Repeat Iraq Tours Raise Risk of PTSD, Army Finds

By Ann Scott Tyson
Washington Post Staff Writer
Wednesday, December 20, 2006

U.S. soldiers serving repeated Iraq deployments are 50 percent more likely than those with one tour to suffer from acute combat stress, raising their risk of post-traumatic stress disorder, according to the Army's first survey exploring how today's multiple war-zone rotations affect soldiers' mental health.

More than 650,000 soldiers have deployed to Iraq or Afghanistan since 2001 -- including more than 170,000 now in the Army who have served multiple tours -- so the survey's finding of increased risk from repeated exposure to combat has potentially widespread implications for the all-volunteer force. Earlier Army studies have shown that up to 30 percent of troops deployed to Iraq suffer from depression, anxiety or post-traumatic stress disorder (PTSD), with the latter accounting for about 10 percent.

The findings reflect the fact that some soldiers -- many of whom are now spending only about a year at home between deployments -- are returning to battle while still suffering from the psychological scars of earlier combat tours, the report said.

"When we look at combat, we look at some very horrific events," said Col. Ed Crandell, head of the Army's Mental Health Advisory Team, which polled 1,461 soldiers in Iraq in late 2005. "They come back, they know they're going to deploy again," and as a result they don't ever return to normal levels of stress, Crandell said.

Overall, soldiers in Iraq are facing a greater exposure to some key traumatic events than in the past, according to the report, the Army's third mental health survey conducted in Iraq since 2003. Seventy-six percent of soldiers surveyed, for example, said they knew someone who had been seriously injured or killed, and 55 percent experienced the explosion of a roadside bomb or booby trap nearby.

The proportion of soldiers who reported that they suffered a combination of anxiety, depression and acute stress rose to 17 percent, compared with 13 percent in the last survey in 2004.

Fourteen percent of soldiers surveyed said they have taken medications, such as antidepressants, for mental health problems.

Combat stress is significantly higher among soldiers with at least one previous tour -- 18.4 percent, compared with 12.5 percent of those on their first deployment, the survey found.

"The most likely explanation . . . is that a number of soldiers returned" to Iraq "with acute stress/combat stress symptoms" that were unresolved from previous tours, it said.

Soldiers with multiple tours also reported greater concern over the length of the 12-month deployments than those on their first tours and were more likely to give lower ratings for their own morale and that of their units, which 55 percent described as low.

This contrasts with 45 percent for soldiers overall, who rated unit morale higher than in the two earlier surveys, in 2003 and 2004.

The report also found a doubling of suicides among soldiers serving in the Iraq war from 2004 to 2005, the latest period for which data are available. Twenty-two soldiers took their own lives in Iraq and Kuwait in 2005, compared with 11 in 2004 and 25 in 2003, Army officials said.

"This is a concern for us," said Army Surgeon General Kevin Kiley in a briefing on the report, referring to the increase in suicides. Although the number who took their own lives remains within historical norms, "we consider one suicide to be too many," Kiley said. He said he is creating a "suicide prevention cell" to address the problem, as soldiers report having difficulty identifying comrades at risk.

Most of the suicides are impulsive and related to relationship, financial or disciplinary problems rather than combat stress, he said. "We've had young soldiers who will get bad relationship news, and the first thing they do is walk to a port-a-potty and end their lives," leaving no opportunity for anyone to intervene, he said.

The Army has significantly increased the number of mental health professionals in Iraq and Afghanistan, with the goal of treating soldiers more quickly and returning them to their units. About 20 to 40 soldiers are evacuated from Iraq each month for serious mental health problems, said Col. Cameron Ritchie, an Army psychiatrist.

As a result, one positive finding of the survey was that 95 percent of soldiers reported that mental health care was readily available to them.

In another improvement, the stigma associated with seeking help also decreased, with 28 percent of soldiers expressing concern that they would be seen as weak if they did so, compared with more than 30 percent in the 2003 and 2004 surveys.

Still, stigma remains a problem, with Army research showing that less than 40 percent of soldiers with mental disorders seek care.

In an effort to prevent soldiers returning with combat stress from being overlooked, the Army is expanding a pilot program in which primary-care doctors at Army bases are taught to screen their patients for PTSD and then coordinate specialized care, even if the patient declines to see a mental health expert.

So far, the program has screened more than 4,100 soldiers at Fort Bragg, N.C., with about 10 percent of those turning up positive for PTSD or depression, said Col. Charles Engel, director of the Deployment Health Clinical Center at Walter Reed Army Medical Center.

"Many people who are struggling with their emotions after a wartime experience have mixed feelings about seeking assistance," he said.

"We have to reach out to soldiers" through their primary doctors, Engel said.

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