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Iraq War Veterans Ignore Mental Problems

Many suffer, but stigma keeps them from seeking help

WEDNESDAY, June 30, 2004 (HealthDayNews) -- Soldiers are returning from combat operations in Iraq and Afghanistan with a wide variety of mental health problems, yet few are seeking help or thinking about seeking help.

That's the conclusion of new research, which also found that the combat veterans suffer from such problems as posttraumatic stress disorder (PTSD), anxiety and major depression, but decide to soldier on without professional assistance once they're stateside because of the fear of being stigmatized.

The study, which appears in the July 1 issue of the New England Journal of Medicine, pointed out that this is the first sustained ground combat undertaken by the United States since the war in Vietnam.

The research is unusual for a number of reasons, one of which is how early the assessment is taking place.

"They are actually getting information while people are still in the theater of operations," said Dr. Matthew Friedman, author of an editorial accompanying the study, executive director of the Department of Veterans Affairs' National Center for PTSD, and a professor of psychiatry at Dartmouth Medical School.

Also, the researchers have obtained predeployment data, giving them something to compare post-combat figures to.

"What's important about getting this data is that we can actually gauge how much of the reported psychiatric symptoms can be pinpointed as resulting from deployment to Iraq or Afghanistan," Friedman said. After the 1990-91 Persian Gulf War, it was impossible to tell how many of the unexplained medical problems cropped up during combat because there was no baseline.

The researchers asked members of four U.S. combat infantry units (three Army and one Marine Corps) to fill out an anonymous survey either before their deployment to Iraq (2,530 individuals were in this category) or three to four months after their return from Iraq or Afghanistan (there were 3,671 soldiers in this group).

Personnel in Iraq had greater exposure to combat than those in Afghanistan, and the survey results seemed to reflect that.

Some 15.6 percent to 17.1 percent of those who had been in Iraq met the screening criteria for major depression, generalized anxiety, or PTSD, compared to 11.2 percent who had returned from Afghanistan and 9.3 percent who had not yet been deployed to Iraq. The largest difference was in the rate of PTSD; the prevalence of PTSD among those returning from combat may increase, Friedman stated in his editorial.

Only 38 percent to 45 percent of service personnel who met the criteria for a mental disorder expressed interest in receiving help, and only 23 percent to 40 percent of these people sought professional help. In addition, those who appeared to have a mental disorder were twice as likely as those who didn't to be concerned about the possible stigma and other obstacles to seeking care.

"The most disturbing thing, in my opinion, is the stigma, and people who are most severely affected are the ones least likely to seek treatment," Friedman said. This, despite the fact that there are now treatments for these problems, even PTSD. "We can help them," Friedman said. "We can help them right away."

How do the new findings compare to other eras and other wars? Traditionally, little data was taken so quickly after leaving combat. But studies have shown a prevalence of current PTSD of 15 percent among male Vietnam veterans (lifetime prevalence of 30 percent), and 2 percent to 10 percent among veterans of the first Gulf War years after their service ended. About 3 to 4 percent of the general adult U.S. population suffers from PTSD.

Dealing with the stigma of seeking mental health treatment is a priority, the study authors said.

How to do this? "That's the $64 million question," Friedman said. "Many, many people are now trying to come up with a variety of solutions. Possibilities include putting mental health within a primary-care setting, and finding ways to guarantee confidentiality.

"The good news is that the U.S. military understands the importance of getting this information, and supporting this research while we're still fighting," Friedman said. "We're light years ahead of where we were during the Vietnam era."

More information

The National Center for PTSD has more on the war in Iraq.

SOURCES: Matthew J. Friedman, M.D., Ph.D., executive director, Department Veterans Affairs' National Center for PTSD, and professor of psychiatry and pharmacology and toxicology, Dartmouth Medical School, Hanover, N.H.; July 1, 2004, New England Journal of Medicine
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