my personal edition > depression > news


  E-Mail this DGReview to a colleague

DGReview

Less Than Half of Combat Personnel Seek Help for Mental Disorders, Which Are More Prevalent Among Those Deployed to Iraq than Afghanistan

A higher percentage of combat personnel deployed to Iraq meet criteria for major depression, generalised anxiety, or post-traumatic stress disorder (PTSD), compared with those deployed to Afghanistan, yet less than half of these individuals seek professional help, according to the findings from a cross sectional analysis.

Charles W. Hoge, MD, Department of Psychiatry and Behavioral Sciences, Walter Reed Army Institute of Research, U. S. Army Medical Research and Materiel Command, Silver Spring, Maryland, United States, and colleagues analysed 6201 anonymous surveys for the prevalence of a major depressive disorder, a generalised anxiety disorder, and PTSD among Army personnel both before and 3 or 4 months after deployment to Iraq or Afghanistan, and among Marine personnel after deployment to Iraq.

"Respondents to our survey who had been deployed to Iraq reported a very high level of combat experiences, with more than 90 percent of them reporting being shot at and a high percentage reporting handling dead bodies, knowing someone who was injured or killed, or killing an enemy combatant," the authors note, adding "Soldiers who served in Afghanistan reported lower but still substantial rates of such experiences in combat."

Assessments obtained after deployment to Iraq indicated that 15.6% of the Marines surveyed and 17.1% of the Army personnel surveyed met strict criteria for depression, anxiety, and PTSD, with criteria for PTSD comprising most of the disorders (12.2% and 12.9%, respectively). Assessments obtained after deployment to Afghanistan indicated any of the 3 disorders in 11.2% of the Army personnel surveyed, with PTSD accounting for 6.2%.

The investigators noted a strong correlation between the prevalence of PTSD and the level of combat experienced. Among those deployed to Iraq and experiencing no firefights 4.5% met the strict criteria for PTSD, while of those experiencing more than 5 firefights 19.3% met PTSD criteria. The prevalence of PTSD among those deployed to Afghanistan also trended higher with increasing firefight experience.

Among participants who met strict criteria for a mental disorder, 38% to 45% indicated an interest in receiving help, while 23% to 40% reported having received such help during the previous year.

"Soldiers and Marines whose responses were scored as positive for a mental disorder were twice as likely as those whose responses were scored as negative to show concern about being stigmatized and about other barriers to mental health care," the authors note.

"Reducing the perception of stigma and the barriers to care among military personnel is a priority for research and a priority for the policymakers, clinicians, and leaders who are involved in providing care to those who have served in the armed forces," the authors conclude.

N Engl J Med 2004;351:13-22

E-Mail this DGReview to a colleague

To print, use this version