Nearly 1 out of 5 combat soldiers are leaving Iraq with a mental
health problem, such as post-traumatic stress disorder, suggests a
landmark study published in today's New England Journal of
Medicine. It is the first large survey on front-line forces'
The numbers probably are slightly higher than the study shows
because the severely wounded and others who have been removed from
units weren't included, say the study's co-authors, Army Col.
Charles Hoge, a psychiatrist, and Army Lt. Col. Carl Castro, a
psychologist, of the Walter Reed Army Institute of Research. Most
servicemen with mental disorders aren't getting treatment, and a key
reason is fear of stigma, they say.
The anonymous survey of 6,201 Army and Marine servicemen deployed
to Iraq and Army troops sent to Afghanistan shows higher rates of
post-traumatic stress disorder (PTSD), major depression and
generalized anxiety for the troops serving in Iraq.
About 16% of Marines and 17% of Army soldiers had symptoms of
mental disorders three to four months after combat in Iraq. After
Afghanistan duty, the rate was 11% for Army troops; no Marines in
the study served in Afghanistan.
The military should fully integrate mental health care into
medical clinics instead of having some separate offices for therapy;
train soldiers to recognize signs of mental disorders; and use more
therapists who are independent of the military, the study's authors
The services are trying to identify soldiers with mental health
concerns after combat for early treatment, says William Winkenwerder
Jr., assistant secretary of Defense for health affairs. Also, extra
mental-health specialists are joining units in Iraq, says Lt. Gen.
James Peake, the Army's surgeon general.
Today's returning soldiers may recover more easily than Vietnam
veterans because the latter were more vilified at home, says
psychiatrist Matthew Friedman, executive director of the National
Center for Post-Traumatic Stress Disorder.
On the other hand, Gulf War research shows that PTSD prevalence
can rise sharply during the two years after combat, Friedman says.
And the study doesn't include National Guard and Reservists called
up for duty, who had much higher levels of PTSD than active military
after the war, he says.
But many in the Guard and Reserves are older, "and the older you
were when you went to Vietnam, the less likely you were to come back
with psychological problems," says Jonathan Shay of the Boston
It's hard to compare current soldiers with Vietnam veterans, who
weren't studied until 10 to 20 years after the war; 15% of male
soldiers had PTSD, and 30% reported PTSD symptoms during their
lives. For troops a few months after Iraqi combat, 13% of Army
soldiers and 12% of Marines had PTSD. Also, the Vietnam studies
included any veterans of the war, and the Iraq survey includes only
Some experts had speculated that about one-third of Iraq veterans
could develop PTSD, says Harvard University psychologist Richard
McNally. The new findings "suggest a degree of resilience for these
soldiers in Iraq that some would not have expected."
The study "is a wake-up call," says Charles Figley, a PTSD
expert. "These young people are shouldering responsibility for the
war, and for some of them, it's breaking their backs. Now we need to
step up and do much more for them."