work performance. CONCLUSIONS: Although issues of morale and fraternization in the military remain challenges, no evidence in this review supports the exclusion of homosexuals from service in the U.S. armed forces.

Adult↗
PubMed1995

Ambulatory mental health services at a U.S. Army combat support post: the effects of the Persian Gulf War.

A study of ambulatory mental health services on a U.S. Army post where logistic support personnel are stationed compared utilization of psychiatric services before, during, and after the Persian Gulf War. Rates were calculated for service utilization for the at-risk groups from consecutive cases presenting at the post's ambulatory mental health services in the Department of Psychiatry. Our findings include a high rate of dysfunction for soldiers in training during the war; significant age, race, and sex differences between utilizers and non-utilizers throughout the study period; increased routine evaluations for military schools following the war; and significant increases in utilization of services by identified high-stress units during this conflict. Rates of utilization for a combat support post can be used for resource allocation and have implications for mental health manpower planning and stress prevention.

Adult↗
PubMed1995

Mobilization and rejection of Individual Ready Reserve personnel in Operations Desert Shield/Storm at a U.S. Army Quartermaster post.

The individual Ready Reserve (IRR) is an important component of the U.S. Army's total combat force. After Operations Desert Shield/Storm, we investigated the mobilization of soldiers with combat service support specialties from the IRR to a quartermaster training post. In the initial 2 weeks of activation prior to assignment and deployment, the soldiers went through medical and administrative screening, and general and specialized military training. During this period, a sizable portion (one-quarter) of IRR troops who reported to duty were rejected for a variety of reasons (overweight, inadequate dependent arrangements, etc.) and did not remain on active duty. Potential changes to the policies that led to these rejections are discussed.

Body Weight↗
PubMed1994

Witnessed suicides.

Suicides that take place in the presence of others have not been the topic of systematic scientific inquiry. The so-called witnessed suicides account for a small percentage of all suicides but offer a unique view into the dynamics of self-destructive behavior. An epidemiologic and forensic description of 50 witnessed suicides drawn from a 15-year series of over 1,000 cases is presented. A taxonomy is developed based on the role played by the witness and related to previous work on self-destructive behavior and its motivation. Brief vignettes are used to illustrate some of the interpersonal dynamics associated with these deaths.

Adolescent↗
PubMed1994

Use of inpatient psychiatric services on a U.S. Army combat support post during Operations Desert Shield and Desert Storm: the stress of non-deployment.

We studied the utilization of inpatient psychiatric services during Operations Desert Shield and Desert Storm (the Persian Gulf War of 1990-1991) on a U.S. Army combat support post. Inpatient psychiatric admissions and dispositions for the post's catchment area were tallied before, during, and after Operations Desert Shield and Desert Storm. Subjects included active duty soldiers (deployed soldiers were not studied while they were away from the post), their families, and retirees. Overall, there was no increase in psychiatric hospitalizations for active duty soldiers, their family members, or retirees. However, coincident with the return of soldiers from Operations Desert Shield and Desert Storm, the psychiatric proportion of all hospitalizations increased in the subpopulation of soldiers not deployed who had served less than 1 year. These soldiers in training may be more susceptible to increased stress levels associated with the return of soldiers from war because of their inadequate group bonding.

Combat Disorders↗
PubMed1994

Desert Shield deployment and social problems on a U.S. Army combat support post.

We undertook a study of selected mental health-related services at a combat support post to determine if stress levels surrounding Operations Desert Shield/Desert Storm had an effect on the utilization of these services. Our measure was the problem rate formed by adding the visits to the alcohol and drug service and the social work service. The findings (not all of which reached statistical significance in our small study) were that the problem rates were higher in those units which deployed, both before and after deployment. The pre-deployment differences in age, rank, and race between those soldiers deployed and not deployed is a finding which may help to account for the difference between units. There was a transient, but not sustained, problem rate increase immediately following return home for those units which deployed. Implications for mental health-related services staffing and directions for further research are discussed.

Adult↗
PubMed1992

Treatment issues and treatment configurations for mentally ill homeless women.

This article reviews and discusses various issues pertinent to effective delivery of treatment services to mentally ill homeless women. The central emphasis is upon the gender-specific issues unique to this population and includes attention to distinctive features of effective case management, utilization of group therapy techniques, and greater integration of the psychiatrist into the treatment team. The article concludes with a discussion of the future issues relevant to community based services to homeless mentally ill women.

Female↗
PubMed1992

Parasuicidal behavior on an active duty army training post.

The incidence of suicidal behavior among active duty Army personnel at a training post has not been the subject of analysis since the advent of the all-volunteer military. A review of admissions over 16 consecutive months showed most of the behaviors to be parasuicidal, with low levels of lethality and high rescuability. Compared to previously published studies, the characteristics of these soldiers are little changed over the past 25 years. This report suggests a standard method for handling suicidal behavior which includes an active role for psychiatric consultation to units and commanders.

Adjustment Disorders↗
PubMed1991

Psychiatric care of the homeless mentally ill: an opportunity for military psychiatry training.

This paper reviews the phenomenon of homelessness in the United States and locally in Washington, D.C. Prevalence data of psychiatric illness in the homeless is presented, as is the formation of a psychiatric service network to treat the homeless mentally ill. Additionally, the author describes the development of an innovative training program in community psychiatry, focusing specifically on issues inherent in understanding the work of the psychiatric resident in community-based training and service delivery. The relevance of this experience to military medicine involves training psychiatric residents to develop service-delivery schemes in times of rapidly expanding mental health needs, such as combat.

Acquired Immunodeficiency Syndrome↗