Benedict Carey / The New York Times – 2010-05-17 22:33:42
NEW YORK (May 16, 2010) — British troops who have fought in Iraq or Afghanistan suffer far lower rates of post-traumatic stress than Americans do, according to the most rigorous psychiatric study of Britainâ€™s military so far.
While estimated rates of the condition in troops returning to the United States range from 10 to 15 percent, the new study found a rate of just 4 percent among Britons — even though they and the Americans have seen equal amounts of combat in recent years.
When British researchers first reported low rates of post-traumatic stress, in 2006, the Americans were suffering far more casualties in Iraq. But the new study found no increase in mental health problems in British troops from 2003 to 2009, despite an escalating role in active combat in Afghanistan and rising rates of multiple deployments.
The findings, being reported in the current issue of The Lancet, are likely to stir debate about why the numbers are so different. In both countries, mental problems still carry a strong stigma among many military people, and both governments have taken extensive measures to prevent and treat combat stress.
“This is truly a landmark study, in its size and rigor, and the findings are surprisingly positive,” said Richard J. McNally, a psychologist at Harvard. “The big mystery is why we find these cross-national differences.”
In the study, led by Dr. Simon Wessely, of King’s College London, researchers analyzed answers from mental health questionnaires given to Royal Army, Navy and Air Force members from 2007 to 2009. The surveys included questions about general mental health, including standard items on depression and anxiety, as well as questions about alcohol use and post-traumatic stress. Many participants had also been involved in the 2006 survey.
It found that about one in five struggled with some mental health problem, most often depression or anxiety, and 13 percent drank heavily, but relatively few qualified for a diagnosis of probable post-traumatic stress. The study found that reservists were more likely than regular troops to report its symptoms, including disabling flashbacks and hyperarousal.
That may partly explain the discrepancy between the two countries; reservists make up about 30 percent of American forces but only 10 percent of British forces, Dr. Wessely said.
Researchers in the United States also point out that most of their estimates of post-traumatic stress come from combat battalions that spent tours “outside the wire” — in very hot zones of the conflict. “You’re going to get different estimates, depending on the troops you’re looking at and their experience,” said Col. Charles W. Hoge, a psychiatrist and senior scientist at the Walter Reed Army Institute of Research.
Dr. Wessely and Colonel Hoge also pointed to the vast difference in deployment schedules between the two countries. British troops deploy for six-month tours, and no more than 12 months in every 36. American forces do tours lasting 12 to 15 months, with a year off in between. A recent Army mental health report concluded that most service members need closer to two years between tours before their battle-related symptoms resolve themselves.
Another big difference between the two countries is national health care. In Britain, returning soldiers are covered free for life; in the United States, they are entitled to five years of free care from the Department of Veterans Affairs, though service-related injuries are covered for life.
“I’ve brought this up with American military commanders; why not switch to nationalized health care?” Dr. Wessely said. “Went over like a cup of cold spit.”
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