Anxiety, post-traumatic stress disorder and record-high suicide rates are haunting American veterans of the wars in Iraq and Afghanistan, amid a taboo over mental distress.
At the Walter Reed Army Medical Center in Washington, psychological help is part and parcel of the care provided to soldiers wounded in combat, according to Colonel John Bradley, chief of the hospital's psychiatric department.
"We don't wait for a declaration of emotional distress or dysfunction but we rather see the patient right from the beginning. We are looking for early signs of PTSD (post-traumatic stress disorder), depression or difficulty coping with their battle injuries," he told AFP.
Insomnia, violent nightmares, high agitation and a constant state of high alert are some of the more common PTSD symptoms, he explained.
"When I came back, initially I would have dreams that I wouldn't remember, things like that. You go through some pretty nasty things," Staff Sergeant Michael Downing, a double amputee and a veteran of the war in Afghanistan, said in an interview.
But at Walter Reed, "they help you with PTSD, brain traumatic injuries.... Here, I am talking to a lot of soldiers, people who have been through what you've been through and it kind of helps," he added.
According to Bradley, 10 to 15 percent of wounded veterans treated at Walter Reed suffer from PTSD. But he admitted the proportion is likely higher among all Iraq and Afghanistan veterans, who do not all benefit from preventive care and treatment at a medical facility.
More US soldiers committed suicide in January than were killed in combat in both wars combined that month. According to official figures a record 128 soldiers took their lives last year, up from 115 in 2007, as tours of duty in the past seven years come ever more frequently and last longer.
The 20.2 per 100,000 suicide rate among US soldiers is above the national record of 19.5 per 100,000 in 2005 in the United States.
But mental distress is sometimes difficult to detect, especially in a community that values the combat-hardened and shuns weakness.
In a 2008 poll by the American Psychological Association (APA), 61 percent of servicemen and women said that asking for help to treat psychological problems would have a negative impact on their career, and 53 percent said it would decrease their status among their peers.
"There is still a stigma," admitted General Carter Ham, Commander of US Army Europe.
"There is still a culture out there that says if you have to go get help, that's a sign of weakness. And we've got to defeat that."
In response to the alarming statistics, the Pentagon has launched suicide prevention programs and stepped up its efforts to screen psychological problems.
At Walter Reed, medical personnel also provide support to veterans' families, which have been hit hard with the long absences of their loved ones and the wounds they sustain in combat.
"There is all sorts of anxiety about how roles are going to change in the family: will I be able to throw ball with my son, how much responsibility is going to shift to the spouse. There are also concerns about the finances, if this injury is going to lead to retirement," said Bradley.
But for soldiers and their families alike, the battle is far from over.
While President Barack Obama has announced the withdrawal of all US forces from Iraq by the end of 2011, he has authorized the deployment of another 17,000 soldiers to Afghanistan.