The first study of the mental health of U.S. troops who fought in Iraq and Afghanistan found about one in six reported experiencing a mental health problem and one in eight reported symptoms of posttraumatic stress disorder.
Of those whose responses were positive for a mental disorder, only 23%-40% reported receiving professional help--mostly because of concerns about being stigmatized.
Subjects whose responses were positive for a mental disorder were twice as likely as were those whose responses were negative to report concerns about possible stigmatization and other barriers to seeking mental health services, the study found. (See chart on page 4.)
"This finding has immediate public health implications," reported Dr. Charles W. Hoge of the department of psychiatry and behavioral sciences at the Walter Reed Army Institute of Research, Silver Spring, Md. (N. Engl. J. Med. 351:13-22, 2004).
Dr. Hoge suggested that the perception of stigmatization and other barriers could be reduced through education, and by providing more mental health services in primary care clinics and confidential counseling through employee assistance programs.
Screening for major depression, which is done in military primary care settings, also should be expanded to include screening for post-traumatic stress disorder (PTSD).
An accompanying editorial noted that military personnel are skeptical that the use of mental health services can remain confidential (N. Engl. J. Med. 351: 75-78, 2004).
Troops were able to acknowledge PTSD-related problems in an anonymous survey, but "they apparently were afraid to seek assistance for fear that a scarlet P could doom their careers," wrote Dr. Matthew J. Friedman, executive director of the Department of Veterans Affairs' National Center for Post-Traumatic Stress Disorder.
A total of 6,201 members of four U.S. combat infantry units--three Army units and one Marine Corps unit--were given an anonymous survey either before their deployment to Iraq or 3-4 months after their return from combat duty in Iraq or Afghanistan. The outcomes included major depression, generalized anxiety, and PTSD, which were evaluated on the basis of standardized, self-administered screening instruments.
The percentage of subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6%-17.1%) than after duty in Afghanistan (11.2%) or before deployment to Iraq (9.3%).
The largest difference was in the rate of PTSD, which was between 12.2% and 12.6% after duty in Iraq vs. 6.2% after duty in Afghanistan, and 5.0% before deployment to Iraq.
For all groups responding after deployment, there was a strong reported relation between the prevalence of PTSD and combat experience such as being shot at, handling dead bodies, knowing someone who was killed, or killing enemy combatants.
The prevalence of PTSD increased in a linear manner with the number of firefights during deployment: 4. …