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Thousands of war-hardened Pennsylvania soldiers might face their toughest battles when they return to civilian life.

Most of those who survive combat do so without developing mental problems, but a significant percentage suffers post-traumatic stress disorder or other mental problems. If history is any guide, as many as a third of combat veterans could need help, a U.S. Department of Veterans Affairs official said.

Daniel Ziff, clinical coordinator of the post-traumatic stress disorder team for the VA's Pittsburgh Healthcare System, said about a third of Vietnam War veterans developed mental disorders. Because of comparable battle conditions, the wars in Afghanistan and Iraq have the potential to cause similar problems, he said.

"You can never relax. Any car that drives by can be a bomb," Ziff said. "You don't know who the enemy is, where they are."

At least 9,000 Pennsylvania National Guard and Reserve soldiers have seen actual combat in Afghanistan and Iraq, according to the Pentagon. More than 26,000 active, Guard and Reserve soldiers from Pennsylvania have served in one or both areas in some capacity.

A mental health study published last July in the New England Journal of Medicine found that 15 percent to 17 percent of the Iraq veterans and 11 percent of the Afghanistan veterans exhibited signs of major depression, generalized anxiety or post-traumatic stress disorder within three to four months of returning home.

The study attributed the higher rate of symptoms among Iraq veterans to the fact that a higher percentage of those veterans were involved in combat.

The study was conducted by Dr. Charles Hoge and others at the Walter Reed Army Institute of Research in Silver Spring, Md.

Perry Bishop, spokesman for the assistant secretary of defense for health affairs, said the symptoms of post-traumatic stress disorder usually appear between three months and several years after a soldier returns home.

The Vietnam veterans' figure came from studies done years after the veterans returned, and it's too soon to come up with comparable numbers for Iraq and Afghanistan veterans, he said.

"It's not a trackable number like bullet wounds," Bishop said.

Feeling of helplessness

Rachel Yehuda, a psychiatry professor and director of the Traumatic Stress Studies Division at the Mt. Sinai School of Medicine in New York City and the Bronx Veterans Affairs Medical Center, said modern diagnosis and treatment won't reduce the number of cases but could keep those soldiers from developing long-term problems the way many Vietnam veterans did.

"People who are exposed to combat trauma can be helped if we do it at the right time," she said.

Randall Marshall, associate professor of clinical psychiatry at Columbia University, is part of a team that is reanalyzing the Vietnam War veteran data on post-traumatic stress disorder. He said it's important to be clear about what groups of soldiers -- particularly combat versus non-combat troops -- are under consideration when determining a rate.

"You don't want to start saying that 30 percent of everyone who served in the military is going to develop PTSD," he said.

While training could reduce the number of combat veterans who suffer the initial stages of the disorder, the main goal of treatment now is to reduce the number who suffer long-term.

"You could say fairly that 20 to 30 percent of (Vietnam) vets who saw heavy combat had PTSD for months to years after," Marshall said.

Ziff said a common factor between Vietnam and Iraq is the "unconventional" nature of the combat.

In conventional combat, enemy troops wear identifiable uniforms and the fighting occurs along a definable battle front. In Iraq and Afghanistan, however, friend and foe might dress alike and fighting can erupt anywhere and at anytime, making soldiers feel less in control, he said.

Post-traumatic stress disorder is "based upon a perception of helplessness," Ziff said.

'Just being bait'

Jason Brosk, 28, of Penn Hills, knows that feeling.

As a captain leading a platoon of infantry scouts with the Army's 101st Airborne Division, he advanced on Najaf, Iraq, on March 30, 2003, with a clear set of orders -- capture or kill any Iraqi holding a weapon.

"I wasn't really worried about much," Brosk said.

Four days later, after the city fell, "everything starts getting gray," he said.

Instead of scouting ahead of the main battle group, Brosk's men were checking farmers' harvest licenses, manning checkpoints and watching for homemade bombs, which the military refers to as IEDs -- improvised explosive devices.

Most difficult of all, they separated friends from enemies by waiting to see who attacked them.

"We're just being bait," he said.

Public acceptance

Marshall and Ziff said a key factor that should reduce the long-term rate of post-traumatic stress disorder for the most recent groups of combat veterans is public acceptance. While some people are protesting the Iraq War, the protests are mainly aimed at the Bush administration rather than the military.

Vietnam veterans, by contrast, often found themselves directly blamed for that war, Ziff said. Faced with such public disapproval, they were even more reluctant than most combat veterans to seek help or discuss their combat experiences.

"They went underground," Ziff said. "It caused them to suppress their feelings even further."

Mt. Sinai's Yehuda said one of the main barriers to reducing the number of veterans with long-term mental problems is the reluctance of people to seek mental help because of the social stigma attached to it. Another is the perception that most such problems will resolve themselves.

"In fact, time only heals some wounds," Yehuda said. "Even if time is going to heal your wound, you're not going to be harmed by checking into the VA or checking with a mental health worker."

Ideally, veterans should view a visit to a counselor the same way they would a medical checkup.

"It's not just for people who can't cope," Yehuda said.

Bishop said the Defense Department has learned since Vietnam that many veterans won't voluntarily seek help. The department's health services program has already performed one sweep of one-on-one interviews with Iraq War veterans and is preparing to do another, he said.

Brosk now works for Veterans Affairs as an outreach counseling technician at the McKeesport Veterans Center in White Oak.

Veterans Affairs believes early treatment of veterans will keep initial readjustment problems from developing into persistent mental disorders, Brosk said.

"If we can talk to them a couple of months after they come home, we can help them get through it," he said

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