To the editor:

Two articles from the New England Journal of Medicine give some insight into how war affects our troops. Three large groups of soldiers and Marines were surveyed a year ago after their return from Iraq. This did not include troops evacuated for injuries or mental health problems.

About 16 percent met screening criteria for major depression, generalized anxiety disorder or post traumatic stress disorder (PTSD). Of those with indications of a mental disorder, 60 to 77 percent did not seek mental health care. Interestingly, an assistant secretary of defense, as reported by the Armed Forces Information Service, told reporters that 6 percent experienced mental health problems and “some” of them were not seeking help.

An article in December described the truly amazing surgical care provided in battle areas. Because of body armor and rapid and sophisticated treatment, the death rate is much lower than in earlier wars. However, proportionally more individuals are left with massive residual damage. One airman was described who survived the loss of both legs, his right hand and part of his face. As the author put it, his survival is remarkable but “how he and others like him will be able to live and function remains an open question.” The article did not address injuries to Iraqi civilians.

According to the U.S. Department of Defense official Web site, as of Wednesday, 5,301 U.S. troops have been wounded and evacuated; hundreds of others have been evacuated because of mental health problems. Another 1,041 have been killed in action and 285 others have died.

Joe Douglas,

Lawrence