The stresses and trauma of war are not limited to military personnel on the battlefield. Defense contractors exposed to combat zones exhibit similar rates of mental health problems as members of the military, according to a report by RAND Corporation.

“Although these contractors are not supposed to engage in offensive combat, they may nonetheless be exposed to many of the stressors that are known to have physical and mental health implications for military personnel,” the report said.

RAND surveyed 660 Defense contractors around the world who had been deployed to a conflict zone at least once between early 2011 and early 2013.

Among respondents, 25 percent met criteria for probable post-traumatic stress disorder (PTSD). In addition, 18 percent screened positive for depression, and 10 percent reported high-risk drinking.

The numbers were even higher among U.S. respondents — 32 percent met criteria for probable PTSD.

In comparison, RAND said it is estimated 20 percent of U.S. service members returning from deployments suffer from PTSD.

Exposure to stressors such as gunfire, improvised explosive devices and deaths of fellow personnel affect the physical and mental well-being of both military personnel and contractors.

“In 2010, T. Christian Miller of ProPublica was the first to report that contractor deaths had exceeded those among military personnel in Iraq and Afghanistan,” the report said. From January through June 2010, 250 civilians died in conflict, compared with 235 services members.

The length of time and proximity to the combat zone were contributing factors in levels of PTSD and other mental health disorders among the surveyed contractors.

Transportation contractors showed the highest rates of probable PTSD. RAND attributed this to greater combat exposure than other types of contractors, but also noted the small sample size of transportation contractors.

The report speculated that rates of PTSD among contractors might be high because of a lack of mental health services available for contractors.

“Contractors are often referred to in the literature as a ‘shadow force,’ operating below the radar or in the shadow of their military counterparts,” the report said.

The survey revealed only 28 percent of contractors with probable PTSD were receiving mental health treatment.

Compared to veterans, “contractors with probable PTSD or depression were twice as likely to report barriers to receiving mental health treatment, including cost, embarrassment and concerns about being perceived as weak,” the report said.

RAND outlined a few recommendations to improve mental health services for contractors.

The report said private contracting firms should provide resources and training in stress management prior to deployment. Such training among military personnel was shown to reduce instances of PTSD.

It also recommended increasing awareness and encouraging use of mental health care, in order to reduce the negative stigma associated with seeking treatment for mental health problems.

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