Getting out, military health issues - Air Force Times

Study: Returning soldiers wait to seek mental health help

A new Army study finds that soldiers returning from Iraq are more likely to report mental health problems several months later rather than immediately after their return — and reserve component troops are twice as likely to report such problems with the passage of time.

On average, one in five active-duty sol diers and more than two in five reservists who served in Iraq required referral for mental health treatment, the study said.

The study, the combined result of initial and follow-on post-deployment screenings of 88,235 active and Reserve soldiers who filled out questionnaires between June 2005 and December 2006, validates a decision made two years ago to institute a follow-on mental health screening three to six months after troops return from war, Army researchers said. This was the first-ever study of troops who had completed both screenings.

Marine Corps records were excluded, because while Marines also filled out the surveys, the follow-on questionnaire had not been widely distributed to Marine Corps units during the study period, researchers said.

The findings were published Nov. 14 in the Journal of the American Medical Association. Col. (Dr.) Charles Milliken, an Army psychiatrist and principal investigator for the Walter Reed Army Institute of Research Division of Psychiatry and Neuroscience, called the effort “part of the Army’s continuing efforts to better understand the human dimension of war.”

The Army is doing the assessments, a combination of answers to survey questions and follow-ups by clinicians, to “reach out” to soldiers stressed by their deployments “and get them the care they need,” Milliken said.

“This is all about reducing stigma, and breaking down the barriers to getting care,” he said.

The previous study, published in JAMA in March 2006, reported preliminary findings that troops were more likely to report mental health problems months after returning from Afghanistan and Iraq rather than immediately after getting home, making it likely that some problems were being missed. As a result of those findings, the Defense Department instituted the follow-on screening, which this time included only Iraq war veterans.

In the new initial screenings, the data for active and reserve troops “look almost identical,” with around 4 percent needing referrals for treatment, Milliken said. But several months later, the need for referrals rose significantly in all four categories in the study — interpersonal conflicts, post-traumatic stress disorder, depression and overall mental health.

“When you come back ... you’re feeling great,” said Brig. Gen. Stephen Jones, assistant surgeon general, U.S. Army Medical Command. “You’re almost euphoric. You’re just glad to be home. And then over the next three to four weeks … the normal stress that everybody feels when they return home starts to surface.”

Jones called it a “normal, adaptive response we see with everybody. We would expect to see the stress levels at home go up. It’s one reason that we sought to have the second survey, so we could identify those folks and provide them with treatment.”

The Army doctors said they could not state conclusively why reservists report a higher rate of problems over time.

“We don’t think it’s about the war exposures or a basic resiliency difference,” Milliken said. “It may be a difference in just the health coverage situation they’ve got.”

When they return three to six months later for the follow-on screening, many reserve troops have uncertainty about whether they qualify for government health care due to war-related problems. Milliken said that at the time of the second screening, half of them are already beyond the period in which they qualify for transitional health care under Tricare, “so the whole issue of medical coverage is already on their mind.”