A Quarter of Iraq and Afghanistan Vets Show Mental Health Problems

SAN FRANCISCO, March 12 -- A quarter of all veterans treated at VA hospitals after returning home from the wars in Iraq and Afghanistan brought mental health problems back with them, reported investigators here.

When psychosocial and behavioral problems were thrown into the mix, nearly a third of all veterans of Afghanistan and Iraq who sought care at VA facility had a diagnosis of a mental-health-related disorder, reported Karen H. Seal, M.D., M.P.H., from the University of California San Francisco, and the San Francisco VA, and colleagues.

And more than half of the returning vets who had a mental health diagnosis were found to have two or more mental health disorders, the investigators wrote in the March 12 issue of the Archives of Internal Medicine.

Previous studies have shown that only one in five veterans returning from combat duty in Iraq or Afghanistan with signs of post-traumatic stress disorder (PTSD) is actually screened for it, the Government Accountability Office reported last May.

Using data provided by the Department of Defense, GAO investigators found in review that 9,145 (5%) of the 178,664 service men and women deployed in Afghanistan or Iraq may be at risk for developing PTSD, but only 2,029 (22%) of the at-risk group were referred for further mental health evaluations.

In March of 2006, researchers from the Walter Reed Army Institute of Research reported in the Journal of the American Medical Association that 35% of Iraq war veterans sought mental health services for any reason in the year after returning home. Of them, 12% per year received a diagnosis of a mental health problem, the investigators found, and an additional 23% per year were seen in mental health clinics but did not receive a diagnosis.

In the current study, Dr. Seal and colleagues looked at records of US veterans separated from service in either Iraq or Afghanistan, or both, who were first seen at a VA health facility from Sept. 30, 2001 to Sept. 30, 2005.

They used ICD-9 clinical modification (ICD-9-CM) codes to assess the burden of mental health and psychosocial behavioral problems in the vets.

They found that of the 103,788 veterans of the two campaigns, 25,658 (25%) received at least one mental health diagnosis, and of this group, 56% had multiple diagnoses. Specifically, 7,342 (29% of the subgroup) had two diagnoses, and 6,997 (27%) had three or more diagnoses.

PTSD was the most common diagnosis, occurring in 52% of all patients with a mental health problem, and 13% of the veterans in the overall sample.

"When we broadened our definition of 'mental health problems' to include those with a mental health diagnosis and/or those receiving a V-code, representing a psychosocial problem, overall, 32,010 Iraq or Afghanistan veterans (31%) were coded as having 'mental health problems'," the investigators wrote.

The mental health problems were diagnosed within a median of about two weeks from the first VA clinic visit, and almost two-thirds of the initial diagnoses were made in primary care or other non-mental health settings.

Veterans from the ages of 18 to 24 years were most at risk for PTSD and other mental health problems compared with veterans 40 years or older. The youngest vets had a more than three-fold risk for at least one mental health diagnosis (relative risk 3.32, 95% confidence interval, 3.12-3.54) and a five fold risk for PTSD (relative risk 5.04, 95% CI, 4.52-5.62) compared with active-duty veterans 40 years or older.

"Our results signal a need for improvements in the primary prevention of military service-related mental health disorders, particularly among our youngest service members," Dr. Seal and colleagues wrote. "Furthermore, early detection and evidence-based treatment in both VA and non-VA mental health and primary care settings is critical in the prevention of chronic mental illness, which threatens to bring the war back home as a costly personal and public health burden."

The authors said that the findings are not generalizable to all veterans of Iraq or Afghanistan, because they studied only those vets who sought help at VA facilities, and only those who were new users of the VA system who were separated from their overseas service after the start of the war in Afghanistan.

The military personnel included in the study also were not systematically assed with validated diagnostic instruments or self-report questionnaires, suggesting that there could have been a bias from misdiagnosis of some cases.