Pentagon plays catch-up as toll of repeat combat duty rises

A Department of Veterans Affairs study reports a three-fold increase in depression and post-traumatic stress after repeat combat duty, raising questions about the Pentagon’s ability to keep soldiers with combat-related psychological problems away from the front.

Emotional pain, depression, and angst among US soldiers seeing multiple deployments in war zones are much more common than the Pentagon has reported, a new Department of Veterans Affairs survey says.

Soldiers facing multiple deployments, moreover, are at least three times more likely to anonymously report problems of depression and post-traumatic stress disorder (PTSD) than are those with a single deployment, according to the study published Thursday in the American Journal of Public Health.

Coming as 30,000 more troops are being sent to Afghanistan, the findings in a study of nearly 3,000 New Jersey National Guardsmen are likely to spur additional debate over military and societal response to America’s heavy dependence on volunteer soldiers for repeated deployments in two wars.

The findings also raise questions about the military’s ability – and willingness – to properly screen soldiers for combat-related problems that could limit their effectiveness in war zones, writes Anna Kline, lead author of the VA study.

“The Pentagon has tried to downplay these problems, and now it’s a moral and strategic outrage that we’ve got on our hands,” says Lawrence Korb, assistant defense secretary in the Reagan administration and now a senior fellow at the Center for American Progress in Washington. “They’re in essence playing catch-up.”

Prescription drug abuse a related problem

Still, the Pentagon does not have its head in the sand about the effects of turnstile deployments on both enlisted men and National Guard troops. A study of 28,000 troops released by the Pentagon on Wednesday acknowledged that 20 percent had abused prescription drugs, mostly painkillers, and that the number of troops experiencing PTSD has gone from 9 percent in 2005 to 13 percent in 2008.

The new VA study, however, says that up to 30 percent of soldiers seeing multiple deployments have psychological problems, including post-traumatic stress.

The study points out a potentially key caveat: National Guard troops may not be as well equipped to handle multiple deployments as are enlisted troops.

Another issue is the “buck up, soldier” attitude in the Army and Marine Corps. The VA survey finds that 53 percent of those who anonymously reported deployment-related problems did not let the Army know, fearing “mental health stigma” from officers and fellow soldiers. Moreover, 90 percent of soldiers who screened positive for alcohol dependence reported receiving no treatment in the past 12 months.

Recently, reports of suicides by active-duty soldiers and newly returned veterans have alarmed military commanders enough to start “spiritual resilience” campuses at places like Fort Hood, in Texas. The Pentagon has also established a new suicide hot line with an online chat option. Moreover, military officials report that all VA hospital patients are now screened for PTSD and are seen by professionals within two weeks of a diagnosis.

But the Army has also struggled to increase the time between deployments as the US mounts a new offensive in Afghanistan. Relatively calm Iraq, too, could flare back up, putting renewed stress on the volunteer force.

The VA study confirms what many mental health professionals have been warning of for years: the cumulative effects of a nation relying on a relatively few volunteers to fight what’s now the longest-lasting war in modern US history fought without a draft. Currently, 38 percent of the fighting force has seen two deployments and 10 percent has seen three or more.

Difficulties increase with each deployment

"The difficulties with combat stresses increase with each deployment, and now we have people that have been there five, six times and we're going to be sending them back again," Dr. Judith Broder, a psychiatrist who runs the Soldiers Project, a nonprofit group that helps veterans, told the Whittier (Calif.) Daily News recently. "I don't think we're ready."

The VA study says another problem is that soldiers known by the Pentagon to be struggling mentally and physically are too often being redeployed. The Pentagon has reported that 43,000 medically unfit soldiers were pressed into service between 2003 and 2008, a practice which the Office of the Army Surgeon General warns can have adverse effects on the ability of soldiers to carry out their duties.

“Screening programs and mobilization trainings remain imperfect mechanisms for identifying and insuring treatment of psychologically impaired soldiers,” Ms. Kline writes. “It is important, therefore, for military and veteran authorities to develop mechanisms for the truly confidential and accessible … treatment of mental and behavioral health problems … and to examine existing policies regarding multiple deployments of troops.…”

One available but politically unpopular solution to the grinding stress on the volunteer force is the draft, Mr. Korb says. The mandatory US Selective Service system currently has 5 million able-bodied young Americans who could be called up, he notes.

The other option is to simply endure what’s being played out now, he says.

“People are being sent back that don’t have the required time home, and that’s why we need to face up to this,” he says. “These are battle-hardened guys, no doubt about it, but you do have this other aspect [of psychological trauma for some soldiers] and it’s going to be dogging them for years.”

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