Mental disorders are common for Iraq veterans, study finds

Yet few seek treatment for post-traumatic stress, anxiety and depression

July 01, 2004|By Jonathan Bor | Jonathan Bor,SUN STAFF

Echoing Vietnam and other wars, combat duty in Iraq and Afghanistan has triggered symptoms of depression, anxiety and post-traumatic stress disorder among many troops returning home.

Researchers reporting in a medical journal today found that 15 percent to 17 percent of the combat troops who served in Iraq suffered from at least one of the three disorders - yet few sought help because they feared being stigmatized.

A somewhat lower proportion, 11.2 percent, reported symptoms of mental distress after serving in Afghanistan, but most also kept their problems secret.

"The message is that there is still a very large stigma in the military, as well as in civilian life, from seeking mental health care," said Lt. Col. Carl A. Castro of the Walter Reed Army Institute of Research in Silver Spring, who was one of the investigators.

Accounts of shell-shocked soldiers from World War I are well-known, as are accounts of World War II, Korea and Vietnam combat veterans who became withdrawn or despondent, or drank heavily when they returned home.

But there has never been a survey as comprehensive as the one appearing in today's New England Journal of Medicine, experts said. This is the first time, for instance, that researchers questioned combat troops days after they returned, rather than months or years later.

For those reasons, researchers said, it was impossible to determine whether troops in Iraq or Afghanistan are suffering more - or less - than veterans of previous wars.

Nonetheless, Col. Charles Hoge, the chief investigator, said none of the findings surprised him. "This study really put numbers to what we already knew," said Hoge, also a Walter Reed researcher.

The results were gleaned from a survey of 2,530 soldiers before their deployment to Iraq and 3,671 soldiers and Marines shortly after they returned from Iraq and Afghanistan. Troops responded to a lengthy questionnaire that asked about their feelings and behavior.

By surveying troops before and after their tours, researchers were able to discern the emotional impact that could be attributed to combat duty.

Among soldiers deployed to Iraq, rates of post-traumatic stress jumped from 5 percent before deployment to 12.9 percent afterward. Similarly, rates of troops suffering any of the three mental disorders rose from 9.3 percent to 17.1 percent.

Troops admitting that they wanted or needed to cut down on their drinking ranged as high as 29 percent among Marines who saw combat in Iraq.

Overall, the emotional toll was greater among troops in Iraq, but researchers said that was because units there generally saw more action than those in Afghanistan.

Post-traumatic stress disorder was the most common problem among the returning troops - occurring in about 12 percent of those returning from Iraq or Afghanistan.

The disorder is marked by persistent nightmares and "flashbacks" of horrific scenes, and a tendency to startle easily or lash out in anger. A survey of Vietnam veterans found that 14 percent suffered from the disorder at some point - but they were questioned 10 years to 20 years after their service.

That many troops suffer in silence came as no surprise to counselors who have treated veterans of previous wars and those returning from Iraq and Afghanistan.

"It really still is the mentality that you should suck it up and move on, pull yourself up by your bootstraps," said Sonja Batten, a psychologist specializing in post-traumatic stress disorders at the Veterans Affairs Medical Center in Baltimore.

In the survey, 23 percent to 40 percent of troops reporting mental distress said they received professional help after returning from combat. The rates varied by military branch and where they served.

"The sticking point is skepticism among military personnel that the use of mental health services can remain confidential," Dr. Matthew J. Friedman, a VA psychiatrist in White River Junction, Vt., wrote in an editorial accompanying the study.

Dr. William Winkenwerder, the Defense Department's chief medical officer, said yesterday that mental health services are sufficient but that too few people take advantage of them.

Although he acknowledged that many fear coming forward, he said the problem is more perception than reality.

That view isn't shared by Robert Brown of Peru, Ind., who served as a chaplain's assistant during the invasion of Iraq.

Brown, 34, said he counseled Marines who were injured and, in some cases, mutilated in battle.

Since returning home in June, Brown has suffered recurrent nightmares.

"Some of [the dreams] were just different images of blown-up vehicles or of young kids you know," said Brown, who also started drinking heavily. "You wake up in a cold sweat, and your anxiety levels are through the roof."

Brown said his commanding officers demoted him and reassigned him to menial duties at a U.S. military base, and later threatened him with a court-martial. They eventually agreed to discharge him.

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