Benedict Carey / The New York Times & Dexter Mullins / Al Jazeera America – 2014-03-05 00:03:12
http://www.nytimes.com/2014/03/04/science/suicidal-tendencies-are-evident-before-deployment-study-finds.html
Suicidal Tendencies Are Evident Before Deployment, Study Finds
Benedict Carey / The New York Times
(MARCH 3, 2014) — Amid growing alarm at the rate of suicide among members of the military and confusion about possible causes, researchers reported on Monday that most of the Army’s enlisted men and women with suicidal tendencies had them before they enlisted, and that those at highest risk of making an attempt often had a long history of impulsive anger.
The new research — contained in three papers posted online Monday by the journal JAMA Psychiatry — found that about one in 10 soldiers qualified for a diagnosis of “intermittent explosive disorder,” as it is known to psychiatrists — more than five times the rate found in the general population. This impulsive pattern, in combination with mood disorders and the stresses of deployment, increased the likelihood of acting on suicidal urges.
The new papers bring together five years of work by a coalition of academic, government and military researchers, investigating hundreds of suicides and surveying thousands of active soldiers in anonymous questionnaires.
Living in Limbo
In 2013, a former combat videographer, Kathryn Robinson, described trying to get her life back on track after her return from Iraq left her with P.T.S.D. and thoughts of suicide.
The effort began in 2008, after the suicide rate among active soldiers rose above the civilian rate among young healthy adults for the first time. The wars in Iraq and Afghanistan have relied on an all-volunteer Army, not a draft like previous wars, and many of today’s enlisted men and women have deployed two, three, sometimes four times.
The new reports provide the first glimpse at how changes in the makeup of the fighting force and the increased demands of service have affected the suicide rate. The annual soldier suicide rate more than doubled between 2004 and 2009, to over 23 per 100,000, up from 10 per 100,000. In that period, 569 soldier deaths were ruled suicides. Since then, the rate has begun to fall back toward 20 per 100,000, which has consistently been the civilian rate in the same age group.
“This effort will do for suicide what the Framingham Heart Study did for cardiology, provide for the first time a way to look at multiple factors over a huge number of people,” said Dr. David Brent, a psychiatrist at the University of Pittsburgh who was not involved in the research. The results, he added, strongly suggest that “the baggage people bring with them and often don’t disclose in order to get into armed services presumably interacts with the stresses of deployment” to increase vulnerability to suicide.
The three reports do not settle whether so-called accession waivers, which relax standards for new soldiers and which the Army has used to shore up its ranks, increased the force’s vulnerability to suicide. One study, an investigation of suicides and accidental deaths led by Michael Schoenbaum of the National Institute of Mental Health, found a host of risk factors many have suspected: demotions, a lower rank and previous deployment among them. But looser standards for enlistment were not correlated with increased suicides.
A study finds removing weapons from homes of depressed vets cut suicides to zero. A top general attempts to implement a no-guns policy but is blocked when the NRA objects that such a policy “threatens” gun owners’ freedom.
Overall, the three reports sketch a portrait of suicide risk that in many respects is like the civilian one. About 14 percent of the surveyed soldiers said they had had suicidal thoughts, and 5 percent had made plans at least once to take their lives — mirroring the rates among civilian peers. About 2 percent had actually made an attempt. (The attempt rate for civilians is actually twice as high, but soldiers’ attempts are more often lethal.)
About a quarter of soldiers surveyed qualified for at least one current psychiatric disorder, such as depression, anxiety or substance abuse. That is roughly twice the rate among peers in the general population, but only about half of those disorders developed after enlistment.
The biggest difference between soldiers and young adults in the civilian population was in impulsive anger. The rate was more than 11 percent among surveyed soldiers, and less than 2 percent among young civilians. The anger issues predated enlistment about three-quarters of the time, said Matthew Nock, a lead author on one of the papers and a psychologist at Harvard.
“The people at highest risk of making an attempt struggled with depression and anxiety, or post-traumatic stress, in combination with impulsiveness and aggression,” Dr. Nock said. “The former gets people thinking about suicide, and the latter gets them to act on those thoughts.”
The new findings present the military with a challenging question: How do you identify people vulnerable to suicide without driving them underground? More intensive scrutiny typically leads would-be recruits to hide mental struggles. Some experts suggested that the services could screen people after enlistment, to identify those who might be offered additional support.
“A small minority of soldiers are responsible for a disproportionate amount of suicidal behavior,” wrote Dr. Matthew J. Friedman, of the National Center for PTSD, in an editorial accompanying the three reports. “Better identification of and intervention with the cohort are likely to have the best payoff.”
These experts also said that the military could invest in courses that shore up mental toughness service-wide as a preventive measure. In 2009, the Army invested in such a program for its 1.1 million members, but a recent report concluded that the program had not been effective.
A version of this article appears in print on March 4, 2014, on page A10 of the New York edition with the headline: Suicidal Tendencies Are Evident Before Deployment, Study Finds.
Study: 1 in 4 Army Soldiers Had Mental Illnesses before Enlisting
Dexter Mullins / Al Jazeera America
(March 4, 2014) — Three new studies raise concerns over recruit screening and suicide rates among US military personnel. More than a quarter of US soldiers met the criteria to be diagnosed with some of the most common mental disorders — depression, panic disorder and Attention Deficit Hyperactivity Disorder (ADHD) — prior to enlisting in the Army, and more than eight percent considered killing themselves at one time or another, according to a series of studies published in JAMA Psychiatry on Monday.
The reports come amid growing concern over high suicide rates among members of the US armed forces.
The studies state that those who are most at risk of attempting suicide, 1 in 10 of those surveyed and interviewed, also have a history of impulsive anger, a condition known as “intermittent explosive disorder.” That is more than five times the rate found in the civilian population, according to the reports.
A combination of this impulsive behavior, stress developed as a result of deployment and other mood disorders increase the potential for a soldier to act on their suicidal thoughts. Intermittent explosive disorder is the most common disorder among Army personnel and the second most common in the general population, coming in behind general “phobias,” experts say.
The three research papers are the culmination of five years of collaborative work by academic, government and military researchers that have been investigating the numerous military suicides.
Ronald Kessler, a sociologist at Harvard University who lead one of the three studies, called the problem a “blind alley” and said the solution isn’t as simple as just excluding people with common mental illnesses from the military.
“If I said to your news organization, what you should do is just have people who have never been ill, you wouldn’t have anybody to hire,” Kessler said.
“The kinds of disorders that are the very common ones, you just can’t have a business and say I’m not going to take anybody like that” Kessler added. “Already, close to one third of the population is ineligible to enlist in the army. Now go into that two thirds and take the half who have had a mental illness, there’s nobody left.”
In an e-mail to Al Jazeera, Lt. Col. Cathy Wilkinson, a defense department spokesperson, said the Army was “reviewing the results of the Army STARRS article,” one of the three reports, and that the Department of Defense will “work to incorporate these lessons learned and future Army STARRS findings into our resilience efforts.”
Lt. Col. Alayne Conway, an Army spokeswoman, told Al Jazeera that the Army “continues to aggressively combat stigma associated with help seeking behaviors, which adversely impacts readiness,” and noted that the Army did see a modest decrease in the number of suicides in 2013.
Army suicides decreased 19 percent in 2013, down from 185 confirmed and suspected suicides to 150, according to Army figures.
If the Army were to intensify its screening process, it could lead new recruits to hide their mental health issues, and some experts have suggested it may be better to screen people after enlistment, so there is less incentive to hide any problems and those who need it can get help.
“A small minority of soldiers are responsible for a disproportionate amount of suicidal behavior,” Dr. Matthew J. Friedman, of the National Center for PTSD (posttraumatic stress disorder) wrote in an editorial that accompanied the reports. “Better identification of and intervention with the cohort are likely to have the best payoff.”
Experts have also suggested that the military should take a preventative step and invest in training courses that would tackle the issue of mental readiness across the board, but the Army tried that in 2009 and found the program to be unsuccessful.
“You have to live with the reality that having these common mental disorders is part of life,” Kessler said.
“The way you handle it is to recognize it exists, to say to people that your job when you come in is to get yourself strong, trained and do what you need to do, and that doesn’t mean just lifting weights and being able to take your weapon apart in the dark — It means getting your head straight,” Kessler added.
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