Officials Report Progress, Challenges in Treating Combat Stress

(2005-07-28)

Recognizing the link between combat and mental health symptoms, the Defense Department is working to improve the way it prevents, identifies and treats mental illness among troops who are serving or have served in Iraq and Afghanistan, Army officials told Congress July 27.

Surveys show that 19 to 21 percent of troops who have returned from combat deployments meet criteria for post-traumatic stress disorder, depression or anxiety, Army Col. Charles Hoge, chief of psychiatry and behavior services at the Walter Reed Army Institute of Research, told the Committee on Veterans Affairs' Health Subcommittee. Of these, 15 to 17 percent of troops surveyed three to 12 months after their deployments had PTSD symptoms.

In general, Hoge said in his prepared testimony, PTSD rates were highest among units that served deployments of 12 months or more and had more exposure to combat. Rates were much lower for troops returning from Afghanistan than Iraq, with 6 percent of Operation Enduring Freedom veterans surveyed experiencing PTSD symptoms.

In addition, many returning servicemembers may not have a full-blown psychiatric disorder, but experience some form of psychological distress after their wartime service, Army Lt. Col. Charles Engel, director of the Department of Defense Deployment Health Clinical Center, told the subcommittee.

Calling mental health symptoms "common and expected reactions to combat," Hoge said DoD and the Army are working to learn as much as possible and adjusting their programs to better prevent symptoms from arising and treat troops who need it. Part of that effort, he said, is an ongoing survey focused on combat operational units that includes post-deployment assets conducted three times after their deployments: at three to four months, six months, and 12 months.

Hoge reported a "substantial increase" in Operation Iraqi Freedom veterans seeking mental health care, but said the same factors that prevent many civilians from seeking mental health care apply to servicemembers as well.

Studies show that soldiers and Marines are concerned that they'll be treated differently in their units if their peers or leaders know they're getting mental health treatment. Others say they can't get the time off work to get care, or don't have transportation to get treatment. And men are less likely to seek mental health help than women, Hoge said.

The military is working to overcome these barriers and better serve troops who need care, Hoge said. Research projects are focusing on identifying symptoms and intervening earlier, improving access to mental health care and evaluating mental health programs already in place. DoD also is working with the Department of Veterans Affairs and other groups to improve awareness about depression and PTSD among primary-care professionals and promote routine screening in primary care, he said.

Recognizing that soldiers are more likely to report mental health problems three to four months after a deployment than when they first return, DoD has expanded its post-deployment health assessment program. The department also is evaluating interventions such as psychological debriefing, and is developing training modules to help better educate soldiers, leaders and health-care providers, Hoge said.

As these efforts move forward, Engel said, it's critical that adequate mental health and operational stress control services are available to servicemembers, while in the combat environment as well as after redeployment.

And while providing the best mental health services possible, DoD also must convey an important message to servicemembers that the reactions they may experience after combat "are common and expected," Hoge said. Getting that message across is a key to reducing the stigma associated with getting mental health care and to promoting earlier invention, he said.

"We have made great strides in improving access to mental health care programs," Engel told the subcommittee. "But if you consider all the untapped demand out there, we may still have challenges to overcome."

A key, he said is making servicemembers more willing to offer frank accounts of their mental state, something Engel said requires confidentiality and trust. If the military doesn't ensure that trust, provide the needed care and protect the careers of those who seek it, "they we will not be able to reliably detect and diagnose these illnesses and provide proper care and assistance," he said.

As a result, Engel told the subcommittee, "those in need will reject our services and keep their personal problems to themselves until they balloon out of control."



By Donna Miles
American Forces Press Service