Roughly one in every five U.S. troops who have survived the bombs and other dangers of Iraq and Afghanistan now suffers from major depression or post-traumatic stress, an independent study said Thursday. It estimated the toll at 300,000 or more.


As many or more report possible brain injuries from explosions or other head wounds, said the study, the first major survey from outside the government.
Only about half of those with mental health problems have sought treatment. Even fewer of those with head injuries have seen doctors.
Army Surgeon General Eric Schoomaker said the report, from the Rand Corp., was welcome.
"They're helping us to raise the visibility and the attention that's needed by the American public at large," said Schoomaker, a lieutenant general. "They are making this a national debate."
The researchers said 18.5 percent of current and former service members contacted in a recent survey reported symptoms of depression or post-traumatic stress. Based on Pentagon data that more than 1.6 million have deployed to the two wars, the researchers calculated that about 300,000 are suffering mental health problems.
Nineteen percent _ or an estimated 320,000 _ may have suffered head injuries, the study calculated. Those range from mild concussions to severe, penetrating head wounds.
"There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan," said Terri Tanielian, the project's co-leader and a researcher at Rand. "Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation."
The study, the first large-scale, private assessment of its kind, includes a survey of 1,965 service members across the country, from all branches of the armed forces and including those still in the military as well veterans who have completed their service. The Iraq war has been notable for the repeat tours required of many troops, sometimes for longer than a year at a time.
The results of the study appear consistent with mental health reports from within the government, though the Defense Department has not released the number of people it has diagnosed or who are being treated for mental problems.
The Department of Veterans Affairs said this month that its records show about 120,000 who served in the two wars and are no longer in the military have been diagnosed with mental health problems. Of those, about 60,000 are suffering from post-traumatic stress, and depression runs a close second.
Veterans Affairs is responsible for care of service members after they have leave the military. The Defense Department covers active duty and reservist needs.
The lack of numbers from the Pentagon was one motivation for the Rand study, Tanielian said in an interview.
The most prominent and detailed Pentagon study on the military's mental health that is released regularly to the public is the Army's survey of soldiers, taken annually at the battle zones since 2003.
The most recent one, last fall, found 18.2 percent of Army soldiers suffered mental health problems such as depression, anxiety or acute stress in 2007, compared with 20.5 percent the previous year.
Other studies have variously estimated that 10 percent to 20 percent of troops had symptoms of mental health problems.
Col. Loree Sutton, who heads a new Pentagon center on brain injury, said the Rand study will add to the work defense officials are doing. That includes researching best practices used inside the military and out, improving and expanding training and prevention programs, adding mental health staff and trying to change a military culture in which many troops are afraid or embarrassed to get mental health treatment.
"We've got to get the word out that seeking help is a sign of strength," Sutton said.
She said officials have been working to add thousands more mental health professionals to help the uniformed psychiatrists, psychologists and others struggling to meet the wartime demands of troops and their families. Across the services, officials are trying to hire over 1,000 additional staff. Also, companies providing health care by contract to the Pentagon have added over 3,000 in the past year, and the U.S. Public Health Service has provided some 200, she said. Veterans Affairs has added some 3,800 professionals in the past couple of years, officials there said.
In other survey results:
_About 7 percent of those polled reported both a probable brain injury and current post-traumatic stress or major depression.
_Rates of post-traumatic stress and major depression were highest among women and reservists.
_About 53 percent of service members with post-traumatic stress or depression sought help over the past year, and 43 percent reported being evaluated by a physician for their head injuries at some time.
_They gave various reasons for not getting help, including that they worried about the side effects of medication, they believed family and friends could help them with the problem, or they feared seeking care might damage their careers.
The Army's own warfront survey found the stigma associated with getting help has been decreasing slowly but steadily in recent years.
Thursday's report was titled "Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery." It was sponsored by a grant from the California Community Foundation and done by researchers from Rand Health and the Rand National Security Research Division. The division also has done work under contracts with the Pentagon and other defense agencies as well as allied foreign governments and foundations