Military doctors have discovered that signs of post-traumatic stress disorder and alcohol abuse are often only showing up in a second medical examination given to the troops some three to six months after coming home.
The study of some 88,235 soldiers found that on their second evaluation some 10,288 or about 11.7 percent were prescribed some kind of psychiatric care, compared to 3,925 (4.4 percent) on their first evaluation, given just after they return from the field.
The study in the Journal of the American Medical Association found that by combining the figures some 20.3 percent of active soldiers and 42.4 percent of reserves had been diagnosed with some kind of mental health problem, linked to their experiences in Iraq and Afghanistan.
It was the second study initiated by the Department of Defense after an earlier one "raised concerns that mental health problems might be missed because of the early timing of this screening," the authors of the study wrote.
The second study, carried out via a questionnaire and an interview with a clinicians, "found that soldiers reported more mental health concerns, such as post-traumatic stress disorder (PTSD), major depression or alcohol misuse during the later screening."
"The study shows that the rates that we previously reported based on surveys taken immediately on return from deployment substantially underestimate the mental health burden," the authors write.
"This emphasizes the enormous opportunity for a better-resourced Department of Defense mental health system to intervene early before soldiers leave active duty."
Concerns about conflicts, especially within the family, also quadrupled between the first and second examinations of the returning soldiers, the study said.
"Increased relationship problems underscore shortcomings in services for family members," the authors from the Walter Reed Army Institute of Research wrote.
"Soldiers frequently reported alcohol concerns, yet very few were referred to alcohol treatment," added the report.
But all those with some kind of mental health care problem had either already been treated or were receiving some kind of medical care, the study noted.
And although soldiers were more likely to report symptoms of post-traumatic stress disorder on their second screening, between 49 to 59 percent of those diagnosed on their first test had shown some improvement.
"Among active component soldiers, use of mental health services increased substantially following the later screening, especially within 30 days of the assessment," the report added.