Mental health problems affect an estimated 44 million American adults each year. Evaluating the psychological effects of war on soldiers is relatively new, having started in the 1980s when Vietnam veterans were evaluated 10–20 years after service.
Recently, researchers from the Walter Reed Army Institute of Research studied the mental health of soldiers sent to Afghanistan in Operation Enduring Freedom, and soldiers sent to Iraq in Operation Iraqi Freedom. A new study published in the July 1, 2004 issue of the
New England Journal of Medicine
, is the first to evaluate soldiers so early, both before deployment and while the fighting continues.
The study found that soldiers sent to Iraq experienced significantly greater exposure to combat than those sent to Afghanistan. The percentage of soldiers who experienced
post-traumatic stress disorder
(PTSD) was higher in soldiers who fought in Iraq than those who fought in Afghanistan. Of those soldiers with symptoms of mental health disorders, less than half sought out help because of a fear of stigmatization or harming their careers.
About the Study
The study included data from three Army combat infantry units and one Marine Corps combat unit. Using an anonymous survey, the researchers assessed the mental health of 2,530 Army soldiers before deployment to Iraq, 1,962 Army soldiers after 6 months in Afghanistan, 894 Army soldiers after 8 months in Iraq, and 815 Marines after 6 months in Iraq.
The researchers used health questionnaires to assess depression and generalized anxiety, and the Department of Veteran Affairs PTSD Checklist to look for post-traumatic stress disorder. The participating soldiers were also asked about current levels of stress as wells as any emotional, alcohol, or family problems they were experiencing. They were then asked to rate these problems as mild, moderate, or severe, and asked if they were interested in receiving help. Finally, they were asked about past use of mental health services and if they thought there were any barriers to receiving services.
Returning soldiers filled out these questionnaires a full 3–4 months after their return to the United States, so that adequate time was given to transition back and seek treatment if necessary.
There was far more enemy contact among soldiers returning from Iraq versus Afghanistan. The majority of soldiers—71% to 86%—who served in Iraq reported engaging in a firefight with the enemy, compared with only 31% of soldiers who served in Afghanistan. Seventeen percent of soldiers returning from Iraq experienced a mental health problem, versus 11% of soldiers returning from Afghanistan, and 9% of soldiers awaiting deployment to Iraq.
For all returning soldiers, there were strong correlations between being shot at, handling dead bodies, knowing someone who was killed, or killing the enemy and the subsequent development of PTSD. And yet of those who met the criteria for a mental disorder, only 38% to 45% expressed an interest in receiving help, and only 23% to 40% reported receiving help in the past year. The participants who screened positive for a mental disorder were the least likely to seek treatment because of a fear of stigmatization, harming their careers, or other barriers.
This is one of only a few studies that have looked at mental health problems—particularly PTSD—so soon after combat. The National Vietnam Veterans Readjustment Study evaluated PTSD 10–20 years after combat and found a prevalence rate of 15%. It is possible the rate of PTSD among soldiers in Iraq and Afghanistan could go up over time.
How Does This Affect You?
These findings suggest that there are significant psychological effects on soldiers involved in combat. The risk of PTSD in particular increases with the number of combat experiences, and yet there is a real reluctance to seek treatment among those who need it most. Whether the barriers to mental health treatment are real or perceived, the study highlights the need to tear these barriers down so that those in need of care can seek it without fear of consequences.
If you know anyone who has recently served in Afghanistan or Iraq, this study suggests that he or she may benefit from your help in recognizing their risk of serious mental health problems and in seeking the care they need.
Eliminate Disparities in Mental Health. Centers for Disease Control and Prevention website. Available at:
. Accessed July 6, 2004.
Epidemiological Facts about PTSD. National Center for PTSD website. Available at:
. Accessed July 6, 2004.
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI and Koffman RL. Combat Duty in Iraq and Afganistan, Mental Health Problems, and Barriers to Care. The New England Journal of Medicine. 2004:351:13–22.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a