title: Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008.
abstract: OBJECTIVE
  We sought to investigate longitudinal trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans.
  
  
  METHODS
  We determined the prevalence and predictors of mental health diagnoses among 289,328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008 using national VA data.
  
  
  RESULTS
  Of 289,328 Iraq and Afghanistan veterans, 106,726 (36.9%) received mental health diagnoses; 62,929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and 50 432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7 times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders. Greater combat exposure was associated with higher risk for PTSD.
  
  
  CONCLUSIONS
  Mental health diagnoses increased substantially after the start of the Iraq War among specific subgroups of returned veterans entering VA health care. Early targeted interventions may prevent chronic mental illness.
authors.affiliation: San Francisco VA Medical Center, San Francisco, CA 94121, USA. Karen.Seal@va.gov
authors.forename: Karen H
authors.initials: KH
authors.lastname: Seal
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Metzler
authors.forename: Kristian S
authors.initials: KS
authors.lastname: Gima
authors.forename: Daniel
authors.initials: D
authors.lastname: Bertenthal
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
authors.forename: Charles R
authors.initials: CR
authors.lastname: Marmar
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data* / Q000639:trends*; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult