No Purple Hearts are awarded for the often hidden wounds of posttraumatic
stress disorder, but ultimately those wounds can be deadly--linked to suicides, accidents
and, over the long term, increased risk of death from cardiovascular diseases
and cancer (Boscarino, 2005). Aware of the risks,
government agencies, veterans groups and the U.S. Congress in recent months
have grabbled with identification, treatment and benefit issues for the growing
number of troops and veterans afflicted with PTSD.
"Studies indicate that troops who serve in Iraq are suffering from [PTSD]
and other problems brought on by their experiences on a scale not seen since
Vietnam," according to one report (Robinson, 2004). The National Vietnam
Veterans' Readjustment Survey (from 1986 to 1988) found that 15.2% of male and
8.5% of female Vietnam War veterans suffered from current PTSD (Schlenger et al., 1992).
In Iraq and Afghanistan, the visible manifestations of the
mental health toll of U.S.
combat operations include suicides and medical evacuations. Official Army
statistics from March 19, 2003, through July 31, 2005, indicated that 6.4% of
the 19,801 soldiers evacuated from Iraq
and 7.2% of the 1,733 evacuated from Afghanistan had psychiatric
problems. Among the 1,275 psychiatric disorder evacuations from Iraq, 596 were
for depression, 109 for suicidal ideation and 91 for PTSD. There have been 53
suicides among service members fighting in Iraq and nine among those fighting
in Afghanistan, as reported in a review of suicide data from 2003 to July 19,
2005 (Ireland, 2005).
Yet most suicides, according to veteran groups and media accounts, occur
after troops return home. One highly publicized case was that of Marine
reservist Jeffrey Lucey, deployed to Iraq for five
months. When he returned home to Belchertown,
Mass., he began drinking heavily
and suffering from insomnia, night sweats, hallucinations and panic attacks. He
received treatment at a Veterans Affairs facility, where he was described by
one physician as having PTSD, depression with psychotic features, suicidal
ideation and acute alcohol intoxication. One day, Lucey's
father came home to find his son had hung himself in the cellar. On Lucey's bed were the dog tags of two unarmed Iraqi
prisoners he said he had been forced to shoot (Srivastava,
2004). A recent Associated Press story (2005) reported that three men who had served with the Army's 10th Special Forces in Iraq
returned home and committed suicide shortly thereafter.
Other statistics and surveys are equally revealing. The Figure illustrates medical surveillance data obtained from the Army's Center for Health Promotion and Preventive Medicine on health assessment
responses completed between January and August of 2005 by 193,131 troops
returning from Operation Iraqi Freedom (OIF). Col. Charles Hoge, M.D., chief of psychiatry and behavior services at the Walter Reed Army
Institute of Research, told the U.S. House Committee on Veterans Affairs' Health Subcommittee last July that 19% to 21% of troops who have returned from
combat deployments meet criteria for PTSD, depression or anxiety. Of these, 15%
to 17% of troops who served in Iraq
and 6% of those who served in Afghanistan
had PTSD symptoms when surveyed three to 12 months after their deployments. In
general, PTSD rates were highest among units that served deployments of 12
months or more and had more exposure to combat.
The numbers are similar to those published in another study (Hoge et al., 2004). Researchers studied the prevalence of
mental health problems among members of three Army units and one Marine Corps
unit before deployment or three to four months after returning from deployment
to Iraq or Afghanistan.
The rates of PTSD were significantly higher after combat duty in Iraq (18.0% for
Army units and 19.9% for the Marine group) than before deployment (9.4%). There
was a strong relationship between combat experiences-such as being shot at,
handling dead bodies or killing enemy combatants-and the prevalence of PTSD.
The study also found that the fear of stigmatization deterred some active duty
personnel from seeking mental health care even when they recognized the
severity of their psychiatric problems.
A survey of 1,300 paratroopers three months after they had returned to Fort Bragg, N.C., after
spending a year in Iraq
found that 17.4% of the soldiers had PTSD symptoms (Associated Press, 2004). In
another study comparing the mental health of men and women in violence-prone
jobs (e.g., medics, mechanics, drivers) in Iraq, researchers found that 11% of
the men and 12% of the women had PTSD symptoms when they were screened three
months after their deployment ended (Elias, 2005).
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Nov. 17, 2005.
2. Associated Press (2004), Survey: soldiers suffer stress disorder. Aug. 10.
Available at: www.armytimes.com. Accessed Nov. 17, 2005.
3. Benjamin M (2005), The V.A.'s bad review.
Available at: www.salon.com/news/feature/2005/10/26/suicide/index.html. Accessed Oct. 27, 2005.
4. Boscarino JA (2005), Posttraumatic stress disorder
and mortality among U.S. Army veterans 30 years after military service. Ann Epidemiol Aug 11 [Epub
ahead of print].
5. Elias M (2005), Stress equal for female soldiers--Women do no better, no
worse than men. USA
TODAY Aug 18, D5.
6. GAO (2004), VA and Defense Health Care. More
Information Needed to Determine if VA Can Meet an Increase in Demand for
Post-Traumatic Stress Disorder. Available at: www.gao.gov/cgi-bin/getrpt?GAO-04-1069.
Accessed Nov. 16, 2005.
7. Hoge CW, Castro CA, Messer SC et al. (2004),
Combat duty in Iraq and Afghanistan, mental health problems, and barriers to
care. N Eng J Med 351(1):13-22 [see comments].
8. Ireland RR (2005), Suicide Prevention and Suicide Rates. Washington, D.C.; Office of Assistant Secretary of Defense.
9. Robinson SL (2004), Hidden Toll of the War in Iraq. Washington, D.C.:
Center for American Progress. Available at: www.americanprogress.org. Accessed Nov. 17, 2005.
10. Schlenger WE, Kulka RA, Fairbank
JA et al. (1992). The prevalence of post-traumatic stress disorder in
generation: a multimethod, multisource
assessment of psychiatric disorder. J Trauma Stress 5:333-363.
11. Srivastava M (2004), Swallowed by pain. Dayton Daily News. Oct. 11. Available at:
/content/project/suicide/daily/1011lucey.html. Accessed Nov. 17, 2005.
12. VA Office of the IG (2005), Review of State Variances in VA Disability
Compensation Payments. Report No. 05-00765-137. Available at:
Nov. 17, 2005. [PDF}