Insufficient combat stress help for US troops faulted

By Will Dunham

WASHINGTON (Reuters) - Only 22 percent of U.S. troops returning from Iraq and Afghanistan seen at risk for Post-Traumatic Stress Disorder have been referred by Pentagon officials for mental health evaluation, a report has found.

Thursday's report by the Government Accountability Office, the investigative arm of Congress, found the Pentagon did not provide reasonable assurance that troops who needed referral for evaluation for combat-related stress actually got it.

Investigators found that 9,145 of 178,664 troops -- about 5 percent -- who served in Iraq or Afghanistan may have been at risk for developing Post-Traumatic Stress Disorder based on responses they gave to a Defense Department questionnaire. Among Army soldiers, the figure was 6.4 percent.

Of those at risk, the report found that Pentagon health care providers referred 22 percent for further mental health evaluations, with the rate differing among Army, Marine Corps, Navy and Air Force personnel.

The study looked at troops deployed through the end of September 2004.

The report said the Pentagon did not identify the factors that its health-care providers used in determining which troops merited mental-health referrals.

Experts say the disorder's symptoms include irritability or outbursts of anger, sleep difficulties, trouble concentrating, extreme vigilance and an exaggerated startle response. A person may initially respond to the trauma with horror or helplessness, then may persistently relive the event.

William Winkenwerder, assistant secretary of defense for health affairs, took issue with the report's suggestion that some troops who might have needed help did not get it.

In a statement included as part of the report, the Pentagon said a negative reaction to the stress and trauma of combat is "just a part of human nature."

"If these normal reactions to an abnormal situation are immediately medicalized, the individual takes on a patient role and the symptoms that may dissipate with rest and restoration tend to persist," the Pentagon stated.

The Pentagon questionnaire contained questions intended to screen for risk of the disorder. They involved whether a person had a traumatic experience that caused him in the past month to have nightmares about it, feelings of numbness or detachment from others, to try hard not to think about it, and to be constantly on guard or easily startled.