Nearly half of the 2.2 million U.S. troops who served in Iraq and Afghanistan have struggled to readjust to American life in part because the Departments of Defense and Veterans Affairs have been sluggish in helping those coming home in droves, according to a sweeping report released today.

After examining veteran suicides and unemployment as well as the military’s handling of sex assaults, women in uniform and same-sex family issues, the Institute of Medicine said returning service members deserve “timely and adequate care,” yet it cited cases in which the DOD and VA are using unproven diagnostic and therapy tools.

"The (federal) response has been slow and has not matched the magnitude of this population's requirements as many cope with a complex set of health, economic, and other challenges," said co-author Dr. George Rutherford. He chairs the IOM’s committee on the assessment of readjustment needs of military personnel, veterans, and their families. The IOM, an independent nonprofit, is the health arm of the National Academy of Sciences. 

"The number of people affected, the influx of returning personnel as the conflicts wind down, and the potential long-term consequences of their service heighten the urgency of putting the appropriate knowledge and resources in place to make re-entry into post-deployment life as easy as possible,” added Rutherford, head of preventive medicine and public health at the University of California, San Francisco School of Medicine.

Another 34,000 U.S. service members will be flown home from Afghanistan during the next 12 months. The high suicide toll among veterans (22 per day) has drawn recent Congressional scrutiny as have the elevated veteran-unemployment rate and access limits to VA mental health care. Congress requested the IOM study. 

Among the recommendations within the 500-plus page report:

• DOD and VA must “boost efforts to reduce the stigma” associated with service members or veterans simply asking for help to deal with mental-health issues or with substance-abuse problems.
• The tool DOD uses to assess cognitive function following a head injury – Automated Neuropsychological Assessment Metrics (ANAM) — carries “no clear scientific evidence” to show that it works. That’s key because more than 200,000 U.S. troops have sustained traumatic brain injuries since 2000 — most non-combat-related. On March 5, Congressional members sent a letter to the chiefs of DOD and VA seeking data to investigate a new theory linking TBIs with the military’s suicide crisis.
• One of the VA’s “first-line treatments for depression” — Acceptance and Commitment Therapy — similarly “lacks sufficient evidence” to show its efficacy.
• Research has found that curbing access to lethal weapons prevents suicides, however, “DOD policy prohibits restricting that individual's access to privately owned weapons” — even if a service member is known to be at risk for suicide.
• DOD and VA should link their databases so that the health records of all service members are available to track their medical conditions from the moment they enter the service through the day any future treatment is eventually rendered by a VA facility. 

"These (recommendations) are meant to be helpful, meant to be more of a roadmap of how to pursue” these issues, Rutherford said. “These are extraordinary challenges that the systems are facing and they’ve gone to extraordinary efforts to try and work with them.

'Demand is large'
“Yeah, it can all be streamlined. Yeah, (the available help) can be matched better to the demands. Yeah, you can improve this stuff. But they are trying like crazy to make it match the demand,” he added. “The demand is large, and it’s growing.”

Compared to past post-war generations, a higher percentage of returning Iraq and Afghanistan Veterans are using the VA for their health care — 56 percent of that population, according to the VA.

"This report provides VA a better understanding of the difficulties some Veterans face as they readjust to home, reconnect with family members, find employment and return to school," read an email from Josh Taylor, a VA spokesman. "Greater collaboration with the Department of Defense (DoD) in the areas of research, treatment and clinical outcomes will further enhance continuity of care as service members transition from active to veteran status."

Pentagon officials will examine the IOM’s suggestions, said Cynthia O. Smith, a DoD spokeswoman.

“DoD appreciates IOM's hard work and will thoughtfully consider the study's key findings and recommendations,” Smith wrote in an email. She added that the agency’s Deployment Health Clinical Center “will work collectively with the VA to provide a joint response to Congress no later than June 2013.” 

The IOM study reports that 44 percent of veterans have had "readjustment difficulties," 48 percent have dealt with "strains on family life," 49 percent have experienced post-traumatic stress, and 32 percent have felt "an occasional loss of interest in daily activities." Those figures were plucked from an earlier Pew Research Center survey. 

"I’m not surprised (by those numbers), talking to my other buddies that have gotten out. I’ve got several buddies that still can’t find jobs but, to be honest with you, I think it's a factor of (their) motivation" to hunt for work, said Ryan Kriesel, 24, an Army tank operator who served two tours in Iraq. He's now a student at the University of Minnesota. He described his own transition as "pretty smooth." 

When it comes to those younger veterans who report a flagging interest in daily life, Kriesel believes some of that may be due to the loss of the emotional rush that once came with combat. 

"Part of it is being back in the civilian world," he said. "There’s not as much adrenaline going on as when you were overseas, out on combat missions several times a day."

Related:

• Hunt for bogus war heroes uncovers thousands of hoaxers
• Obama urged to step in to fix VA backlog

A serial tragedy — like Friday's mass shooting at Sandy Hook Elementary School in Newtown, Conn., that left 20 children dead — is like “a big rock thrown in a pond,” grief experts say, casting emotional ringlets that drench those closest to the bloodshed in life-changing despair and bathe entire communities and even distant observers in sorrow.

"What happens after that rock lands in the pond? The waves circulate out from ground zero. There are the victims. And these (at Sandy Hook Elementary School) are babies, so unbelievably sad,” said Dr. Jeff Dolgan, chief psychologist at Children's Hospital in Denver. “Some people are not even directly touched by the trauma but are in fact traumatized — think about the other kids at the school, the administrators at the school, the first responders, the caregivers. Then the waves radiate out from the school into the community."

Those ripples may initially unite a town in candlelight and song then splinter it into a torrent of blame and lawsuits, as happened after the Columbine High School shootings in 1999 that killed 12 students and one teacher and injured 24 others.

"At Columbine, the impact was very widely felt. I talked to the people who were dealing with the fatalities at the hospitals. They had caregiver trauma. They did everything they could with the influx of severely injured but felt inadequate to the task,” he added.

After the Columbine massacre, Dolgan and his colleagues aligned with mental health experts in Jefferson County, Colo., launching a hotline where local parents could call for advice on soothing their own kids' anxieties. On Friday, Dolgan urged the parents in Newtown to similarly band together.

“This is a neighborhood elementary school and the parents there hopefully are tight-knit. Once you have the care done, I hope the parents are supportive of one another and work with one another,” Dolgan said. “I hope parents team up and, in time, do get-togethers.”

Dolgan witnessed firsthand how some Columbine families looked initially to condemn and penalize neighboring families and local law enforcement officers for the deaths in their school. The families of more than 30 Columbine victims sued the parents of the two killers, also Columbine students, eventually settling for $2.53 million. The families of 17 Columbine victims also sued the Jefferson County sheriff’s department; one of those victims settled in 2004 for $117,500.

Many of the Columbine families, Dolgan agreed, were likely seeking outlets to vent their anger at the tragic event, and at the murders.

“But who are you going to blame? The first responders? No. (Columbine principal Frank) DeAngelis? No. The school security? No,” Dolgan said. “In time, there was more healing and the parents came together. But initially, no, there were some fractious qualities.”

While heartache and fury may engulf a town after a mass killing, such serial traumas psychologically damage those closest to the suffering on a far deeper level than they do people who were merely in the vicinity, who were, perhaps, close enough to hear the gunfire but not see the deaths, science has found. 

Among 1,000 students who were on campus at Dawson College in Montreal in 2006 when a man shot and wounded 19 people, killing one, about one-third were found to be dealing with some form of mental illness within 18 months of that tragedy, according to a paper published in 2009. 

“The most common form was clinical depression – which affected 12 percent or 1 in 8. That is about three times higher than would be expected in a normal population,” said Dr. Warren Steiner, head of the department of psychiatry at McGill University Health Centre in Montreal, and one of the paper's authors.

“The next highest was substance abuse — drug or alcohol — which affected about 10 percent, people who were self-treating their own anxieties. That’s about three times higher than you would see in the normal population,” Steiner said.

The precise proximity of the survivors to the violence that day directly affected their mental health later, the research team learned. They divided the 1,000 students into four groups based on their “level of exposure.” Those who had witnessed the shootings received the “highest” exposure score, followed by those who only heard gunfire, followed by those who locked themselves into classrooms without knowing if they were next, followed by those who were on campus but unaware of the attacks.

Slideshow: Connecticut school massacre

Michelle Mcloughlin / Reuters

The second deadliest school shooting in U.S. history sent crying children spilling into the school parking lot as frightened parents waited for word on their loved ones.

Launch slideshow

“There was a direct correlation between the level of exposure to the shootings and the development of mental illness. It’s common sense, but it had never been proven before,” Steiner said.

For those who viewed the killings, or who had held a wounded classmate in their arms, post-traumatic stress disorder was the most commonly diagnosed illness, followed by depression and then alcohol dependency. 

But while the mass traumas at Columbine and Dawson College soaked each community in immediate anguish -- and, eventually, imbued those closest to the gunfire with psychological turmoil -- they continue to resonate in the Denver area and in Montreal, the psychologists said.

Memories of each are rekindled after the news of other serial shootings, including the 32 people who were shot and killed at Virginia Tech in 2007, the 13 people who were shot and killed at Fort Hood in 2009, and the 70 moviegoers who were shot — 12 fatally — in Aurora, Colo. on July 20.

“You hear about another one, and there’s the reflex of anxiety,” Steiner said. “I guarantee everyone who was at Dawson will hear the news this evening and they will have flashbacks and disturbing memories, PTSD-like symptoms from what happened to them.

“It goes on for a generation, no doubt about that,” Steiner said.

Dolgan agreed that the shelf-life of a local mass tragedy sticks with a community for several decades, and isn't simply shaken by the passing of time.

“No, no,” Dolgan said. “This is very long-lived.”

Related content from NBCNews.com:

• Elementary school massacre: 28 killed, including 20 kids
• Vigils, services honor school shooting victims
• Video: 'Our hearts are broken,' Obama says
• Gunman's mother owned weapons used in massacre
• 'Screams were coming over the intercom'
• Video: School shooting reignites gun control debate
• Massacre leaves America shocked and grieving ... again
• Connecticut school shooting is second worst in US history
• Authorities ID gunman who killed 27 in elementary school massacre

Follow US news from NBCNews.com on Twitter and Facebook

The Department of Defense is hoping that two new weapons – big money and little oil – can curb the rising military suicide rate.

A three-year, $10 million study, to be funded by the Department of Defense and conducted at the Medical University of South Carolina, will test whether omega-3 fatty acids found in fish oils can relieve the anxieties and quiet the suicidal thoughts plaguing many combat veterans, one of the lead researchers said Monday.

Scientists at the National Institutes of Health have long maintained that a diet heavy in omega-3 – common in salmon, anchovies and other oily fish – can elevate happiness.

“The problem is coming to a head with the recognition that in the military, you’re more likely to die by suicide than by enemy combatant – and that’s not acceptable,” said Dr. Ron Acierno, a co-investigator on the project and a professor in the department of psychiatry at the Medical University of South Carolina in Charleston, S.C.

“Omega-3s are among the primary fatty acids in the brain. They cannot be synthesized by the body – which means they have to be eaten (via food, drink or pill form). They’re responsible for neural generation and neural repair – for new neurons to be made and for broken ones to be fixed,” added Acierno, who also serves as the director of the PTSD clinical team at the Ralph H. Johnson VA Medical Center in Charleston.

The participants are veterans or service members who have been referred to a VA mental health treatment program because they are having suicidal thoughts. If the patients agree to join the study, they will be secretly placed in one of two groups. One segment will drink juice-box-sized smoothies high in omega-3. The second will drink placebos.

“Anybody who is showing suicidal ideation is going to be referred for the standard mental health treatment at the VA here in Charleston, which is a best practices site, so the standard treatment here is pretty good,” Acierno said. That means, he added, that military folks in the placebo group will not receive inadequate care. 

Watch the most-viewed videos on NBCNews.com

For those former and current service members who receive the omega-3-laced smoothies, they’ll be asked to gulp one in the morning and another at night. All of the study participants then will be tracked over time as researchers interview them and measure, via a scoring system, their suicidal thoughts and intentions – whether they have formed a plan to take their own lives – along with their anxiety levels and cognitive-processing abilities, Acierno said. Any actual attempts by the participants to harm themselves will be immediately treated but that bahavior will become part of the study’s data.

In addition to medical literature accounts that show omega-3 can buoy mental health, the study team is “excited” about the prospects of fish oil serving as something of a solution, Acierno said, because the product carries an “extremely low risk” for side effects. It's also relatively cheap – costing between $12 and $35 retail.

At Target, for example, a bottle of Nature Made Ultra Omega-3 Fish Oil, priced at $11.89, holds 45 softgel pills each containing 1,400 milligrams. Target also sells $44.99 boxes of Coromega orange-flavored squeeze packets that each contain 650 milligrams of omega-3, derived from pharmaceutical-grade fish oil. 

“The potential good versus the potential extraordinarily low risk and low cost make this a type of intervention that can be – if findings are warranted – rolled out extremely fast and on a large scale,” Acierno said.

Bonnie Carroll, a leading expert in military suicides and founder and president of the Tragedy Assistance Program for Survivors (TAPS),  said she has not read or heard about omega-3 as a possible medicinal tool in treating depression or post-traumatic stress. 

"We are very open-minded on any techniques that might be useful," said Carroll, whose organization provides peer-based emotional support for families affected by the death of a loved one serving in the U.S. military. She also was co-chair of the DOD Task Force on the Prevention of Suicide in the Armed Forces. 

Omega-3 has been on under the microscope for more than a year as experts have tried to dissect the high number of military suicides. In August 2011, a study published in the Journal of Clinical Psychiatry suggested that certain fish oil components had potent psychiatric benefits and suggested that taking an omega-3 supplement might help service members. That research, performed in part by the Uniformed Services University of Health Sciences, scanned through the medical records of 800 U.S. service members who took their own lives between 2002 and 2008, comparing those against the health files of 800 active-duty personnel who had not attempted suicide. The scientists found that service members with higher blood amounts of docosahexaenoic acid - an omega-3 fatty acid - were less likely to take their own lives.

Should veterans who have considered suicide begin swallowing omega-3 pills on their own now?

“Buying the omega-3s and taking them is not going to be a problem,” Acierno said. “However, if they do have these types of thoughts or feelings, remember that even the people in this study – even those who are on the placebo – are getting mental health care.

“So we never want to say this is a replacement for evidence-based mental health care," he added. “This is a supplement and one that is easily added. It’s also important that you get the care you need.” 

More content from NBCNews.com:

• Sandusky insists he's innocent, alleges conspiracy
• Visit Detroit at your own risk, police union warns
• Detroit police chief resigns amid sex scandal
• Wedding brawl aftermath: Man charged with assaulting cop
• Search for missing Colorado schoolgirl expanded after backpack found
• Video: Kony 2012 filmmaker: ‘I was not in control of my mind’

Follow US news from NBCNews.com on Twitter and Facebook

Mitch Dumke / Reuters

In this file photo, U.S. Rep. Jesse Jackson Jr. speaks at a news conference on Capitol Hill in Washington on Dec. 10, 2008. The congressman is currently on medical leave.

Rep. Jesse Jackson Jr. is "regaining his strength," following his admittance to the Mayo Clinic for bipolar disorder earlier this summer, the Rochester, Minn., facility said Monday.

The Illinois Democrat, who has been on medical leave from his job since June 10, is being treated for Bipolar II depression, the clinic said. Jackson has been at the Mayo Clinic since July 25.

"Congressman Jackson is responding well to the treatment," Mayo Clinic spokeswoman Traci Klein said in a statement. Jackson asked the clinic to distribute this information on his behalf, and Monday's update comes after mounting pressure to reveal the nature of his medical leave.

The Mayo Clinic says Bipolar II disorder is a treatable condition, affecting parts of the brain that control drive, thought and emotion. This type of depression is most likely caused by a set of genetic and environmental factors.

Jackson's wife said earlier this summer that the congressman was "completely debilitated" by depression.

Klein said the 47-year-old congressman underwent gastric bypass surgery back in 2004, which changes how the body absorbs things like foods, liquids and medications.

There's no timeline for Jackson's recovery, according to Jackson's father, civil rights activist Rev. Jesse Jackson. The elder Jackson said earlier this month that his son has no plans to step down from his post.

Jackson is currently under investigation by the House Ethics Committee for his connections to former Illinois Gov. Rod Blagojevich, who was convicted on corruption charges for trying to sell off Barack Obama's Senate seat after Obama was elected president. Jackson has repeatedly denied wrongdoing in the scandal and has not been charged.

Former Rhode Island Rep. Patrick Kennedy said Monday he plans to visit Jackson on Thursday at the Mayo Clinic, The Associated Press reported. Kennedy was treated at the Mayo Clinic himself for addiction and depression in 2006 after a late-night car crash at the U.S. Capitol. He decided not to run for a ninth term in 2010 and retired from Congress last year. 

More content from NBCNews.com:

• Big debt threatens security clearance for troops
• Wife of former congressman dies after being run over by her own car
• Report: Ex-Navy sub commander faked death to get out of affair
• Evangelist Billy Graham 'doing fine' at hospital
• Family: Cops didn't have to shoot knife-wielding man near Times Square
• Video: Multiple cameras show man driving wrong way

Follow US News from NBCNews.com on Twitter and Facebook