Multiple deployments, extended tours of duty in Iraq, and less time at home
between them have kept the rate of mental health problems among U.S. soldiers
close to that of previous years, despite a decline in overall combat exposure,
according to the latest annual report from Army researchers.
About 18 percent of U.S. Army soldiers serving in Iraq screened positive
for mental health problems, according to data collected in October and
November 2007. That figure rose to 27 percent for those on their third tour.
At the same time, troops also said they had greater difficulty getting mental
health services, while the personnel assigned to help them complained of
shortages in their ranks and more burnout.
Among the good news in the report was that soldiers in Iraq said they felt
less stigma about seeking mental health care, continuing a steady downward
trend. Unit cohesion and special training designed to improve adjustment to
battlefield stress apparently have lessened mental health problems too. The
percentage of soldiers reporting high unit morale rose from 2006 to 2007,
although the Army did not provide exact figures.
The U.S. Army's Fifth Mental Health Advisory Team (MHAT-V) surveyed 2,295
soldiers in Iraq and 699 in Afghanistan, augmented with interviews, and also
questioned mental health care, primary care, and unit chaplain teams. The MHAT
investigators announced the findings on March 7 at the Pentagon. MHAT surveys
have been conducted since 2003.
The MHAT surveys are intended to result in improved mental health services
to soldiers, said Maj. General Gale Pollock, deputy surgeon general for force
management, at a news briefing.
"Our goal is to get every soldier the health care he or she
needs," said Pollock. "These advisory teams help us learn how and
where we can better meet those needs."
MHAT-V also made public for the first time survey data from soldiers
fighting in Afghanistan. They now screen positive for symptoms at rates
similar to those of troops in Iraq, a change from previous studies showing
fewer psychological effects of service in that country. Combat exposure there
is now at least as high as that seen in Iraq. Also, troops say they have
difficulty getting mental health care, and providers say they have difficulty
reaching soldiers in the field, said the report.
Tours of duty now last 15 months, rather than 12, and mental health
screening results showed increasing problems toward the middle of soldiers'
deployment, but improvement toward the end as soldiers looked forward to going
home—"redeployment optimism," according to Army psychologist
Lt. Col. Paul Bliese, who led the study team. ("Redeployment" is
the military term for "coming home.")
The stress of multiple deployments also appears to be taking its toll.
Soldiers on their second, third, or fourth deployment were at increased risk
for low morale, mental health problems, and degraded performance due to stress
or emotional problems, said the report. Sergeants and other noncommissioned
officers—the backbone of any army—make up a larger proportion of
those who have returned to Iraq more than once. They screen positive for
mental health problems at rates of 11 percent during a first tour, but at 27
percent during a third or fourth.
Longer time between deployments would help soldiers "reset"
emotionally, said Bliese at the briefing. Soldiers get 12 months back at their
home bases after the standard 15-month deployment, but a year is not enough to
let them recover from the mental health problems related to being in war, he
"We need to look at ways to slow down the deployment, but there are
no quick fixes," added Pollock.
About 15 percent to 20 percent of married service members said they were
considering divorce or separation. Homefront stress is the most common reason
soldiers seek care in the war zones. Family stressors in particular concern
health officials, especially given their ties to suicide. Both MHAT-V and last
year's Army suicide report said that "failed relationships with spouses
or intimate partners" is the highest risk factor for suicide.
Suicide rates in 2007 among soldiers in both Iraq and Afghanistan remained
higher than historic Army rates. Eighty-nine suicide deaths among active-duty
troops have been confirmed for 2007, while 32 cases are still being
investigated as possible suicide deaths. There were 102 confirmed suicides in
2006. Suicidal ideation peaks around mid-deployment and continues to rise
beyond the six-month point.
The survey also found that unethical behavior toward noncombatants had not
increased overall from 2006. However, said the report, "Soldiers who
screened positive for mental health problems of depression, anxiety, or acute
stress were significantly more likely to report engaging in unethical
behaviors," such as insulting or hitting civilians or damaging private
property unnecessarily while on patrol.
The Army team also surveyed 131 mental health
professionals—psychiatrists, psychologists, social workers, nurses, and
Army mental health specialists. They were short on equipment and personnel,
they said. Their own mental well-being was poor, and their ability to do their
jobs was also compromised by long deployments.
The Army is trying to hire an additional 275 psychiatrists, psychologists,
social workers, and other professionals to work in the United States and in
Europe, said Elspeth Cameron Ritchie, M.D., psychiatry consultant to the Army
surgeon general, at the news briefing. "We have found 148, an
improvement, but not where we want to be."
Thus far, civilian employees or contractors working to fill the Pentagon's
needs for health care have worked in the United States or at bases in Germany
or Korea to free up uniformed providers for the war zones. MHAT-V recommended
that the Army augment military mental health specialists with civilians who
would volunteer to serve "downrange," in Iraq. A shortened
military obligation might lure others to join the service in uniform, but that
option is still in an early stage, said Pollock.
The team also suggested that TRICARE, the contracted health care plan for
service members and their families, expand benefits to include marital and
family counseling services.
"Every year we've found problems, make recommendations, and try to
improve," said Ritchie, who has served on all the MHAT teams. "But
many psychiatric disorders, like PTSD, may manifest later, so as a nation we
must look to take care of our troops for the long term to prevent the problems
that happened with veterans after the Vietnam War."
A redacted version of the "Mental Health Advisory Team
V" report is posted at<www.armymedicine.army.mil/news/mhat/mhat_v/MHAT_V_OIFandOEF-Redacted.pdf>.▪