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).
