Veterans struggle with war trauma

The Army previously has said that an estimated 1 in 6 service members suffered from a form of post-traumatic stress disorder, or PTSD, a slightly lower rate than the Rand study found. In addition to current PTSD rates, the Rand study found that 19.5% of people who had served in Iraq or Afghanistan suffered a concussion or other traumatic brain injury during their combat tour, a number similar to Army estimates.

Taken together, the study shows that 31% of those who have served in combat have suffered from brain injury, stress disorder, or both.

Combat-related mental ailments and stress can lead to suicide, homelessness and physical health problems. But more mundane disorders can have long-term social consequences.

"These conditions can impair relationships, disrupt marriages, aggravate the difficulties of parenting, and cause problems in children that may extend the consequences of combat trauma across generations," the study said.

Failure to adequately treat disorders can cost the government billions of dollars, said Lisa H. Jaycox, one of the study's authors.

"We make the case that investing in treatment early would prevent some of the negative consequences from unfolding and save money," Jaycox said.

Some service members avoid a diagnosis of a mental health problem, fearing negative consequences, the study said. These troops worry about damage to their military careers and relationships with co-workers. "When we asked folks what was limiting them from getting the help that they need, among the top barriers that were reported were really negative career repercussions," said Terri Tanielian, another of the study's authors.

The study proposes two key changes. It recommends ways to allow service members to get mental health care "off the record," to avoid any possible stigma. And since some soldiers and Marines fear that seeking treatment will prevent their redeployment, the study recommends that fitness-for-duty reports not rely on decisions to seek mental health care.

Col. Loree Sutton, director of the Defense Department's PTSD center, expressed concern about the Rand finding that only half of service members with stress disorders seek help. Changing military culture to encourage troops to get help is difficult, she said at a news conference.

Service members who seek treatment face a dearth of healthcare providers with expertise in war-related mental disorders, the study found. The shortage leads to long waits that discourage some people from obtaining help.