Mental Health Problems Common After Combat Duty
June 30, 2004

NEW YORK (Reuters Health) - Findings from a study of soldiers involved in combat duty in Iraq and Afghanistan suggest that up to 17% met criteria for a mental disorder after deployment. Moreover, less than half of such subjects sought help (emphasis added), researchers report in the July 1st issue of The New England Journal of Medicine.

To better characterize the mental health problems faced by military personnel in these countries, Dr. Charles W. Hoge, from the Walter Reed Army Institute of Research in Silver Spring, Maryland, and colleagues sent an anonymous questionnaire to more than 6000 infantry soldiers before or after combat duty in the regions.

Standardized, self-administered screening instruments were used to test the responses for three main disorders: major depression, generalized anxiety, and post-traumatic stress disorder (PTSD).

The researchers found that combat exposure was significantly greater with service in Iraq than in Afghanistan. The rate of the three primary mental disorders among personnel deployed to Iraq was around 16%, significantly higher than the 11.2% rate seen among subjects who served in Afghanistan or the 9.3% rate recorded before deployment to Iraq.

The greatest variability in disease rates occurred with PTSD. For example, service in Iraq was tied to a PTSD rate of about 13%, more than double the 6.2% rate seen with deployment to Afghanistan.

Overall, of those with mental problems, between 23% and 40% reported receiving professional help for the condition. They were also twice as likely as their peers to show concern about being stigmatized by receiving care for their problem.

Dr. Matthew J. Friedman, from Dartmouth Medical School in Hanover, New Hampshire, notes in a related editorial that "our acknowledgment of the psychiatric costs of war has promoted the establishment of better methods of detecting and treating war-related psychiatric disorders,"

"It is now time," he adds, "to take the next step and provide effective treatment to distressed men and women, along with credible safeguards of confidentiality."

N Engl J Med 2004;351:13-22,75-77.