Study: War Effects Mental Health of One-Third of Military-Separated OEF/OIF Veterans

A new article appears today in the Archives of Internal Medicine, one of the JAMA/Archives journals. The study looked at VA records of all returning OEF/OIF veterans who had sought care from the Veterans Administration following their return home.

Researchers at the University of California-San Francisco, and San Francisco VA Medical Center found that a full one-third of our Iraq and Afghanistan vets treated at the VA from 2001-2005 received a "mental health or psychosocial diagnosis," i.e., homelessness or marital problems/domestic violence.

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Specifics:

Karen H. Seal, M.D., M.P.H., and colleagues at the University of California, San Francisco, and San Francisco VA Medical Center examined data from a VA database including 103,788 veterans of these operations who were first seen at VA facilities between Sept. 30, 2001, and Sept. 30, 2005. About 13 percent were women, 54 percent were younger than age 30, close to one-third were minorities and almost one-half were veterans of the National Guard or Reserves rather than full-time military personnel.

A total of 32,010 (31 percent) received mental health and/or psychosocial diagnoses, including 25,658 (25 percent) who received mental health diagnoses (56 percent of whom had two or more diagnoses). The most common such diagnosis was PTSD; the 13,205 veterans with this disorder represented 52 percent of those receiving mental health diagnoses and 13 percent of all the veterans in the study. "Mental health diagnoses were detected soon after the first VA clinic visit (median of 13 days), and most initial mental health diagnoses (60 percent) were made in non-mental health clinics, mostly primary care settings," the authors write. "The youngest group of Operations Enduring Freedom and Iraqi Freedom veterans (age, 18 to 24 years) were at greatest risk for receiving mental health or post-traumatic stress disorder diagnoses compared with veterans 40 years or older."

About 29 percent of veterans returning from Iraq and Afghanistan have enrolled in VA health care, a high rate compared with 10 percent of Vietnam veterans. This and the relatively short period of time between the first VA clinic visit and diagnosis with a mental health condition suggest an opportunity to intervene early to diagnose and treat mental health concerns, the authors note. "Our results signal a need for improvements in the primary prevention of military service-related mental health disorders, particularly among our youngest service members," they conclude. "Furthermore, early detection and evidence-based treatment in both VA and non-VA mental health and primary care settings is critical in the prevention of chronic mental illness, which threatens to bring the war back home as a costly personal and public health burden."

Additional details from Time magazine:

Over half—56%—were suffering from more than one disorder. The median was three disorders, says Dr. Seal: "So instead of treating just Post Traumatic Stress Disorder, you're treating PTSD, depression and substance abuse." The most common combination, she says, was PTSD and depression. "That's understandable," says Seal, because soldiers face horrifying events in combat that lead to PTSD while experiencing "a lot of loss and separation that lead to depression."

Post traumatic stress disorder affected 13% of veterans in the study. That number is consistent with figures from other conflicts, including Vietnam. But Seal is concerned that the numbers on PTSD and other mental disorders have been rising since the study was completed. "We just did a quick peek at more recent data and the numbers have gone up. They may surpass the numbers from Vietnam." She and her fellow authors attribute the prevalence of mental problems to the stress of guerilla warfare, the chronic threat of roadside bombs and improvised explosive devices and multiple tours of duty. "A lot of veterans feel they were on the front lines even if they were a cook or a driver," says Seal.

H/t to IAVA's Paul Rieckhoff for the early head's up.