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Homecoming Veterans Often Face Inner Challenge
Date:11/11/2008

Mental health issues may affect 20% of recent returnees, but help is available

TUESDAY, Nov. 11 (HealthDay News) -- In earlier wars, it was known as shell shock. In later military combat -- Vietnam, the Gulf War, Iraq and Afghanistan -- the emotional scars veterans brought back with them got new names for old problems: post-traumatic stress disorder (PTSD), depression, anxiety, substance abuse.

As Americans gather for ceremonies throughout the nation Tuesday to honor those who served in the Armed Forces, many veterans are facing emotional and mental problems brought on by combat, and often, they can't or won't deal with them.

The problem has become almost epidemic, according to Linda Rosenberg, president of the National Council for Community Behavioral Healthcare, one of many organizations focusing on the mental and physical health needs of returning veterans.

The ratio of Iraq and Afghanistan veterans suffering from PTSD or depression is one-in-five, Rosenberg said, citing a landmark study from the Rand Corp. released earlier this year. That's about 300,000 veterans just from the current wars, researchers estimated.

For many combat veterans, the problem is compounded by multiple mental ailments, according to Keith Armstrong, a licensed clinical social worker at the San Francisco Veteran Affairs Medical Center and co-author of "Courage After Fire: Coping Strategies for Troops Returning from Iraq and Afghanistan and Their Families," a 2005 book that explored the scope of the problem.

While depression and PTSD are common, according to experts, so are anxiety and substance abuse.

Making the mental health problems worse, Rosenberg said, is the increase in multiple tours of duty.

"You can imagine having to go through war once, the danger of that," she said. "For some, it's more than twice -- it's three or four times."

Many veterans are reluctant to seek help, the Rand researchers found, because sometimes they fear it will harm their careers, both military and civilian.

But the fallout from mental health issues related to war stretch far beyond jobs, Rosenberg said.

"The problem is not only [with] the vet, but the vet's family," she said. When their soldier is off to war, the family's functioning is often difficult. Reintegrating as a family, likewise, can be difficult, she added, as spouses who assumed new roles now have to relinquish them. In families with children, the kids may act out at school and elsewhere, causing further stress, she said.

Organizations focused on mental health and on veterans are trying to raise awareness and offer more help. And once a veteran acknowledges the problem, help is available and treatment is effective, experts said.

For PTSD, cognitive behavioral therapy that focuses on discussing the traumatic events is commonly used, said Armstrong. "Typically what happens with events you don't like [such as combat] is you avoid them," he said. "And you end up perpetuating problems."

Armstrong and others who work with veterans encourage them to talk in detail about what happened in combat. This, over time, eases the negative emotions by helping the veteran face the fear he or she carries inside.

In addition to therapy, medications can help veterans with depression, anxiety and PTSD, experts say.

And friends and family can also help, by encouraging the veteran to talk about the problems, Rosenberg said.

"Give them a chance to open up," she said. "Let them know you're available to listen. Try to help them figure out where to go to get help."

More information

The Veterans Administration has more on its "Warrior Care" program.



SOURCES: Linda Rosenberg, president and CEO, National Council for Community Behavioral Healthcare, Rockville, Md.; Keith Armstrong, L.C.S.W., director, couples and family therapy, San Francisco VA Medical Center, and author, "Courage After Fire: Coping Strategies for Troops Returning from Iraq and Afghanistan and Their Families" (2005, Ulysses Press); April 2008 Rand Corp. study: "Invisible Wounds of War"


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