Tuesday, August 28, 2007

The Invisible Casualties of War: Suicide Surging in the Military

Though the 2006 suicide rate in the Army was the highest in 26 years, Army officials noted that it remains lower than the rate for the same age and gender group in the overall U.S. population. The Army Suicide Event Report, which tracks suicide attempts and completions and the factors involved, showed 99 suicides in 2006 within the Army, 30 of which occurred in Iraq or Afghanistan. That marks an increase from 87 suicides in 2005 and 67 in 2004.

“With more and more service members returning from tours of duty and leaving the military, we must ensure that they receive the health services they need,” Rep. Leonard Boswell, D-3rd District, a decorated Army veteran who served in the Vietnam War, said in a press release. “With our military facing constant deployments, this report is one more reason why we must do more for our returning men and women in service and those who have left service.”

The report indicates the Army’s suicide rate for 2006 was 17.3 suicides per 100,000 soldiers. That compares to the overall U.S. population rate, for the same age and gender group, of roughly 19 suicides per 100,000 people.

“The loss of any member of the Army family is a tragedy, and the Army has made prevention of suicide a top priority,” said Army Col. Dennis W. Dingle, director of the Army’s Human Resources Policy Directorate, while talking with reporters at a media roundtable conference. Dingle noted that the number of confirmed suicides in the Army has been rising since 2003, and leaders are emphasizing suicide prevention and education programs to counter that trend.“Our message to you today is that the Army recognizes this issue and is taking deliberate steps to mitigate those risks that may contribute to suicidal behavior,” Dingle said. “Our prevention efforts do help our soldiers and their families deal with the challenges they face every day.”

A majority of suicides in 2006 involved firearms, the report says, and the most common contributing factors were failed personal relationships and occupational, legal and financial problems. The report did not find a direct relationship between increased deployments and suicides, Dingle said.

Army officials recognize that increased deployments put strain on soldiers and on their relationships, so deployment frequency and length was closely examined in this report, said Army Col. Elspeth C. Ritchie, behavioral health psychiatry consultant to the U.S. Army surgeon general, at the roundtable. While the data has not shown a correlation between those factors and suicides, other studies, such as the Mental Health Assessment Team, have found that longer and more frequent deployments have increased the rates of post-traumatic stress disorder, anxiety and depression, she said.

The threat of suicide is not unique to the Army, for its rate mirrors the Army National Guard, where suicide is the third leading cause of death among soldiers. The Army National Guard’s Suicide Prevention Program indicates there have been 42 cases of suicide in the Army National Guard so far this fiscal year (up to Aug. 13), narrowly trailing accidents and combat deaths, which accounted for 45 and 47 casualties respectively. The Army National Guard’s total of 42 is already 17 more than the 2006 total and marks the highest total since the Guard began keeping suicide statistics in 2004.

“The comparison to the active duty group has one major difference though,” said Master Sgt. Marshall Bradshaw, the National Guard Bureau suicide prevention manager in a press release. “The active duty Army has resources and facilities available to the Soldiers 24 hours a day, seven days a week,” Bradshaw said. “They have a greater ability to track information and provide suicide prevention resources to their soldiers.”

Given the dynamics of the wars in Iraq and Afghanistan, it’s hard for the military to pinpoint exactly why these numbers are increasing when comparing these numbers to previous wars. One factor contributing to the spike in suicides may include the rise of reported cases of Post Traumatic Stress Disorder (PTSD), which reportedly afflicts one out of every four soldiers returning from the theaters of war in Iraq and Afghanistan, and that number doesn’t include the number of soldiers who don’t report PTSD, fearing a backlash of being perceived weak by their superior officers.

Other factors possibly contributing to the rise in suicides is the number of multiple deployments and the absence of a clear “war front,” which would imply that there’s a back end of the war, where soldiers can rest and recuperate from the mental anguish of worrying about being killed at any moment. Furthermore, the mental disconnect between soldiers and their families has led to failed relationships, an increase in divorces, legal and financial issues stemming from the opportunity loss of employment income while deployed.

Having recognized the growing problem of suicide, the Army and Army National Guard are taking steps to combat these threats before the rate further escalates. The Army is using the Army Suicide Event Report (ASER) to help improve its prevention and training, focusing not only on the prevention of suicide, but also on increasing awareness about mental health issues and decreasing the stigma associated with seeking mental health care.

In mid-July, the Army began a new training program for post-traumatic stress disorder, brain injuries and stress. This training will be given to every soldier -- active-duty, National Guard and Army Reserve -- within 90 days. The Army also is taking the data gathered in this report and others and integrating it into its suicide prevention and training program. For example, the Army’s suicide prevention has historically focused on young men, but the data in the report indicates these programs need to be expanded to focus more on women and older men.

The Army also is working on hiring 250 more mental health professionals, and all the Army’s medical personnel are being trained in recognizing post-traumatic stress disorder, brain injuries and suicide risk, Ritchie said. In addition, the Army is instituting programs to reduce the stigma associated with seeking mental health care.

In Iowa, the Guard has checkpoints in place to gauge potential suicide risks among soldiers returning from deployment. “When soldiers are leaving active duty from a combat theater, the first line of defense we have in place is a demobilization process in the U.S.,” Iowa National Guard Press Secretary Lt. Col. Greg Hapgood told the Iowa Independent. “During the five to eight day course of out-processing, soldiers take part in a series of briefings that talk about Post Traumatic Stress Disorder (PTSD).”

Moreover, Hapgood said there are other outreach programs implemented for soldiers and their families to help with the transition back into civilian life. “We have a family program at Camp Dodge and a full-time chaplain to help families deal with issues and symptoms related to suicide,” Hapgood said “After the soldiers come back, they go through a program called “Enduring Iowa,” which is a series of classes facilitated by a counselor, who talks about reintegration issues. We also have ‘Army One Source’ in place, which is an entity that helps families get counseling from outside sources if they need it.”

Often times, soldiers are reluctant to seek help on their own. “The soldiers have a fear that there’s a stigma attached with seeking help, but this couldn’t be further from the truth,” Hapgood said. “We emphasize that it’s in their best interest to go and seek assistance. The only way that you can get a soldier help who needs it is one of two ways. Either they recognize some of the symptoms themselves and are willing to go get help, or their families or friends recognize symptoms and they’re able to convince them that it would be in their best interest to seek help.”

“The most important thing that we can do is to convince our soldiers that there is no detrimental effect whatsoever if they realize they have an issue and get help,” Hapgood said. “The real detriment occurs if soldiers don’t get help, and their situation won’t get better, but rather, it will only get worse.”


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