The wars in Afghanistan and Iraq are the longest combat operations since Vietnam. Many stressors face soldiers in Afghanistan and Iraq. Soldiers are at risk for death or injury. They may see others hurt or killed. They may have to kill or wound others.

Other factors can add more stress to an already stressful situation. These include what service members do in the war, the politics around the war, where the war is fought, and the type of enemy they face. These factors can increase the chance of having PTSD or other mental health problems.

For many soldiers, being away from home for long periods of time can cause problems at home or work. These problems can add to the stress. This may be even truer for National Guard and reserve troops who did not expect to be away for so long.

Another cause of stress in Iraq and Afghanistan is military sexual trauma (MST). This is any sexual harassment or sexual assault that occurs in the military. It can happen to men and women. MST can occur during peacetime, training, or war.

There is no information available on MST in Iraq and Afghanistan. Among veterans using VA health care, about

• 23 out of 100 women (23%) reported sexual assault when in the military.
• 55 out of 100 women (55%) and 38 out of 100 men (38%) have experienced sexual harassment when in the military.

We know that frequent and intense stressors are more likely to cause mental health problems.

What are the mental health impacts of the wars in Afghanistan and Iraq?

One early study looked at the mental health of service members in Afghanistan and Iraq (Hoge et al., 2004). The study asked soldiers and Marines about war-zone experiences and about their symptoms of distress. Soldiers and Marines in Iraq reported more stressors than soldiers in Afghanistan.

Soldiers and Marines who had more combat stressors had more mental health problems. About 12% to 20% of soldiers and Marines had PTSD after serving in Iraq. About 6% to 11% of soldiers had PTSD after serving in Afghanistan. About 7% to 15% of soldiers and Marines had depression after serving in Iraq or Afghanistan. About 1 in every 4 soldiers or Marines said they used alcohol more than they meant to.

Are service members getting mental health care?

All service members answer mental health questions when they return from Iraq and Afghanistan (Hoge et al., 2006). Based on these questions, about 19% of service members from Iraq have a mental health problem. About 11% of service members from Afghanistan have a mental health problem.

About 1 out of every 3 (35%) service members from Iraq were seen in VA for a mental health visit within a year of their return. About a third of those seen were given a mental health diagnosis. Most were seen 3 times over the year.

We do not know if those who need treatment most are getting treatment. One study (Hoge et al., 2004) suggested that service members with mental health problems were less likely to seek help because they would

• Be seen as weak
• Be treated differently
• Or that others would lose confidence in them

What is the long-term outcome for soldiers exposed to stressors in Iraq and Afghanistan?

It is too soon to know the long-term outcome of serving in Iraq and Afghanistan. Based on studies from other conflicts, we can expect that most service members will have some distress but that it will not be severe or long lasting. Having some symptoms early on does not tell us much about who will remain distressed.

We do know that soldiers who had more exposure to stressors and soldiers who had stronger reactions to those stressors are more likely to develop prolonged stress reactions. Service members should seek help for their mental health issues before they become long lasting.

References

Hoge, C.W., Auchterlonie, J.L., & Milliken, C.S. (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Journal of the American Medical Association, 295, 1023-1032.

Hoge, C.W., Castro, C.A., Messer S.C., McGurk, D. Cotting, D.I. & Koffman, R.L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351, 13-22.