US Soldiers from Iraq with PTSD are not Getting Treatment

July 2004

A study published in the New England Journal of Medicine found that large numbers of soldiers returning from Iraq and Afghanastan suffer from symptoms of post-traumatic stress disorder (PTSD), major depression, generalized anxiety disorder, and other mental health disorders. Soldiers who were in Iraq were more likely to be exposed to combat, and they had more PTSD symptoms. Between 23 and 40 percent of those suffering from mental health problems had sought help, and many reported that they feared seeking treatment would make them appear weak or cause their peers treat them differently.

The full text of the article is available Online. The authors summarized their study this way:

• Background: The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans.
  
• Methods: We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments.
  
• Results: Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent), the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care.
  
• Conclusions: This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. (Hoge, et. al., 2004)

It took several years for full-blown PTSD to develop in most Viet Nam veterans. This study suggests that we need to find ways to get soldiers returning from Iraq and Afghanistan into treatment sooner, and to find ways of lowering the barriers to treatment. Some have questioned whether the United States leadership learned the right lessons from Viet Nam. Hopefully the mental health community has, and treatment will commence.

Reference: Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care. Charles W. Hoge, M.D., Carl A. Castro, Ph.D., Stephen C. Messer, Ph.D., Dennis McGurk, Ph.D., Dave I. Cotting, Ph.D., and Robert L. Koffman, M.D., M.P.H. New England Journal of Medicine Volume 351:13-22 July 1, 2004.

Last edited 11/4/05.