Can better medical records prevent Iraq War syndrome?

Sloppy and incomplete medical records made it nearly impossible to pin down the cause of Gulf War syndrome, a mysterious set of immune and cognitive ailments possibly linked to chemical, vaccine, or pathogen exposure by soldiers.

Before the recent wars in Iraq and Afghanistan, military health officials were determined to avoid these mistakes, and they’ve spent the past decade monitoring veterans' health.

Sam Kean reports for Science.

Because soldiers would be returning to Iraq in 2003, some experts on Gulf War syndrome feared a reprise of the 1990s fiasco. So epidemiological studies were set up to monitor service-member health, and millions were spent on environmental surveillance.

• The US Army collected 25,000 samples of air, water, soil, and other materials in Iraq and Afghanistan, monitoring everything from garbage-pit burns to fires in sulfur mines.
• The Defense Medical Surveillance System holds data on 9.3 million personnel and houses 54 million serum samples; and it started linking samples to databases about post-deployment health.

In contrast to the earlier Gulf War, health officials know in general what service members were exposed to during the recent wars, and doctors can take that into account when making diagnoses.

One thing seems clear already: there's no Iraq War syndrome. However, mental health has emerged as the big concern of the Iraq and Afghanistan wars.

• An Army program called Re-Engineering Systems of Primary Care Treatment in the Military (RESPECT-Mil) has trained 2,700 primary care doctors and nurses to spot signs of anxiety, depression, posttraumatic stress disorder (PTSD), and, soon, alcohol abuse, by running through a standard list of questions during medical appointments with veterans.
• Of the 1.9 million screenings so far, 16,000 have been positive for suicidal thoughts. (The military also set up a veterans' suicide hotline to provide counseling.)
• To screen service members right before and after deployment, personnel fill out questionnaires that probe for signs of stress disorder, depression, pain, exposure to chemicals, and signs of traumatic brain injury. Up to 15% of returning service members show signs of mild brain injury.

Military physicians have also published studies within the last decade on connections between physical and psychological trauma.

• Of service members injured at least once, 31.8% had PTSD, compared with 13.6% among those never injured.
• Blasts or other blows that made service members lose consciousness, even for seconds, led to more PTSD than blows that left them merely dazed or seeing stars.
• Comparing an evaluation of veterans right after deployment and a reassessment 3 to 6 months later showed a significant jump in overall risk for mental health problems – suggesting how many service members didn’t admit to mental struggles until they left a military setting. (The military has now instituted new waves of post-deployment screening to identify more at-risk veterans.)

A 2009 report from the Government Accountability Office examined a Department of Defense repository that houses some post-deployment health reports needed for screening and assessment. Of 319,000 service members returning from combat over 17 months in 2007 and 2008, around 23% – well over 70,000 service members – had no report in the database.

Since then, the number of service members who complete reports has risen 8%, but that still leaves tens of thousands missing.

Perhaps it’s a privacy issue. A study from last year showed how soldiers were much more likely to admit to signs of PTSD or depression when anonymous, and more than three times more likely to admit thoughts of suicide.

Even if soldiers do reach out for professional help, some investigators found, they often must wait weeks for a response. And beyond the bureaucratic issues, one big problem is a stigma associated with seeking help – though attitudes have improved. According to Colonel Charles Engel at the Uniformed Services University of the Health Sciences: “It's a brand-new thing for senior military leaders to acknowledge that we need to look out for these things.”

[Via “From Soldiers to Veterans, Good Health to Bad” in Science]

Images by the US Army via Flickr

This post was originally published on Smartplanet.com