Fort Bliss Monitor

Army doctors publish combat stress study

Courtney Hickson
Army News Service

WASHINGTON – Soldiers deploy-ed to the front lines of Iraq face a higher chance of developing post-traumatic stress disorder and other mental disorders than their counterparts in Afghanistan, a recent Army study reported.

The study, published in the July 1 New England Journal of Medicine, was led by Col. Charles W. Hoge, a medical doctor at the Department of Psychiatry and Behavioral Sciences, Walter Reed Army Institute of Research. It surveyed members of three Army units and one Marine unit.

The study was conducted with service members who had various lengths of deployment. Some Soldiers were surveyed in January 2003 before a year-long deployment to Iraq; the second group responded to questions after a six-month deployment to Afghanistan; while a third group of Soldiers was surveyed after an eight-month deployment to Iraq. The Marines were surveyed after a six-month deployment to Iraq. All who were surveyed were involved in hazardous security duties.

There were 5,386 Soldiers and 815 Marines in the survey. Hoge said they focused exclusively on combat arms units and Army Infantry during the initial invasions of Afghanistan and Iraq. This was done with the knowledge that these Soldiers and Marines would be more likely to have seen combat and have combat stress as a result.

“This is not generalized to all service members,” he said. “The initial ground experiences may be different.”
Hoge said the study puts numbers to what is already known.

“What is unique is this is the first time we have looked at this so close to combat deployment,” he said.
Eighteen percent of the Soldiers who responded to the survey questions after returning home from Iraq had PTSD, almost double the number, of Soldiers surveyed before deployment to Iraq. While only 11.5 percent of those returning from Afghanistan had the broad definition of PTSD. Soldiers in Iraq had a significantly higher exposure to combat than those deployed to Afghanistan.

PTSD is “a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person’s daily life,” according to the National Center for PTSD Web site.
When asked if they have received professional help in the past months – which could have been help from a mental health care profession, a general medical doctor or a clergy member – 11 percent of Soldiers returning from Iraq said yes. In the same group, more than 16 percent said they were interested in receiving professional help, while 19.5 percent had a perceived moderate or severe problem.

Many Soldiers, who need mental health care the most, said they are not seeking treatment out of fear of being stigmatized the survey reported. Of those meeting the screening criteria for a mental disorder, the largest perceived barrier – at 65 percent – was “I would be seen as weak.” The next largest barrier was “My unit leadership might treat me differently,” at 63 percent.

Hoge said the perception of being stigmatized with a mental health disease is not unique to the military but there are some factors such as cohesion and leadership that are unique.

“They are perceived that they may be treated differently but that may not be the reality,” he said. “But it could be enough to not want to seek help.”

One of the challenges now is to find a way to reduce the stigma and encourage Soldiers to seek treatment, Hoge said.

In addition to Hoge, Army and Navy doctors performed and wrote study results. It is part of a larger ongoing study, which will be reported on in the future. Hoge said they will be looking at in greater detail factors shown in this study and looking to improve mental health and intervention to help the Soldiers. The study took over two years to complete and had support from the highest levels of the Army from the beginning, Hoge said.



www.bliss.army.mil	Published for the Fort Bliss/El Paso, Texas Community	July 15, 2004

	Army doctors publish combat stress study Courtney Hickson Army News Service Voyageur Airways WASHINGTON – Soldiers deploy-ed to the front lines of Iraq face a higher chance of developing post-traumatic stress disorder and other mental disorders than their counterparts in Afghanistan, a recent Army study reported. The study, published in the July 1 New England Journal of Medicine, was led by Col. Charles W. Hoge, a medical doctor at the Department of Psychiatry and Behavioral Sciences, Walter Reed Army Institute of Research. It surveyed members of three Army units and one Marine unit. The study was conducted with service members who had various lengths of deployment. Some Soldiers were surveyed in January 2003 before a year-long deployment to Iraq; the second group responded to questions after a six-month deployment to Afghanistan; while a third group of Soldiers was surveyed after an eight-month deployment to Iraq. The Marines were surveyed after a six-month deployment to Iraq. All who were surveyed were involved in hazardous security duties. There were 5,386 Soldiers and 815 Marines in the survey. Hoge said they focused exclusively on combat arms units and Army Infantry during the initial invasions of Afghanistan and Iraq. This was done with the knowledge that these Soldiers and Marines would be more likely to have seen combat and have combat stress as a result. “This is not generalized to all service members,” he said. “The initial ground experiences may be different.” Hoge said the study puts numbers to what is already known. “What is unique is this is the first time we have looked at this so close to combat deployment,” he said. Eighteen percent of the Soldiers who responded to the survey questions after returning home from Iraq had PTSD, almost double the number, of Soldiers surveyed before deployment to Iraq. While only 11.5 percent of those returning from Afghanistan had the broad definition of PTSD. Soldiers in Iraq had a significantly higher exposure to combat than those deployed to Afghanistan. PTSD is “a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person’s daily life,” according to the National Center for PTSD Web site. When asked if they have received professional help in the past months – which could have been help from a mental health care profession, a general medical doctor or a clergy member – 11 percent of Soldiers returning from Iraq said yes. In the same group, more than 16 percent said they were interested in receiving professional help, while 19.5 percent had a perceived moderate or severe problem. Many Soldiers, who need mental health care the most, said they are not seeking treatment out of fear of being stigmatized the survey reported. Of those meeting the screening criteria for a mental disorder, the largest perceived barrier – at 65 percent – was “I would be seen as weak.” The next largest barrier was “My unit leadership might treat me differently,” at 63 percent. Hoge said the perception of being stigmatized with a mental health disease is not unique to the military but there are some factors such as cohesion and leadership that are unique. “They are perceived that they may be treated differently but that may not be the reality,” he said. “But it could be enough to not want to seek help.” One of the challenges now is to find a way to reduce the stigma and encourage Soldiers to seek treatment, Hoge said. In addition to Hoge, Army and Navy doctors performed and wrote study results. It is part of a larger ongoing study, which will be reported on in the future. Hoge said they will be looking at in greater detail factors shown in this study and looking to improve mental health and intervention to help the Soldiers. The study took over two years to complete and had support from the highest levels of the Army from the beginning, Hoge said.