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American Forces Press Service

Combat Degrades Some Troops' Mental Health, Report Says

By Gerry J. Gilmore
American Forces Press Service

WASHINGTON, July 1, 2004 - A first-of-its-kind Army medical report that queried Afghanistan and Iraq combat veterans shows that front-line action has adversely affected the mental health of some service members.

The report, titled, "Combat Duty in Iraq and Afghanistan, Mental Health Problems and Barriers to Care" appears in the July 1 issue of the New England Journal of Medicine.

About 6 percent of the soldiers and Marines who participated in the anonymous study say they've experienced mental health problems after combat tours in Afghanistan or Iraq, Dr. William Winkenwerder, assistant secretary of defense for health affairs, told reporters during a June 30 Pentagon roundtable.

However, "the vast majority" of service members surveyed for the report, Winkenwerder noted, "seem not to be having any significant mental health concerns or problems."

That's not to say, he pointed out, that those surveyed didn't experience stress during their tours in Afghanistan or Iraq. "These are the folks that were in the most intense types of (ground) combat situations," Winkerwerder noted.

Army Col. (Dr.) Charles Hoge, a principal author of the study, accompanied Winkenwerder at the press conference and said the report contains "no surprises," but that it "puts numbers to what we already knew."

Hoge, chief of the department of psychiatry and behavioral sciences at Walter Reed Army Institute of Research, told reporters the new report shows "those soldiers and Marines who had higher levels of combat exposure - frequency and intensity of combat - had higher rates of mental health concerns."

Winkenwerder said the report also says some returning combat veterans suffering from depression, anxiety or post-traumatic stress disorder aren't seeking medical help.

"We believe," he said, "that there are adequate services available" to identify and assist combat veterans experiencing mental health issues.

However, Winkenwerder noted, one main barrier preventing access to those services "is the perception of stigma that some individuals have about coming forward to get that care and counseling." Providing more education about mental health care, he noted, should help to persuade more service members to seek help.

The report is unique, Winkenwerder said, because of its use of near-real-time data. For example, combat-stress studies conducted on the Vietnam War, he pointed out, used data gathered years after the conflict ended.

"There's a lot of work to be done," Winkenwerder acknowledged, in finding ways to enable service members to better cope with the stresses of combat.

Mental health teams are embedded in units in Afghanistan and Iraq to assist troops, Army Surgeon General Lt. Gen. (Dr.) James Peake, who participated in the press briefing with Winkenwerder and Hoge, noted to reporters.

Troops experiencing mental health issues can also access confidential counseling via the Defense Department's "Military One Source" program, the 24- hour-a-day service for service members and their families when they need quick, professional assistance with any kind of problem. High quality training, Peake noted, can help prepare service members for the realities of combat.

Army Chief of Staff Gen. Peter Schoomaker, Peake pointed out, is a special operations combat veteran who's focused on "the issue of tough, realistic training" across the force. To illustrate, Peake described his recent visit to a medical training site in San Antonio.

"We're putting in a live-fire range for convoys," Peake explained, "so that the medics and the combat service supporters" get a more realistic feel for wartime operations.

"We do want to take care of our soldiers," Peake said, noting combat can occur anywhere on today's nonlinear battlefields.

Citing recent Centers for Disease Control and Prevention research, Winkenwerder noted some people seem more predisposed to develop depression, anxiety or post- traumatic stress disorders as a result of negative childhood experiences.

"Is there a point," Winkenwerder asked, "at which one could intervene during late adolescence, or during early accession time into the armed services to begin to . build mental resiliency?

"We're looking at what might be able to do that," he said.

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