1 in 6 Iraq Veterans Is Found to Suffer Stress-Related Disorder
by Anahad O'Connor
1 July 2004. About one in six soldiers returning from the war in Iraq shows signs of post-traumatic stress disorder or other emotional difficulties, researchers are reporting today.
Lower levels of psychiatric problems were found among troops who served in Afghanistan.
The study, published today in The New England Journal of Medicine, is the first to examine the mental health of troops returning from Iraq.
The researchers surveyed more than 6,000 soldiers in the months before and after service in Iraq or Afghanistan. Almost 17 percent of those who fought in Iraq reported symptoms of major depression, severe anxiety or post-traumatic stress disorder, compared with about 11 percent of the troops who served in Afghanistan.
The rates were slightly higher than those found among soldiers in the 1991 Persian Gulf war, and lower than the rates in Vietnam veterans. But mental health studies of soldiers in those earlier conflicts were carried out years — in the case of Vietnam, decades — after the troops returned home. The new study examined soldiers before deployment and within three to four months after they returned.
"In the Vietnam era, post-traumatic stress disorder hadn't even been recognized as a disorder," said Dr. Charles W. Hoge, lead author of the study and chief of the department of psychiatry and behavioral sciences at the Walter Reed Army Institute of Research. "It wasn't until 10 or 15 years later that many of the experiences the soldiers were having were recognized as P.T.S.D. Because of those lessons, we're now trying to take a more proactive approach to mental health."
He and other experts said that every war imposed unique pressures. Soldiers in Iraq have more contact with the enemy and more exposure to terrorist attacks than did troops in the earlier Iraq war.
National Guardsmen and Reserve troops are playing a larger role. At the same time, soldiers in Iraq have more public support than did the veterans returning from Vietnam.
The finding that rates of psychiatric problems among the soldiers returning from Iraq were higher in the new study than those among troops who were in Afghanistan reflects their greater exposure to combat, the researchers said. More than 90 percent of the Iraq troops reported having been shot at, while among those returning from Afghanistan, 66 percent said they had been attacked.
In each group, those who had the largest number of symptoms were also the ones least likely to seek help, the study found. More than half the soldiers who met the criteria for a psychiatric disorder reported that they had not sought help out of fear that they would be stigmatized or their careers would be harmed.
Whether the percentage of troops experiencing post-traumatic stress will change over time is unclear, but most experts say that the figures are likely to increase.
Dr. Robert Rosenheck, a professor of psychiatry and public health at Yale and director of the Department of Veterans Affairs Northeast Program Evaluation Center, said it was possible that some soldiers were experiencing symptoms but had not yet recognized them.
In the late 1990's, a long-term study of veterans of the Persian Gulf war found that the prevalence of post-traumatic symptoms more than doubled between an initial survey and a second one two years later. Based on those findings, and the continued fighting in Iraq, the percentage of returning soldiers with post-traumatic symptoms could still go up, said Dr. Matthew J. Friedman, director of the Department of Veterans Affairs at the National Center for Post-traumatic Stress Disorder.
"We know from research on soldiers deployed to Somalia in the early 90's that as the nature of the mission changed from peacekeeping to the capture of warlords, the prevalence of P.T.S.D. went up," he said. "The current study was conducted back when the war was one of liberation."
Another variable is the increasing numbers of National Guard and Army Reserves troops that are being sent overseas. Because they receive relatively little warning before deployment and are often less prepared for combat than soldiers in regular units, Dr. Friedman said, Guard and Reserves troops are more prone to post-traumatic stress.
"This study was only about those who were exposed to things that, in essence, were part of their jobs," he said. "There is a major concern about how Guard and Reserve troops are going to fare, particularly now that their tours are being extended."
Citation: Anahad O'Connor, "1 in 6 Iraq Veterans Is Found to Suffer Stress-Related Disorder," New York Times (01 July 2004.)