Nearly five years into the war in Iraq, the US Army has taken steps to improve the process by which it screens soldiers returning from war.

Many have trouble transitioning from combat dangers to a normal routine at home. But sometimes just identifying the problem is the issue.

The Army has improved its process by adding a second mental-health assessment three to six months after its initial screening, which is completed as soon as a soldier returns from war. This second screening has allowed the Army to unmask troubling trends among its soldiers: a fourfold increase in relationship problems compared with those reported in the first assessment, a surge of major depression among many, and increased alcohol abuse.

"The whole idea is [that] we're trying to catch these problems early, before they're a diagnosable condition, and hopefully intervene and prevent it from becoming that," said Col. Charles Milliken, an Army psychiatrist, during a recent Army briefing with reporters.

For example, about 3.5 percent of active-duty soldiers in the first screening reported relationship problems. In the reassessment of the same soldiers, taken six months later, that number jumped to about 14 percent, according to Dr. Milliken and two other Army medical officials in an article published Wednesday in the Journal of the American Medical Association.

Ditto for active-duty soldiers reporting problems with post-traumatic stress disorder, or PTSD, the medical officials found. On the initial assessment, 11.8 percent reported problems relating to the disorder; that number increased to 16.7 percent on the second assessment. Likewise, those soldiers reporting depression problems rose from 4.7 percent to 10.3 percent. In the second screening, as many as 12 percent said they were misusing alcohol. Overall, soldiers seen as being at risk for mental-health problems jumped from 17 percent to 27 percent.

Reports of problems increased even more dramatically among Army reservists, but Army officials believe much of that rise stems from the perception that their healthcare coverage will expire sooner than that of active-duty soldiers. So, even though reservists' medical coverage continues after their return, they are more likely to report problems during the second assessment, Army officials speculate. The study was based on responses from more than 88,000 soldiers.

The transition from combat to home has always been tricky. The unexpected length of the war in Iraq has posed additional challenges for the Defense Department, whose readjustment programs were initially unprepared for the depth and number of problems.

Many programs within the unit rely on military chaplains who prepare soldiers for the transition while they are still deployed. Typical is a soldier who returns home after a year and attempts to reassert his authority.

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