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Friday, April 07, 2006

Psychiatric News: Iraq and Afghanistan Combat Experiences Compared

The American Psychiatric Association's Psychiatric News offers a quick glimpse at the differences found between the OEF and OIF combat arenas. The article also discusses a selection of findings from last month's ground-breaking mental health study published in the Journal of the American Medical Association.

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From Psychiatric News, Volume 41, Number 7, page 1:

Service in Iraq was more hazardous to soldiers' mental health than serving in Afghanistan or elsewhere, wrote the researchers.

"Overall, 19.1 percent of soldiers and Marines who returned from [Iraq] met the risk criteria for a mental health concern, compared with 11.3 percent for [Afghanistan] and 8.5 percent for other locations," they said. The latter rate is close to baseline levels from soldiers surveyed before initial service in Iraq and Afghanistan.

Soldiers and Marines returning from Iraq were twice as likely to screen positive for PTSD as those who had served in Afghanistan (9.8 percent versus 4.7 percent) and were twice as likely to be referred for mental health care (4.3 percent versus 2.0 percent). There were only minor differences in mental health issues when comparing active service troops with National Guard or Reserve members, or women with men. Overall, 28.4 percent of Iraq vets and 16.0 percent of Afghanistan vets were referred for any medical follow-up. Veterans of Iraq were hospitalized more often during deployment (6.6 percent) than Afghanistan vets (3.6 percent), which may serve as a marker for injury.

The need for mental health services is a function of combat experience, and ground service in Iraq entailed a greater exposure to combat, according to the PDHA data. Compared with troops in Afghanistan, troops in Iraq more frequently saw comrades killed or wounded and were three times more likely to fire their weapons. Half the soldiers and Marines in Iraq had felt in great danger of being killed, twice the rate of those who served in Afghanistan.

Both the nature of the war and deployment practices may account for differences in mental health outcomes in the two theaters. There are no safe zones in Iraq, Col. Elspeth Cameron Ritchie, M.C., psychiatry consultant to the U.S. Army surgeon general, told Psychiatric News. "Danger can come from any direction, and it's hard to tell friend from foe."

The multiple, year-long deployments to the war zone are tough on troops and their families. In World War II, soldiers, sailors, and Marines knew they were in for the duration of the war, and troops served only for one year in Vietnam. But those serving today in Iraq or Afghanistan may be there for a year, return, adjust to life back in the States, and then have to ship out again when their units are called up again. They must face the threat of roadside bombs and stresses on family life at the same time.

Please read the rest of the article. Additional information can be found in 2004's Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care study published in JAMA.

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