Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care

• Published in: The New England journal of medicine Vol. 351; no. 1; pp. 13 - 22
• Main Authors: Hoge, Charles W, Castro, Carl A, Messer, Stephen C, McGurk, Dennis, Cotting, Dave I, Koffman, Robert L
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 01.07.2004
• Subjects: Adolescent; Adult; Afghanistan; Anxiety - epidemiology; Anxiety - etiology; Armed forces; Biological and medical sciences; Combat Disorders - epidemiology; Combat Disorders - psychology; Data Collection; Delivery of Health Care; Depressive Disorder - epidemiology; Depressive Disorder - etiology; Female; General aspects; Health Services Accessibility - statistics & numerical data; Humans; Iraq; Male; Medical sciences; Mental disorders; Mental Disorders - epidemiology; Mental Disorders - etiology; Mental health; Mental Health Services - utilization; Military deployment; Military personnel; Military Personnel - psychology; Military Personnel - statistics & numerical data; Patient Acceptance of Health Care; Post traumatic stress disorder; Prejudice; Prevalence; Socioeconomic Factors; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - etiology; United States; Warfare; Asia; Afghanistan; Iraq; United States; United States > US; Medicine; Barrier; Public health; Care; Mental health
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa040603

Most members of the military services returning from combat duty in Iraq and Afghanistan have experienced traumatic events such as being shot at, killing someone, and knowing someone who was injured or killed. Almost 20 percent of respondents to a survey of soldiers and Marines returning from Iraq suffered from post-traumatic stress disorder, but most had not sought or received treatment. Perceived barriers to treatment included concern about the stigma associated with mental illness and about possible harm to a career. Most of those returning from combat duty in Iraq and Afghanistan have experienced traumatic events such as being shot at. Many suffer from post-traumatic stress disorder, but most have not sought treatment. The recent military operations in Iraq and Afghanistan, which have involved the first sustained ground combat undertaken by the United States since the war in Vietnam, raise important questions about the effect of the experience on the mental health of members of the military services who have been deployed there. Research conducted after other military conflicts has shown that deployment stressors and exposure to combat result in considerable risks of mental health problems, including post-traumatic stress disorder (PTSD), major depression, substance abuse, impairment in social functioning and in the ability to work, and the increased use of health care services. . . .