The Joint Base Lewis-McChord sergeant now accused of mass murder of Afghan civilians previously did three tours of duty in Iraq. His alleged actions are likely to put a new spotlight on the grinding mental effects of multiple front-line deployments by many American soldiers.

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Before he arrived in Afghanistan, the Joint Base Lewis-McChord sergeant now accused of mass murder reportedly had completed three tours of duty in Iraq.

That made him a seasoned front-line veteran, while also putting him at significantly higher risk of post-traumatic stress disorder (PTSD) and other mental wounds of war that might have eroded his ability to cope with the rigors of another war-zone deployment.

Roaming house to house in two Kandahar province villages, the noncommissioned officer, a 38-year-old family man, is accused of killing at least 16 unarmed men, women and children in a stunning display of violence.

These actions are likely to put a fresh spotlight on the grinding effects of repeated deployments by U.S. soldiers who have helped sustain more than a decade of warfare in Afghanistan and Iraq.

The increased risks of multiple deployments are well-documented.

A 2008 study released by the Army surgeon general’s office found that more than 25 percent of soldiers who completed three or four tours of duty in Iraq showed signs of mental-health problems such as PTSD, compared to 11 percent after a first deployment. Other studies have shown similar findings.

“People who have a history of being traumatized are going to be more vulnerable to PTSD, and the more their exposure, the more vulnerable they become,” said Dr. David Reiss, a private-practice psychiatrist in California who evaluates PTSD patients. “Being repeatedly in a war zone you can have more and more dehumanization, where it’s us against them.”

In recent years, the Army and other military branches have developed a series of mental-health screenings to try to identify soldiers who may be struggling with PTSD. The military also has developed screenings to check for traumatic brain injury that can result from bomb blasts, vehicle accidents or other violent events.

But some soldiers balk at disclosing their problems for fear that might end their military advancement. And unit commanders, bent on filling their rosters with experienced personnel, may be reluctant to acknowledge mental-health issues raised by a soldier’s spouse or friend.

Moreover, Gen. Peter Chiarelli, the retired vice chief of the Army who championed mental-health issues in the military, says the science behind the screenings still has a long way to go.

“We’ve got tons of soldiers who have gone on five tours of duty and would never contemplate anything like this,” Chiarelli said Monday. “But we don’t have the mature science to find the person with the stressor that could lead to something like this. That’s the problem.”

Official sources leaked limited information about the staff sergeant, an 11-year Army veteran accused of murder.

ABC News, citing an anonymous U.S. official, reported the soldier suffered a mild traumatic brain injury — either from a car accident or hitting his head on the hatch of a vehicle — but went through advanced treatment at Lewis-McChord and was deemed to be fine.

ABC also reported that the soldier in 2008 passed a mental-health screening to become a sniper. He also cleared routine behavioral health screenings later, though he had difficulties reintegrating after his last deployment to Iraq, including marital problems that he appeared to have worked through.

Soldiers receive a health assessment within 60 days of deployment overseas. They receive a follow-up within 30 days after they return and another within 180 days to help identify emerging health conditions, according to a statement by the Army surgeon general’s office.

Several soldiers, speaking on condition of anonymity, told The Seattle Times that it’s easy to make it through a mental-health screening.

“It wasn’t hard at all,” said one soldier screened for deployment in Afghanistan in 2009 after previously serving in Iraq. “I had some sporadic signs … an emotional distance, and I would lash out at people. But I wanted to make the deployment and passed the screening.”

The soldier said he faced an often-hostile civilian population in Afghanistan and coped with the deaths of more than a half-dozen friends and acquaintances in his unit. He said he also was exposed to the deaths of Afghan civilians, most from Taliban attacks.

Throughout the tour, the soldier said there was plenty of frustration as a rarely seen enemy repeatedly attacked with bombs that struck vehicles and foot patrols.

Upon his return to Lewis-McChord, the soldier said he was diagnosed with PTSD characterized by aggression and other symptoms. He was hospitalized twice. A 2010 medical evaluation found he no longer was fit to carry and fire a weapon, according to documents reviewed by The Seattle Times.

“The emotional time in Afghanistan was multiple times worse (than) Iraq,” the soldier said. “It hit me incredibly deeply.”

While this soldier was eager for the Army to acknowledge his PTSD, others try to hide it.

“There are people trying to pretend like there is nothing wrong with them. And a lot of that is reinforced by the internal culture of the military, which is to suck it up and drive on,” said retired Staff Sgt. Kevin Baker, who was diagnosed with PTSD after returning to Lewis-McChord from Iraq. “It’s a huge step to seek help, and very difficult for many people.”

Patricia Bailey, of Yelm, whose former husband served twice in Iraq, said, “Soldiers are not coming forward because they are afraid they won’t get promoted and move up the ranks.”

Some of the biggest stresses pile up on Army Rangers and other special-operations personnel who may head overseas during their careers more than a dozen times for short, intense deployments.

One wife of an Army Ranger at Lewis-McChord says her husband called from Afghanistan to say he feared he couldn’t withstand the pressures of the deployments.

Once he returned home, she was disturbed by his conduct and worried that he had PTSD. She says she was brushed off her concerns.

“They said his performance at work was stellar and there was nothing that they could do,” the wife said.

Hal Bernton: 206-464-2581