Dr. Cliff Cleaveland
Commentary
In 2009 more U.S. soldiers died of high-risk behaviors than died in combat. That is the sad conclusion of a report issued by the Army on July 29. The 200-plus-page report may be accessed at www.army.mil/hprrsp. The fatalities included 160 men and women who committed suicide. The rate of suicide among soldiers exceeds that of the civilian population.
While civilian suicides have leveled off in recent years, military suicides have steadily increased: 119 in 2007, 128 in 2008. The suicide rate among Marines is slightly higher.
The report further documents more than 1,700 attempted suicides and 146 deaths from other "high-risk behaviors" during 2009. Such behavior includes drug overdosage, violence and fatal accidents where intoxication is involved.
For the first six months of 2010, 120 soldiers have taken their lives.
The majority of the suicides were young, Caucasian males. Fifty-eight percent were married. Seventy-one percent had one or more deployments to combat zones. Most suicides occurred upon return to the United States. Reserve and National Guard members who had been called to active duty had a higher rate of suicide than regular Army personnel.
Among the presumed causes of suicide cited by the report are: repeated and extended deployments to combat zones, injuries, separation from families and permissive environments within military units. Troubled soldiers may feel stigmatized if they seek psychiatric counsel. Young officers may not know how to recognize or to respond to potentially suicidal troops under their command. The Army lacks sufficient mental health professionals.
In reading the report, I was struck by the number of soldiers prescribed medications for pain, anxiety or depression. An estimated 160,000 received these agents. Oxycodone and hydrocodone, both highly addictive, often were dispensed in the field. Five percent of soldiers received anti-depressant medications within 90 days of combat deployment. Many prescription antidepressants carry warnings of potential suicidal or homicidal urges that may develop, especially in younger users. In a combat zone, who will have the time or the competency to spot such side effects?
Post-traumatic stress disorder, for which the diagnostic criteria recently have been expanded, was a factor in 14 percent of suicides. No one really knows the incidence of PTSD in our combat veterans of Iraq and Afghanistan. Symptoms may not appear right away. They may persist for years. PTSD may be masked by drugs and alcohol.
Mild traumatic brain injury is another factor implicated in suicide and risky behavior. Accounts by reporters embedded with combat units document the frequency of concussions following exposure to blast waves from mines and other explosive devices. Unlike athletes who can be carefully monitored after sustaining concussions, soldiers often return to duty as soon as the dust from explosions settles. Headache, which prompts the prescription of narcotics, and depression, which prompts the use of psychoactive drugs, are frequent consequences of traumatic brain injury. Multiple factors may act simultaneously to disorder the thinking of a soldier.
The report focuses upon prevention: "The overall goal of this concerted effort is to increase resiliency in our soldiers and their families who continue to serve under a high operational tempo." Greater awareness of the emotional health of subordinates is emphasized along with a need to provide many more specialists in mental health. Both servicemen and veterans will need access to such services for years to come. Terrible experiences do not simply evaporate.
As I closely follow our current wars, I am concerned that the environment in which our troops serve their combat tours defies efforts to promote "resiliency." Every civilian in combat zones is a potential enemy. Each step can detonate a mine. Any combat vehicle is subject to powerful blasts. There is no such thing as a safe area. How can mental health be safeguarded in such surroundings? At what point do we emotionally exhaust our service men and women? What counsel can be given in continuously hellish circumstances?
The Army's forthright report deserves close and prayerful attention by members of Congress and the administration. And by us.