Almost one-third of returning veterans who received health care at Veterans Affairs facilities between 2001 and 2005 were given a mental health or psychosocial diagnosis, according to a report in the March 12 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Some reports have suggested that soldiers returning from Operations Enduring Freedom and Iraqi Freedom, the most recent military efforts in Iraq and Afghanistan, experience high rates of substance abuse, post-traumatic stress disorder (PTSD) and other mental health conditions, according to background information in the article. In these operations, the most sustained ground combat since the Vietnam era, “the majority of military personnel experience high-intensity guerilla warfare and the chronic threat of roadside bombs and improvised explosive devices,” the authors write. “Some soldiers endure multiple tours of duty, many experience traumatic injury and more of the wounded survive than ever before.” These veterans are eligible for two years of free health care related to their military service through the Department of Veterans Affairs (VA).
Karen H. Seal, M.D., M.P.H., and colleagues at the University of California, San Francisco, and San Francisco VA Medical Center examined data from a VA database including 103,788 veterans of these operations who were first seen at VA facilities between Sept. 30, 2001, and Sept. 30, 2005. About 13 percent were women, 54 percent were younger than age 30, close to one-third were minorities and almost one-half were veterans of the National Guard or Reserves rather than full-time military personnel.
A total of 32,010 (31 percent) received mental health and/or psychosocial diagnoses, including 25,658 (25 percent) who received mental health diagnoses (56 percent of whom had two or more diagnoses). The most common such diagnosis was PTSD; the 13,205 veterans with this disorder represented 52 percent of those receiving mental health diagnoses and 13 percent of all the veterans in the study. “Mental health diagnoses were detected soon after the first VA clinic visit (median of 13 days), and most initial mental health diagnoses (60 percent) were made in non-mental health clinics, mostly primary care settings,” the authors write. “The youngest group of Operations Enduring Freedom and Iraqi Freedom veterans (age, 18 to 24 years) were at greatest risk for receiving mental health or post-traumatic stress disorder diagnoses compared with veterans 40 years or older.”
About 29 percent of veterans returning from Iraq and Afghanistan have enrolled in VA health care, a high rate compared with 10 percent of Vietnam veterans. This and the relatively short period of time between the first VA clinic visit and diagnosis with a mental health condition suggest an opportunity to intervene early to diagnose and treat mental health concerns, the authors note. “Our results signal a need for improvements in the primary prevention of military service–related mental health disorders, particularly among our youngest service members,” they conclude. “Furthermore, early detection and evidence-based treatment in both VA and non-VA mental health and primary care settings is critical in the prevention of chronic mental illness, which threatens to bring the war back home as a costly personal and public health burden.”
(Arch Intern Med. 2007;167:476-482. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded by a VA Health Services Research and Development Career Development Award and a grant from the VA Seattle Epidemiological Research and Information Center. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.