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Study shows troops back from Iraq get help for stress

By Jerry Harben
March 1, 2006

SAN ANTONIO, Texas (Army News Service, March 1, 2006) -- Soldiers and Marines who are disturbed by the stress of the war in Iraq are receiving mental-health services early after their return, helping prevent development of serious conditions, according to a just-released study.

“A high percentage are using mental-health services,” said Col. Charles W. Hoge, director of the department of psychiatry and neuroscience at Walter Reed Army Institute of Research.

“A portion of these people receive diagnosis of mental-health problems, but the majority do not. We think a lot of care is related to screening, prevention and milder conditions that may not require lengthy treatment,” Hoge said.

“A majority of these Soldiers receive their mental-health care early after returning, which is what we encourage them to do,” he added.

Study highlighted in medical journal

Hoge was lead author on the study, collaborating with Col. Charles S. Milliken, also of WRAIR, and Jennifer L. Auchterlonie from the Army Medical Surveillance Activity of the Army Center for Health Promotion and Preventive Medicine. Their report is published in the March 1 issue of the Journal of the American Medical Association.

The study looked at records of 303,905 Soldiers and Marines who completed a Post-Deployment Health Assessment between May 1, 2003 and April 30, 2004. This included 222,620 who had deployed to Iraq, as well as others who deployed to Afghanistan or other locations. The study used records maintained in the Defense Medical Surveillance System database.

Screenings help troops get treatment

A screening process for Soldiers returning from deployment is intended to detect physical or mental problems that need correction, officials said.

Soldiers undergo this Post-Deployment Health Assessment, or PDHA, when they return. They answer written questions and confer with a physician, physician assistant or nurse practitioner.

In addition, Soldiers now have a reassessment three to six months later to detect issues that are not immediately apparent. Records used for the current study, though, were compiled before the second reassessments began, officials pointed out.

Overall, 19 percent of Soldiers and Marines returning from the first deployment of Operation Iraqi Freedom reported a mental-health concern on the PDHA (a higher percentage than those who deployed to Afghanistan or other areas). Concerns included symptoms of Post-Traumatic Stress Disorder, depression symptoms or concerns about interpersonal conflicts, aggression or thoughts of suicide.

Treatment often for minor problems

About 4 percent of study participants were referred for mental-health services. But a referral does not mean that person has a serious mental-health condition, Hoge said.

“Because of answers on the screening form, a primary-care professional thinks it would be good for this person to see a mental-health professional,” is how he described a referral.

“A lot of people documented as using mental-health services don’t have serious conditions,” he added. “I think a large portion of this falls in the category of prevention. We’re trying to get help to people early so long-term conditions do not develop.”

Care includes chaplains, others

Records show about 54 percent of those referred for mental-health services were documented receiving follow-up care, which Hoge said is a high figure and probably understates the amount of care actually received.

“In any primary-care practice, many people referred don’t come in to see mental health,” he said. “Referral in the military system could include seeing a chaplain, family support services or using the MilitaryOneSource service (a toll-free phone number, 1-800-342-9647, Soldiers can call for assistance), which would not be counted in the medical system. We think the figure of documented care is quite high.”

35 percent back from Iraq use services

About 35 percent of Soldiers and Marines returning from Iraq used mental-health services within a year after their return. These services included evaluations and preventive services. About 12 percent were diagnosed with mental-health problems, officials said.

“Almost everyone who deploys to a war zone is affected in some way,” Hoge said. “We know from several studies that 20 to 30 percent of Soldiers who have experienced combat will report symptoms such as sleep disturbance, anxiety, irritability or increased alcohol use.

“These often are normal reactions that will improve over time,” Hoge said. However, he added, “Soldiers may need help if symptoms persist or interfere with their work or occupational functioning.”

See related article: Army treating more PTSD.

(Editor’s note: Jerry Harben writes for the U.S. Army Medical Command.)