Pre-deployment mental woes make combat stress more likely

Civilians who don the uniform and march into war carrying the psychological burden of previous trauma -- or of afflictions such as depression or anxiety disorder -- are far more likely than their mentally healthy comrades to suffer battle-related stress following deployment, new research has found.

A study published this week in the Archives of General Psychiatry also found that women, African Americans and those with less education were slightly more likely to suffer from post-traumatic stress disorder (PTSD) following their return from a war zone. Less surprisingly, sustaining a battle injury also boosted the odds, as did the length of time an individual spent in a wartime theater of operations.

For service personnel with significant symptoms of post-traumatic stress disorder before deployment, the odds of suffering the disorder after deployment is almost five times greater, the study found. For those with a history of panic syndrome, anxiety disorder and/or depression, the probability of developing post-deployment post-traumatic stress disorder rose two and a half fold.

Even without signs of mental illness, a serviceman or woman with an extensive history of psychological stressors and hardships--bankruptcy or deep poverty, divorce, being the victim of disabling illness or injury, or of violent or sexual assault, the death or severe illness of a loved one--is 2.8 times more likely than one with few or no such difficulties to suffer from the disorder.

The study was the first to track service personnel from the time they enlisted or were commissioned into the military until after their deployment to Iraq or Afghanistan. It is the largest and most comprehensive effort to date to identify what factors make a service member more vulnerable to combat-related stress. Its findings are likely to shape mental health interventions for those already deployed or deploying, and to influence future recruitment policies as well. It was led by physicians and epidemiologists from the Naval Health Research Center.

In all, the study found that 8.1% of those deployed to Iraq or Afghanistan appeared to suffer post-traumatic stress disorder in the wake of their return--well within the range of current estimates of 4% to 17% of recent veterans. But that figure doesn’t convey big differences in disorder rates among the branches of military service: Army soldiers were almost twice as likely to show signs of post-deployment post-traumatic stress disorder as Marines--even though both are widely deployed to Iraq and Afghanistan, and Navy personnel were about three-quarters as likely to develop post-traumatic stress disorder as Army personnel.

The study may put the nation’s all-volunteer military force in a bind, so long as economic news remains bad on the home front and combat operations continue abroad. Those looking to escape economically stressed communities and their problems have presented the armed services with a recruitment bonanza in recent years. But sending those with vulnerabilities to post-traumatic stress disorder off to war may be a more and more costly proposition for the nation once they return.

In September 2010, the military had identified some 89,000 cases of post-traumatic stress disorder among troops deployed to and returned from Afghanistan and Iraq. A recent Rand Corp. study has found that the cost of treating post-traumatic stress disorder in veterans for two years following their return could be $6,000 to $25,000 per case.