WASHINGTON — U.S. troops on the battlefield found it harder to get the mental health care they needed last year, when violence rose in Afghanistan and new tactics pushed soldiers in Iraq farther from their operating bases.
A report the Army released Thursday recommends sending civilian psychiatrists to the warfront, supplementing members of the uniformed mental health corps.
Surveying a force strained by its seventh year of war, officials found that more than one in four soldiers on repeat tours of duty screened positive for anxiety, depression and other mental health problems. That was comparable to the previous year.
The report found more troops reported marital problems, an increased suicide rate, higher morale in Iraq, but a greater percentage of depression among soldiers in Afghanistan.
"They do show the effects of a long war," said Col. Elspeth Ritchie, psychiatry consultant to Army Surgeon General Lt. Gen. Eric Schoomaker.
Added Maj. Gen. Gale S. Pollock, a deputy surgeon general: "I think the fact that they are doing as well as they are with the demands they are under speaks to a strength and resiliency of the men and women of America."
The report was drawn from the work of a team of mental health experts who traveled to the wars last fall. The experts surveyed more than 2,200 soldiers in Iraq and nearly 900 in Afghanistan.
In the fifth such effort, the team also gathered information from more than 400 medical professionals, chaplains, psychiatrists, psychologists and other mental health workers deployed there.
The recommendation of civilian mental health professionals for battlefield duty is unusual. But civilian contract employees are doing many other jobs in Iraq, from security to providing food service.
The report also recommended longer home time between deployments, more focused suicide-prevention training and insurance coverage for marital and family counseling.
Among other findings were:
_More than 27 percent of troops on their third or fourth combat tour suffered anxiety, depression, post-combat stress and other problems. That compared with 12 percent among those on their first tour.
_Suicide rates "remained elevated" in both Iraq and Afghanistan. There were four in Afghanistan and 34 confirmed or suspected in Iraq. If all are confirmed, it would be the highest rate since the war began.
_The percentage of soldiers reporting depression in Afghanistan was higher than that in Iraq, and mental health problems in general were higher than they had previously been in Afghanistan. The adjusted rate last year for depression in Afghanistan was 11.4 percent, compared with 7.6 percent in Iraq.
Though U.S. troops suffered their highest level of casualties in both campaigns last year, that came as violence was decreasing in the five-year-old Iraq conflict and increasing in Afghanistan, now in its seventh year.
_As fighting against Taliban and al-Qaida fighters in Afghanistan worsened, 83 percent of soldiers there reported exposure to traumatic combat events _ a key factor in the risk for mental health among the troops.
_Having troops spread out and more isolated over the rugged terrain in a less developed Afghanistan occasionally made it more difficult for them to get mental health treatment.
_About 29 percent of soldiers in Iraq said it was difficult to get to mental health specialists for help. That was among troops who had moved from bases to combat outposts set up so they could be closer to the Iraq population. The number among troops not at the outposts who had trouble getting help was only 13 percent.
_Soldiers who had special "Battlemind" training reported fewer problems than those who did not. The program teaches troops and families what to expect before soldiers leave for the wars and what common problems to look for when readjusting to home life after deployment.
_Progress was made toward reducing the fear and embarrassment that keeps soldiers from asking for help with mental health problems. In 2007, 29 percent of those surveyed in Iraq said they feared seeking treatment would hurt their careers, down from 34 percent the previous year.
_Eleven percent of those surveyed in Iraq said their unit's morale was high or very high, compared with 7 percent the previous year. Individual morale was reported high or very high among 20.6 percent, compared with 18.3 percent the previous year.
_In Iraq, some 72 percent of soldiers reporting knowing someone seriously injured or killed.
_Soldiers reported an average of 5.6 hours of sleep per day in Iraq _ significantly less than needed to maintain their best performance _ yet officers appeared to underestimate how it could have that effect.
_Nearly one-third of troops in Afghanistan were highly concerned that they were not getting enough sleep and about a quarter reported falling asleep during convoys last year. Sixteen percent reported taking mental health medications and about half of those were sleep medications.
On the Net:
Defense Department: http://www.defenselink.mil
Army mental health report: http://www.armymedicine.army.mil