Hidden Scars of Battle

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BATTLE WEARY The more fire fights a soldier faces, the greater the risk of the postwar disorder

The operation Iraqi freedom group meets on Wednesdays at a Veterans Affairs outpatient clinic in Los Angeles. Veterans find their way to the 90-min. group-therapy sessions in a variety of ways, most of them slow and circuitous. "Often the parents call and say you've got to get them in," says clinical social worker Leslie Martin. "Some are married, and their wives make them come." Others are referred by VA doctors after a checkup detects signs of psychological distress.

Just getting vets to come in for help can be the toughest part of the job for Martin, who heads the VA's Post-Traumatic Stress Disorder (PTSD) Outpatient Services team for the greater Los Angeles area. Avoidance is a classic symptom of PTSD, she says. "They are 21 years old, and they say, 'All I want to do is play my Walkman and go to school.'" Or they act dutifully: "It's 'Yes, ma'am; no, ma'am; thank you, ma'am; see you around." It's not unusual for veterans suffering from PTSD to wait a year before seeking help — like a 24-year-old Marine corporal Martin knows who was discharged after finishing a tour of duty in Iraq. For months he watched the news from Iraq obsessively and was worried about "my guys over there." Then one day he began weeping uncontrollably. Martin calls this a "breakthrough," not a breakdown. It's what finally prompted him to get help.

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Jan. 17, 2004

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Veterans groups and the U.S. military are only beginning to get a sense of the psychological fallout of the wars in Iraq and Afghanistan, but a major study published in the New England Journal of Medicine last week brought the problem into sharp focus. The study, which involved 6,200 soldiers and Marines and was conducted by a team at the Walter Reed Army Institute of Research, is the first attempt to understand the psychological effects of a U.S. war while it is ongoing. Most of the participants were screened within three or four months of returning from battle, when memories — and any psychological wounds — were still fairly fresh. "One of our goals is to describe the onset of PTSD," says Lieut. Colonel Carl Castro, a Walter Reed psychologist, who led the study along with Dr. Charles Hoge. Many experts believe that early identification of symptoms and early intervention could help prevent the kind of massive psychological devastation seen in veterans of the Vietnam War. Some 30% of Vietnam vets eventually suffered PTSD — a grab bag of psychological effects that can include flashbacks, sleep disorders, panic attacks, emotional numbness and violent outbursts. "Here we were trying to be proactive, to better support returning soldiers," says Castro.

Men and women participating in the study completed a detailed psychological assessment anonymously — a measure that researchers believe was largely responsible for a high rate of cooperation. One group was evaluated before deployment to Iraq. Other groups were evaluated after returning from Iraq or Afghanistan in 2003. These participants were asked for specific details about their combat experiences. Among the key findings:

--As many as 17% of veterans who had been deployed in Iraq showed symptoms of PTSD, depression or anxiety. Of the total, more than 12% had symptoms of PTSD.

--About 11% of those who served in Afghanistan had symptoms of PTSD, depression or anxiety. Of this total, only 6% had PTSD symptoms.

--The risk of developing PTSD rose in direct proportion to the number of fire fights a soldier had experienced. Thus the rate was 4.5% for Iraq war veterans who had experienced no fire fights, 9.3% for those who had seen one or two fire fights, 12.7% for three to five, and 19.3% for those who had been through more than five such battles. The lower rate of PTSD symptoms among those who served in Afghanistan vs. those who served in Iraq could be largely explained by their lesser exposure to combat.

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