DEPRESSION
August 10, 2009

For Veterans, the War Lingers

It is no surprise: there is an epidemic of mental disorders among veterans of the wars in Afghanistan and Iraq. A lack of social support...

For many veterans, the wars in Iraq and Afghanistan didn't end when their tours of duty did. They brought a small piece of the war back home with them. Sometimes a large piece. It won't go away and it's not helping them resume a normal life.

The problem of veterans readjusting to civilian society after a war isn't new. The Greek historian Herodotus mentions it as far back as 490 BC. It used to be known as shell shock or battle fatigue. While current language favors post traumatic stress disorder (PTSD), it's still the same condition. War is hell and once in one, it can be very difficult to lead a normal life afterwards. And that's for the winners.

There is a large population of recent veterans walking around who need help. The VA knows of over 100,000 and there are undoubtedly more.

A recent study shows that over 40% of all veterans of the Iraq and Afghanistan wars who were seen at VA hospitals are having serious difficulties with the tasks of day to day living. Clinically, they're said to be suffering from mental disorders or psychosocial behavioral problems. The most common diagnosis is PTSD, followed by depression. Alcohol and drug use disorders are less common. Many veterans have been diagnosed with more than one condition; about a third of all veterans with mental health problems have been diagnosed with three or more conditions.

The study only deals with veterans seen at VA hospitals. There are almost certainly other vets with serious problems who are seeking care privately. Or not seeking it at all.

The prime risk factor for PTSD seems to be the extent of combat exposure. Active duty veterans in the Army, particularly those with multiple tours of duty, are those most likely to experience symptoms.

All this means that there is a large population of recent veterans walking around who need help. The VA knows of over 100,000 and there are undoubtedly more. Problems like PTSD can take years, even decades to develop. This is one reason that veterans' eligibility for VA health care benefits was extended to five years in 2008.

So how can veterans get the help they need? One finding of the study was that veterans lacking in social support — those who are single, divorced, widowed or separated — are at greater risk of developing problems. This suggests that family members and friends need to help out. And non−VA doctors who see veterans need to be aware of the health risks of veterans and be prepared to help with appropriate treatment or referrals.

The study looked at data from 289,328 Iraq and Afghanistan veterans who sought health care at VA centers from 2002 to 2008. Of these, 106,726 received some form of mental health care. This is slightly under 40%. When conditions such as homelessness are added in, the total rises above 40%.

An online, ahead of print version of the study and its results was published July 16, 2009 by the American Journal of Public Health.

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