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Study: Help upfront reduces troops' mental ills

A battlefield study conducted by the Army on 20,000 soldiers during the troop surge in Iraq shows that more aggressive efforts to question and counsel GIs about their mental health reduce by nearly 80% the number who develop behavioral health illnesses during combat.

The results of the study, to be published today in the American Journal of Psychiatry, also show that 54% fewer soldiers contemplated suicide and that the number who needed to be sent home from Iraq with mental health problems dropped by nearly 70%.

"We're excited about what this study shows," says Maj. Gen. Patricia Horoho, Army deputy surgeon general. "It is the first direct evidence that a program (of more aggressive screening and treatment) is effective in preventing adverse behavioral health outcomes."

The Army will begin using screening and treatment methods from the study within six months, Horoho says.

Battlefield doctors who authored the study tracked six brigades attached to the 3rd Infantry Division fighting in Iraq in 2007 during a surge ordered by President George W. Bush. At the core of the experiment was an effort to more thoroughly screen soldiers as they were heading off to war.

Soldiers from three brigades, or 10,678 servicemembers, were asked questions about their mental health — such as whether they had ever received mental health care, ever contemplated suicide, were taking antidepressants or mood-stabilizing medication or abused alcohol or drugs.

The questions raised concerns for 819 soldiers; each immediately met with a psychiatrist, psychologist or social worker for a more thorough mental health examination, the study says.

Doctors were better able to determine who was fit for combat and identify those who needed more attention from battlefield counselors, says Army Maj. Christopher Warner, a psychiatrist and co-author of the study. In Iraq, mental health workers singled out certain soldiers, based on their screening results, to talk with them routinely. "Our teams would go out and locate soldiers on the forward operating bases," Warner says.

After collecting six months of data, researchers compared the three brigades who were more aggressively screened and treated with a control group of three other brigades, made up of 10,353 soldiers, who were screened and treated under existing protocols.

Where one out of eight soldiers in the control group — or 1,365 servicemembers — developed psychiatric disorders during six months of combat, that ratio was one in 35 soldiers — or 307 servicemembers — in the brigades receiving stronger screening.

Ninety-three soldiers in the control group admitted contemplating suicide. Only 44 experienced such thoughts among those aggressively screened. Twenty-eight soldiers were sent home with mental illnesses from the control group, 13 from the screened brigades.

Even for the most common mental health problem that soldiers experience — stress from being deployed and separated from families — the screened group did better: 1,676 soldiers were diagnosed with stress problems in the screened brigades, compared with 2,273 soldiers in the control group.

Researchers said they did not track the soldiers beyond the initial six months and have no data on long-term mental health consequences of combat.