Study Finds Delayed Combat Stress Reporting
November 13, 2007
WASHINGTON (Army News Service, Nov. 13, 2007) - In a study that will appear in the "Journal of the American Medical Association" Wednesday, Army medical officials examined increased Soldier-reported mental-health concerns in mandatory post-deployment health screenings.
Col. Charles Milliken, M.D. and Col. Charles W. Hoge, M.D., two of the study's authors, found that between the initial Post-Deployment Health Assessment and the Post-Deployment Health Re-assessment three to six months later, Soldiers are more likely to report signs of post-combat stress and Post Traumatic Stress Disorder.
"These efforts are about taking better care of Soldiers," said Col. Milliken, the principal investigator at Walter Reed Army Institute of Research's Division of Psychiatry and Neuroscience during a media roundtable at the Pentagon Friday. "What we're hoping to do with the screenings is detect mental health problems while they are still small, simple and temporary. When these problems get bigger and more complicated, they are much harder to treat and it increases the likelihood that they will become a chronic, long-term problem."
The study examined the assessments of 88,235 Iraq veterans completed between June 1, 2005 and December 31, 2006, and found that while only 4 to 5 percent of Soldiers were referred for mental healthcare on the PDHA, three to six months later that number jumped to 20.3 percent for active-duty Soldiers and 42.4 percent for reserve-component Soldiers.
The second set of numbers encompasses the PDHA, PDHRA and Soldiers who were under mental-health care because of self-referral or employee-assistance referrals. According to Col. Milliken, these Soldiers were not necessarily diagnosed with PTSD, but they were exhibiting symptoms that were serious enough that a medical provider wanted to have them evaluated.
Similarly, symptoms of depression reported on the PDHA rose from 5 percent to 10 percent on the PDHRA.
The highest jump the study found between the PDHA and PDHRA were reports of conflict with family and friends. This rose from 3.5 to 14 percent for active-duty Soldiers and 4.2 to 21.1 percent for reserve-component Soldiers.
Although the study didn't examine causes and effects, Brig. Gen. Stephen L. Jones, assistant surgeon general for force protection, who has deployed twice, suggested Friday that the PDHA numbers may simply be skewed because Soldiers are so happy to go home and haven't yet interacted with their families.
"When you come back, you're feeling great, almost euphoric. You don't have any problems in the world. You're just glad to be home. And then over the next three-four weeks, you re-establish relationships with your family and the normal stress everybody feels when they return home starts to surface. This is a normal, adaptive response and we would expect the stress levels at home to go up," he said.
The disparity between active and Army Reserve and National Guard Soldiers was a bit more challenging for the study's authors, especially because they determined that combat exposure for Reserve and National Guard Soldiers was virtually identical to that of active-duty Soldiers, and they reported more physical health concerns as well.
Col. Milliken believes this may be due to the differences in health coverage for reserve-component and active-duty Soldiers. Active-duty Soldiers can go to sick call any time, so he said they may not feel as pressed to report every little concern, but Reserve and National Guard Soldiers only have six months of TRICARE coverage when they return and two years of Department of Veterans Affairs benefits. After that, the VA will pay for service-related injuries or illnesses, if they are documented on forms like the PDHRA.
The PDHRA adds a question about alcohol use, and while 11.8 percent of Soldiers admitted that they might be misusing it, only 0.2 percent of these were referred for a treatment program and still fewer were seen within 90 days.
While acknowledging the Army has a long way to go when it comes to alcohol treatment, and sight the lack of confidentiality as a real roadblock, both Brig. Gen. Jones and Col. Milliken said they were encouraged that so many Soldiers were even willing to report that they had a problem, because the PDHRA becomes part of a Soldier's permanent medical record.
They also believe that the Army's efforts to reduce the stigma around PTSD and seeking mental-health assistance, including the chain-teaching and Battlemind programs, are working.
"I think this study shows that we've done a pretty good job of reducing the stigma," said Brig. Gen. Jones. "There's several factors. Number one: the fact that over half the Soldiers who seek behavioral-health counseling do so within 30 days of the survey and do so on their own. They go in on their own and ask for the counseling. I think the response we've gotten to our Soldiers stepping up and saying yeah, I'd like some help is another indication that we've helped reduce that stigma."