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Troops screened as never before
By Gregg Zoroya, USA TODAY
10/18/2005 10:48 PM

Pentagon efforts to screen troops for medical and psychological problems before and after they go to war and in the months after they return home could make the Iraq war veteran the most scrutinized fighter in American history.

"They are collecting data before and after, and then doing follow-up. That's amazing," says Joseph Boscarino, a Vietnam War veteran and scientist at the New York Academy of Medicine who does research on post-traumatic stress disorder. "That was never done before. It was always ad hoc."

The screening began in 1997. When it was expanded in 2003, William Winkenwerder Jr., assistant secretary of Defense for health affairs, testified before Congress that it was necessary to avoid the kind of health problems that had occurred in the Persian Gulf War of 1991.

Thousands of returning veterans of that conflict complained of ailments ranging from memory loss to respiratory problems.

"That was a big problem in the Gulf War," Winkenwerder testified. "We really didn't know the baseline health status of people, so it was very difficult to compare when they came back as to what their status had been before they left."

The current screening before and after deployment is designed to correct that, Winkenwerder said.

First comprehensive effort

Servicemembers fill out a four-page health survey, which is entered into their medical record. They meet with a nurse, medical assistant or doctor, who goes over answers and can make a referral.

"This is the first war in which we're doing comprehensive assessments," says Col. Elspeth Ritchie, psychiatric consultant to the Army surgeon general.

The emphasis, she says, is on early detection and treatment of health problems: "We have to have strong and resilient soldiers in order to fight the war."

The Army Center for Health Promotion and Preventive Medicine provided USA TODAY with screening results of servicemembers returning from the Iraq war from the time the war began in 2003 through August of this year.

The results came from the surveys filled out by troops. In some cases, servicemembers who were sent back to the fighting may have been screened more than once. The Pentagon says about 20% of deployed troops serve their tours outside Iraq, such as in Kuwait, and do not see combat.

See Chart::
Among service members returning from the Iraq war:
45% felt they were in great danger of being killed during their tour.
19% were bothered by finding little interest or pleasure in doing things.

14% were bothered by feelings of depression or hopelessness.

9% had an experience that gave them nightmares or that they thought about when they didn't want to.

3% worried about serious conflicts with their spouse, family or close friends.

Source: 538,232 Defense Department Post-Deployment Health Assessments of servicemembers returning from the Iraq war from April 2003 to August 2005

The screening results show that the percentage of returning troops referred for follow-up medical or mental health treatment rose from 22% in 2003 to 35% in 2004. This year, slightly more than 28% of returning troops have required medical or mental health care.

The percentage of female troops with health issues has been higher than that of men. Last year, 43% of returning women required follow-up medical or mental health care, compared with 36% of men. This year, about 33% of female servicemembers were referred for follow-up care, compared with 27% of men.

In addition, a higher percentage of National Guard and Reserve troops have had health issues than those in active-duty forces, the survey shows.

Forty-seven percent of National Guard troops and 45% of reservists required some kind of medical or mental health care last year, vs. 29% of active-duty troops. This year, 30% to 35% of Guard and Reserve troops needed health referrals, compared with 25% of active-duty service members.

A change in combat

The numbers suggest that the severity of the war increased after 2003, when much of the fighting had been concentrated around the initial invasion of Iraq by U.S.-led forces in March and April. As the insurgency took root in 2004, the percentage of U.S. military personnel who witnessed someone being killed or wounded rose from 36% in 2003 to 50% in 2004. It is 47% this year.

The percentage of troops who said they needed stress-related therapy after war duty has almost doubled since the first year of the war. But that portion remains small, rising from about 3% in 2003 to about 6% this year.

The actual proportion of troops with stress-related mental health problems may be far higher. In an anonymous survey in 2003, Army researchers found that 15% to 17% of front-line troops suffered depression, anxiety or post-traumatic stress disorder (PTSD).

A 1986-88 study, the National Vietnam Veterans Readjustment Survey, found 15% of male and 8% of female Vietnam veterans had been diagnosed with stress disorders.

A recent study by Boscarino, of the New York Academy of Medicine, found that the postwar mortality rate of Vietnam veterans who had suffered post-traumatic stress disorder was twice that of other veterans from that conflict.

Because so many PTSD cases remain undiagnosed and untreated, Michael Kilpatrick, deputy director of the Deployment Health Support Directorate in the Defense Department, says the Pentagon will begin follow-up health assessments of troops later this year. The screenings will occur three to six months after troops get home, when some mental and physical symptoms may be more evident.

"It's yet another opportunity for accessing care," he says.