Although there is a general perception that this is one of the nastiest, toughest wars American soldiers have ever fought, after that there is not much understanding of how bad it is or is not for these returning vets.

How bad is it? Really bad.

Really bad for the families and friends, too.

That means this is  really bad for the nation, too.

Six years is a long time in an active duty soldier’s record, which was the length of time this study ran.

However, as more soldiers have conditions such as Post-Traumatic Stress Disorder (PTSD)—which are not always apparent right away—evaluating them for a period after their initial assessment is an important step in determining the true impact of combat on the deployed soldiers.

The VA health care system had no way to be prepared for the responsibilities of caring for grievously injured soldiers, who arrive in Washington, D.C., for example, only 72 hours from the battlefield.

The VA had made a major transition from the “old soldier’s” hospital model to an outpatient one. The VA has won high marks for that and for its use of electronic medical records (EMRs) to better coordinate patients’ care.

So, their own care-givers had no way of preparing.

Although the study abstract does not get into this, many soldiers were reservists. They can be from small towns where there are no VA facilities. What is the real tally when one adds up the severity of the injuries, the years their recoveries may take, the burdens on their families, their employers—-if they still have them—-and their communities? We do not know.

This study could serve as the first installment on figuring out the real damages of this war.

Other studies need to measure the familial, economic and societal impact, too.

Some of the study’s findings:

• More than one-third of returning veterans have psychiatric disorders, a six-fold increase.

• Previously, 6.4 percent of veterans were assessed as suffering from psychiatric disorders.

• Most who were diagnosed had more than one condition.

• Risk was higher for depression for women.

• Drug use disorders were higher among men.

• If broadening the analysis to a period of adjustment after return—behavioral, marriage and family problems, “the prevalence of a new diagnosis was 42.7% by the study’s end.” The study period covered the six years between 2002-2008.

Journal Watch

“Newspapers and magazines are filled with stories about high rates of psychiatric disorders in veterans from the Iraq and Afghanistan theaters. Just how bad is it? Using a Veterans Affairs database, investigators analyzed data on 289,328 veterans who entered the VA health system in 2002–2008 after service in Iraq or Afghanistan.

“New mental health diagnoses increased sixfold, from 6.4% (28 of 439 veterans) to 36.8% (106,726 of 289,328) during the study period; overall prevalence was 21.8% for PTSD and 17.4% for depression. Most diagnosed veterans had at least two diagnoses. In an analysis that more broadly included behavioral, marital, and family problems, the prevalence of a new diagnosis was 42.7% by study’s end. Risk was higher for depression among women than men and for drug use disorders among men than women. Age under 25 compared with age over 40 increased risks for PTSD and alcohol and drug use disorders. Among active-duty veterans, PTSD risk increased independently with combat exposure (as determined through enlisted vs. officer rank, being in the army vs. other service branches, and multiple deployments).” (Emphasis added)

Source: Journal Watch/Psychiatry, September 21, 2009

Citation: Am J Public Health 2009 Sep; 99:1651.