Army Suicides Reached Unprecedented Level

BALTIMORE – Suicides by active-duty soldiers in the U.S. Army reached their highest level in history last year, with 164 confirmed instances of soldiers taking their lives.

This unprecedented level came in the seventh consecutive year of steadily increasing suicide rates; in 2008, the suicide rate among active-duty U.S. Army personnel exceeded the prevailing civilian rate for the first time in history, and in the years following 2008 the annual rate among soldiers continued to rise, Maj. Gen. L.P. Chang said at the annual conference of the American Association of Suicidology.

Mitchel L. Zoler/IMNG Medical Media Gen L.P. Chang

"The Army takes this very seriously because our most valuable asset is our soldiers," said Gen. Chang, commanding general of the 807th Medical Command based in Fort Douglas, Utah. He noted that in 2009, with the Army’s leadership recognizing that the suicide rate had surpassed the rate among civilians, the U.S. Department of Defense launched a suicide prevention task force that, among other goals, has worked to update suicide education and prevention programs. "It will take continued, concerted effort to begin to see the results we’re expecting from the changes that have been implemented," said Gen. Chang, who is also a doctor of osteopathic medicine practicing in Alexandria, Va.

According to Army data presented by Gen. Chang, the suicide rate among active-duty soldiers stood at 10 episodes per 100,000 in 2004, and then steadily rose to a level of 22 per 100,000 in both 2009 and 2010. The rate seen last year projected to a new high, of 24 per 100,000, he said. Throughout this period, the suicide rate among American civilian adults held steady at about 19 episodes per 100,000.

Army data for the first 3 months of 2012 showed no ebbing of the suicide rate. In a press release on April 18, the Department of Defense reported 45 potential suicides among active-duty Army personnel during the first 3 months of 2012, including 20 confirmed suicides and 25 episodes still under investigation. At that rate, the 2012 rate could exceed what happened last year: In May 2011, the Department of Defense reported that during the first 3 months of last year it had tallied six confirmed suicides and was investigating an additional 24 possible cases.

The factors behind the burgeoning rate of Army suicides since 2004 remain unclear. "Our hypothesis is that repeated exposures to stressors have changed," said Gen. Chang, and he particularly cited the increasing rate of multiple deployments among U.S. soldiers as a possible contributing factor. In 2011, 43% of soldiers had been deployed more than once, a statistic that has risen steadily in recent years. But other factors also play a role. Data collected by the Army showed that among active-duty soldiers work-related stress is the most common stressor faced, followed by relationship issues, and discipline.

An Army study of the most immediate triggers identifiable just before suicides during 2007-2011 were failed relationships (37%), followed by work problems (21%), legal concerns (16%), and financial problems (6%). But Gen. Chang added "a lot of relationship and work problems can be financial." The data also showed that about 19% of the suicides involved alcohol use, he said.

Gen. Chang said he had no disclosures.

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Many Factors Contribute to Soldier SuicidesThere are several issues to keep in mind when considering the relationship between deployments and suicide.

Dr. Craig J. Bryan

Deployment might entail going to an area with high levels of combat, such as Iraq or Afghanistan, or an area that supports combat zones but does not actually involve combat exposure. Even within combat zones, there is variability in what a soldier does based on location and occupation. This means that when you look at number of deployments as a factor in understanding suicide, you actually have a relatively "messy" variable that could mean a lot of different things.
The next issue is what we mean by "combat exposure." Combat exposure has several different dimensions, two of which we can fairly reliably distinguish: traditional combat events and aftermath events. These two dimensions of deployment have different relationships to mental health problems, with aftermath events being especially strong predictors of posttraumatic stress disorder, depression, and suicidal ideation.
A final key issue ... is the role of non-deployment stressors. Soldiers also experience family problems, work-related stress, financial strain, legal problems, and so on. In almost every case I’ve worked with, soldiers who attempted suicide said they did so because of these problems. Many of them were also deployed, and some suffered from posttraumatic stress disorder. But the "final straw" for all of them was the stressful event or annoyance they experienced the day before their suicide attempt.
Deployments don’t seem to trigger suicide attempts in and of themselves, but rather they seem to create other problems or difficulties that are much more closely related to suicide. Veterans who report feeling less like a civilian are the ones with the greatest number of psychological symptoms and alcohol-use problems. Those with repeated deployments therefore likely experience the cumulative effects of this disruption to their lives, and many feel increasingly isolated or disconnected from the rest of society.
Craig J. Bryan, Psy.D. is associate director of the National Center for Veterans Studies at the University of Utah in Salt Lake City. Dr. Bryan made these remarks in an interview. He said he had no relevant disclosures.