On Wednesday, USA Today published two articles by reporter Gregg Zoroya on the problems of returning Iraq war veterans.  --  The articles were based on the results of a survey conducted by the Army Center for Health Promotion and Preventive Medicine that has not been publicly released.  --  The lead article states that overall 28% of returning Iraq veterans (about 50,000 people) had self-identified as having "problems ranging from lingering battle wounds to toothaches, from suicidal thoughts to strained marriages."[1]  --  The second piece focused on the survey itself, and indicated more troubling statistics: of soldiers returning in 2004, "43% of returning women required follow-up medical or mental health care, compared with 36% of men."[2]  --  The statisics for those who are not regular troops were even more disturbing:  "Forty-seven percent of National Guard troops and 45% of reservists required some kind of medical or mental health care last year."  --  In July, the Army reported that a survey of 1000 soldiers suggested that 30% of returning veterans were suffering from stress-related mental health problems 3-4 months after returning from the Iraq war;[3] Zoroya's articles do not refer to these earlier data.  --  For more information, and links to resources for veterans, see the Mental Strain of War page developed by Operation Truth, a "non-partisan organization representing those who have served in the Iraq and Afghanistan wars." ...


By Gregg Zoroya

USA Today
October 19, 2005


More than one in four U.S. troops have come home from the Iraq war with health problems that require medical or mental health treatment, according to the Pentagon's first detailed screening of servicemembers leaving a war zone.

Almost 1,700 servicemembers returning from the war this year said they harbored thoughts of hurting themselves or that they would be better off dead. More than 250 said they had such thoughts "a lot." Nearly 20,000 reported nightmares or unwanted war recollections; more than 3,700 said they had concerns that they might "hurt or lose control" with someone else.

These survey results, which have not been publicly released, were provided to USA TODAY by the Army Center for Health Promotion and Preventive Medicine. They offer a window on the war and how the ongoing insurgency has added to the strain on troops.

Overall, since the war began, about 28% of Iraq veterans -- about 50,000 servicemembers this year alone -- returned with problems ranging from lingering battle wounds to toothaches, from suicidal thoughts to strained marriages. The figure dwarfs the Pentagon's official Iraq casualty count: 1,971 U.S. troops dead and 15,220 wounded as of Tuesday.

A greater percentage of soldiers and Marines surveyed in 2004-05 said they felt in "great danger" of being killed than said so in 2003, after a more conventional phase of fighting. Twice as many surveyed in 2004-05 had fired a weapon in combat.

"The (wartime) deployments do take a toll," says Lt. Col. Ellen Krenke, a Pentagon spokeswoman. "We send them to austere locations, places that are extremely hot, extremely cold, very wet, very dry . . . where they may also encounter an armed enemy."

The Pentagon's goal is to identify all troops in need of care in part by screening every servicemember on a wide range of issues before and after overseas duty.

Begun in 1997 and expanded in 2003, it is the most detailed health assessment of deployed troops ever. It came in response to ailments that surfaced after the 1991 Persian Gulf War. Jim Benson, a spokesman at the Department of Veterans Affairs, says comparable data from previous wars don't exist.

In October 2004, a federal panel of medical experts that studied illnesses of Gulf War veterans estimated that one in seven suffer war-related health problems.

Benson said the percentage of troops back from the wars in Iraq and Afghanistan with health issues is close to the portion of former servicemembers coming to the VA for mental health or medical care. He says 101,000 of the 431,000 war vets who have separated from the military, or about 23%, have sought help.

--Contributing: Paul Overberg


By Gregg Zoroya

USA Today
October 19, 2005


[INSET: THE STRESS OF WAR: -- Among servicemembers returning from the Iraq war: 45% felt they were in great danger of being killed during their tour. -- 19% were bothered by finding little interest or pleasure in doing things. -- 14% were bothered by feelings of depression or hopelessness. -- 9% had an experience that gave them nightmares or that they thought about when they didn't want to. -- 3% worried about serious conflicts with their spouse, family or close friends. -- Source: 538,232 Defense Department Post-Deployment Health Assessments of servicemembers returning from the Iraq war from April 2003 to August 2005]

Pentagon efforts to screen troops for medical and psychological problems before and after they go to war -- and in the months after they return home -- could make the Iraq war veteran the most scrutinized fighter in American history.

"They are collecting data before and after, and then doing follow-up. That's amazing," says Joseph Boscarino, a Vietnam War veteran and scientist at the New York Academy of Medicine who does research on post-traumatic stress disorder. "That was never done before. It was always ad hoc."

The screening began in 1997. When it was expanded in 2003, William Winkenwerder Jr., assistant secretary of Defense for health affairs, testified before Congress that it was necessary to avoid the kind of health problems that had occurred in the Persian Gulf War of 1991.

Thousands of returning veterans of that conflict complained of ailments ranging from memory loss to respiratory problems.

"That was a big problem in the Gulf War," Winkenwerder testified. "We really didn't know the baseline health status of people, so it was very difficult to compare when they came back as to what their status had been before they left."

The current screening before and after deployment is designed to correct that, Winkenwerder said.


Servicemembers fill out a four-page health survey, which is entered into their medical record. They meet with a nurse, medical assistant, or doctor, who goes over answers and can make a referral.

"This is the first war in which we're doing comprehensive assessments," says Col. Elspeth Ritchie, psychiatric consultant to the Army surgeon general.

The emphasis, she says, is on early detection and treatment of health problems: "We have to have strong and resilient soldiers in order to fight the war."

The Army Center for Health Promotion and Preventive Medicine provided USA TODAY with screening results of servicemembers returning from the Iraq war from the time the war began in 2003 through August of this year.

The results came from the surveys filled out by troops. In some cases, servicemembers who were sent back to the fighting may have been screened more than once. The Pentagon says about 20% of deployed troops serve their tours outside Iraq, such as in Kuwait, and do not see combat.

The screening results show that the percentage of returning troops referred for follow-up medical or mental health treatment rose from 22% in 2003 to 35% in 2004. This year, slightly more than 28% of returning troops have required medical or mental health care.

The percentage of female troops with health issues has been higher than that of men. Last year, 43% of returning women required follow-up medical or mental health care, compared with 36% of men. This year, about 33% of female servicemembers were referred for follow-up care, compared with 27% of men.

In addition, a higher percentage of National Guard and Reserve troops have had health issues than those in active-duty forces, the survey shows.

Forty-seven percent of National Guard troops and 45% of reservists required some kind of medical or mental health care last year, vs. 29% of active-duty troops. This year, 30% to 35% of Guard and Reserve troops needed health referrals, compared with 25% of active-duty servicemembers.


The numbers suggest that the severity of the war increased after 2003, when much of the fighting had been concentrated around the initial invasion of Iraq by U.S.-led forces in March and April. As the insurgency took root in 2004, the percentage of U.S. military personnel who witnessed someone being killed or wounded rose from 36% in 2003 to 50% in 2004. It is 47% this year.

The percentage of troops who said they needed stress-related therapy after war duty has almost doubled since the first year of the war. But that portion remains small, rising from about 3% in 2003 to about 6% this year.

The actual proportion of troops with stress-related mental health problems may be far higher. In an anonymous survey in 2003, Army researchers found that 15% to 17% of front-line troops suffered depression, anxiety or post-traumatic stress disorder (PTSD).

A 1986-88 study, the National Vietnam Veterans Readjustment Survey, found 15% of male and 8% of female Vietnam veterans had been diagnosed with stress disorders.

A recent study by Boscarino, of the New York Academy of Medicine, found that the postwar mortality rate of Vietnam veterans who had suffered post-traumatic stress disorder was twice that of other veterans from that conflict.

Because so many PTSD cases remain undiagnosed and untreated, Michael Kilpatrick, deputy director of the Deployment Health Support Directorate in the Defense Department, says the Pentagon will begin follow-up health assessments of troops later this year. The screenings will occur three to six months after troops get home, when some mental and physical symptoms may be more evident.

"It's yet another opportunity for accessing care," he says.



Associated Press
July 28, 2005


WASHINGTON -- Thirty percent of U.S. troops surveyed have developed stress-related mental health problems three to four months after coming home from the Iraq war, the Army's surgeon general said Thursday.

The survey of 1,000 troops found problems including anxiety, depression, nightmares, anger, and an inability to concentrate, said Lt. Gen. Kevin Kiley and other military medical officials. A smaller number of troops, often with more severe symptoms, were diagnosed with post-traumatic stress disorder, or PTSD, a serious mental illness.

The 30% figure is in contrast to the 3% to 5% diagnosed with a significant mental health issues immediately after they leave the war theater, according to Col. Elspeth Ritchie, a military psychiatrist on Kiley's staff. A study of troops who were still in the combat zone in 2004 found 13% experienced significant mental health problems.

Soldiers departing a war zone are typically given a health evaluation as they leave combat, but the Army is only now instituting a program for follow-up screenings three to six months later, said Kiley, speaking to reporters at a breakfast meeting.

Screenings of 1,000 U.S. soldiers who returned from Iraq to their home bases in Italy last year found that three to four months later, 30% of them had some mental health difficulties -- a much greater incidence than expected. Kiley attributed that to post-combat stress problems taking time to develop once the danger has passed.

Only about 4% or 5% of troops coming home from combat actually have PTSD, but many others face problems adjusting when they come home, Kiley said.

Such problems are sometimes more acute in members of the National Guard, who return to a civilian job when they leave active military duty, Ritchie said.

Military medical officials, however, cautioned against people reading their data as suggesting the war had driven so many soldiers over the edge. Instead, they characterized the anxiety and stress as normal reactions to combat, seeing dead and mutilated bodies, and feeling helpless to stop a violent situation.

Still, such reactions can lead to problems with spouses and children, substance abuse, and just day-to-day life, they said.

Truck drivers and convoy guards in Iraq are developing mental health problems in greater numbers than other troops, Ritchie said, suggesting the long hours on the road, constantly under threat of attack, are taking their toll.

The military has about 200 mental health experts in Iraq, grouped in what the Army calls "combat stress control teams." These teams are at many posts around the country and talk with troops after battles, try to prevent suicides and diagnose troops who should be evacuated from of the country because of mental health problems.

"They are worth their weight in gold," Kiley said of the teams.

An inquiry into the mental health of soldiers serving in Iraq found an improvement in the mental health and morale in 2004 over 2003. The military made its report on the inquiry public last week.

The report said the number of suicides in Iraq and Kuwait declined from 24 in 2003 to nine last year.

Historically, mental health problems have always been a part of warfare, and was looked at systematically when shellshock cases accounted for significant losses during World War I.

Ritchie said mental health cases ebb and flow during a war, and suggested they are sometimes connected to a soldier's sense of success of the larger war effort. During the Korean War, cases increased when U.S. forces were losing ground but decreased as the situation improved, she said.