Data suggest many soldiers will return with emotional problems

This could result in `immediate public health implications.'


``Soldiers and Marines who had returned from Iraq were significantly more likely to report that they were currently experiencing a mental health problem, to express interest in receiving help, and to use mental health services than were soldiers returning from Afghanistan or those surveyed before deployment.''

So far, nearly 15,600 servicemen and women reportedly have been injured in the war in Iraq.

An additional 650 or so have been wounded in action in Afghanistan and throughout the world in Operation Enduring Freedom.

The departments of defense and veterans affairs will spend years caring for those with lost limbs and other physical disabilities.

But then there are the lost souls.

Rick Harvey, a former Oregon National Guard soldier, returned from Iraq last year with an injured back, neck and knee ailments and lung damage.

And an invisible but debilitating disability _ post-traumatic stress disorder.

At least one scientific survey and a corresponding analysis say that Harvey is far from alone. The data suggest a significant number of soldiers will return with emotional problems resulting in ``immediate public health implications.''According to the study published July 1, 2004, in The New England Journal of Medicine, 15.6-17.1 percent of a sampling of soldiers and Marines returning from Iraq suffered from major depression, generalized anxiety or PTSD.

That estimate is about one in six of the 1,709 service people surveyed in 2003. And experts believe the numbers may be too low.

Dr. Matthew J. Friedman wrote in the corresponding journal editorial that there is reason to believe the estimates may be conservative and that the numbers of victims will rise.

Unlike most studies, this one examined mental health complications soon after the soldiers returned from battle, not years later.

Friedman _ a professor of psychiatry and pharmacology at Dartmouth Medical School in Hanover, N.H., and executive director of the VA's National Center for Post-Traumatic Stress Disorder _ cited a previous study that says ``the prevalence of PTSD may increase considerably during the two years after veterans return from combat duty.

``Second, on the basis of studies of military personnel who served in Somalia, it is possible that psychiatric disorders will increase now that the conduct of war has shifted from a campaign for liberation to an ongoing armed conflict with dissident combatants.''Dave Beebe, a mental health expert at Walla Walla's Jonathan M. Wainwright Memorial VA Medical Center, predicts 30 percent of returning vets will need treatment for some type of emotional problem.

The New England Journal study questioned participants about stress, emotional and family problems, and alcohol use. In addition to questioning those who served in Iraq, about 1,960 soldiers were surveyed after a six-month deployment to Afghanistan.

About 11.2 percent of them met the screening criteria for mental problems.

The survey pointed out that the prevalence of PTSD _ based on its strict definition _ was much higher for service people who were in firefights or wounded.

Among those returning from Iraq, 4.5 percent who experienced no firefights met the criteria as compared with 19.3 percent who were in more than five firefights.

``Soldiers and Marines who had returned from Iraq were significantly more likely to report that they were currently experiencing a mental health problem, to express interest in receiving help, and to use mental health services than were soldiers returning from Afghanistan or those surveyed before deployment.''So far, the Walla Walla VA is treating less than 30 veterans of the current conflicts for mental illnesses and chemical dependency, according to Beebe.

That number is included in the approximately 1,500 mental health patients seen at the center, most of whom are treated on an outpatient basis.

About 50 department employees including nurses and social workers offer a variety of programs in the VA's service area. But because of temporary staffing shortages, ``We're maxed right now,'' Beebe said.

The VA currently is recruiting for a second full-time psychiatrist in Walla Walla, in addition to other personnel. Once hiring is complete and other factors are considered, Beebe is optimistic the local facility _ and others in the Southeastern Washington, Northeastern Oregon and Idaho service area _ will be able to handle the additional load.

He explained that military experts in war zones are trying to identify potential victims immediately after traumatic events, and coordination between the departments of defense and veterans affairs has improved greatly.

Still, as addressed in the New England study, only 23-40 percent of those needing help are seeking it. Some may be in the process of mentally assimilating war-time trauma on their own, therefore needing little professional assistance, according to Beebe.

``We're not going to know for a while if these people really are sick or if they're recovering,'' he said.

Also, although the prevalence of PTSD is higher than those of Vietnam veterans, Americans who served in that war numbered about three times the more-than-one-million men and women deployed in the current conflicts.

Beebe added that, nationwide, the VA expects a $100 million increase in funding for mental health care.

``If (an influx of patients) came right now, I'm afraid there are some gaps,'' Beebe said.

``(But) I think we're going to be OK in mental health. I think there's going to be an expansion.''


Post-traumatic Stress Disorder, or PTSD, is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life.

PTSD is marked by clear biological changes as well as psychological symptoms. PTSD is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person's ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting.

Source: National Center for PTSD Web site.


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