title: Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.
abstract: BACKGROUND
  The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans.
  
  
  METHODS
  We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments.
  
  
  RESULTS
  Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care.
  
  
  CONCLUSIONS
  This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel Command, Silver Spring, Md 20910, USA. charles.hoge@na.amedd.army.mil
authors.forename: Charles W
authors.initials: CW
authors.lastname: Hoge
authors.forename: Carl A
authors.initials: CA
authors.lastname: Castro
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Messer
authors.forename: Dennis
authors.initials: D
authors.lastname: McGurk
authors.forename: Dave I
authors.initials: DI
authors.lastname: Cotting
authors.forename: Robert L
authors.initials: RL
authors.lastname: Koffman
mesh_terms: D000293:Adolescent; D000328:Adult; D000346:Afghanistan; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D003130:Combat Disorders / Q000453:epidemiology* / Q000523:psychology; D003625:Data Collection; D003695:Delivery of Health Care; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007493:Iraq; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D011287:Prejudice; D015995:Prevalence; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology; D014481:United States; D014857:Warfare