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Barbara Van Dahlen, Ph.D. is a licensed clinical psychologist and the founder and president of Give an Hour™
Special to Veterans Advantage
Since 2010, suicide has outpaced traffic accidents, heart disease, cancer, homicide, and all other forms of death in the military besides combat. Indeed, one in four noncombat deaths among service members were suicides during this period. And sadly the number of “preventable deaths” per month has continued to climb. Thirty-eight soldiers killed themselves in July of this year, making July the worst month for suicides since the Army began to release monthly figures in 2009. If soldiers continue to take their lives at the current rate, the Army will lose about 200 active duty troops this year, a number that is significantly higher than in any year in the past decade. Although there has been tremendous time, energy, and effort focused on preventing suicide over the last several years, the military has yet to determine how best to identify those at risk. And the military has been unsuccessful in its attempt to encourage those contemplating such drastic choices to step forward and seek help. Indeed, some observers have referred to the current situation as an “epidemic.”
Several articles appearing in major newspapers and magazines have recently explored the issue in an effort to identify the gaps in knowledge and the limitations of current interventions. Not surprisingly, there had been speculation that as length of deployments were shortened and the wars began to wind down, we would see a decrease in both suicide attempts and completions among service members. But as suicides continue to mount, Gregg Jaffe reported in the Washington Post (August 17, 2012), “The losses are a significant blow to senior Army officials who had been hoping that the reduced rate of combat deployments and a series of initiatives to improve mental health care would result in a drop in the suicide rate.” Jaffe goes on to note that efforts by the Army to hire additional mental health and substance abuse professionals have done little to change the current upward trend in suicide.
In Time Magazine’s cover story titled “One a Day” ( July 23, 2012), Mark Thompson put some names and faces to the numbers. He profiled the downward spiral of two service members who eventually killed themselves. In both of the cases Thompson described, the service members actually sought help.In one case the service member’s wife pleaded with her husband's command to order her husband into treatment. But the system failed both of these service members, and their families must now struggle to come to terms with and eventually heal from these tragedies.
While many in the military and civilian communities remain frustrated by the lack of success in the efforts to reduce military suicide, recent research and one scientific review may shed a little light on this very dark issue. Researchers at the National Center for Veterans Studies at the University of Utah have released several reports this summer that may help us better understand the factors that lead a service member to commit suicide. In one study, the researchers interviewed a sample of 72 male soldiers in an effort to understand why they had tried to kill themselves. They found that those who made suicide attempts did so not because they specifically wanted to die or even hurt themselves. Rather, these service members attempted suicide because they wanted the intense emotional pain they were experiencing to stop, and they didn’t see any other way to end their distress.
They also found that many of those who attempted suicide lacked significant life skills with which to manage the demands of their lives. These were men who were unable to successfully navigate the stress of life - and became overwhelmed as difficulties with relationships, finances, and superiors began to pile up. It seems that they may have entered the military with limited life skills. Adding the stress of being in the military may have been too much for them to withstand. The good news is that if these results hold true, there is much that can be done to identify those who lack sufficient problem-solving skills and to provide them with additional tools to improve their capacity to manage the stress of life in the military. In addition, improving life skills will likely lead to healthier relationships. And a healthy social support network is an important buffer for all of us against the stress of life.
Another study discussed by this same group of researchers appears to confirm what we have suspected for quite some time: that those who are repeatedly exposed to intense combat are at a higher risk for later suicidal ideation, attempts, and completions. How incredibly sad and unfair this seems. These brave men complete and survive multiple dangerous missions only to come home and kill themselves, apparently to escape the memories of what they saw and did.
The University of Utah research seems to suggest that there are at least two different groups of high-risk individuals within the military community - both of whom need to be identified and need assistance and proper support. And this research confirms that one size can’t fit all with respect to identifying those in need or to providing effective interventions.
In the August 2012 issue of the Journal of the American Medical Association Charles Hoge, M.D., and Carl Castro, Ph.D., discuss the issue of suicide in their article "Preventing Suicides in U.S. Service Members and Veterans: Concerns after a Decade of War."
The authors begin with a bit of a history lesson. They note that before the current wars in Iraq and Afghanistan, the incidence of suicide in active duty U.S. service members was consistently 25% lower than that in civilians. They attribute this fact to the "healthy-worker" effect of being in the military and to the universal access to health care available to service members. Between 2005 and 2009 the incidence of suicide in Army and Marine personnel nearly doubled, and from 2009 through the first half of this year the incidence of suicide among Army soldiers remained elevated (22 per 100,000 per year), with the number dying of suicide each year exceeding the number killed in action.
Drs. Hoge and Castro looked at efforts currently under way to prevent suicide in the Army and came to several conclusions based on their review. They note that there are problems with deployment screening tools: those currently used have low predictive value, and many service members remain unwilling to truthfully report concerns because of the real or perceived stigma associated with doing so. Surveys currently administered in an effort to identify those in need too often identify as “at risk” service members who never attempt suicide, while failing to identify others who ultimately do kill themselves.
The most hopeful finding reported by Drs. Hoge and Castro suggests that developing a multipronged approach can be an effective strategy for preventing suicide. According to the authors, "Although evidence remains insufficient, experience from clinical practice and some trials lends support to a wide range of targeted interventions focused on enhancing access to care (e.g., crisis call lines, providing emergency contact information), means restriction (e.g., gun locks, bridge netting, dispensing medications in individual blister packages rather than bottles), and psychosocial treatment to reduce repeated attempts (e.g., problem solving, risk management, cognitive or dialectical behavioral therapy).”
So what does all of this mean and how does this new information help us address the current suicide crisis? Suicide is a complex human behavior that is difficult to predict - whether we are looking at service members or civilians. But in the military we are beginning to see some patterns that may help us target programs and interventions to improve the likelihood that those who need relief from their intense emotional pain, those who lack appropriate coping mechanisms and life skills to effectively deal with the challenges of life in the military, those who see no other way out...can find hope and, most important, can find the support and treatment they need and deserve.
Now we need to identify leaders who are willing to take this information and translate it into action. Fortunately, some appear to be stepping forward to do just that.
Give an Hour™, providing free mental health services to military personnel and their loved ones, at www.giveanhour.org.
Editors Note: Give an Hour™ is a strategic partner of Veterans Advantage. Learn more about our partnership with Give an Hour™.
Veterans Advantage is also hosting a special online PTS Transition Center for its members, with customized news and resources to help in this vital area.
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