Multiple combat tours linked to mental strain, disease

The Army sergeant accused of killing 16 Afghan men, women and children on Sunday was reportedly on his fourth combat tour and had suffered a traumatic brain injury when his vehicle rolled over in 2010. He served three deployments in Iraq and was currently on his fourth tour of duty, this time in Afghanistan.

There is no way of knowing if the sergeant's brain injury and multiple deployments are related to the brutal crime he allegedly committed. But the incident highlights the enormous strain the country's beleaguered all-volunteer military force is under. The longest war in U.S. history has meant extensive and frequent deployments with troops now reporting mental illness at record rates.

The Army's own research has shown that a higher rate of soldiers are diagnosed with post-traumatic stress disorder (PTSD) after their second deployment, and that multiple deployments put soldiers at risk for a slew of mental problems. An Institute of Medicine study found that 27 percent of "those who deployed 3-4 times received diagnoses of depression, anxiety or acute stress compared to 12% of those deployed just once." As of the end of last year, the Army had more than 125,000 soldiers who have been deployed three to four times. The Army recently moved to shorten deployments from 12 to nine months and to lengthen rest periods between them.

The group Iraq Veterans Against the War has called for an end to multiple deployments, citing this mental strain. Member Alejandro Villatoro, an Army reservist sergeant who was deployed in 2003 to Iraq and in 2010 to Afghanistan, tells Yahoo News that he thinks most soldiers volunteer for multiple deployments for financial reasons, and that it should raise a red flag if someone is asking to serve many combat tours. One of Villatoro's comrades volunteered for a fifth tour of duty in seven years, in part because of a lack of job opportunities in his home state. (Unemployment rates are higher for veterans than for the general population.) "Just because the soldier's not suicidal or poses no danger to other people doesn't mean that they're OK," he said. "It's just the fact that he doesn't feel comfortable going back home because he has no life there anymore." Another man in Villatoro's unit assaulted his wife after returning home from his first deployment. He had shown behavioral issues in Afghanistan, and at one point had to have his weapon temporarily taken away, he says. But no one wanted to report him outside the company. "They would hide a lot of these incidents under the table just to keep a clean record," Villatoro says.

The Army reported increases in domestic violence, child abuse and violent sexual assault cases from 2006 to 2011. People suffering from PTSD are more likely to engage in violent behavior than those without the disease.

But four-star General Peter Chiarelli, who retired as Army vice chief of staff in January, tells Yahoo News that most soldiers are fully capable of multiple deployments. Chiarelli led the Army's effort to remove the stigma associated with seeking mental health counseling. (About 50 percent of soldiers in a 2011 survey said seeking professional help for mental problems would make them appear weak.)

"We've got thousands and thousands and thousand of soldiers who've gone on multiple deployments and not displayed any issues associated with post traumatic stress and traumatic brain injury," he says. "I think it's based on the individual." Chiarelli is now CEO of the nonprofit One Mind for Research, which supports brain research. In the Army, Chiarelli became frustrated with how difficult it was to diagnose soldiers who suffered brain injuries or mental disorders. "Incidents like this underline for me even more clearly really how much we don't understand," he says of the shootings.

"If you walk into a room of people with a blood pressure cuff, you could tell pretty quickly who has high blood pressure and who doesn't. If you walk into a room with 100 soldiers with mental health problems, because of the stigma some would deny ... they have the symptoms, that they have the problem."

A Pew Center survey in 2011 found that nearly 4 in 10 post-9/11 veterans believe they suffer from post traumatic stress, even if they were not diagnosed. Just 16 percent of veterans of earlier wars said the same. The medical center at the Lewis-McChord Army base, where the soldier accused in the killings was stationed, is under investigation for allegedly downgrading hundreds of PTSD diagnoses to other mental conditions like anxiety disorder, in what some say was an effort to avoid costly PTSD benefits. A PTSD diagnosis means a soldier can no longer be deployed and can receive disability payments. Meanwhile, 200,000 troops have been diagnosed with traumatic brain injuries, which are correlated with violent behavior and are believed to increase the likelihood of developing PTSD. An NPR investigation in 2010 found that the military was under-diagnosing and treating traumatic brain injuries.

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