One in eight soldiers returning from service during the first year of the Iraq war was diagnosed with post-traumatic stress disorder or some other mental illness, according to the most comprehensive study yet of the effects of war on the mental health of veterans.
More than one-third of the veterans had sought psychological help in the year after their return, but the majority required only one or two visits to resolve their concerns, said the team at Walter Reed Army Institute of Research that conducted the study.
The results, reported today in the Journal of the American Medical Assn., are based on a study of computerized medical records of 300,000 soldiers and are thought to be the most accurate indicator to date of the percentage of soldiers requiring mental health services.
The results did not surprise those involved in the care of veterans.
"I think it's probably on a par with what you would expect," said Dr. Charles W. Hoge of Walter Reed.
In the Persian Gulf War, he said, the rate of post-traumatic stress disorder among combat soldiers was about 10% to 12%.
Nonetheless, the new study shows that mental health issues represent a problem for many veterans.
"The study confirms what we've heard from our members for the last two years -- that mental health issues and [post-traumatic stress disorder] are among the No. 1 issues facing Iraq veterans," said Paul Rieckhoff, executive director of the Iraq and Afghanistan Veterans of America.
Some experts speculated that the percentage could grow in coming years, because stress disorders often take months or years to appear and because of the strong upsurge in roadside bombings and other attacks by insurgents in Iraq.
Long-term studies after the Vietnam War showed that as many as one-third of the veterans of that conflict required psychological care.
Balancing those concerns, Hoge and others argue that there are many new factors in this war that may help reduce stress, including better living conditions in war zones, Internet and phone access that keep soldiers in contact with distant family members, and the military's increasing efforts to provide care and remove the stigma from those who accept it.
"We've learned from past wars that war has psychological effects, and we are trying to do something about that," Hoge said.
Combat stress was documented in the late 19th century after the Franco-Prussian War. After the Civil War, doctors called the condition "nostalgia" or "soldier's heart." In World War I, soldiers were said to suffer shell shock. In World War II and Korea, it was called combat fatigue or battle fatigue.
But it wasn't until 1985 that the American Psychiatric Assn. gave a name to the condition that had sent tens of thousands of Vietnam veterans into lives of homelessness, crime or despair.
Post-traumatic stress disorder is a debilitating condition that often follows a terrifying physical or emotional event. It causes the person who survived the event to have persistent, frightening thoughts and memories, or flashbacks, of the ordeal. Symptoms include emotional numbing, sleep problems, irritability, hyper vigilance, depression, anxiety and poor concentration.
The latest study was based on the military's Post-Deployment Health Assessment, required of all returning soldiers since May 2003 -- two months after the invasion of Iraq. The study covered all veterans who returned before the end of April 2004, and followed them for another year.
The study included 222,620 Army soldiers and Marines who were deployed to Iraq, 16,318 deployed to Afghanistan and 64,967 deployed in Bosnia-Herzegovina, Kosovo and other locations.
The team also was able to access electronic treatment records for the soldiers, a feat that had not been possible in previous wars.
Answers provided by soldiers in the post-deployment survey showed that 19.1% of those returning from Iraq reported mental problems, compared with 11.3% of those returning from Afghanistan and 8.5% of those returning from other overseas postings, mostly in noncombat areas.
By the end of the first year, 35% of Iraq veterans had sought mental care. A portion of those, 12% of the total, were diagnosed with post-traumatic stress disorder, depression or another serious disorder.
Hoge and his colleagues released a similar study in 2004 showing that about one in six returning soldiers faced severe mental disorders, but those conclusions were based on interviews with about 6,000 soldiers.
In the latest study, exposure to combat was found to be the one factor most closely associated with mental problems. Among the 21,822 Iraq veterans who reported symptoms of post-traumatic stress disorder, 79.6% had engaged in combat or witnessed people being wounded or killed. Among the 200,798 who did not have the disorder, 47.8% had done so.
Psychologist Richard J. McNally of Harvard University said the results of the study pointed to a glaring weakness in the post-deployment survey.