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2007-9-2 9:51:23

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And experts worry the numbers are rising

By Steven Reinberg
HealthDay Reporter


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MONDAY, March 12 (HealthDay News) -- Nearly a third of U.S. soldiers returning from Iraq and Afghanistan between 2001 and 2005 are being diagnosed with at least one mental health problem when seeking care at Veterans Administration hospitals, University of California, San Francisco, researchers report.

"Twenty-five percent of veterans who were new users of the VA health care system had a mental health diagnosis," said lead researcher Dr. Karen H. Seal, from the San Francisco Veterans Administration Medical Center. "When you include psychosocial behavioral problems, 31 percent had a psychosocial or mental health diagnosis," she said.

Seal is concerned that the number of veterans from Iraq and Afghanistan with mental problems is higher than in other wars. "I am surprised by the high prevalence and what may be an upward trend." she said.

Earlier reports have already spotted high rates of substance abuse, post-traumatic stress disorder (PTSD) and other mental health problems in soldiers returning from Iraq and Afghanistan. A study released late February from Walter Reed Army Institute of Research found that slightly more than 19 percent of Iraqi vets met the criteria for a mental health concern, as did more than 11 percent of those returning from Afghanistan.

The new study, which shows even higher numbers, is being released at a time when the military and the VA have been under continuing criticism for their inability to provide adequate care for returning soldiers. These concerns have led to Congressional inquires and the appointment of a presidential commission to investigate both military and VA health care.

The report is published in the March 12 issue of the Archives of Internal Medicine.

In the study, Seal and colleagues collected data on almost 104,000 veterans. Of these, about 13 percent were women, 54 percent were younger than age 30, and close to one-third were minorities. Almost half were in the National Guard or Reserves rather than full-time military.

The researchers found that 31 percent of the patients received mental health and/or psychosocial diagnoses. For the 25 percent who received a diagnosis of a mental health disorder, more than half (56 percent) had two or more mental conditions diagnosed. PTSD was the most common diagnosis. It accounted for 52 percent of all those who were diagnosed with a mental problem and 13 percent of all the veterans in the study.

"This new generation of veterans will be challenging to treat, because they have co-occurring mental health disorders," Seal said.

She noted that most mental health problems were identified during visits with primary care doctors, not with mental health professionals. "We found that most of these diagnoses occurred in primary care settings," Seal said.

Because primary care doctors are not trained mental health professionals, Seal thinks that there are many more veterans who may have undiagnosed mental health problems, further increasing the total number of affected veterans.

To deal with the problem, the VA is spending money to integrate mental health care into primary care. "The VA is really stepping up to the plate," she said.

However, many patients who do receive a diagnosis of a mental health problem do not seek further help, Seal said.

"Most of the patients went on to a mental health clinic, where the diagnosis was confirmed," Seal said. "But 40 percent did not seek further mental health care -- that was concerning," she said. This may be because the stigma of having a mental health problem is especially strong within the military, she said.

In addition, most of the burden of mental health woes fell on the youngest veterans, Seal said. "The youngest group of veterans -- 18-to-24-year-olds returning from Iraq and Afghanistan -- were at the highest risk for having a mental health diagnosis or a PTSD diagnosis," she said. "The highest prevalence of mental health diagnosis were in the youngest group of active-duty veterans," she added.

Seal believes that the youngest veterans were most affected, because they saw the most combat. "Combat exposure directly correlates with the development of PTSD and other mental health diagnoses," she said.

"The numbers are staggering," noted Simon Rego, an associate director of psychology training at Montefiore Medical Center and assistant professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine, New York City.

The prevalence of PTSD among these veterans is roughly the same as it was for Vietnam veterans, Rego said, "but if you look at the prevalence of PTSD in the general population -- it's about 3.5 percent -- this is a bubble coming our way."

Because most patients were diagnosed by primary care doctors, Rego believes that many of these physicians will need better training to spot veterans at risk. "We have to do our best to educate the primary care doctors that these patients could come to you first, and you should look for the symptoms of PTSD or other mental health disorders and refer patients for specialty care," he said.

More information

There's more on the mental health toll on soldiers of the war in Iraq and Afghanistan at the U.S. National Center for PTSD.



SOURCES: Karen H. Seal, M.D., M.P.H., San Francisco VA Medical Center, University of California, San Francisco; Simon Rego, Psy.D., associate director of psychology training, Montefiore Medical Center and assistant professor, psychiatry and behavioral sciences, Albert Einstein College of Medicine, New York City; March 12, 2007, Archives of Internal Medicine

Last Updated: March 12, 2007

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