Study details high, costly psychological toll on troops

WASHINGTON — About 300,000 U.S. military personnel who survived the bombs and other dangers of Iraq and Afghanistan have post-traumatic stress disorder (PTSD) or major depression, a toll that will cost the nation up to $6.2 billion over two years, according to a RAND study released Thursday.

In addition, nearly 20 percent of the 1.64 million veterans of Iraq and Afghanistan, or about 320,000 people, reported a probable traumatic brain injury (TBI) during deployment, the study found, though it said their treatment needs had not been determined.

Taken together, the study shows that nearly 31 percent of those who have served in combat have suffered brain injuries, stress disorders or both.

The economic cost of the PTSD and depression cases — including medical care, forgone productivity and lost lives through suicide — was put at $4 billion to $6 billion over two years.

Meanwhile, the cost incurred by traumatic brain injury, based on all cases diagnosed through June 2007, was estimated at $600 million to $900 million.

The study, "Invisible Wounds of War," said prolonged and repeated exposure to combat stress is causing a disproportionately high psychological toll compared with physical injuries. It warned of "long-term, cascading consequences" for the nation — ranging from a greater likelihood of drug use and suicide to increased marital problems and unemployment — if the mental-health problems are left untreated.

Yet, based on a survey of 1,965 service members included in the study, serious gaps in mental-health care were found. For example, it determined that only 53 percent of service members with PTSD or depression had sought help from a provider in the past year. Of those who sought care, about half received "minimally adequate" treatment.

Some service members avoid seeking help, fearing negative consequences, according to the study. These troops worry about damage to their military careers and relationships with co-workers. "When we asked folks what was limiting them from getting the help that they need, among the top barriers that were reported were really negative career repercussions," said Terri Tanielian, one of the study's authors.

The study suggested two key changes. It suggested ways to allow service members to get mental-health care "off the record" to avoid stigma. And since some soldiers and Marines fear that seeking treatment will prevent their redeployment, the study recommended that fitness-for-duty reports not rely on decisions to seek mental-health care.

Screening techniques for stress disorders are vastly improved from previous wars, making comparisons with Vietnam, Korea or World War II difficult or impossible.

Military officials praised the RAND study Thursday, saying its findings were consistent with their studies and adding that it would reinforce their efforts to try to improve mental-health care. Veterans Affairs officials, while questioning the study's methodology, said their department has intensified efforts to find discharged service members who have mental disorders.

Lt. Gen. Eric Schoomaker, the Army surgeon general, said the study, the first large-scale, private assessment of its kind, would help draw the nation's attention. "They are making this a national debate," Schoomaker said.

The Army previously has said about 1 in 6 service members has a form of PTSD, a slightly lower rate than RAND's study found. In addition to PTSD rates, the RAND study found that 19.5 percent of people who had served in Iraq or Afghanistan suffered a concussion or another traumatic brain injury during their combat tour, a number similar to Army estimates.

Material from the Los Angeles Times and The Associated Press

is included in this report.