Rocky
21-12-06, 13:33
UPDATE: REPEAT TOURS TIED TO ACUTE STRESS AND INCREASED
RISK OF PTSD -- Analysis of Army's mental health survey.
Repeat duty tied to acute stress
A survey by the Army indicates the mental health of soldiers on return deployment to Iraq has suffered.
By Julian E. Barnes, Times Staff Writer
WASHINGTON — American soldiers who serve repeated tours of duty in Iraq are more likely to suffer from acute stress, according to a mental health survey released Tuesday by the Army.
Overall, 13.6% of soldiers serving in Iraq reported suffering from acute stress in late 2005, when the survey was taken. Among soldiers serving their first tours, 12.5% reported suffering such stress. But among soldiers on their second tour of duty, the figure jumped to 18.4%.
"There is a sense that the yearlong deployments are challenging, even if morale is good," said Lt. Gen. Kevin Kiley, the Army's surgeon general. "The normal things — births, first steps, birthdays — those are missed. When soldiers are on second or third tours, my sense is they feel that a bit more."
The adverse effect of multiple, long deployments is a critical factor for military leaders as they consider increasing the number of troops in Iraq. If the White House orders a surge in the force size in an effort to control sectarian violence, the military will probably have to extend the tours of thousands of combat soldiers, keeping them in Iraq longer than a year.
In addition, the number of soldiers on their third tour is likely to increase next year, with the return of the Army's 3rd Infantry Division.
Paul Rieckhoff, the founder of Iraq and Afghanistan Veterans of America, an advocacy group, said he expected to see the numbers of soldiers reporting acute stress increasing, especially if troop levels rose.
"It is a bad sign of things to come," Rieckhoff said of the report. "There is a tremendous mental health toll to this war. That toll is only going to continue as we repeatedly ask the same people to sacrifice again and again. It is not just the equipment being run down, it is the people."
Col. Edward O. Crandell, who helped oversee the survey, said it was too early to know for sure why soldiers on second tours had higher stress levels. But he said the increased stress may be helpful — a way to stay sharp in a dangerous situation.
"In some ways, in the soldier's mind it may be adaptive to maintain that heightened level of arousal," Crandell said. "I have had numerous soldiers tell me: 'I am going back. I need to be pumped. I need to be ready to do this.' "
The survey did not examine the effect of extensions on mental health. But soldiers have reported in focus groups that stress rises near the end of their tours and that the long deployments are difficult, the Army researchers said.
Stress rates rise, experts in military psychology believe, when tours go beyond a year.
"You are going to have all kinds of problems, discipline problems, all kinds of mistakes, misconduct," said Stephen N. Xenakis, a psychiatrist and retired brigadier general in the Army medical corps. "Everyone feels things will go downhill by extending tours."
The survey, known as the Mental Health Advisory Team Report, is the third the Army has released since the beginning of the war. The results are based on a poll of soldiers taken in October and November 2005. Kiley said it took a more than a year to analyze the data and then brief officials in Iraq and at the Pentagon on the results.
The results were not held back until after the midterm election, he said. "There was nothing nefarious in the delay," Kiley said.
Army officials have finished collecting 2006 survey data, but there are no preliminary results yet, Kiley said.
The mental health report also found fluctuations in the rate of suicides among soldiers in Iraq. The 2005 rate was 19.9 per 100,000, up from 10.5 the year before. In 2003, the rate was 18.8 per 100,000. The data are based on the actual number of suicides among soldiers in Iraq: 22 in 2005, 11 in 2004 and 25 in 2003.
"We consider one suicide to be too many," Kiley said.
He added that the suicide rate in the Army has fluctuated over time, and he cautioned against reading anything into the latest numbers, saying the change was not statistically significant. The rates are slightly lower than those for the general population of young men, he said.
Army researchers have not been able to make a connection between the stress on the force and the suicide rate. The Army is trying to develop better ways to identify people at risk for suicide. But most suicides occurred on impulse and could have been related to relationship problems or financial stress, as opposed to combat stress, Kiley said.
But Rieckhoff thinks the official numbers underestimate the severity of the problem because they do not account for suicides that occur after a soldier has left the Army.
Kiley said the Army was concerned that soldiers on their second or third tours in Iraq might be at a increased risk of post-traumatic stress disorder upon their return. But he said they had not found any link between multiple tours and suicide rates.
The report can be viewed online at
http://www.armymedicine.army.mil/news/news.html (http://www.armymedicine.army.mil/news/news.html) .
---------------
Second story here... http://www.washingtonpost.com/ (http://www.washingtonpost.com/wp-dyn/content/article/2006/12/19/AR2006121901659.html)
wp-dyn/content/article/2006/12/19/AR2006121901659.html (http://www.washingtonpost.com/wp-dyn/content/article/2006/12/19/AR2006121901659.html)
Story below:
---------------
Repeat Iraq Tours Raise Risk of PTSD, Army Finds
By Ann Scott Tyson
Washington Post Staff Writer
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.
---------------
MHAT III results at a glance
• 14 percent of soldiers in Iraq surveyed in late 2005 experienced acute stress and 17 percent reported a combination of depression, anxiety and acute stress. These were similar to the rates found in 2003 and higher than in 2004.
• Top non-combat causes of stress were related to long deployments away from family.
• Soldiers reported their units' morale was higher than in previous studies, while their personal morale was higher than reported in 2003 and similar to 2004.
• Soldiers serving a repeat tour reported higher stress than first-time deployments. The suicide rate among soldiers serving in Iraq and Kuwait was 19.9 per 100,000 soldiers — similar to the 18.8 rate per 100,000 soldiers in 2003 and higher than 2004.
• Leading suicide risk factors were 'relationship issues at home and in theater, followed by legal actions, problems with fellow soldiers and command and duty performance.'
Source: Defense Department, Mental Health Advisory Team III survey of 1,124 soldiers in Iraq in October-November 2005.
RISK OF PTSD -- Analysis of Army's mental health survey.
Repeat duty tied to acute stress
A survey by the Army indicates the mental health of soldiers on return deployment to Iraq has suffered.
By Julian E. Barnes, Times Staff Writer
WASHINGTON — American soldiers who serve repeated tours of duty in Iraq are more likely to suffer from acute stress, according to a mental health survey released Tuesday by the Army.
Overall, 13.6% of soldiers serving in Iraq reported suffering from acute stress in late 2005, when the survey was taken. Among soldiers serving their first tours, 12.5% reported suffering such stress. But among soldiers on their second tour of duty, the figure jumped to 18.4%.
"There is a sense that the yearlong deployments are challenging, even if morale is good," said Lt. Gen. Kevin Kiley, the Army's surgeon general. "The normal things — births, first steps, birthdays — those are missed. When soldiers are on second or third tours, my sense is they feel that a bit more."
The adverse effect of multiple, long deployments is a critical factor for military leaders as they consider increasing the number of troops in Iraq. If the White House orders a surge in the force size in an effort to control sectarian violence, the military will probably have to extend the tours of thousands of combat soldiers, keeping them in Iraq longer than a year.
In addition, the number of soldiers on their third tour is likely to increase next year, with the return of the Army's 3rd Infantry Division.
Paul Rieckhoff, the founder of Iraq and Afghanistan Veterans of America, an advocacy group, said he expected to see the numbers of soldiers reporting acute stress increasing, especially if troop levels rose.
"It is a bad sign of things to come," Rieckhoff said of the report. "There is a tremendous mental health toll to this war. That toll is only going to continue as we repeatedly ask the same people to sacrifice again and again. It is not just the equipment being run down, it is the people."
Col. Edward O. Crandell, who helped oversee the survey, said it was too early to know for sure why soldiers on second tours had higher stress levels. But he said the increased stress may be helpful — a way to stay sharp in a dangerous situation.
"In some ways, in the soldier's mind it may be adaptive to maintain that heightened level of arousal," Crandell said. "I have had numerous soldiers tell me: 'I am going back. I need to be pumped. I need to be ready to do this.' "
The survey did not examine the effect of extensions on mental health. But soldiers have reported in focus groups that stress rises near the end of their tours and that the long deployments are difficult, the Army researchers said.
Stress rates rise, experts in military psychology believe, when tours go beyond a year.
"You are going to have all kinds of problems, discipline problems, all kinds of mistakes, misconduct," said Stephen N. Xenakis, a psychiatrist and retired brigadier general in the Army medical corps. "Everyone feels things will go downhill by extending tours."
The survey, known as the Mental Health Advisory Team Report, is the third the Army has released since the beginning of the war. The results are based on a poll of soldiers taken in October and November 2005. Kiley said it took a more than a year to analyze the data and then brief officials in Iraq and at the Pentagon on the results.
The results were not held back until after the midterm election, he said. "There was nothing nefarious in the delay," Kiley said.
Army officials have finished collecting 2006 survey data, but there are no preliminary results yet, Kiley said.
The mental health report also found fluctuations in the rate of suicides among soldiers in Iraq. The 2005 rate was 19.9 per 100,000, up from 10.5 the year before. In 2003, the rate was 18.8 per 100,000. The data are based on the actual number of suicides among soldiers in Iraq: 22 in 2005, 11 in 2004 and 25 in 2003.
"We consider one suicide to be too many," Kiley said.
He added that the suicide rate in the Army has fluctuated over time, and he cautioned against reading anything into the latest numbers, saying the change was not statistically significant. The rates are slightly lower than those for the general population of young men, he said.
Army researchers have not been able to make a connection between the stress on the force and the suicide rate. The Army is trying to develop better ways to identify people at risk for suicide. But most suicides occurred on impulse and could have been related to relationship problems or financial stress, as opposed to combat stress, Kiley said.
But Rieckhoff thinks the official numbers underestimate the severity of the problem because they do not account for suicides that occur after a soldier has left the Army.
Kiley said the Army was concerned that soldiers on their second or third tours in Iraq might be at a increased risk of post-traumatic stress disorder upon their return. But he said they had not found any link between multiple tours and suicide rates.
The report can be viewed online at
http://www.armymedicine.army.mil/news/news.html (http://www.armymedicine.army.mil/news/news.html) .
---------------
Second story here... http://www.washingtonpost.com/ (http://www.washingtonpost.com/wp-dyn/content/article/2006/12/19/AR2006121901659.html)
wp-dyn/content/article/2006/12/19/AR2006121901659.html (http://www.washingtonpost.com/wp-dyn/content/article/2006/12/19/AR2006121901659.html)
Story below:
---------------
Repeat Iraq Tours Raise Risk of PTSD, Army Finds
By Ann Scott Tyson
Washington Post Staff Writer
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.
---------------
MHAT III results at a glance
• 14 percent of soldiers in Iraq surveyed in late 2005 experienced acute stress and 17 percent reported a combination of depression, anxiety and acute stress. These were similar to the rates found in 2003 and higher than in 2004.
• Top non-combat causes of stress were related to long deployments away from family.
• Soldiers reported their units' morale was higher than in previous studies, while their personal morale was higher than reported in 2003 and similar to 2004.
• Soldiers serving a repeat tour reported higher stress than first-time deployments. The suicide rate among soldiers serving in Iraq and Kuwait was 19.9 per 100,000 soldiers — similar to the 18.8 rate per 100,000 soldiers in 2003 and higher than 2004.
• Leading suicide risk factors were 'relationship issues at home and in theater, followed by legal actions, problems with fellow soldiers and command and duty performance.'
Source: Defense Department, Mental Health Advisory Team III survey of 1,124 soldiers in Iraq in October-November 2005.