Wednesday, October 31, 2007

Iraq, Afghan Vets at Risk for Suicides

Abridged version of an article by Kimberly Hefling,
The Associated Press

Wednesday 31 October 2007

Washington -

A total of 147 troops have killed themselves in Iraq and Afghanistan since the start of the wars, according to the Defense Manpower Data Center, which tracks casualties for the Pentagon.

Add the number of returning veterans and the finding is that at least 430 of the 1.5 million troops who have fought in the two wars have killed themselves over the past six years. And that doesn't include people like Gallagher's husband who committed suicide after their combat tours and while still in the military - a number the Pentagon says it doesn't track.

That compares with at least 4,227 U.S. military deaths overall since the wars started - 3,840 in Iraq and 387 in and around Afghanistan.

In response, the VA is ramping up suicide prevention programs.

Research suggests that combat trauma increases the risk of suicide, according to the National Center for Post Traumatic Stress Disorder. Difficulty dealing with failed relationships, financial and legal troubles, and substance abuse also are risk factors among troops, said Cynthia O. Smith, a Pentagon spokeswoman...

Suicides in Iraq have occurred since the early days of the war, but awareness was heightened when the Army said its suicide rate in 2006 rose to 17.3 per 100,000 troops - the highest in 26 years of record-keeping.

That compares with 9.3 per 100,000 for all military services combined in 2006 and 11.1 per 100,000 for the general U.S. population in 2004, the latest year statistics were available. The Army has said the civilian rate for the same age and gender mix as in the Army is 19 to 20 per 100,000 people.

Just looking at the VA's early numbers, Dr. Ira Katz, the VA's deputy chief patient care service officer for mental health, said there does not appear to be an epidemic of suicides among those who served in Iraq and Afghanistan who left the military.

Katz said post-traumatic stress disorder, depression and problem drinking increase a person's suicide risk by two or three times, but the rate of suicide among those with those conditions "is still very, very low."

Katz acknowledged, however, that it is too early to know the long-term ramifications for those who served in the wars and said the VA "is very intensely involved in increasing suicide prevention."

"We're not doing it because there's an epidemic in returning veterans, though each death of a returning veteran is a tragedy and it's important to prevent it," Katz said.

The VA and Defense Department have hired more counselors and made other improvements in mental health care, including creation of a veterans suicide prevention hotline.

At the VA's national suicide hotline center based in Canandaigua, N.Y., counselors have taken more than 9,000 calls since July. Some callers are just looking for someone to talk to. Others are concerned family members. Callers who choose to give their names can opt to be met at a local VA center by a suicide prevention counselor; more than 120 callers have been rescued by emergency personnel - some after swallowing pills or with a gun nearby, according to the center...

One government study of Army veterans from Vietnam found they were more likely to die from suicide than other veterans in the first five years after leaving the military, although the study found that the likelihood dissipated over time. There is still heated debate, however, over the total number of suicides by Vietnam veterans; the extent to which it continues even today is unknown.

One major hurdle in stopping suicide is getting people to ask for help. From 20 percent to 50 percent of active duty troops and reservists who returned from war reported psychological problems, relationship problems, depression and symptoms of stress reactions, but most report that they have not sought help, according to a report from a military mental health task force.

"It's only when it becomes painful will someone seek counseling," said Chris Ayres, manager of the combat stress recovery program at the Wounded Warrior Project, a private veterans' assistance group based in Jacksonville, Fla. "That's usually how it happens. Nobody just walks in, because it's the hardest thing for a male, a Marine, a type-A personality figure to just go in there and say, 'Hey, I need some help.'"

While not suicidal, Ayres, 37, a former Marine captain from the Houston area who had the back of his right leg blown off in Iraq, has experienced episodes related to his post-traumatic stress disorder and said he worried about being stigmatized if he got help.

He's since learned to manage through counseling, and he's encouraging other veterans to get help.

Ayres is among 28,000 Americans injured in the war, more than 3,000 seriously.

In a study published earlier this year, researchers at Portland State University found that veterans were twice as likely to commit suicide as male nonveterans. High gun ownership rates, along with debilitating injuries and mental health disorders, were all risk factors that seemed to put the veterans at greater risk, said Mark Kaplan, one of the researchers.

While veterans from Iraq and Afghanistan were not included in the study, Kaplan said that given the nature of the injuries of the recent wars and the strain of long and repeated deployments, the newer generation of veterans could be at risk for suicide.

Kaplan said primary care physicians should ask patients whether they are veterans, and if the answer is yes, inquire about their mental health.

"This is war unlike other wars and we don't know the long-term implications and the hidden injuries of war," Kaplan said.

Dr. Dan Blazer, a professor of psychiatry at Duke University Medical Center who served this year on the military's mental health task force, said improvements in care will likely help some veterans, but he's concerned about this generation. He said he treats World War II veterans still struggling mentally with their military experience.

"There's still going to be individuals that just totally slip through all of these safety nets that we construct to try to help things in the aftermath," Blazer said.

Suicide, Blazer said, "is a cost of war. It's a big one."

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