Treatments

Psychiatric Problems Send More Troops Home Than Combat Injuries

A new study reports a sharp increase in the number of U.S. troops evacuated for psychiatric reasons in both Iraq and Afghanistan.

In fact, more troops were evacuated for mental health problems in 2007 than for combat injuries. That's according to a Johns Hopkins study recently published in the Lancet.

The rise in psychiatric evacuations was seen despite an increased attention to mental health problems and the provision of services aimed at treating combat stress.

"Most people think that in a war, getting shot is the leading cause of medical evacuation, but it almost never is," said study leader Steven P. Cohen, an associate professor of anesthesiology at the Johns Hopkins School of Medicine and a colonel in the U.S. Army Reserve, told the JHU Gazette.

The largest group of troop evacuations by far continues to be noncombat-related injuries, such as muscle and joint problems that come from carrying equipment.

The Johns Hopkins study suggests that the increase in psychiatric evacuations may be due to the psychological toll of repeated deployments, as well as a lower threshold for evacuating troops from the field.

In an email, Cohen told Shots that repeat deployments don't "desensitize" troops. Rather, they add to previous stresses, especially psychological ones.

And those suffering from mental health issues had a remarkably low rate of returning to full duty. "Psychiatric conditions have the lowest return to duty rates among any diagnostic group aside from combat injuries," Cohen wrote. "But the effects are much worse, because psychiatric conditions worsen the prognosis for all other conditions."

"Patients with PTSD — as a rule — have multiple other complaints," he continued. "Studies have shown that most people with persistent PTSD have ongoing musculoskeletal, neurological and constitutional complaints that are unlikely to respond to treatment."

The lesson for health care providers? Continue to strengthen mental health support and treatment programs for troops.

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