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Mental disorders are on the rise among Afghanistan, Iraq veterans

By Marilyn Elias, USA TODAY

As many as one out of four veterans of Afghanistan and Iraq treated at Veterans Affairs hospitals in the past 16 months were diagnosed with mental disorders, a number that has been steadily rising, according to a report in Thursday's New England Journal of Medicine.

Records show that 20% of eligible ex-soldiers came to VA hospitals seeking medical treatment between October 2003 and February 2005. Overall, 26% of them were diagnosed with mental disorders, say Han Kang and Kenneth Hyams of the VA.

Post-traumatic stress disorder (PTSD) was most common, diagnosed in 10% of patients, followed by drug or alcohol abuse (9%). Seven percent were diagnosed with depression; 6% had anxiety disorders, such as phobias and panic. Many ex-soldiers had multiple disorders, Kang says.

But these are tentative diagnoses. Sometimes they were made by primary-care doctors and not yet confirmed by mental health specialists, he says.

At this point, it is an open question whether these numbers predict how many soldiers ultimately will develop mental health problems, Kang says.

Patients coming to the VA often lack insurance and might be at a disproportionately higher risk for mental health problems, he says. Also, soldiers who have left active duty may be in more mental distress than those who stayed, adds Army Lt. Col. Carl Castro, chief of military psychiatry at the Walter Reed Army Institute of Research.

On the other hand, fear of being stigmatized was a key reason that traumatized soldiers didn't seek help while still in the military, an earlier study showed. So these post-duty numbers could more accurately reflect the final toll, says Harvard psychologist Richard McNally, a PTSD expert.

So far, VA hospitals can easily meet the challenge of mental health care for Afghanistan and Iraq war veterans, Kang says.

But large funding cuts in VA psychiatry programs over the past several years and the limited number of doctors trained in PTSD could signal big trouble ahead, cautions Bruce Kagan, staff psychiatrist at the West Los Angeles VA Hospital.

"The soldiers didn't come right away after Vietnam, either. If they come in the numbers predicted, the numbers the VA's own studies predict, we could be overwhelmed," Kagan says.

About 31% of male soldiers who served in Vietnam developed PTSD, but diagnosis standards were looser then than they are now, says McNally.

Treatments using therapy and medication have improved greatly since Vietnam, he says. The increasing numbers coming for help could be a positive sign, suggesting earlier detection and possibly better recovery rates. "There's reason for optimism," he says. USA Today | August 18, 2005

Army women in support units exposed to combat don't have higher post-traumatic stress or depression rates than their male counterparts a few months after leaving Iraq, according to a pilot study due today.

It's believed to be the first research comparing the mental health of men and women in violence-prone support jobs -- medics, mechanics, drivers -- in Iraq, says Army Lt. Col. Carl Castro, chief of military psychiatry at the Walter Reed Army Institute of Research. Castro was scheduled to report his results to the American Psychological Association meeting in Washington, D.C.

"If the argument is women can't handle the stresses of combat as well as men, we see no evidence of a sex difference in these units," Castro says. Women can't serve in front-line combat, "but truck drivers in Iraq have the dangerous jobs," he says, and Army women fill about 10% of such support jobs.

Castro gave mental-disorder screening tests to a random sample of men and women in such posts -- 50 women and 300 men -- three months after their deployment ended. He says there wasn't a statistical difference between the two sexes: About 6% of men and 8% of women had depression, and 11% of men and 12% of women had PTSD symptoms.

"It's possible that sex differences could develop later on," Castro says, "but right now we don't think women need any more mental health help than men."

He had no mental health reports on the soldiers before deployment, so he could not say how combat affected any pre-existing emotional problems.

Not everyone says it's a good idea to put women in positions that could come under fire. "It's not because women don't have 'the right stuff.' Women are very tough mentally," says Janice Crouse of Concerned Women for America, a public policy group that favors traditional family values. "But the best-trained women still can't keep up with the best-trained men physically. If we're putting men in harm's way, we owe them battle colleagues who are just as strong as they are."

Although front-line combat is not permitted for women, "the military has skirted that by putting them in these 'support' roles. It's tantamount to having them in combat," Crouse says.

Says Kim Gandy, president of the National Organization for Women: "There is no job that women should be excluded from because of their gender. If you can do the job, you should have an opportunity to get the job. If you can't, you shouldn't be there, male or female."

Copyright 2005 USA Today.

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