Mental health problems of returning Iraq war veterans

Psychiatric casualties are the hidden wounds of war. It is expected that 19-30% of veterans returning from war in Iraq and Afghanistan will meet criteria for a serious mental health disorder. These may take the form of anxiety disorders including posttraumatic stress disorder (PTSD), mood disorders, and substance abuse disorders. PTSD will be examined in detail as a prototypic syndrome resulting from exposure to war trauma.

No one emerges from war unchanged. Even for the majority who do not develop a full-blown psychiatric disorder, the challenges of readjustment and reintegration are profound. The major issues faced by returning veterans and their families will be explored.

Exposure to combat results in substantial morbidity that can last for decades. Beyond the impact on the individual, there are significant long-term effects on families, communities and the entire society. These include family violence, divorce, and unemployment. The financial burden to the nation will be much greater than has generally been anticipated. Providing health care and disability benefits for veterans of the current conflict will cost hundreds of billions of dollars.

Early recognition and treatment of PTSD and other psychiatric conditions has the potential to alleviate some of this burden. Unfortunately, substantial barriers to obtaining care have been evident. These obstacles, including the stigma of mental illness and institutional deficiencies, will be explored along with some efforts to overcome them.