Tuesday, March 30, 2004

Suicides in the Military

Army sent mentally ill troops to Iraq

By Mark Benjamin
United Press International
Published 3/12/2004 5:53 PM
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WASHINGTON, March 12 (UPI) -- The Army appears to have "inappropriately" deployed soldiers to Iraq who already were diagnosed with mental problems, according to documents obtained by United Press International.

More than two dozen suicides by U.S. troops in Iraq, and hundreds of medical evacuations for psychiatric problems, have raised concerns about the mental health of soldiers in Operation Iraqi Freedom. An Army Medical Department after-action report obtained by UPI suggests that the Army sent some soldiers to war who were mentally unfit in the first place.

"Variability in predeployment screening guidelines for mental health issues may have resulted in some soldiers with mental health diagnoses being inappropriately deployed," the report said. That could "create the impression that some soldiers develop problems in theater, when, in some cases, they actually have pre-existing conditions."

The October 2003 report said the Army should consider quickly changing course to prevent deploying more soldiers with mental problems. In a massive troop rotation now under way, more than 100,000 troops are heading to the region.

"Perhaps stricter predeployment screening is required to keep at-risk soldier from deploying," the report said. That would help in "identifying soldiers that may become non-functional in theater due to mental health problems."

It says that idea, among others, "must be passed on in a timely manner since units will more than likely be deploying in the near future."

A number of veterans' advocates say signs of widespread mental problems among soldiers from Iraq shock them -- one in 10 soldiers evacuated from the war on terror to an Army hospital in Germany were sent solely for mental problems. The Pentagon says that number is not out of line. It also is investigating more than two dozen suicides in Iraq and Kuwait but says the rate is not alarmingly high.

Analysis: In a randomly selected group of people in the USA, out of 100,000 people, in one year, you would expect about 10.7 suicides.  The Pentagon said that the number of suicides -- "more than two dozen"  -- is "not alarmingly high."  Looking at the most recent complete figures at NIMH Suicide Facts, and crunching a few numbers, and making some assumptions, we seen that among males ages 20-24, we would expect 20 suicides in a group of 100,000 in one year.  (The assumption is that all of the deployed soldiers are male, and that all of those who killed themselves are male.  Probably not exactly true, but close enough.)  There are some factors we cannot quantify.  Suicide risk is increased among those with ready access to firearms, those with a history of violence, those with substance abuse problems, and so forth.  Although we can't quantify this, it seems reasonable to think that among male soldiers in a combat zone, an increased risk of 20% above baseline is reasonable.  Therefore, 24 suicides is about what one would predict.  Although I would love to say that the number of suicides is an indication that there is something wrong with the military, the numbers do not support that position. 

Furthermore, efforts to predict suicide in individuals have not proven to be very accurate; and efforts to demonstrate reduction in suicide via suicide prevention programs largely have been futile.  So it does not seem likely that the military has much chance of actually reducing the risk.  Still, on humanitarian grounds, they should increase their screening and not deploy soldiers at risk.  I doubt this would have a measurable impact on the suicide rate, but it easily could reduce the amount of chronic posttraumatic stress disorder and reduce the incidence of exacerbation of pre-existing serious mental illness.

My wife used to work with at-risk veterans.  Her group consisted of about 50, mostly male, who had the most days in-hospital of all the veterans in the area.  Two of her patients committed suicide over a period of several years (despite intensive case management and individualized treatment).  Several of them had been sent into combat (mostly in Viet Nam) even though they clearly had been exhibiting signs of serious mental illness prior to deployment.  I don't know if those two suicides could have been prevented, but I do think that those patients would not have had such severe illness if they had been screened out, and not sent to combat.