Veterans of war have been known to suffer from high incidence of post-traumatic stress disorder (PTSD), depression and traumatic brain injury in addition to any physical wounds. And a new study of thousands of U.S. Army soldiers returning from combat duty in Iraq found up to 31 percent reported symptoms of PTSD or depression as long as a year after returning from the battlefield.

Between 2004 and 2007, 18,305 soldiers returning from Active Component and National Guard infantry brigade combat teams completed surveys that screened for PTSD, depression and other trends, such as alcohol abuse, aggression and general difficulties getting along in civilian life, three months and a year after the soldiers returned from deployment in Iraq.

Based on general definitions of the disorders the researchers found that 20.7 to 30.5 percent of soldiers met the criteria for PTSD, and 11.5 to 16 percent met the criteria for depression. And "using the strictest definitions with high symptom rates and serious functional impairment," the authors found up to 11.3 percent of soldiers had PTSD and up to 8.5 percent suffered from depression. Between 8.5 and 14 percent of soldiers reported "serious functional impairment" due to their symptoms, the authors noted in their study, which was led by Jeffrey Thomas, of the Division of Psychiatry and Neuroscience at Walter Reed Army Institute of Research, and published online June 7 in Archives of General Psychiatry.

About half of soldiers who had PTSD or depression also reported aggressive behavior or misuse of alcohol, "findings [that] indicate that it may be beneficial to screen for alcohol and aggressive behaviors when soldiers present for treatment of PTSD or depression," Thomas and colleagues noted in the study.

Rather than improving over time, the soldiers' conditions seemed to worsen from three months to 12 months after returning from combat. (The rates over time increased "most dramatically" in National Guard soldiers, who also only have free medical coverage for the first six months after deployment, the researchers noted.) These findings show that even a year after deployment "many combat soldiers have not psychologically recovered," the authors reported, suggesting a need for greater mental health monitoring and coverage for soldiers coming back from active combat.

The report also "has immediate implications for current Department of Defense policy and troop rotations," the authors noted, as standard time between deployment assignments for many combat groups is 12 to 18 months. And for those in the service these days, multiple deployments are likely. "If soldiers are struggling with serious functional impairments as the result of a previous deployment are deployed again, there is potential that this could impair their performance in combat," Thomas and colleagues observed. "This has implications for the safety of unit members and mission success."

The rates of PTSD and depression might also have longer-term effects beyond the first year or subsequent deployment. Another study, published in the same issue of Archives of General Psychiatry, found that older veterans with PTSD were more than twice as likely to have dementia.

The researchers, led by Kristine Yaffe, of the Department of Psychiatry at the University of California, San Francisco's School of Medicine, surveyed 174,806 veterans (with a mean age of 68 years, who had not been diagnosed for dementia), and found that even after adjusting for other factors, including general demographics, depression, head injury and substance abuse, those with PTSD were still more likely to meet the criteria for dementia. Although the study did not have enough data to establish causation, the authors noted that the link has "important public health, policy, and biological implications…As patients with PTSD age, these adverse health conditions usually increase with frequency."

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