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Publication Briefs

Mental Health Diagnoses among OEF/OIF Veterans Increased Rapidly Following Invasion of Iraq


  • The prevalence of new mental health diagnoses among OEF/OIF Veterans using VA healthcare increased rapidly following the Iraq invasion. Among the 289,328 Veterans in this study, new mental health diagnoses increased 6-fold from 6.4% in April of 2002 to 36.9% by March 2008.
  • 21.8% of Veterans were diagnosed with post-traumatic stress disorder (PTSD), and 17.4% with depression. Two-year prevalence rates of PTSD increased 4-7 times after the invasion of Iraq.
  • The youngest active duty OEF/OIF Veterans (< 25 years) were at nearly twice the risk for PTSD, more than twice the risk for alcohol use disorders, and at a nearly 5-fold risk for drug use disorders than older active duty Veterans (> 40 years).
  • Among National Guard/Reserve Veterans, those older than age 40 were at greater risk for PTSD and depression. Women Veterans from both service components (active duty and Guard/Reserve) were at higher risk for depression, while male Veterans were at greater risk for drug use disorders.
  • Authors suggest that early targeted interventions may prevent chronic mental illness.

To date, more than 1.6 million Veterans have served in Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq. This study sought to investigate longitudinal trends and risk factors for mental health diagnoses among Veterans from these Operations. Using VA data, investigators identified 289,328 OEF/OIF Veterans who were first-time users of VA healthcare between 4/02 and 3/08, following their military service. Investigators examined new mental health diagnoses among this cohort and cohort subgroups (i.e., women, younger Veterans), as well as two-year prevalence rates. Investigators designated a broader definition of "mental health problems," which included psychosocial and behavioral problems (i.e., marital/family problems), focusing on four mental health disorders associated with military service: PTSD, depression, alcohol use disorders, and drug use disorders.


  • These results are not generalizable to all OEF/OIF Veterans; e.g., rates of new mental health diagnoses may be higher in Veterans who use VA healthcare versus non-VA users.
  • Findings are based on ICD-9-CM codes, which are subject to physician or patient reporting biases and/or clerical errors.

This study was funded by HSR&D. Drs. Seal, Maguen, and Marmar are affiliated with HSR&D’s Program to Improve Care for Veterans with Complex Comorbid Conditions in San Francisco.

PubMed Logo Seal KH, Metzler TJ, Gima KS, Bertenthal D, Maguen S, Marmar CR. Trends and Risk Factors for Mental Health Diagnoses Among Iraq and Afghanistan Veterans Using Department of Veterans Affairs Health Care, 2002-2008. Am J Public Health. 2009 Jul 16. [Epub ahead of print]

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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