High rates of mental health disorders are being diagnosed among US military personnel soon after being released from duty in Iraq and Afghanistan, according to investigators in San Francisco.

They estimate that out of 103,788 returning veterans, 25 per cent had been diagnosed with mental health problems, and more than half of these patients had two or more distinct conditions. Those most at risk were the youngest soldiers and those with the most combat exposure, Dr Karen H Seal of the Veterans Administration Medical Center and her associates report in the Archives of Internal Medicine.

Dr Seal's group based their findings on records of US veterans deployed in Iraq and Afghanistan who were seen at veteran healthcare facilities between September 2001 and September 2005.

In addition to the high rate of mental health disorders, about one in three

(31 per cent) were affected by at least one psychosocial diagnosis.

The most frequent diagnosis was post-traumatic stress disorder (PTSD).

Other diagnoses included anxiety disorder, depression, substance-use disorder, or other behavioural or psychosocial problems.

The researchers found that 31 per cent of the patients received mental health and/or psychosocial diagnoses. For the 25 per cent who received a diagnosis of a mental health disorder, more than half (56 per cent) had two or more mental conditions diagnosed. PTSD accounted for 52 per cent of all those who were diagnosed with a mental problem and 13 per cent of all the veterans in the study.

The researchers observed very little difference between men and women, between racial and ethnic subgroups, and between those on active duty and in the national guard or the reserves.

"The youngest group of active-duty veterans (aged 18 to 24 years) had a significantly higher risk of receiving one or more mental health diagnoses and post-traumatic stress disorder, compared with active-duty veterans 40 years or older," according to Dr Seal and her colleagues.

The research team said enhanced prevention, detection and treatment of mental health problems "should be targeted at the youngest . . . veterans", especially those who were on active duty.

"This new generation of veterans will be challenging to treat because they have co-occurring mental health disorders," Dr Seal said.

She noted that most mental health problems were identified during visits with primary-care doctors, not with mental health professionals.

"We found that most of these diagnoses occurred in primary-care settings,"

Dr Seal said. "Most of the patients went on to a mental health clinic, where the diagnosis was confirmed. But 40 per cent did not seek further mental healthcare - that was concerning."

She added: "The youngest group of veterans - 18 to 24-year-olds returning from Iraq and Afghanistan - were at the highest risk for having a mental health diagnosis or a PTSD diagnosis . . . the highest prevalence of mental health diagnosis were in the youngest group of active-duty veterans."

Dr Seal said she believed the youngest veterans were most affected because they saw the most combat."Combat exposure directly correlates with the development of PTSD and other mental health diagnoses."

"The numbers are staggering," noted Simon Rego, an associate director of psychology training at Montefiore Medical Center and assistant professor of psychiatry and behavioural sciences at Albert Einstein College of Medicine, New York.

The prevalence of PTSD among these veterans is roughly the same as it was for Vietnam veterans, Prof Rego said. "But if you look at the prevalence of PTSD in the general population, it's about 3.5 per cent. This is a bubble coming our way." - ( Reuters ) © 2007 The Irish Times

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