Iraq Vets Bringing Home Mental Health Needs at High Rate
by Neil Osterweil

Soldiers and marines who served in Iraq during the current war are seeking mental health services at a high rate within a year of returning home, according to army researchers here.

The problems go beyond post-traumatic stress syndrome, although the investigators at the Walter Reed Army Institute of Research counted nearly 22,000 veterans in that category.

Of the 21,822 service members who screened positive for post-traumatic stress syndrome, 79.6% said they either saw someone being killed or wounded or took part in direct combat during which they fired their guns.

In contrast, 47.8% of 200,798 veterans who screened negative for post-traumatic stress syndrome reported similar combat experiences during the invasion of Iraq and its aftermath, reported Charles W. Hoge, M.D., and colleagues in the March 1 issue of the Journal of the American Medical Association.

Nineteen out of every 100 returning soldiers and marines met the criteria for "a mental health concern," said the army researchers, compared with about 11 in 100 returning from duty in Afghanistan, and about nine in 100 coming home from other locations...

In all, 35% of Iraq war veterans sought mental health services for any reason in the year after returning home. Of them, 12% per year received a diagnosis of a mental health problem, the investigators found, and an additional 23% per year were seen in mental health clinics but did not receive a diagnosis.

More than half of those who were referred for a mental health problem received follow-up care, but less than 10% of all returning vets who were treated for mental health problems were referred through the military's screening program, the investigators found.

The study marked the first systematic assessment of how veterans of the Iraq and Afghan wars have used mental health services, the investigators wrote.

"This study provides new data showing the strong relationship between combat duty and a variety of mental health outcomes and most importantly high mental health care utilization in the first year after deployment," the authors wrote.

"The findings have important implications for estimating the level of mental health services that may be needed in military, Veterans Affairs, and civilian practice settings that care for returning veterans," they added. "Additional research is needed beyond a year after deployment to determine the long-term burden that this war will have on the mental health care system.

Previous studies have shown that after other wars and military engagements, returning soldiers are at a significantly increased risk for post-traumatic stress syndrome, substance abuse, major depression, and difficulties functioning in the day-to-day work and home environments, the authors noted.

Among the service personnel returning from Iraq, 9.8% had scores of two or more on the four-item posttraumatic stress disorder scale, compared with 4.7% of those who had been in Afghanistan, and 2.1% for those coming back from deployment elsewhere. The adjusted odds ratio for a high posttraumatic stress disorder score among Iraq veterans compared with Afghanistan veterans was 2.52, 95% CI, 2.30-2.76; P <0.001, and compared with veterans deployed to other places, the adjusted OR was 5.51, 95% CI, 5.20- 5.83; P<0.001.

The authors found that 'the prevalence rates of mental health problems and combat experiences were consistently higher" following deployment to Iraq than to Afghanistan or other locations.

In all, 19.1% of soldiers and Marines who returned from Iraq met risk criteria for a mental health concern, compared with 11.3% for those deployed to Afghanistan and 8.5% for those sent to other locations. The adjusted odds ratio for service personnel sent to Iraq compared with other deployment locations was 2.72; 95% confidence interval, 2.63-2.80; P<0.001.

The odds ratio for those deployed to Afghanistan compared with other locations was 1.55, 95% CI, 1.46- 1.64; P<0.001).

The 8.5% prevalence of mental health problems among soldiers sent elsewhere is similar to that reported in a different study for soldiers surveyed prior to first-time deployment in Iraq or Afghanistan, the researchers reported.

The investigators analyzed data from the Post-Deployment Health Assessment survey, which all service members returning from deployment are required to complete.

They looked at data on 16,318 service men and women returning from Afghanistan, 222,620 returning home from Iraq, and 64,967 coming from other spots around the world.

Their purpose was to "determine the relationship between combat deployment and mental health care use during the first year after return and to assess the lessons learned from the post-deployment mental health screening effort, particularly the correlation between the screening results, actual use of mental health services, and attrition from military service."

The researchers looked at how veterans used health care services, and at occupational outcomes for one year after their return, or until the time they left the service, if this occurred sooner.

Study outcome measures included a positive screen for posttraumatic stress disorder, major depression, or other mental health problems, a referral for a mental health reason, use of mental health care services after returning from deployment, and attrition from military service.

"Mental health problems reported on the post-deployment assessment were significantly associated with combat experiences, mental health care referral and utilization, and attrition from military service," Dr. Hoge and colleagues wrote.

They noted that the military's mental health screening program was inadequate at predicting the level of mental health services that returning soldiers would need.

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