Instead of fading as time passes, mental health problems, including posttraumatic stress disorder and depression, actually increase late in the year after combat veterans return from serving in Iraq, according to a report in the June issue of the Archives of General Psychiatry.
In a cross-sectional study of more than 13,000 returning veterans of ground combat, both PTSD and depression not only persisted, they actually increased between 3 months and 12 months after return from duty in Iraq.
“Despite efforts to systematically assess soldiers following deployment, dispel stigma, encourage treatment, and improve access to care, the prevalence rates … showed increases…. These data make clear that at 12 months, many combat soldiers have not psychologically recovered,” said Jeffrey L. Thomas, Ph.D., Walter Reed Army Institute of Research, Silver Spring, Md., and his associates.
PTSD and depression both were associated with increases in aggressive behaviors and misuse of alcohol in these patients, and half of those affected reported serious functional impairment. Since it is “a virtual certainty” that veterans who remain in the service will have to deploy again to combat zones—usually after 1 year of “dwell time” away from combat—“a sizable proportion” will be struggling with their symptoms when they redeploy, the investigators noted.
Dr. Thomas and his colleagues collected anonymous survey data from 4,933 active-duty soldiers at 3–4 months after they returned from ground combat, 4,024 active-duty soldiers at 12 months after return, 2,684 National Guard soldiers from ground combat units at 3–4 months after return, and 1,585 National Guard soldiers from the same ground combat units at 12 months after return.
The researchers assessed PTSD symptoms (collected on the 17-item PTSD Checklist) according to seven case definitions of the disorder, as well as depression symptoms (collected on the 9-item Patient Health Questionnaire) using three case definitions of depression.
From 8% to 14% of all soldiers reported serious functional impairment because of either PTSD or depression symptoms 1 year after returning from combat, Dr. Thomas and his colleagues said (Arch. Gen. Psychiatry 2010;67:614–23).
With the least stringent diagnostic criteria, PTSD prevalence 1 year after return from active combat ranged from 21% to 31%. With the most stringent criteria, which included only patients with high symptom rates and serious functional impairment, PTSD prevalence ranged from 6% to 11%.
The least stringent diagnostic criteria yielded a depression prevalence rate at 1 year from 12% to 16%; with the most stringent criteria, depression prevalence ranged from 5% to 8%.
National Guard soldiers had a higher prevalence of both disorders than did active-duty soldiers by all criteria and at all time points. The estimated prevalence of either depression or PTSD based on strict DSM-IV criteria was 23% for active-duty soldiers and 28% for National Guard soldiers at 1 year.
This difference is likely related to the fact that National Guard soldiers immediately return to civilian life upon return from combat duty, so they must make a more difficult adjustment, have less access to veterans' health care, and have less support from combat-exposed peers than active-duty soldiers who remain in the military, the investigators noted.
Comorbid aggression and alcohol misuse were common across all case definitions, with approximately half of soldiers who had PTSD or depression reporting that they had kicked or smashed something, slammed doors, threatened someone with physical violence, gotten into a fight, needed to cut down on their drinking, and had drunk more than they meant to since returning from combat.
“These findings indicate that it may be beneficial to screen for alcohol and aggressive behaviors when soldiers present for treatment of PTSD or depression,” Dr. Thomas and his associates said.
Disclosures: This study was supported by the U.S. Army Medical Research and Material Command, Fort Detrick, Md. No financial conflicts were reported.