March 31, 2005 - As many as one out of four veterans of Afghanistan and Iraq treated at Veterans Affairs hospitals in the past 16 months were diagnosed with mental disorders, a number that has been steadily rising, according to a report in today's New England Journal of Medicine.

Records show that 20% of eligible ex-soldiers came to VA hospitals seeking medical treatment between October 2003 and February 2005. Overall, 26% of them were diagnosed with mental disorders, say Han Kang and Kenneth Hyams of the VA.

Post-traumatic stress disorder (PTSD) was most common, diagnosed in 10% of patients, followed by drug or alcohol abuse (9%). Seven percent were diagnosed with depression; 6% had anxiety disorders, such as phobias and panic. Many ex-soldiers had multiple disorders, Kang says.

But these are tentative diagnoses. Sometimes they were made by primary-care doctors and not yet confirmed by mental health specialists, he says.

At this point, it is an open question whether these numbers predict how many soldiers ultimately will develop mental health problems, Kang says.

Patients coming to the VA often lack insurance and might be at a disproportionately higher risk for mental health problems, he says. Also, soldiers who have left active duty may be in more mental distress than those who stayed, adds Army Lt. Col. Carl Castro, chief of military psychiatry at the Walter Reed Army Institute of Research.

On the other hand, fear of being stigmatized was a key reason that traumatized soldiers didn't seek help while still in the military, an earlier study showed. So these post-duty numbers could more accurately reflect the final toll, says Harvard psychologist Richard McNally, a PTSD expert.

So far, VA hospitals can easily meet the challenge of mental health care for Afghanistan and Iraq war veterans, Kang says.

But large funding cuts in VA psychiatry programs over the past several years and the limited number of doctors trained in PTSD could signal big trouble ahead, cautions Bruce Kagan, staff psychiatrist at the West Los Angeles VA Hospital.

"The soldiers didn't come right away after Vietnam, either. If they come in the numbers predicted, the numbers the VA's own studies predict, we could be overwhelmed," Kagan says.

About 31% of male soldiers who served in Vietnam developed PTSD, but diagnosis standards were looser then than they are now, says McNally.

Treatments using therapy and medication have improved greatly since Vietnam, he says. The increasing numbers coming for help could be a positive sign, suggesting earlier detection and possibly better recovery rates. "There's reason for optimism," he says.

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