Many Veterans Need Mental Health Care

Those returning from Iraq may not show sign of problems right away, study notes

By Steven Reinberg
HealthDay Reporter

(HealthDay News) -- More than 40 percent of the U.S. soldiers from the Iraq and Afghanistan wars seen at VA hospitals suffer from mental health disorders or psychosocial behavioral problems, a new study shows.

Curiously, the researchers from the San Francisco VA Medical Center found that most mental health diagnoses were not made in the first year that a veteran entered the VA health-care system, but several years after. This finding supports the recent move to extend VA benefits to five years of free health care, which allows VA doctors the time to detect and treat more mental illness in returning combat veterans, the researchers noted.

"After the start of the Iraq War, there is a growing burden of mental illness, particularly post-traumatic stress disorder (PTSD), that will require increased allocation of resources for better detection and early intervention to prevent chronic mental illness, which threatens individual veterans, their families and communities," said lead researcher Dr. Karen Seal, an assistant professor of medicine and psychiatry at the University of California, San Francisco.

The report is published in the July 16 online edition of the American Journal of Public Health.

For the study, Seal's team collected data on 289,328 Iraq and Afghanistan veterans who sought health care at VA medical centers from 2002 to 2008.

Among these returning vets, 106,726 were given mental health care. These included 62,929 diagnosed with PTSD and 50,432 diagnosed with depression. That's nearly 37 percent of veterans, the authors noted.

"When the definition is expanded to include diagnoses of mental health disorders or psychosocial behavioral problems such as homelessness, or both, 43 percent of these veterans received these diagnoses," Seal added.

The diagnoses included 22 percent with PTSD, 17 percent with depression, 7 percent with alcohol use disorder, and 3 percent with drug use disorder. Many vets had several of these problems. In fact, 29 percent of veterans with mental health problems were diagnosed with two different conditions, and 33 percent were diagnosed with three or more, Seal said.

In addition, women had a higher risk for depression, but men had more than twice the risk for drug use problems, the researchers found.

Since the start of the Iraq war, mental health problems increased more than fourfold among active-duty personnel and sevenfold for members of the National Guard or Reserve, Seal said.

Age also played a role in the risk for PTSD, Seal said. While younger active-duty veterans had a higher risk for PTSD, "among Guard and Reserve members, those over 40 were at significantly higher risk for PTSD than their colleagues under 25," she said.

Moreover, active-duty enlisted veterans in the Army rather than other service branches, or who had multiple tours of duty, thus more combat exposure, were at greater risk for PTSD, Seal said. This was not seen in National Guard and Reserve personnel, she noted.

Mark Kaplan, a professor of community health at the School of Community Health at Portland State University in Oregon, noted that the study only covers vets who have received care at the VA, but there are many more with serious mental health problems that are either seeking care privately or not at all, he said.

"This study adds to what we know about this population, however, that's the veterans who seek care at the VA system. But if you look at the total population of veterans from all wars, there are one-third of all veterans who have these problems," Kaplan said.

Doctors who are not connected with the VA but who see veterans need to ask them about any mental health issues they have, Kaplan said. "They need to be aware of the risks associated with veteran status, and in particular those who served in Iraq and Afghanistan," he said.

Kaplan added that it is not uncommon for problems such as PTSD to arise years, even decades, after service. "We don't know the full emotional toll of the wars in Iraq and Afghanistan," he said.

Simon A. Rego, associate director of psychology training at Montefiore Medical Center in New York City, says that "while the results may be somewhat inflated due to the researchers' inability to assess data on clinical outcomes, potential treatment outside of the VA system, or even subsequent deployments, they are nevertheless, stunning."

The authors found a much higher percentage of veterans enrolling in the VA now than at any other time in history: 41 percent since 2002 versus 10 percent of Vietnam veterans. And, Rego noted, new mental health diagnoses in 2008 were six times higher than in 2002 -- 37 percent versus 6.4 percent.

"An important and often overlooked finding here was that a lack of social support -- being separated, divorced, widowed, etc.-- may pose a serious risk for new post-deployment mental health problems," Rego said.

This underscores the need for ancillary social support services for returning veterans who are unmarried and/or without social support, he said. "All too often we focus on treating the symptoms but fail to address the individual's social context. Based on the data here, a failure to do so could lead to increased risk in developing new mental health problems."

More information

For more information on the mental health toll on soldiers of the war in Iraq and Afghanistan, visit the U.S. National Center for PTSD .

SOURCES: Karen Seal, M.D., M.P.H., assistant professor, medicine and psychiatry, University of California, San Francisco; Mark Kaplan, Dr.PH., professor, community health, School of Community Health, Portland State University, Oregon; Simon A. Rego, Psy.D., associate director, psychology training, Montefiore Medical Center, New York City; July 16, 2009, American Journal of Public Health, online