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Nearly one in five, or about 300,000, soldiers who has served in Iraq or Afghanistan has post-traumatic stress disorder or major depression — illnesses that could cost the U.S. as much as $6.2 billion over two years in care, lost productivity and lost lives through suicide, according to a RAND report released on Thursday, the Washington Post reports (Scott Tyson, Washington Post, 4/18). The study was based on telephone interviews conducted from August 2007 to January with 1,965 soldiers who have served in Iraq or Afghanistan, in some cases more than once. The soldiers interviewed live in 24 communities with high concentrations of service members, reservists and veterans. Researchers also conducted focus groups. About 1.6 million people have served in Iraq or Afghanistan in the past five years (Alvarez, New York Times, 4/18).
In total, 31% of Iraq and Afghanistan soldiers have experienced a brain injury, stress disorder, or both, the report found. The study found that 19.5% of service members experienced a concussion or other traumatic brain injury during their service (Barnes, Los Angeles Times, 4/18). Of soldiers who reported having a traumatic brain injury, 43% were evaluated by a physician. The report also found that about 7% of soldiers surveyed have a probable brain injury and currently have PTSD. PTSD and major depression were most prevalent in women and reservists, according to the report (Jelinek, AP/Miami Herald, 4/18). The treatment costs for brain injuries have not been determined, but according to the report, based on the number of traumatic brain injury cases diagnosed through June 2007, the cost is expected to be between $600 million and $900 million.
According to the report, the stress of war has resulted in a disproportionately high psychological toll compared with physical injuries. The report warns of "long-term, cascading consequences" for the U.S. if the mental health problems are not treated. Consequences include higher rates of drug use, suicide and unemployment, and increased marital problems (Washington Post, 4/18).
The study was funded by a grant from the Iraq Afghanistan Deployment Impact Fund at the California Community Foundation (Carter, Washington Times, 4/18).
Treatment
The report also found "serious gaps in mental health care," according to the Post. According to the report, 53% of service members with PTSD or depression had sought treatment from a provider in the past year, about half of whom received "minimally adequate" treatment. To care for all of the service members, thousands more certified mental health professionals are needed in both military and civilian sectors, as some veterans are seeking care outside of the Department of Veterans Affairs system because of stigma attached to mental illness, according to the report (Washington Post, 4/18).
Terri Tanielian, one of the study’s authors, said, "When we asked folks what was limiting them from getting the help that they need, among the top barriers that were reported were really negative career repercussions." While the treatment costs might seem high to government officials, failure to treat mental illness could cost the government billions of dollars, according to Lisa Jaycox, another one of the study’s authors. She said, "We make the case that investing in treatment early would prevent some of the negative consequences from unfolding and save money."
Recommendations
The study recommended allowing service members to receive mental health care "off the record," to avoid any possible stigma. Researchers also recommended that fitness-for-duty reports for redeployment not be based on a soldier’s decision to seek mental health care (Los Angeles Times, 4/18). According to Jaycox, Department of Defense Secretary Robert Gates is considering removing a question from security clearance questionnaires about soldiers’ health care history. Col. Loree Sutton, head of the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury, said removing the question would be a "big step forward to help our service members understand that seeking care, in fact, is a sign of strength" (New York Times, 4/18).
Gerald Cross, the VA’s principal deputy undersecretary for health, said VA was increasing outreach to veterans, regardless of whether they reported mental illness. Ira Katz, the VA’s mental health chief, said the VA budget for mental disorders increased from $2 billion in 2001 to $4 billion next year. However, Paul Sullivan, executive director of Veterans for Common Sense, said, "The VA is completely unprepared for the tidal wave," adding, "Unless the VA gets a massive amount of money (and) a set of new strong pro-veteran leaders, the situation will collapse" (Los Angeles Times, 4/18).
The report is available online.
Generic soma pills no prescription CBS’ "Evening News" on Thursday reported on the study. The segment includes comments from Carissa Picard of Military Spouses for Changes, Col. Casper Jones and a soldier diagnosed with PTSD (Dozier, "Evening News," CBS, 4/18). Video of the segment and expanded CBS News coverage are available online.
NBC’s "Nightly News" on Thursday also reported on the study. The segment includes comments from Tanielian and Sutton (Miklaszewski, "Nightly News," NBC, 4/17). Video of the segment is available online.
Reprinted with kind permission from You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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A study recommended by David Spiegel of Faculty of 1000 Medicine (), looks at the relationship between depression care management and survival rates in older patients. He identifies it as "an important and well-conducted study of the effects of treatment of depression on survival in a primary care setting"
A leading authority on mind-body interactions and professor of psychiatry and behavioural sciences at Stanford University, Spiegel evaluates the research published in the Annals of Internal Medicine, stressing the finding that "Comorbid depression shortens survival time with cancer, and intervention with medication and psychotherapy can therefore extend survival among cancer patients."
The better survival rates were not seen in patients with depression and cardiovascular disease, only in those with cancer. Spiegel notes that this "is surprising given the well-known link between depression and poor cardiovascular disease outcome".
He concludes, "Vigorous diagnosis and treatment programs for comorbid depression in cancer patients should, based on this study, extend survival time."
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Article adapted by Medical News Today from original press release.
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1 Dr. David Spiegel, Faculty Member for F1000 Medicine Psychiatry Specialty, is a global authority on mind-body interactions and professor of psychiatry and behavioural sciences at Stanford University
2 The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial.
Gallo JJ, Bogner HR, Morales KH, Post EP, Lin JY, Bruce ML
Ann Intern Med 2007 May 15 146(10):689-98

3 Faculty of 1000 Medicine’s evaluation of this article is available at
4 Faculty of 1000 Medicine, is a unique online service that helps clinicians and researchers stay informed of high impact articles and access the opinions of global leaders in medicine. Buy synthroid without prescription A distinguished international faculty select and evaluate key articles across medicine, providing a rapidly updated, authoritative guide to the medical literature that matters.
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The Journal of Environmental and Occupational Medicine (JOEM) has published a series of new studies that suggest depression in the workplace may be a much bigger problem - with more serious social and economic impacts - than employers realize.
The peer-reviewed journal has devoted an entire special-edition, titled "Depression in the Workplace," to the topic, with 15 papers prepared by experts on depression and workplace health. The special issue presents a comprehensive update on workplace depression and calls for a new approach to managing the disorder.
Among the findings highlighted in the special issue:
- Workplace depression closely tracks depression in the general population. More than six percent of the employed population meets criteria for major depressive disorder. When people with bipolar disorder and other forms of depression are added, the true rate is even higher.
- Only about half of depressed workers receive any treatment, and less than half of these receive care that is consistent with current treatment guidelines for organizations such as the American Psychiatric Association.
- Because so few workers are treated for depression, workplace productivity is impacted significantly. Studies show increases in absenteeism and unemployment, as well as disruptive effects on work organization and increased health and disability costs.
- Depression tends to strike workers earlier than other chronic diseases and may affect productivity for a much longer period. Unlike conditions such as cardiovascular disease or hypertension, depression often strikes very early in a worker’s career, creating a disease burden that may last for decades in the workplace.
Buy generic lasix The latest JOEM findings follow a major JOEM study released last summer indicating that the costs of health conditions such as depression, sleep disorders and fatigue have not been fully measured by employers. Using new measurement tools, including employee self-assessment, the study showed that conditions such as depression can be more costly than health conditions that have traditionally been assumed to be an organization’s key cost-drivers - such as cardiovascular disease and hypertension.
The JOEM study suggested that when measurements of health costs take into account factors such as absenteeism and presenteeism, conditions such as depression may be costing employers up to four times more than they realize in lost productivity.
The American College of Occupational and Environmental Medicine, which publishes JOEM, presented the special issue as the latest offering in its Depression in the Workplace Project, which is striving to raise awareness of the problem. Project co-directors are Garson M. Caruso, MD; and T. Larry Myette, MD.
"We are now beginning to fully realize how great an impact depression has on workplace productivity," said Dr. Myette. "Unlike other chronic conditions such as cardiovascular disease, depression may strike at a much earlier age - often in one’s twenties - so workers may experience disability throughout their working careers."
The result, he said, is an ongoing drain on productivity as those dealing with depression experience recurring episodes of the disease. "The average person has depression ten years before it is diagnosed," Dr. Myette said. "Sometimes it is not until the third or fourth depressive episode that depression is finally recognized."
The result is that over time, depression may cost employers thousands of dollars in productivity losses per affected employee - losses that can be lowered or prevented through effective treatment strategies.
"What we are trying to establish through research, and one of the major points of the entire Depression in the Workplace project, is that businesses can achieve a positive return on investment when they create programs to intervene and treat depression at its early stages," Dr. Caruso said. "More and more studies are now making this connection."
Conditions such as depression are more responsive, more quickly, in the workplace than others (diabetes, heart disease, etc.); offering employers an opportunity for greater return on dollars invested in treatment than may be recognized.
Having defined the scope of the problem, the JOEM issue examines promising approaches to improving the management of workplace depression, including programs to improve coping skills, screening programs and the promotion of early treatment. The JOEM studies also suggest that while antidepressant medications are effective for some depressed workers, specific types of psychotherapy may be underused.
The JOEM issue also calls for a new, collaborative approach to depression that integrates the best features of clinical, community and workplace programs.
About ACOEM
ACOEM, an international society of 5,000 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments.

About Journal of Occupational and Environmental Medicine
The Journal of Occupational and Environmental Medicine is the official publication of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.
Journal of Occupational and Environmental Medicine
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Researchers have long known that type-2 diabetes and depression often go hand in hand. However, it’s been unclear which condition develops first in patients who end up with both. Now, a new study led by Johns Hopkins doctors suggests that this chicken-and-egg problem has a dual answer: Patients with depression have an increased risk of developing type-2 diabetes, and patients with type-2 diabetes have an increased risk of developing depression.
For the study, published in the June 18 Journal of the American Medical Association, diabetes expert Sherita Hill Golden, M.D., M.H.S., and her colleagues took advantage of data generated by the Multi-Ethnic Study of Atherosclerosis (MESA), which examined risk factors for atherosclerosis, or hardening of the arteries, in an ethnically diverse group of 6,814 men and women between ages 45 to 84. Participants in the MESA study identified themselves when they enrolled as white, black, Hispanic or Chinese.
During MESA, participants made three visits to clinics over the course of three years to be examined for various atherosclerosis risk factors, including type-2 diabetes and symptoms of depression, which could serve as a precursor for full-blown clinical depression.
The study also collected information on other atherosclerosis risk factors, such as participants’ body-mass indices, blood pressure, diet and exercise patterns, and smoking habits, as well as information correlated with health in general, such as income and socioeconomic factors.
Mining the data for their own purposes, Golden and her colleagues excluded from their analysis all participants who had high fasting glucose, an indication of diabetes, at the initial clinic visit. They then looked to see whether participants who initially had elevated symptoms of depression, as indicated through a questionnaire, were more likely than those who didn’t to develop high fasting glucose at the end of the three-year study period.
Results showed that those with elevated depressive symptoms were 42 percent more likely overall to develop diabetes by the end of the study than those without these symptoms. Moreover, the stronger the symptoms, the higher the risk of diabetes, a "dose response" that lends strength to the findings.
Even when the researchers accounted for such factors as overweight, lack of exercise, and smoking, the risk of developing diabetes was still 34 percent higher for patients with depressive symptoms.
To investigate whether diabetes could lead to depression, Golden and her colleagues used the same pool of MESA information and excluded those who had elevated depressive symptoms at the initial clinic visit. Then, they looked to see whether those who had high fasting glucose with or without a formal diagnosis of diabetes were more likely to develop depressive symptoms by the end of the study.
The researchers found that patients treated for diabetes, about 9 percent of the group, were about 54 percent more likely to develop elevated depressive symptoms than those without diabetes.
Surprisingly, those with prediabetes or untreated diabetes were about 25 percent less likely to develop elevated depressive symptoms than people with normal fasting glucose, a finding Golden’s team cannot explain at this time.
Golden, an associate professor of medicine and epidemiology at the Johns Hopkins University School of Medicine, speculates that depression may lead patients to develop behaviors that trigger diabetes or make it worse, such as overeating, not exercising or smoking. Similarly, keeping up with the often extensive treatment regimens to care for their diabetes may make patients’ depression worse. Understanding how one condition might lead to another could improve treatments for both problems, she says.
"Having both diabetes and depression can make it difficult for patients to get the good clinical outcomes that we like to see for each of these conditions," says Golden. "To make sure that patients with diabetes and depression receive the best care, we wanted to get to the bottom of the connection between these two conditions.
"It’s important that doctors be attuned to look for both conditions in patients at risk for either diabetes or depression," Golden adds. "We may want to develop interventions for both treatments, instead of just one or the other."
generic ultram online buy Other Hopkins researchers who participated in this study include Mariana Lazo, M.D.. M.Sc.; Hochang Benjamin Lee, M.D.; and Constantine Lyketsos, M.D., M.H.S.
The MESA study was supported by grants from the National Heart, Lung, and Blood Institute. Golden and her colleagues’ research was supported by a Patient-Oriented Mentored Scientist Award through the National Institute of Diabetes and Digestive and Kidney Diseases.
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Older adults with low blood levels of vitamin D and high blood levels of a hormone secreted by the parathyroid glands may have a higher risk of depression, according to a report in the May issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
About 13 percent of older individuals have symptoms of depression, and other researchers have speculated that vitamin D may be linked to depression and other psychiatric illnesses, according to background information in the article. "Underlying causes of vitamin D deficiency such as less sun exposure as a result of decreased outdoor activity, different housing or clothing habits and decreased vitamin intake may be secondary to depression, but depression may also be the consequence of poor vitamin D status," the authors write. "Moreover, poor vitamin D status causes an increase in serum parathyroid hormone levels." Overactive parathyroid glands are frequently accompanied by symptoms of depression that disappear after treatment of the condition.
Witte J. G. Hoogendijk, M.D., Ph.D., and colleagues at VU University Medical Center, Vrije Universiteit Amsterdam, the Netherlands, measured blood levels of vitamin D and parathyroid hormone and assessed symptoms of depression among 1,282 community residents age 65 to 95. Buy propecia pills Of those individuals, 26 had a diagnosis of major depressive disorder, 169 had minor depression and 1,087 were not depressed. The average blood vitamin D level was 21 nanograms per milliliter and the average parathyroid hormone level was 3.6 picograms per milliliter.
Blood vitamin D levels were 14 percent lower in individuals with major and minor depression (average, 19 nanograms per milliliter) compared with non-depressed participants (average, 22 nanograms per milliliter). In addition, parathyroid hormone thyroid levels were an average of 5 percent higher in those with minor depression (average, 3.72 picograms per milliliter) and 33 percent higher in those with major depressive disorder (average, 4.69 picograms per milliliter) than in those who were not depressed (average, 3.53 picograms per milliliter).
The findings may be important to patients because both low blood vitamin D levels and high parathyroid hormone levels can be treated with higher dietary intake of vitamin D or calcium and increased sunlight exposure. "Moreover, the clinical relevance of the present study is underscored by our finding that 38.8 percent of men and 56.9 percent of women in our community-based cohort had an insufficient vitamin D status," they conclude. Additional studies are needed to determine whether changes in levels of vitamin D and parathyroid hormone precede depression or follow it.
Arch Gen Psychiatry. 2008;65[5]:508-512.
This study was supported by a clinical fellow grant from the Netherlands Organisation for Scientific Research.
Archives of General Psychiatry
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