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Follow-Up Exams Uncover More Iraq Vets With Emotional Woes

It may take months for conditions like depression, PTSD to emerge, study says

TUESDAY, Nov. 13 (HealthDay News) -- The number of Iraq war veterans needing mental-health care has risen sharply since the U.S. Defense Department began screening them a second time for emotional problems, U.S. military researchers reported Tuesday.

Initial screenings of veterans uncovered 4.4 percent who needed treatment for problems such as depression or post-traumatic stress disorder (PTSD). But six months later, a second screening found 11.7 percent were in need of mental health care, indicating that it might take several months for emotional disorders to emerge, the study suggested.

"We know mental health problems are a problem for soldiers who have been to war," said lead researcher Dr. Charles S. Milliken, of the Walter Reed Army Institute of Research at the U.S. Army Medical Research and Materiel Command. "We are doing a good thing by having erected these screening programs. Between the two screenings, we are finding a large group of soldiers that are having problems."

The findings are published in the Nov. 14 issue of the Journal of the American Medical Association.

For the study, Milliken and his colleagues collected data on the mental health of 88,235 Iraq war veterans who completed an initial screening and a second screening about six months later. Both screenings included a questionnaire and a short interview with a clinician.

"In the second screening, you do find a larger group of soldiers the first screening completely missed," Milliken said. "It's about twice as big."

The researchers found that more soldiers had mental health problems -- such as PTSD, major depression or alcohol abuse -- during the later screening. In the first screening, 4.4 percent of the soldiers were referred for mental health care, but, after the second screening, 11.7 percent were referred.

Milliken thinks the two-step screening process helps remove the stigma attached to seeking help for emotional problems. "Soldiers are like other young males, they have a stigma about seeking mental health care," he said.

Among all the soldiers screened, 20.3 percent of active duty personnel were referred for mental health care, as were 42.4 percent of reserve soldiers, the study found.

Milliken said he didn't know why the difference exists between the active duty soldiers and the reservists. He speculated, however, that it might have to do with the VA's insurance structure that allows reservists access to free care for service-related health problems.

One expert thinks the new, two-tier system for identifying soldiers with emotional problems is working, but the shear numbers of affected veterans could overburden the VA's health-care system.

"I am not surprised by the rates of PTSD among Iraqi vets," said Dr. Randall Marshall, director of Trauma Studies at the New York State Psychiatric Institute and an associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons.

Marshall said the difference in PTSD rates among active duty and reserve personnel is expected. "Part of what training is meant to do is desensitize soldiers to all the potential experiences on the battlefield, and the reservists have less training and are therefore more vulnerable to war experiences," he said.

Marshall also said that many reservists have had several tours of duty, "which is something they had not signed up for."

Also, many of these part-time soldiers were split from their units, which means they didn't have as much of a support system as active duty personnel, he said.

Marshall sees another major problem developing for returning veterans. Most psychotherapists aren't trained in the best ways to treat PTSD, he said. "You can't assume because it's a VA hospital everyone there has had this kind of training," he said.

In addition, the number of soldiers needing mental health care is straining an already overburdened system.

"If 20 percent of the veterans realize they need help and start to seek treatment, the system will be overwhelmed. Signs are, it already is," Marshall said.

More information

To learn more, visit the U.S. Department of Veterans Affairs.

SOURCES: Charles S. Milliken, M.D., Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel Command, Silver Spring, Md.; Randall Marshall, M.D., director, Trauma Studies, New York State Psychiatric Institute, and associate professor of clinical psychiatry, Columbia University College of Physicians amp; Surgeons, New York City; Nov. 14, 2007, Journal of the American Medical Association

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