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Army plans improvements in mental health care, suicide prevention

WASHINGTON—The Army is taking steps to ensure that soldiers in Iraq and Kuwait have better access to psychologists and other mental health professionals after a spike in suicides last summer.

The Army has already appointed a consultant to oversee mental health issues for soldiers in the region, officials said Thursday. Further steps include making sure that soldiers receive treatment nearer to their units and improving the soldiers' psychological care once they are evacuated from the combat zone for such care.

"War is an environment that is inherently stressful for our soldiers," said Col. Virgil Patterson III, chief of the mental health advisory team that visited Iraq last summer and fall. "Our soldiers are performing magnificently. We believe that having well-trained and -positioned behavioral health professionals help our soldiers control combat and operational stress."

At least 23 soldiers in Iraq and Kuwait killed themselves last year, nearly a quarter of the Army's reported 76 cases of suicide. An additional three cases remain under investigation as possible suicides. Army officials have reported one suicide so far this year.

While the rate in the region last year was higher than recent historical Army averages, it was still lower than suicide rates among comparable civilian populations, Patterson and other officials said.

Those deaths represent a rate of 17.3 per 100,000 soldiers during 2003, Patterson and other officials said. The annual Army average is 11.9 per 100,000. The average suicide rate for civilian males ages 20 to 34, the common ages of those serving in the military, is 21.5 per 100,000.

The Army surgeon general sent Patterson's team to survey the mental health of soldiers in the combat zone after five suicides last July. The 12-person team, composed of military and civilian psychiatrists, psychologists, social workers and a chaplain, interviewed 756 soldiers between August and October.

Among those surveyed, 82 percent had been engaged in combat, 67 percent had seen dead bodies and 59 percent reported knowing someone who had been seriously injured or killed.

The survey also found that 77 percent reported experiencing no stress or low levels of stress. Only 7.3 percent reported heightened levels of anxiety, 6.9 percent reported experiencing depression, and 15.2 percent reported experiencing traumatic stress.

Fifty-two percent reported "low" or "very low" personal morale, and 72 percent reported low or very low unit morale.

Patterson and other officials said the findings indicated that the Army mental health care system was working well but could use improvement.

Col. Bruce Crow, a psychologist and suicide prevention expert, said the team found nothing among the suicide cases to indicate a common cause or contributing factors.

All but two of the soldiers who killed themselves were male. All but one shot themselves. The other overdosed on Tylenol and other medications. Nine of the soldiers were married.

Five of the suicides occurred during the first 17 days of July, and the rest averaged out at two a month for 2003. All of the suicides occurred after the war began in March, Crow said.

The most common factors in suicide are failed relationships or financial or legal problems. But none of the soldiers who killed themselves showed any warning signs, Crow said.

Last summer, U.S. troops in Iraq were living in austere conditions, with infrequent contact with their families and no set date for many to return home. While these conditions contributed to low morale, it's unclear what role they might have played in the suicides.

Among the prevention measures the Army is implementing is the use of the "buddy system" to report the warning signs of suicidal behavior. But officials warned that these measures wouldn't completely eliminate the problem.

It's unclear how the suicide rate compares to that of past wars because there's a lack of data, Patterson said. The only figures the team found were annual suicide rates of 15.6 per 100,000 over the duration of the Vietnam War and 3 per 100,000 for the 1991 Gulf war.

Wayne Smith, with the Vietnam Veterans of America, said post-traumatic stress and other disorders may not manifest themselves until years later, and government-funded veterans hospitals may not have adequate resources to treat traumatized veterans.

"It's the same kind of patterns all over again," said Smith, a former combat medic who attended Thursday's briefing. "But at least the military is intervening earlier than they did in Vietnam. They recognize there is a problem, and I think they are earnestly trying to figure out what is going on."


(c) 2004, Knight Ridder/Tribune Information Services.