The US Army has aid that there is declining morale and a reluctance to seek help for anxiety fueled by repeated combat tours. These are the findings of a survey among troops stationed in Afghanistan.
A similar assessment in Iraq this year showed fewer soldiers suffering psychological problems compared to previous years, as violence levels there fall, the army said.
The findings came as President Barack Obama faces a pivotal decision on sending additional forces to Afghanistan and amid renewed scrutiny of the mental fitness of American troops after the Fort Hood shootings last week.Related article: Obama promises Afghan decision
The suspected gunman in the assault, Major Nidal Hasan, was due to deploy to Afghanistan and some of the victims in the shooting included his comrades also assigned to help soldiers there traumatized by combat.Related article: Fort Hood shooter paralyzed
The mental health survey showed soldiers in Afghanistan "reported higher combat exposure and lower unit morale compared to previous years," the army said.
Only 5.7 percent of soldiers surveyed in Afghanistan rated morale for their units as high or very high, compared to 10.2 percent in 2007, according to the assessment.
But soldiers were more positive about their personal morale, with 17.6 percent saying their own morale was high compared to 15.4 percent two years ago.
The assessment underlined the psychological toll of repeated deployments as well as a lack of time home between combat tours, which commanders have cited as key factors in a rise in suicides and depression.
Despite a major push by the military to encourage troubled soldiers to seek help, mental health problems still carried a stigma for many troops, the report said.
In interviews with soldiers quoted in the report, non-commissioned officers said seeking out help was "seen as breaking."
"If you go to the shrink you are trying to get out of the army," said one.
Another NCO said that "to many, going to mental health (doctors) is a sign of weakness or a sign you don't want to deploy again."
Lieutenant General Eric Schoomaker, the army surgeon general, acknowledged that removing the stigma was a "tough problem," especially among soldiers on combat missions.
"In this group of folks, there is a perceived weakness in coming forward with problems they might be experiencing," Schoomaker told reporters in a teleconference.
For lower-ranking enlisted males in the Afghan war -- the soldiers who often spend more time "outside the wire" of a base and in combat -- the survey found 21.4 percent had acute stress, anxiety or depression. That figure was slightly down from 23.4 percent in 2007 but much higher than the 10.4 percent in 2005.
Soldiers in Afghanistan who had gone through three or more deployments were "significantly more likely to meet the criteria for a psychological problem" than those on their first and second tour, the report said.
Among troops facing three or more deployments, 31 percent were suffering from mental health problems compared to 18.1 percent of soldiers on their second deployment and 13.6 percent on their first combat tour, it said.
And marital problems were dramatically higher among soldiers with three or more combat tours, with 30.8 percent experiencing marital crises compared to 14.3 percent for those on their first deployment.
The assessment found that the rate of mental health problems for combat units fell significantly after soldiers had two years back home and returned to peacetime levels after 30 to 36 months between deployments.
Soldiers at the moment tend to have about one year of "dwell time" between combat tours.
The team that carried out the surveys recommended the army deploy more mental health specialists to Afghanistan -- where soldiers reported increasing problems getting access to care -- to reach a ratio of one provider for every 700 soldiers.
Currently, the ratio is one to 1,123 but officers said more than 60 mental health specialists were due to deploy.
"We are making adjustments right now in the request for forces to come within the one to 700 ratio," Schoomaker said.
The rugged Afghan terrain, difficult weather and the dispersal of troops in smaller outposts required more mental health teams to reach soldiers who needed help, he said.