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The first study of mental-health problems among U.S. troops returning from Iraq finds one in eight soldiers reporting symptoms of post-traumatic stress disorder (PTSD), an incidence consistent with earlier wars, according to a psychiatrist at Duke University Medical Center and the Durham VA Medical Center.

"There was a 30 percent lifetime incidence of PTSD in Vietnam veterans," said Harold Kudler, M.D., Duke and VAMC psychiatrist. "The fact is, this 17 percent we're getting for Iraq in the heaviest combat, and up to 20 percent in very heavy combat, is right in line with that."

The first mental-health study of combat units returning from Iraq was recently published in the New England Journal of Medicine. This Department of Defense study was the first to examine mental-health problems of combat veterans within the first several months of their return home.

"What they picked up wasn't only PTSD," says Kudler, who coordinates mental health services for the VA's Network Six, which includes North Carolina, Virginia and part of West Virginia. "It could be PTSD, major depression and/or generalized anxiety. Plus, they found significant signs of alcohol abuse. What we're seeing is really a bigger picture of post-deployment mental health problems."

Kudler says the military's programs to diagnose and treat the psychiatric effects of warfare show how such efforts have evolved.

"There were psychiatrists and psychologists on site during Vietnam," he explained. "But most of them were on hospital ships that picked up casualties. In the Gulf War, they had Combat Stress Control Units that were right there with Army, Marine and Air Force groups in the Gulf region. That has been greatly augmented for this current war. Also, there's been more of an attempt to prepare troops in advance of deployment."

Kudler says PTSD symptoms can include difficulty sleeping, nightmares, concentration problems and feeling overwhelmed in situations that weren't previously overwhelming. Flashbacks to combat experiences are another common symptom.

"These are often intrusive memories, thoughts or images of things that happened to you in combat that you can't get out of your mind, even though you try," he said.

According to Kudler, more counseling help and other services are available to troops and veterans than ever before.

"Significantly, though, of those reporting symptoms in this study, less than half had sought help for their problems," Kudler said. "I'm afraid there still is a stigma in the military culture about seeking this kind of help. People fear they may be seen as weak or cowardly or as letting their buddies and units down. There's also the fear that you may be harming your career.

"But I'm very impressed with what military medicine is trying to do to help our troops. And I think this Hoge study that came out in the New England Journal of Medicine is a major step in the right direction."