Report: PTSD plagues civilian contractors in war zones

Post-Traumatic Stress Disorder (PTSD) and other mental-health issues afflicting American soldiers who’ve fought in wars abroad have received frequent attention in recent years. But when it comes to the thousands of civilian employees contracted by government agencies to work in those same war zones — sometimes in greater numbers than the military — very little is known about their well-being.

A new report by the non-profit RAND Corporation sheds light on the state of mental health among convoy drivers, construction workers, security personnel and translators hired by the Department of Defense (DOD) and State Department to work alongside the U.S. military in Afghanistan and Iraq.

Among 660 contract employees surveyed by RAND who had been deployed to war zones between 2011 and 2013, a whopping 25 percent met criteria for PTSD, 18 percent met criteria for depression and 50 percent reported heavy drinking or alcohol abuse. 

The prevalence of mental-health issues among civilian contractors may even exceed that of the military. According to the Institute of Medicine, 20 percent of U.S. troops deployed to Iraq or Afghanistan experienced PTSD, as many as 37 percent reported depression and up to 39 percent reported alcohol abuse.  

Interestingly, 84 percent of the contractors polled had previously served in the armed forces — a factor that RAND says could have contributed to elevated rates of PTSD and other mental-health problems.

Nearly two-thirds were U.S. citizens, 24 percent were U.K. citizens and the rest were from Australia, South Africa or other countries.

“Contractors who are deploying to these same areas of conflict are likely facing the same kinds of risks that the military does,” Carrie Farmer, a policy researcher for RAND and co-author of the report, told Al Jazeera in a telephone interview.

In fact, a report by non-profit investigative journalism site ProPublica showed that more civilians contracted by the U.S. were killed in war zones between January and June of 2010 than American soldiers — 250 contractors versus 235 service members, according to Pentagon figures.

“This is a very fluid population,” Farmer said. “They may go from company to company. There’s really no data on the entire contactor population,” which is why RAND wanted to know more about how they’re being affected by deployment.

Most of the contractors who participated in RAND’s survey said they were in good or excellent health. However, American contractors were more likely to report mental-health problems than other nationalities, as were contractors working in the transportation sector, those with more combat exposure and those contracted by the DOD or State Department.

What’s more, only about 16 percent of the contractors had ever filed a Defense Base Act claim, which is a type of workers’ compensation for civilian employees who are injured while contracted by the U.S. government to work abroad. Farmer said that while 60 percent of those claims were accepted, most were based on physical injuries, not mental health or trauma.

Just 28 percent of contractors who met criteria for PTSD and 34 percent of those who met criteria for depression had received mental-health treatment within the last year, according to the study.

“Companies interested in having a healthy work force should be interested in assuring that these folks are getting the help they need,” Farmer said.

While contactors deployed by the government are technically supposed to be able to access military treatment facilities, she said, the reality is that they’re probably the last in line to get care.

“For the contractor population, there’s really no support out there,” she said, either because of a stigma they may feel about seeking mental-health treatment and worries about jeopardizing their jobs, or because of a lack of access to it.

The RAND report states that the DOD deployed 155,826 contractors and 152,826 troops to Iraq in 2008, and 94,413 contractors and 91,600 troops to Afghanistan in 2010. However, other government agencies – like the State Department – and private companies and NGOs also employ contractors, making it impossible to know how many were deployed altogether.

The report said that just two previous studies have focused on the health of contract employees working abroad, also finding that they were reluctant to seek help for mental-health issues. One of the studies found that only 10 percent of the contractors surveyed had access to mental-health treatment while deployed.

What surprised RAND researchers most was that one-third of their respondents completed the survey while deployed in conflict zones. Among them, 24 percent showed signs of having PTSD. In other words, at any given point nearly a quarter of contracted civilian employees in war zones struggle with PTSD or other mental-health issues.

“That was one of our biggest wake-up calls, particularly for the companies,” Farmer said. “At a minimum, people with mental health problems are not performing on their jobs to their optimum capacity ... At a maximum, there would be a risk of some sort of negative event happening. From a company’s perspective, that is a risk.”

The researchers recommended providing civilian contractors with better training to deal with stress before deployment, and wider access to mental-health services while posted abroad. In fact, Farmer said, “it could be in the DOD and State’s interests to require it for all bidders.”