Mental health problems seen in more than one third of first-time VA patients who served in Iraq or Afghanistan

By Steve Tokar

Among 289,328 veterans of Iraq or Afghanistan who used the Department of Veterans Affairs medical system for the first time between April 1, 2002 and April 1, 2008, 37 percent received a diagnosis of a mental health problem, according to a study of national VA data conducted by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.

Diagnoses included 22 percent with post-traumatic stress disorder, 17 percent with depression, 7 percent with alcohol use disorder, and 3 percent with drug use disorder.

There were many co-occurring diagnoses: 29 percent of veterans with mental health problems were diagnosed with two different conditions, and 33 percent were diagnosed with three or more.

The study appears in the “First Look” section of the website of the “American Journal of Public Health.”

“What’s really striking is the dramatic acceleration in mental health diagnoses, particularly PTSD, after the beginning of the conflict in Iraq on March 20, 2003,” says lead author Karen Seal, MD, MPH, a staff physician at SFVAMC and an assistant professor of medicine at UCSF. For active duty personnel, the risk of being diagnosed with PTSD increased over four times after the invasion of Iraq, while for National Guard and Reserve members, the risk increased seven-fold. Risks of depression, alcohol use disorder, and drug use disorder diagnoses rose between one-and-a-half and three times, depending on the diagnosis and the veteran sub-group.

Seal says the study was not able to determine reasons for the increase in mental health problems after the start of the Iraq war, but the authors offer several possible explanations, including “waning public support and lower morale among troops,” as occurred during the Vietnam war era; the fact that the Iraq insurgency has no defined front lines, and thus presents a sense of continual threat of exposure to road-side bombs and improvised explosive devices; and “multiple and more-lengthy deployments.”

Interestingly, the risk for PTSD and other mental health diagnoses varied according to factors such as age, nature of service, and gender, says Seal. The youngest cohort of active duty veterans — ages 16 to 24 years — were at significantly higher risk for PTSD and alcohol and drug use disorders than active duty veterans over 40, while, among Guard and Reserve members, those over 40 were at significantly higher risk for PTSD than their colleagues under 25. Women overall were significantly more prone to depression, while men overall were at significantly higher risk for drug use disorders.

Active duty veterans who were of enlisted rank, who served in the Army rather than other service branches, or had multiple tours of duty – all indicators of higher levels of combat exposure – were at greater risk for PTSD.

To prevent what they term a wave of “chronic mental health and social and occupational problems” among veterans, the study authors recommend targeted screening for mental health problems and early interventions tailored to the problems of particular sub-groups of veterans, such as women, young men under 25, and Guard and Reserve members over 40.

Co-authors of the study are Thomas J. Metzler, MA, Kristian S. Gima, BA, Daniel Bertenthal, MPH, and Shira Maguen, PhD, of SFVAMC and UCSF. The senior author was Charles R. Marmar, MD, of SFVAMC and UCSF.

The study was supported by funds from the Department of Veterans Affairs.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.