Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care.

Hoge CW ，Castro CA ，Messer SC ，McGurk D ，Cotting DI ，Koffman RL ... -  《-》

Combat duty in Iraq and Afghanistan, mental health problems and barriers to care.

Hoge CW ，Castro CA ，Messer SC ，McGurk D ，Cotting DI ，Koffman RL ... -  《-》

Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq.

Thomas JL ，Wilk JE ，Riviere LA ，McGurk D ，Castro CA ，Hoge CW ... -  《-》

Combat and peacekeeping operations in relation to prevalence of mental disorders and perceived need for mental health care: findings from a large representative sample of military personnel.

Sareen J ，Cox BJ ，Afifi TO ，Stein MB ，Belik SL ，Meadows G ，Asmundson GJ ... -  《archives of general psychiatry》

Self-reported combat stress indicators among troops deployed to Iraq and Afghanistan: an epidemiological study.

Riddle MS ，Sanders JW ，Jones JJ ，Webb SC ... -  《-》