Mental-health toll of war rising

CHICAGO — The physical risks of war may end when a soldier leaves the battlefield, but new research indicates the mental toll of the wars in Iraq and Afghanistan is continuing to build, creating a psychological health crisis with no end in sight.

Some experts believe the rate of post-traumatic stress disorder, the most common mental-health problem among veterans, may even begin to exceed that seen with veterans of the Vietnam War.

A study published Tuesday of more than 100,000 veterans who have sought medical care since returning from war shows that one-quarter have mental-health problems. Half of those — more than 13,000 people — were diagnosed with PTSD, according to the report in the Archives of Internal Medicine. The disorder affects less than 4 percent of the general public.

The unpredictable aspects of combat in Iraq seem to take a mental toll similar to what Vietnam soldiers experienced, said Dr. Chirag Raval, a psychiatrist in the Army Reserves who served in Iraq and is medical director for the mental-health intensive case management program at the Edward Hines Jr. VA Hospital.

As in Vietnam, "There is no front line to this war," Raval said. With hand-propelled rockets, mortars and IED attacks "there is no true safe place in Iraq. You can be anywhere, even on your base, and still not be safe."

More than a generation after 19 percent of Vietnam vets returned with PTSD, the illness generally carries less of a stigma and has better-defined standards of treatment. But many veterans and researchers say the shame of mental illness persists in military ranks, and soldiers often avoid reporting their symptoms in hopes of preserving their careers.

Meanwhile, significant barriers remain for soldiers who seek psychological care after they return from service, according to several recent studies and congressional hearings.

On military bases there are shortages of psychologists and psychiatrists and long waits for appointments. Relatively few military mental health professionals have been trained in recommended PTSD treatments. Efforts to identify emotionally troubled soldiers are of limited value, since few soldiers will admit problems on questionnaires. Even when evidence points to PTSD, only 22 percent of soldiers get referrals, a report by the Government Accountability Office found last year.