Veterans of Iraq War Seek Mental Health Care

More than one-third of soldiers and Marines who served in Iraq in the first year of the war sought mental treatment after returning, according to a study published on Monday in the Journal of the American Medical Association, the Baltimore Sun reports (Kohn, Baltimore Sun, 3/1).

For the study, researchers from the Walter Reed Army Institute of Research looked at the military's Post-Deployment Health Assessment -- a survey required of all returning soldiers since May 2003 -- for 222,260 Army soldiers and Marines who were deployed to Iraq; 16,318 who were deployed to Afghanistan; and 64,967 deployed in Bosnia-Herzegovina, Kosovo and other locations, the Los Angeles Times reports. They also reviewed electronic medical records for the soldiers (Chong/Maugh, Los Angeles Times, 3/1).

According to the AP/Long Island Newsday, the survey includes questions on whether respondents have nightmares, are constantly on guard or easily startled, and feel numb or detached from others (Johnson, AP/Long Island Newsday, 2/28).

The study finds that in the survey, 19.1% of Iraq veterans reported mental problems, compared with 11.3% of those returning from Afghanistan and 8.5% of those returning from other overseas locations. Researchers also found that within a year of returning from Iraq, 35% of veterans had sought mental health treatment.

Twelve percents of Iraq veterans were diagnosed with post-traumatic stress disorder, depression or another serious disorder by the end of the first year following their return, the study finds. Of 21,822 Iraq veterans who reported symptoms of PTSD, 76.9% had engaged in combat or witnessed people being wounded or killed, compared with 47.8% of the 200,798 who did not report symptoms of the condition, the Times reports (Los Angeles Times, 3/1).

Additional findings include:

• In the survey, more than half of all Iraq veterans reported that they had "felt in great danger of being killed" there, while 2,411 reported having thoughts of committing suicide.
  


• Iraq veterans are much more likely than veterans of other conflicts to have witnessed people getting wounded or killed, to have gone into combat and to have had suicidal or aggressive thoughts (Vedantam, Washington Post, 3/1).
  


• Only a small fraction of veterans who sought mental health treatment after returning from Iraq had been referred by military screeners, and screeners had determined that most did not have significant emotional problems.
  

According to the New York Times, the postdeployment survey was designed in part to identify returning soldiers who might exhibit signs of mental illnesses such as PTSD in order to ensure they receive early treatment. Veterans Affairs Department clinics have treated an estimated 50,000 Iraq veterans for mental health reasons, and "predictions vary widely" on how many more will require treatment, the Times reports (Carey, New York Times, 3/1).

Harvard University psychologist Richard McNally said the findings of the JAMA study suggest the postdeployment survey might have little predictive value, noting that almost 90% of those diagnosed with PTSD did not meet the criteria for that condition according to their responses (Los Angeles Times, 3/1). McNally said, "The approach used to screen for signs of mental trouble is a very sensible one, but I think one question we have to ask now is why is it failing to identify those who seek help."

Charles Hoge, psychiatrist at Walter Reed and co-author of the study, said, "We do know that many mental health concerns tend to emerge two to three months after people get back and that screening at that time should provide us another opportunity" to identify veterans at risk (New York Times, 3/1).

McNally noted the fact that 35% of returning soldiers sought help for mental health concerns "indicates that the stigma barrier may be falling" (Los Angeles Times, 3/1).

Michael Kussman, principal deputy under secretary for health at the Department of Veterans Affairs, noted that although large numbers of returning soldiers sought mental health treatment, many were not diagnosed with psychiatric conditions. "Readjustment and reintegration issues are very common among servicemen returning from any combat," he said, adding, "A large portion of people have this temporary reaction. These are normal reactions to abnormal situations and are not considered mental illnesses" (Washington Post, 3/1).

Hoge attributed the differences in mental health issues reported among soldiers in the various deployment locations to the heightened danger and violence of the Iraq conflict. He said, "Just about everybody who is deployed to Iraq is affected in some way" (Baltimore Sun, 3/1).

Hoge added, "There is no front line in Iraq. Individuals who are patrolling the streets will be at higher risk of being involved in combat, but folks who are largely located at one base are also targets of mortar and artillery, and everyone in convoys is a target" (Washington Post, 3/1). Hoge said, "The most important finding is that a large number of soldiers and Marines are using mental health services very soon after they get home," which shows that the military's mental health support system is working (Baltimore Sun, 3/1).

Ralph Ibson, a vice president of the National Mental Health Association, said the study emphasizes the need for increased spending on mental health care for Iraq veterans, adding that President Bush's proposed budget, which includes a 6% increase in spending for VA, "would ultimately shortchange veterans who need mental health services. This study can and should be a wake-up call in terms of veterans' mental health needs."

Hoge continued, "In prior wars, mental health issues weren't studied until years, sometimes decades, after the soldiers came back. For this war, we're doing it differently. Research is influencing policy, and we're adjusting policies as the data come in" (AP/Long Island Newsday, 2/28).

An abstract of the study is available online.

NPR's "All Things Considered" on Tuesday reported on the study. The segment includes comments from Tom Berger, chair of the PTSD and Substance Abuse Committee for Vietnam Veterans of America and Hoge (Shapiro, "All Things Considered," NPR, 2/28). The complete segment is available online in RealPlayer.