The latest and most comprehensive study of veterans of the Iraq and Afghanistan wars has concluded that nearly 1 in every 5 veterans is suffering from depression or stress disorders and that many are not getting adequate care.
The study shows that mental disorders are more prevalent and lasting than previously known, surfacing belatedly and lingering after troops have been discharged.
An estimated 300,000 veterans among the nearly 1.7 million who have served in Iraq and Afghanistan are battling depression or post-traumatic stress disorder. More than half of these people, according to the study conducted by the Rand Corp., are slipping through the cracks in the bureaucratic system, going without necessary treatment.
The Rand study underscores one of the lessons of modern counterinsurgency conflicts: Such wars may kill fewer troops than traditional fighting but can leave deeper psychological scars.
Screening techniques for stress disorders are vastly improved from previous wars, making comparisons with Vietnam, Korea or World War II difficult. But a chief difference is that in Iraq and Afghanistan all service members, not just combat infantry, are exposed to roadside bombs and civilian deaths. That distinction subjects a much wider swath of military personnel to the stresses of war.
“We call it ‘360-365' combat,” said Paul Sullivan, executive director of Veterans for Common Sense. “What that means is veterans are completely surrounded by combat for one year. Nearly all of our soldiers are under fire, or being subjected to mortar rounds or roadside bombs, or witnessing the deaths of civilians or fellow soldiers.”
Military officials praised the Rand study, saying that its findings were consistent with their own studies, and said it would reinforce efforts to try to improve mental health care. Veterans Affairs officials, while questioning the study’s methodology, said their department had intensified efforts to find discharged service members suffering from mental disorders.
The Rand Study was undertaken for the California Community Foundation, which also has funded other programs for returning veterans. Lt. Gen. Eric Schoomaker, the Army surgeon general, said the study would help draw the nation’s attention.
“They are making this a national debate,” Schoomaker said.
The Army previously has said that an estimated 1 in 6 service members suffered from a form of post-traumatic stress disorder, or PTSD, a slightly lower rate than the Rand study found. In addition to current PTSD rates, the Rand study found that 19.5% of people who had served in Iraq or Afghanistan suffered a concussion or other traumatic brain injury during their combat tour, a number similar to Army estimates.
Taken together, the study shows that 31% of those who have served in combat have suffered from brain injury, stress disorder, or both.
Combat-related mental ailments and stress can lead to suicide, homelessness and physical health problems. But more mundane disorders can have long-term social consequences.
“These conditions can impair relationships, disrupt marriages, aggravate the difficulties of parenting, and cause problems in children that may extend the consequences of combat trauma across generations,” the study said.
Failure to adequately treat disorders can cost the government billions of dollars, said Lisa H. Jaycox, one of the study’s authors.
“We make the case that investing in treatment early would prevent some of the negative consequences from unfolding and save money,” Jaycox said.
Some service members avoid a diagnosis of a mental health problem, fearing negative consequences, the study said. These troops worry about damage to their military careers and relationships with co-workers. “When we asked folks what was limiting them from getting the help that they need, among the top barriers that were reported were really negative career repercussions,” said Terri Tanielian, another of the study’s authors.
The study proposes two key changes. It recommends ways to allow service members to get mental health care “off the record,” to avoid any possible stigma. And since some soldiers and Marines fear that seeking treatment will prevent their redeployment, the study recommends that fitness-for-duty reports not rely on decisions to seek mental health care.
Col. Loree Sutton, director of the Defense Department’s PTSD center, expressed concern about the Rand finding that only half of service members with stress disorders seek help. Changing military culture to encourage troops to get help is difficult, she said at a news conference.
Service members who seek treatment face a dearth of healthcare providers with expertise in war-related mental disorders, the study found. The shortage leads to long waits that discourage some people from obtaining help.
Thousands of additional mental health professionals -- both in government hospitals and in civilian healthcare systems -- are needed, and current practitioners must be given extra training, the report said.
“Since the dramatic increase in the need for services exists now, the required expansion in trained providers is already several years overdue,” the report said.
Gerald M. Cross, the Veterans Affairs’ principal deputy undersecretary for health, said his agency was stepping up outreach, expanding a program designed to contact all veterans, whether or not they had reported problems.
“We contact them by mail, we contact them in person, we call them on the phone,” Cross said. “We are even putting a segment on MTV.”
Veterans Affairs officials questioned the Rand survey’s methodology, but Tanielian said the firm was “confident of our estimates.”
Ira R. Katz, the Veterans Affairs’ mental health chief, said the agency’s budget for mental disorders had surged from $2 billion in 2001 to $4 billion next year. “The VA has done an enormous mobilization, not only to meet the needs of returning veterans but all veterans,” Katz said.
But critics of the Bush administration contend the Rand study highlights that Veterans Affairs did not pay close enough attention to the issue of stress disorders, said Sullivan, the veterans advocate.
“The VA is completely unprepared for the tidal wave,” Sullivan said. “Unless the VA gets a massive amount of money [and] a set of new strong pro-veteran leaders, the situation will collapse.”
Bryan Catherman, a former staff sergeant in the Army Reserve, said he was screened for mental health ailments when he was demobilized in 2004. He said he was focused on saying and doing what was necessary to get home to his family. Besides, the euphoria of being home masked his problems.
“I felt like Superman for the first six months,” Catherman said. “Then I felt like I ate Kryptonite corn flakes. So everything went downhill after the military was done with me.”
Catherman said he sank into a depression and abused alcohol. At first resisting his family’s pleas to get help, he later encountered frustration in dealing with Veterans Affairs. Today, he credits the VA for the help he needed, but thinks the government misread the problem.
“The system is overburdened,” Catherman said. “We should have learned from Vietnam. I feel, as a veteran, that once I got home from Iraq, I wasn’t much of a concern anymore.”
The Rand study can be found at the corporation’s website: https://veterans.rand.org.