US Re-Deploys Sick Soldiers on Meds

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http://www.huffingtonpost.com/nellie-b/us-redeploys-sick-soldie_b_17585.html

Pilecki

03.20.2006

US Re-Deploys Sick Soldiers on Meds (24 comments )

READ MORE: Afghanistan, Iraq

It's no secret that a lot of soldiers return from combat zones with mental

health problems -- the Associated Press reported as much on a study by the

Journal of the American Medical Association at the end of last month, and the

story was widely carried.

Thirty-five percent of Iraq veterans received mental health care during their

first year home, according to the study.In addition, 12 percent of the more than

222,000 returning Army soldiers and Marines in the study were diagnosed with a

mental problem. Nineteen percent of those back from Iraq reported mental health

concerns, compared with 11 percent of those back from Afghanistan and 8.5

percent of those returning from other places, such as Bosnia.

But now the San Diego Union Tribune is reporting that " mentally ill service

members are being returned to combat " equipped " with a cache of antidepressant

and anti-anxiety medications. " You know, the kind that say on the bottle: May

cause drowsiness. Use caution when operating a car or dangerous machinery. Like,

say, heavy weaponry? The redeployments are legal, and nobody is forcing the

soldiers to go, reports the Union-Trib. But Sen. Barbara Boxer (D-Calif) says

the policy needs more civilian oversight, i.e. the Department of Defense Task

Force on Mental Health, which should start next month. Boxer, who wrote

legislation establishing the task force, told the Union-Trib, " We've also heard

reports that doctors are being encouraged not to identify mental-health illness

in our troops.... If people are suffering from mental-health problems, they

should not be sent on the battlefield. "

Officials from the Defense Department and Camp Pendleton, where some units have

been to Iraq three times, said they don't track personnel deployed while taking

mental-health medication or the number diagnosed with mental illness.

But medical officers for the Army and Marine Corps acknowledge that medicated

service members - and those suffering combat-induced psychological problems -

are returning to war. And anecdotal evidence, bolstered by the government's own

studies, suggest that the number could be significant.

A 2004 Army report found that up to 17 percent of combat-seasoned infantrymen

experienced major depression, anxiety or post-traumatic stress disorder after

one combat tour to Iraq. Less than 40 percent of them had sought mental-health

care.

Even more troubling than perhaps complicating soldiers' mental-health illnesses

and endangering their combat-readiness, is the allegation from Steve ,

director of the National Gulf War Resource Center in Silver Spring, Md., that

the Pentagon is trying to pare its budget by cutting needed services to soldiers

and vets.

said three Army doctors have told him about being pressured by their

commanders not to identify mental conditions that would prevent personnel from

being deployed.

" They are being told to diagnose combat-stress reaction instead of PTSD, " he

said. " That does two things: It keeps the troops deployable and it makes it hard

for them to collect disability claims once they get out of the military. "

http://jama.ama-assn.org/cgi/content/abstract/295/9/1023?lookupType=volpage & vol=\

295 & fp=1023 & view=short

Mental Health Problems, Use of Mental Health Services, and Attrition From

Military Service After Returning From Deployment to Iraq or Afghanistan

W. Hoge, MD; L. Auchterlonie, MS; S. Milliken, MD

JAMA. 2006;295:1023-1032.

Context The US military has conducted population-level screening for mental

health problems among all service members returning from deployment to

Afghanistan, Iraq, and other locations. To date, no systematic analysis of this

program has been conducted, and studies have not assessed the impact of these

deployments on mental health care utilization after deployment.

Objectives To determine the relationship between combat deployment and mental

health care use during the first year after return and to assess the lessons

learned from the postdeployment mental health screening effort, particularly the

correlation between the screening results, actual use of mental health services,

and attrition from military service.

Design, Setting, and Participants Population-based descriptive study of all

Army soldiers and Marines who completed the routine postdeployment health

assessment between May 1, 2003, and April 30, 2004, on return from deployment to

Operation Enduring Freedom in Afghanistan (n = 16 318), Operation Iraqi Freedom

(n = 222 620), and other locations (n = 64 967). Health care utilization and

occupational outcomes were measured for 1 year after deployment or until leaving

the service if this occurred sooner.

Main Outcome Measures Screening positive for posttraumatic stress disorder,

major depression, or other mental health problems; referral for a mental health

reason; use of mental health care services after returning from deployment; and

attrition from military service.

Results The prevalence of reporting a mental health problem was 19.1% among

service members returning from Iraq compared with 11.3% after returning from

Afghanistan and 8.5% after returning from other locations (P<.001). Mental

health problems reported on the postdeployment assessment were significantly

associated with combat experiences, mental health care referral and utilization,

and attrition from military service. Thirty-five percent of Iraq war veterans

accessed mental health services in the year after returning home; 12% per year

were diagnosed with a mental health problem. More than 50% of those referred for

a mental health reason were documented to receive follow-up care although less

than 10% of all service members who received mental health treatment were

referred through the screening program.

Conclusions Combat duty in Iraq was associated with high utilization of mental

health services and attrition from military service after deployment. The

deployment mental health screening program provided another indicator of the

mental health impact of deployment on a population level but had limited utility

in predicting the level of mental health services that were needed after

deployment. The high rate of using mental health services among Operation Iraqi

Freedom veterans after deployment highlights challenges in ensuring that there

are adequate resources to meet the mental health needs of returning veterans.

Author Affiliations: Division of Psychiatry and Neuroscience, Walter Army

Institute of Research (Drs Hoge and Milliken) and Army Medical Surveillance

Activity, US Army Center for Health Promotion and Preventive Medicine (Ms

Auchterlonie), Washington, DC.

This Week in JAMA

JAMA. 2006;295:967.

FULL TEXT

Mental Health Service Use After Military Deployment

Journal Watch Psychiatry 2006;2006:3-3.

FULL TEXT