Back from war

March 03, 2005

THE WAR in Iraq is taking a toll on the mental health of the soldiers and Marines serving there - and it is a toll that the United States and all Americans will have to pay.

The violence over the past two years has been bloody, unpredictable and at close quarters. While the death rate among U.S. troops has been kept lower than in past wars thanks to better medical care, this means more have survived with deeply severe wounds. Little things begin to wear on men and women serving in the desert - discomfort, hostility, fear, anxiety over families and jobs back home (especially among reserve troops) - and all these can open the door to more serious mental afflictions.

A study reported last year in The New England Journal of Medicine found that depression, anxiety and post-traumatic stress disorder (PTSD) increased measurably among soldiers who had served in Afghanistan and sharply among those who had been in Iraq. The percentage of those service members who met a strict definition for PTSD rose from 5 percent of those going to Iraq to 12.9 percent of those coming back. That 8 percentage point increase would suggest that if all U.S. troops came home tomorrow, 28,000 would be suffering from PTSD stemming from service in Iraq.

But that would be a huge underestimate of the scope of the eventual problem. Psychological disabilities can take months or years to become evident. One example: Between 1999 and 2004, the number of Vietnam vets being treated for PTSD increased by 80 percent, to 161,000. Not all of those cases stemmed from a war that was over by 1975, but most probably did.

The good news is that PTSD can be treated. But will enough Iraq war veterans seek help? And will they be able to get it?

A new report by the Government Accountability Office is sharply critical of the Department of Veterans Affairs for being too slow to ready itself for what, over time, could become a flood of new PTSD cases - many of them in conjunction with serious and complicating physical injuries. The VA takes strong exception to the report, noting that even before the war it was taking up to 15,000 new PTSD patients every year; last year it offered some form of treatment to a total of 244,000. It has four new centers for multiple traumas - but a total of just 34 beds in them.

Meanwhile, alcohol consumption is up significantly among those back from the war. Families are under stress. The study of mental health among returning soldiers found that fewer than half who reported problems sought treatment.

This is no time for complacency; the war in Iraq has been the toughest military assignment at least since Vietnam. Those veterans who need help must be able to get it.

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