Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care
Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care
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DOI：
10.1056/nejmoa040603
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发表时间：
2004-07-01
影响因子：
158.5
通讯作者：
Koffman, RL
中科院分区：
文献类型：
--
作者：
Hoge, CW;Castro, CA;Koffman, RL
背景：目前在伊拉克和阿富汗的作战行动让美军人员参与了重大地面作战和危险的安全任务。需要进行研究来系统地评估参与这些行动的武装部队成员的心理健康状况，并为向返回的退伍军人提供最佳心理保健服务的政策提供信息。方法：我们采用匿名调查的方式对四个美国作战步兵部队（三个陆军部队和一个海军陆战队部队）的成员进行了研究，该调查是在受试者部署到伊拉克之前（n = 2530）或从伊拉克或阿富汗战斗任务返回后三到四个月（n = 3671）进行的。结果包括重度抑郁症、广泛性焦虑症和创伤后应激障碍 (PTSD)，这些都是根据标准化、自我管理的筛查工具进行评估的。 结果：部署到伊拉克的人员比部署到阿富汗的人员暴露于战斗的情况明显更多。在伊拉克执行任务后（15.6％至17.1％）的反应符合重度抑郁症、广泛性焦虑症或创伤后应激障碍（PTSD）筛查标准的研究对象的百分比显着高于在阿富汗执行任务后（11.2％）或部署到伊拉克之前（9.3％）；最大的差异在于创伤后应激障碍（PTSD）的发生率。在那些对精神障碍的反应呈阳性的人中，只有 23% 至 40% 的人寻求心理保健。那些对精神障碍的反应呈阳性的人，对可能遭受的耻辱和寻求精神卫生保健的其他障碍感到担忧的可能性是那些反应呈阴性的人的两倍。结论：这项研究对参与伊拉克和阿富汗作战行动的陆军和海军陆战队成员的心理健康状况进行了初步研究。我们的研究结果表明，研究小组中存在着显着的心理健康问题风险，并且受试者报告了接受心理健康服务的重要障碍，特别是那些最需要此类护理的人的耻辱感。
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.