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Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care

Hoge, Charles W., Castro, Carl A., Messer, Stephen C., McGurk, Dennis, Cotting, Dave I., Koffman, Robert L.·2004·New England Journal of Medicine

DOI 10.1056/nejmoa040603

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Abstract

BACKGROUND: The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. METHODS: We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. RESULTS: Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. CONCLUSIONS: This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care.

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Authors: Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L.
Affiliations: United States Army Medical Research and Development Command (US)
ORCID: Castro, Carl A.
McGurk, Dennis
Cotting, Dave I.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2004-07
Volume: 351
Issue: 1
Pages: 13-22
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa040603
OpenAlex: W2150261153
Cited by: 4,778
References: 33
Citations by year: 2026: 109 · 2025: 113 · 2024: 136 · 2023: 130 · 2022: 163 · 2021: 195 · 2020: 205 · 2019: 219 · 2018: 237 · 2017: 307 · 2016: 299 · 2015: 330 · 2014: 395 · 2013: 367 · 2012: 310
FWCI: 113.42
Type: journal article
Language: en
Open access: closed
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
NSUWorks (Nova Southeastern University) (submittedVersion)
U.S. Army Academy of Health Sciences, Stimson Library (submittedVersion)
DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords: combat veterans, mental health, post-traumatic stress disorder, major depressive disorder, generalized anxiety disorder, barriers to mental health care, stigma, Iraq War, Afghanistan War, military deployment, combat exposure, returning veterans
MeSH terms: Adolescent, Adult, Afghanistan, Anxiety, Mental Disorders, Combat Disorders, Data Collection, Delivery of Health Care, Depressive Disorder, Female, Health Services Accessibility, Humans, Iraq, Male, Mental Health Services, Military Personnel, Patient Acceptance of Health Care, Prejudice, Socioeconomic Factors, Stress Disorders, Post-Traumatic, United States, Warfare, Prevalence

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Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care

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