It is no surprise that service members and veterans are at increased risk of posttraumatic stress and related disorders as a result of their exposure to combat. The lifetime prevalence estimate of PTSD for veterans who served in Vietnam is approximately 30% when broad and inclusive criteria are used and around 20% when stricter criteria are applied.
This concept is an important one to understand as not all studies look the same. Some studies stick to rigid criteria (e.g. only PTSD as defined by DSM-5 with no comorbid disorders versus “some” posttraumatic stress symptoms with accompanying depression).
Studies of veterans who served in the recent Iraq and Afghanistan conflicts reveal significant levels of PTSD as well. Although, depending on which study you read and how the study was designed, estimates can vary considerably. In one of the first studies on the subject, Charles Hoge and colleagues (2004) from the Walter Reed Army Institute of Research screened four United States combat infantry units with an anonymous survey either before the service member’s deployment to Iraq (n = 2,530) or, in a different set of troops, three to four months after their return from combat tours in Iraq or Afghanistan (n = 3,671).
Results indicated that service members deployed to Iraq screened positive for PTSD at rates of 18–20% and those from Afghanistan at approximately 12%. One explanation for the difference could be related to the type of combat operations in each individual theater of operations (heavy versus light fighting) and the type of unit (active duty versus reserve).
Using the Post-Deployment Health Assessment, in 2006, Hoge, Auchterlonie, and Milliken found that approximately 10% of Iraq veterans and 5% of Afghanistan veterans screened positive for PTSD. An important aspect of this latter study is that it utilized the records of almost 250,000 troops, something that is virtually unheard of when conducting research with veterans.
A study by Milliken, Auchterlonie, and Hoge (2007), which included active-duty, National Guard, and reserve soldiers, revealed that approximately 17% of active-duty soldiers screened positive for PTSD at three to six months following deployment. Levels for National Guard and reserve soldiers reached nearly 25%.
In contrast, a later study had rates of approximately 7% in active-duty service members and 11% in National Guard service members at 12 months postdeployment (Thomas et al., 2010). In a sample of nearly 2,000 Iraq and Afghanistan veterans, the RAND Corporation found a prevalence rate of nearly 14% (Tanielian & Jaycox, 2008). And then there is subthrehshold symptoms of PTSD. It is estimated that approximately 8% of veterans battle clnically significant symptoms associated with trauma and military service, but do not reach the PTSD diagnostic threshold.
Although variation exists in the estimated prevalence rates of PTSD in veterans of the Iraq and Afghanistan wars, the level of PTSD in our service members and veterans is significant. Even using the most conservative estimates, just considering veterans from the Iraq and Afghanistan wars, hundreds of thousands of military members are dealing with the after effects of military related trauma.
Furthermore, millions of loved ones are also affected by this disorder, and billions of dollars are spent each year in the attempt to better understand and prevent PTSD, as well as to rehabilitate those service members and veterans living with the disorder.
*This article was adapted from Dr. Moore’s latest book, “Treatment of PTSD in Military Personnel: A Clinical Handbook-Second Edition.”
Hoge, C. W., Auchterlonie, J. L., & Milliken, C. S. (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Journal of the American Medical Association, 295(9), 1023–1032.
Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13–22.
Milliken, C. S., Auchterlonie, J. L., & Hoge, C. W. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. Journal of the American Medical Association, 298(18), 2141–2148.
Tanielian, T. & Jaycox, L. (Eds.). (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation.
Thomas, J. L., Wilk, J. E., Riviere, L. A., McGurk, D., Castro, C. A., & Hoge, C. W. (2010). Prevalence of mental health problems and functional impairment among active component and National Guard Soldiers 3 and 12 months following combat in Iraq. Archives of General Psychiatry, 67¸ 614–623.