Personal Stress Explained
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Personal Stress
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Soldiers Say Combat Stress Second to
Personal Stress
Christine Lehmann
A mental health team assigned to help soldiers in Iraq deal with trauma
and stress finds that soldiers need more help with mental health issues
related to interpersonal problems than they are getting.
In old war movies, soldiers were always men who had sweethearts back home.
Occasionally, a soldier would receive a painful "Dear John" letter that
underscored the downside to Army life.
Some things have changed since then—women are soldiers in today’s Army,
and soldiers are just as likely to serve in peacekeeping missions as they
are in war action.
But marriage is still a domestic casualty of Army deployments, and Dear
John or Dear Jane letters are still received by soldiers, according to
Maj. Robert Cardona, a U.S. Army psychiatrist assigned to a combat stress
control (CSC) unit, the 98th Medical Detachment, in Mosul in northern Iraq
for the past year. Cardona was interviewed online by Psychiatric News last
August and again last month. He recently returned home to Fort Sill, Okla.
Because U.S. Army Combat Stress Units in Iraq are situated close to where
soldiers are serving, those who need mental health care can get it
quickly.
In the past year, four CSC medical detachments, including the 98th, and
one CSC company of nine combat stress teams were in Iraq. A typical CSC
has three prevention teams, each with a psychiatrist, a social worker, and
mental health technicians, Cardona explained. Another common element is a
restoration team consisting of a psychologist, occupational therapist, and
clinical nurse practitioner, he said.
The units’ mission involves supplementing the work of division and
hospital psychiatrists and mental health professionals, said Cardona.
More than 100, 000 U.S. soldiers have been sent to Iraq during the past
year, often not seeing their family for one year. More replacements will
be sent this year to help keep peace during the shift to self-rule in
Iraq. Cardona described northern Iraq as a combat zone in which U.S.
soldiers are targets of daily mortar attacks by hostile forces.
Most soldiers are aware of combat stress reactions from their training and
from Army education campaigns. Many sought help from the 98th CSC before
being sent back home, Cardona said.
"These soldiers were concerned that they would become violent and injure a
family member or someone else back home. They were aware that [several]
soldiers at Fort Bragg had become violent after returning from duty in
Afghanistan a few years ago, " he pointed out.
Relationship Issues Intensified
Between 60 percent and 90 percent of the 1, 500 soldiers seen in the past
year by the 98th medical detachment and by division psychiatrists had
interpersonal problems. "The real stress results from family, personal,
and work interpersonal issues that are intensified in deployment to a
combat zone, " Cardona said.
Soldiers with major depression can be successfully treated in the field in
most cases. Minor depression and anxiety are more common, and treatment
consists of antidepressant medication and/or a series of brief cognitive-behavioral
therapy interventions, according to Cardona.
Several Developed Psychosis
"Early in the deployment, we used medication to treat a handful of
individuals who experienced their first psychotic or manic episode, " he
noted.
About 8 percent of soldiers treated by the 98th CSC had acute stress
reactions to combat-related attacks on them or their convoys. Their
symptoms including nightmares, insomnia, excessive guilt, anxiety, and an
exaggerated startle response. These symptoms typically remitted in less
than one week with treatment, said Cardona.
Occasionally, there were exceptions. For example, after a soldier saw the
violent death of another soldier during a convoy attack, the experience
triggered troubling memories of how a family member had died, memories
that interfered with his ability to carry out his duties.
"The soldier avoided driving the truck, where he was located after the
attack. He was placed in a restoration unit for four days and then
returned to his unit. His nightmares continued, and he became increasingly
depressed and ultimately suicidal, even though he was receiving medication
and changes were made to his work detail, " Cardona said.
The soldier required hospitalization and medical evacuation to Landstuhl
Regional Medical Center in Germany, Cardona added.
The number of soldiers evacuated from Iraq for mental health problems
nearly doubled between September 2003 and last January. In September, 478
soldiers were evacuated, and by January between 800 and 1, 000 soldiers
were evacuated for mental health reasons. They were treated at Landstuhl
Regional Medical Center in Germany, Cardona stated.
Of the total soldiers evacuated from Iraq, 5 percent to 10 percent were
based in northern Iraq, where 20 percent of U.S. soldiers were stationed
at the time, he noted.
The suicide rate for U.S. soldiers in Iraq last year was higher than the
average entire Army rate for last year, according to a new report released
last month by an Army Mental Health Assessment Team. The team interviewed
soldiers in Iraq between last August and October, according to the report.
At least 24 soldiers committed suicide in Iraq and Kuwait last year.
Cardona said there were no suicides in the northern region, where he was
based.
The Mental Health Assessment Team’s count equates to a suicide rate of
17.3 per 100, 000 soldiers, which is higher than the entire U.S. Army’s
rate of 12.8 suicides per 100, 000 soldiers last year.
The team’s official number did not include three soldiers who committed
suicide when they returned to the United States.
Investigators found a pattern among the soldiers who committed
suicide—they faced personal financial problems, failed personal
relationships, and legal problems, according to the report. The
investigators also found that the soldiers tended to avoid seeking help
for stress or mental health problems out of concern about being
stigmatized.
The team recommended placing more psychiatrists and mental health
professionals in Iraq and Kuwait and training soldiers to recognize signs
of mental health problems using the buddy system.
One reason that the Mosul region may not have had suicides was the CSC’s
decision early on to focus most of its resources on meeting the mental
health needs of the majority of soldiers who were having interpersonal
problems rather than combat-related stress reactions, Cardona said.
"We focused on managing soldiers already experiencing mental health
problems or needing treatment for psychiatric disorders, " Cardona stated.
The Army’s Mental Health Assessment Team report review of suicides (Annex
D) is posted online at www.armymedicine.army.mil/news/mhat/annex_d.pdf.
The U.S. Army’s "4Health Deployment Guide, " written by military
psychiatrists, is posted online at www.hooah4health.com/deployment/familymatters/emotionalcyle.htm;
the American Academy of Child and Adolescent Psychiatry’s "Facts for
Families, " a publication for families in the military, is posted at
www.aacap.org/publications/factsfam//88.htm. {blacksquare}
***** o0o*****
Personal Stress
Benefits of less Stress
Reduce Stress
Recover from Stress
Problems with Stress
Overcoming Stress
Stress and the Fear of
Depression
Stress for Individuals
***** o0o*****
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