IRA FLATOW, host:
And for the rest of the hour we're going to take a look at the mental health of soldiers returning from Iraq because there's an interesting new study out this week in the Journal of the American Medical Association that says that one third, one third of soldiers and Marines returning from Iraq seek out mental health services when they get back home. That number was much higher than that of soldiers or Marines returning from Afghanistan and other locations. So what is different about Iraq? And why do the men and women serving there need more mental health services when they return home? And are they getting, are they getting the help that they need?
Here to talk about it is Colonel Charles W. Hoge, M.D., director of the Division of Psychiatry and Neuroscience at Walter Reed Army Institute of Research in Silver Spring, Maryland. He joins us today by phone. Thanks for talking with us Dr. Hoge.
Colonel CHARLES W. HOGE, M.D. (director of the Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland): You're welcome.
FLATOW: Why are they--why is there a higher rate that we're seeing now?
Dr. HOGE: Well, there's no question that the frequency and intensity of combat is higher in Iraq than in Afghanistan, and the need for mental health services among folks coming back from Iraq is greater.
I want to make a quick comment. You introduced the figure of 1 out of 3 using mental health services and it's true; one out of three soldiers and marines coming back from Iraq use mental health services in the first year that they get back. But most of those folks are coming in very soon after they get back, and are getting help with that transition period. They're not getting diagnosed with mental health problems and mental health disorders. They're getting actually preventive services to help them in that transition period, which is exactly what we're encouraging them to do.
FLATOW: Is it easy for them to request mental health services or is there still a stigma attached?
Dr. HOGE: Well there's definitely still a stigma attached, and it's also easy to get mental health services. We know that soldiers and marines and other service members sometimes are afraid to get care because they, they're concerned that they'll be stigmatized, they'll somehow be treated differently by their peers or by their unit leadership, and we're working very hard to reduce the stigma and make it easy for folks to come in and get the help, especially early, shortly after they get back. Because we know that getting early help is the best way to prevent the long-term consequences that we've seen after past wars.
FLATOW: Is it the intensity of this war, and the closeness of the fighting and the body parts from the bombs that we're seeing that is really making these soldiers seeking more mental help when they get back?
Dr. HOGE: The frequency and intensity of combat, in all sorts of studies from past wars, has been shown to be correlated with mental health concerns when folks get back. And that's certainly the case in this war as well.
FLATOW: This is one of the first times that you're actually able to track soldiers using computerized databases, is it not? And that's one of the reasons you're able to see these statistics here?
Dr. HOGE: That's correct. In past wars, the research that was conducted on the mental health effects of war were done years and often decades after service members came back. This is the first time that we've really had the leadership that's taken a very proactive approach to mental health issues and has put mental health concerns front and center from the very beginning of the war; to include research as the war is going on, and then altering our policies of delivery of services based on that research as the war is going on. So that's a very different situation now then at any point in the past.
FLATOW: What kinds of mental health issues did the returning soldiers and marines have?
Dr. HOGE: Well some come back, some folks come back with serious concerns like post-traumatic stress disorder and depression, and so forth. But there are certainly the vast majority of our service members who've been in combat do very well when they come home and the types of things that they need help with are mostly related to transitioning home and kind of resetting themselves after being in combat for a year. So this could include, a lot of soldiers, for instance, after being in combat for a year, in the war zone for a year, when they come home they may still continue to feel revved up or edgy or irritable or have sleep disturbance after they get home.
And this is very common in the war zone and it can persist after folks come home. Those are normal reactions and a lot of what we do is just education and helping our service members to understand what is normal. Sometimes it's beneficial to get some help for those symptoms before they, you know, to prevent them from going on to become more severe.
FLATOW: Are men and women showing the same kinds of mental health problems?
Dr. HOGE: Yes, actually. We, the, in the, we have done some assessments in the combat zone of units that, like, support units that have both men and women, and we've found that the rates of mental health concerns are very similar among men and women.
FLATOW: Is there a lesson here? Is there a take-home message from this study?
Dr. HOGE: I think that the most important finding of this study really relates to helping our service members in that early transition period when they first get home and it's encouraging to see that a large number of service members are using services when they get home. The hope is that that's going to prevent the long-term, more serious consequences that we saw after other wars like Viet Nam.
You write in your paper that the rates of mental health care use for the entire Army and Marine populations have show linear increases over time since 2000, providing further evidence that the war is burdening the healthcare system at large.
Dr. HOGE: Well, the mental health services that we're providing are both treatment oriented as well as prevention oriented, and that does take resources. And we're continually monitoring how well we're doing in terms of the availability of resources, looking to see, do we have enough resources, are they distributed correctly? We're doing that both in the war zone, where we think it's very important to have mental health services available right there on the, with the troops, and then of course we're doing that when we get home. And we're also collaborating closely with the VA to try and facilitate the transition of care into the VA system.
FLATOW: Let's go to Ann in Walnut Creek, California.
Hi Ann, welcome to Science Friday.
ANN (Caller): Oh, hi.
ANN: I thought I heard, well, I wanted to ask whether, you know, what most of the treatment consists of. Is it talk therapy, is it group therapy, is it psychotropic drugs?
FLATOW: Good question. Yeah.
Dr. HOGE: Yeah, it's all of the above. We certainly know a lot more about how to treat mental health effects of combat now then we ever did in the past, and there are excellent treatments available that include psycho-therapy, or talk therapy, either individual or in group format, as well as medications. And it's a very individual thing to select the right type of therapy.
But the therapy is excellent. The medications, for instance, that are used now and approved for use for PTSD, for instance, are very safe and can be used by soldiers safely even when they're in the war zone.
FLATOW: Thanks for calling, Ann.
ANN: Thank you.
FLATOW: 800-989-8255 is our number. We're talking about soldiers and mental health this hour on TALK OF THE NATION Science Friday from NPR News.
This war is unusual in another way in that we're seeing a lot of, there are a lot of reservists in there, and a lot older people who are part of the reservist system. Do you see any differences in the age of the soldiers about what kind of mental health problems they may be showing up with?
Dr. HOGE: Well, there's kind of a myth that reserve and National Guard soldiers, because they're older and maybe not training on a full-time basis prior to coming on active duty for a rotation like Iraq, there's a myth that they don't do as well. And in fact that's not true.
We've found that they, that the rates of mental health concerns, the concerns that folks have are really very comparable whether its from active component soldiers or soldiers from reserve and national guard. And in fact, a lot of times the older soldiers have a lot more life experience and that can, and more of hem are married, and those can be actually beneficial in terms of helping one to be resilient.
FLATOW: That's what I would've--I was driving at. I would think that the older ones would have more of that life experience and be more resilient. But you're saying that doesn't show up?
Dr. HOGE: Yeah, that's actually true.
Dr. HOGE: That we see somewhat lower rates in older individuals, and uh, no real difference between reserve, National Guard, or active component units.
FLATOW: Do you give a base-line exam to all the soldiers before they go into combat and then like compare later on to see what happens to these soldiers so you might have a fuller idea of before and after?
Dr. HOGE: Well every soldier who deploys is, goes through a medical process to assure that they're fit to deploy. And then we focus more of our attention in terms of medical and mental health resources once folks come home by doing screening for any deployment-related concerns that could include medical concerns or mental health concerns and so all service members go through that. That was actually part of what our paper looked at, was that screening process when our service members come back.
FLATOW: I was wondering whether you might be able to, you know, a lot of data is always collected about things. Maybe in sifting through the data later on someone else might find some way of predicting who might have problems, you know, in the military with any kind of mental problems from this database.
Dr. HOGE: Well, um, I'm not sure exactly what you're asking, but most of the work that was done in the past to try and identify who would be more mentally fit or mentally resilient in combat had, those are actually, those have actually shown, not really shown to be very predictive. We don't really have good prediction of, you know--screening tools that we can use to identify people before they go into combat--who might have more difficulties.
FLATOW: So where do you go, any future plans with studies like this or more of this study?
Dr. HOGE: Well one thing that's happening as a result of the work that we've done, in part as a result of the work that we've done, is that the Department of Defense has expanded the screening program in the post-deployment period to include a new screening at three to six months post-deployment. So they will get both a screen when they first return as well as three to six months later. And so we'll be looking to see how effective is that, how many individuals are identified at that time point, and how well our resources are being utilized at that point. So those are some of the things that we'll be looking at.
FLATOW: Colonel, thank you very much for taking the time to talk with us.
Dr. HOGE: My pleasure.
FLATOW: Colonel Charles W. Hoge is Director of the Division of Psychiatry and Neuro-Science at the Walter Reed Army Institute of Research in Silver Spring, Maryland.
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