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Iraq - been there, done that, got the tee-shirt. Now I'm home, safe and sound with my family, something for which I give thanks every day. And almost every day it seems I read something that tells me I beat the odds. Take this story, for instance, depicting a potential crisis emerging at VA healthcare facilities
Mental Disorders Are On The Rise Among Afghanistan, Iraq Veterans
Funding cuts could overburden system
As many as one out of four veterans of Afghanistan and Iraq treated at Veterans Affairs hospitals in the past 16 months were diagnosed with mental disorders, a number that has been steadily rising, according to a report in today's New England Journal of Medicine.
Records show that 20% of eligible ex-soldiers came to VA hospitals seeking medical treatment between October 2003 and February 2005. Overall, 26% of them were diagnosed with mental disorders, say Han Kang and Kenneth Hyams of the VA.
Post-traumatic stress disorder (PTSD) was most common, diagnosed in 10% of patients, followed by drug or alcohol abuse (9%). Seven percent were diagnosed with depression; 6% had anxiety disorders, such as phobias and panic. Many ex-soldiers had multiple disorders, Kang says.
But these are tentative diagnoses. Sometimes they were made by primary-care doctors and not yet confirmed by mental health specialists, he says.
Some frightening numbers, but like the oft-cited suicide statistic (raw numbers are often tossed about, but it's rarely noted that military suicides lag those of similar demographics in the civilian sector) the meaningful data would be how do these veteran's numbers compare to the population as a whole?
Drug or alcohol abuse was diagnosed in 9% of patients. All Americans:
An estimated 17.6 million American adults (8.5 percent) meet standard diagnostic criteria for an alcohol use disorder and approximately 4.2 million (2 percent) meet criteria for a drug use disorder. Overall, about one-tenth (9.4 percent) of American adults, or 19.4 million persons, meet clinical criteria for a substance use disorder -- either an alcohol or drug use disorder or both -- according to results from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) reported in the current Archives of General Psychiatry [Volume 61, August 2004: 807-816].In other words, the numbers are amazingly similar at 9 percent.
Seven percent were diagnosed with depression. Of the American population as a whole,
Dr. Kessler and his colleagues found that 6.6 percent of adults in America had major depression in a year and that 16.2 percent -- or about one in six people -- were likely to have major episodes in their lifetimes. The rates did not differ based on where people lived but varied for men and women and by income level.Another amazing similarity.
6% had anxiety disorders, such as phobias and panic. America:
As a group, anxiety disorders afflict nearly nine percent of Americans during any six-month period. Symptoms can be so severe that patients are almost totally disabled -- too terrified to leave their homes, to enter the elevator that takes them to their offices, to attend parties or to shop for food.
Leaving PTSD - diagnosed in 10% of patients. The National Institute of Mental Health says PTSD affects about 5.2 million adult Americans. This would be about 2.5 percent of the population based on the conversions used above. You'd expect the numbers to be higher among returning combat vets - but you'd be wrong.
Sharp readers noted that there's another reduction that must be applied to the military totals above. You see, the percentages given were percentages of patients. Repeating:
Records show that 20% of eligible ex-soldiers came to VA hospitals seeking medical treatment between October 2003 and February 2005. Overall, 26% of them were diagnosed with mental disorders.
So only about one quarter of one fifth of all vets were diagnosed with any disorder. Since I took math in college I'll tell you this means only 5% of all vets were diagnosed with anything. So in reality, only 2% (10% of 20%) were diagnosed with PTSD - and this was the most common diagnosis.
If all the various claims above are accurate - and I've no reason to dispute them, the numbers turn out like this:
Percentages of all Americans / OIF and OEF Vets with
PTSD: 2.4% / 2%
Drug/Alcohol abuse: 9.4% / 1.8%
Depression: 6.6% / 1.4%
Anxiety disorders (phobias and panic): 6% / 1.2%
Let's be clear about this: returning vets deserve the best treatment available. Spare no expense! But these numbers for my fellow vets are so low they're stunning, especially in an article headlined "Mental Disorders Are On The Rise Among Afghanistan, Iraq Veterans - Funding cuts could overburden system". While that might be factual, it also appears intentionally deceptive.
Another important disctinction is that the majority of cases would be classified as mild.Posted by Dave B at March 31, 2005 09:51 PM
The few sensational cases will be no doubt played up strongly in the press. Likewise, as with many incidents involving "Vietnam veterans" the media will never recant when it turns out that the homeless guy/bank robber/wife beater they did the big lead story on yesterday was lying about being a vet.Posted by Colorado Kid at March 31, 2005 10:02 PM
The NEJM has a history of deceptive and ideologically driven reporting in its journal. That's not to say it isn't esteemed for 90% of the articles within, ubt some others have been heavily criticized. It's not what it used to be... like the Lancet, but not quite as bad.
Remember the '50% of all bankruptcies caused by medical bills' article that turned out to be junk science?Posted by Max at March 31, 2005 10:11 PM
Ahhh.. but the numbers are legit. It's the spin that won't be. Expect lots of stories using that 1 in 4 figure, without specifying that's 1 in 4 of teh twenty percent that came in at all. Ditto that 10% with PTSD number. It's born to be a victim of lefty reality abuse.Posted by DK at March 31, 2005 10:21 PM
Good job! Hard to keep the MSM honest.Posted by Rod Stanton at March 31, 2005 10:27 PM
I agree that the numbers in the article are misleading...
But your numbers assume that the 80% of veterans who did not go to the VA were not experiencing any of the afflictions mentioned. I don't think we can be so sure that there aren't undiagnosed or untreated cases of PTSD, depression or alcoholism out there.Posted by Jay at March 31, 2005 11:31 PM
Nice post. Lying with statistics is a pretty old game. Catching people at it - priceless.Posted by EagleSpeak at April 1, 2005 12:40 AM
Beautiful post, Greyhawk!
I remember the Media War Cry of Iraq suicides, parroted by Andy Rooney. Shot that down the day it was released and again the day Andy Rooney blathered about it.
Your post is that X's Ten!
Excellent. Thank you for the application of common sense and diligent research.
Cheers!Posted by USMC_Vet at April 1, 2005 01:00 AM
Jay is right; your numbers are probably too low, because it's not an apples-to-apples comparison.
You've certainly discredited the figures used in this article (which is your main point), but you haven't conclusively shown that the true figures for vets are actually lower than the population as a whole (although I wouldn't be surprised for most of them other than PTSD).
Jay is not right.
We are dealing with averages. Even if the 80% who do not go to the VA experience "average" problems with alcoholism, PTSD, etc, there is no increase among the Iraq, Afghanistan veteran population as compared to the population as a whole.
And what Greyhawk is pointing out is that even among the 20% who did show at the VA, the results were, in most cases, at or below the level of the same problems experienced by average Americans.
My daughter's teacher told the class about this report in their 8th grade Global Awareness (propaganda) class. When she told me after school I did some similar research and emailed the teacher to check his facts before teaching propaganda. Your research is much better. I have 16 years active duty and many of my daughter's teachers are learning to hate me. I teach my daughter to think for herself and to question everything.
The one thing you didn't comment upon is the old canard that VA benefits are being "cut". Actually, the 2005 budget shows a modest increase in VA benefits, not a "cut", as does the projected 2006 budget. The increase is less than last year's, and not as high as asked for, but it IS an increase.Posted by Old Patriot at April 1, 2005 02:45 AM
Wow. Guess I am one of the lucky ones as well. Come to think of it, so are the other 6 guys I work with. What are the odds of that?Posted by OIF at April 1, 2005 02:49 AM
Jay, I see your point, but who is to say there are no civillians who are undiognosed or untreated out there?Posted by Friend at April 1, 2005 04:08 AM
The estimates for the civilian population are supposed to take undiagnosed cases into account, in theory.
The true numbers for the military population as a whole fall somewhere between the numbers in the article and Greyhawk's second set of figures. Where exactly they fall is hard to estimate; it depends on how closely correlated the condition is with seeking medical treatment.
For example: if this article had said that 20% of soldiers being treated have green eyes, it would be safe to assume that 20% of soldiers have green eyes, since eye color and hospital visitation are uncorrelated. But if this article had said that 100% of soldiers being treated have medical problems, this would not mean that 100% of all soldiers have medical problems, since having a medical problem and visiting the hospital are highly correlated.
So if I had to guess, I'd say that the true number of PTSD sufferers is closer to the low number (2%) while the true number of alcoholics is closer to the high number (9%). But that's just a guess.
Anyhow, these ranges fall at or below national averages; Greyhawk's point is proven. USA Today is basically lying to us.
Yeah, it's obviously a flawed story. But my problem with it is that they put it on the front page of the paper. This should have been a brief.Posted by Joey at April 1, 2005 06:03 AM
What is also no reported is that when ANY vet goes to a VA center, clinic or hospital and says "I just came back from Iraq/Afghanistan and I find my self getting pissed off alot more than I used to" it gets reported as a case of PTSD. This inflates the numbers and is used to justify more money for VA centers I would imagine. Not that they don't need the money to fo their job, but it looks like the MSM is just retredding the "Crazy Viet Vet" myth for modern consumption.Posted by SGT TED at April 1, 2005 06:08 PM
Well, this report may not be valid, but we vets will probably have to fight to keep our earned VA benefits, and keep them from being eroded. American politicians have short memories after the vets come home and the parades are over.Posted by SFC SKI at April 1, 2005 07:49 PM
Here's my problem with the report. It claims that the numbers are rising, but it doesn't say how it's rising (raw numbers, proportion of vets checking in, etc.), or what it's rising from. What was the # before?
In other words, don't trust the media to report science accurately or competantly.
This is my issue with the related hype. It paints a broad picture that all returning vets are going to be psycho. As an OIF vet, I take very serious offense to that. As a medical type, I understand that folks react to different stress in different ways. I was never in any serious firefights, but I wasn't sheltered from death and gory stuff either. AND I'M FINE! As are the majority of vets coming home. As are the vast majority of the Vietnam Vets. Yeah, we have some issues, but to say we're all going to get PTSD is ludicrous.Posted by armynurseboy at April 1, 2005 10:07 PM
Ouch! Beautifully organized.Posted by Clay at April 1, 2005 11:03 PM
Another difficulty is that PTSD is *much* more likely to be diagnosed in a vet than a civilian. Given two cases with identical histories and symptoms, a doctor would be much more likely to attribute the symptoms to PTSD in a vet than a civilian.
Of course, it really is impossible to glean any useful information from the article. Military types are a very different demographic than the population at large. I assume that overall there is less mental illness, less substance abuse, etc since they wouldn't be accepted in the first place. The best study would compare rates of disorders in combat vets and members of the military who have not seen combat. It would be relatively simple. However, even this would tell us nothing more than war is mentally stressful, which is not big surprise. Any way you slice it, this is not a story.
Well, I am sure that a couple of people here know from which they speak.
I am not including of course the people at MSM which know not of what they speak.
But I can speak a little about this subject (PTSD).
When I got back to the world in late 69 and after I got out of W. Reed in sprink 70, and after I had been able to get out of the house and get almost back to "normal" and consider getting a job (sometime in the late summer of 70), I thought that I was fine and dandy. Even if I had such a scar running from almost top to bottom in the left side of my back and numerous pieces of metal still trying to find their way out all over me, which gives new meaning to the words from a pretty girl, " what are all those red bumps"?
Any way to shorten this up by about TWENTY YEARS.
I stumbled, weaved, drank and screwed up my life until 1989, when my (sixth or seventh, I don't really know) ex-boss (he had just fired me as most of the other ones had) took me and a six pack to the Local VA Hospital (kinda local, 45 miles away).
Once deposited and introduced and all the thousands of pages of forms filled out by a helpful ex vet, I began my real homecoming and journey back to the world of the "normal".
I finished my tearing down and re-building of my soul sometime in the mid ninetys. It will never really be completed, you know..but brick by broken brick, it is being rebuilt and improved.
In 2001, the most expert and hard worker came into this world to help ol' Papa rebuild his soul and to help her grow up to be the most beautiful and light of his life. "Sweet Sarah", the little terror, the most beautiful Grand Daughter an old man could want, is giving me a new outlook and reason to continue on. To help her learn and grow into a young girl.
And if God permits, to be here when she is a young woman, on the way to the rest of her life.