Doctors warned on combat link to military suicide risk

Washington Suicides by active U.S. service members exceeded the number of combat deaths in 2012, and the rate of suicide among military members has been on the rise.

The number of deaths determined by the military to be suicides in 2012 was 349, a 16% increase from 2011 and nearly double the rate at the beginning of the past decade, when the U.S. wars in Afghanistan and Iraq began. No single issue has led to the increase in suicides, but the statistics for military personnel taking their own lives reflect a growing problem across the nation, said Robert J. Ursano, MD, director of the Center for the Study of Traumatic Stress and chair of the Dept. of Psychiatry at the Uniformed Services University of Health Sciences in Bethesda, Md.

“Suicide is a national issue as well as one for the Army,” he said.

During World War II, suicide rates went down compared with what they were during peacetime, and physicians believed they understood mental health problems in the military, Dr. Ursano said.

In more recent times, suicide rates have increased during war. Rates for civilian and military suicides are now about the same when matched along age and gender demographics, but before the Iraq and Afghanistan wars started, the military suicide rate was about half of the rate for the general population.

War creates particular stress for servicemen and women. They are in high-tempo operation environments — where everything moves faster — at the same time that they are separated from family and significant others. Physicians who study military suicides often find depression or anxiety before such a death, but there are other variables.

“It’s a complex mixture, and there is no common thread,” said Elspeth Cameron Ritchie, MD. She’s the chief clinical officer for the District of Columbia Dept. of Mental Health and a retired Army psychiatrist.

Several efforts have been made to increase awareness about mental health care for the military community. The American Medical Association is participating in the national Joining Forces effort to support active members of the military, veterans and their families. Estimates show that roughly 300,000 service members have developed posttraumatic stress disorder or major depression after tours in Iraq or Afghanistan.

How physicians can help

Physicians should educate themselves and have information about mild brain injuries, postcombat depression and PTSD, said AMA President Jeremy A. Lazarus, MD, a psychiatrist in Denver. About half of active military members and veterans with illness related to their service will seek care from a physician in private practice. He said physicians should be prepared to ask questions and screen these patients for depression and anxiety.

“These are illnesses or symptoms that are not always that apparent on the surface,” Dr. Lazarus said. “It is not only important to have the opportunity to talk with veterans or patients on active duty, but also have an opportunity to talk with their families.”

Joining Forces and the AMA have training, screening and treatment resources available online.

“We remain committed to push out as much information as we can to try to help these individuals who have given so much to our country,” Dr. Lazarus said. “We owe them both on the military side and private side to do whatever we can to help them and their families with these very difficult illnesses.”

As clinicians likely will encounter active members of the military or veterans of the recent wars, Dr. Ritchie encourages physicians to ask questions about such patients’ service. For instance, a physician can inquire about service records, relationships and injuries, including head trauma.

About 60% of military suicides involve a firearm, Dr. Ritchie said. If the military or veteran patient owns a personal firearm, the doctor can ask if he or she has trigger locks or a gun safe that children cannot access.

Dr. Ursano also encourages primary care physicians to ask questions and use screening tools to assess risk for depression. These tools can lead to appropriate interventions with psychiatrists.

The Defense Dept. has many programs addressing mental health, Dr. Ursano said. They are moving toward greater collaboration on health care, but suicide remains a difficult problem without a single solution.

“I’ve worked with senior leadership, and they are deeply affected by these events,” he said. “There is no lack of energy to try and address this.”

Lawmakers in Washington have urged the Pentagon and the Dept. of Veterans Affairs to offer more mental health services. Sen. Patty Murray (D, Wash.) has championed legislation on mental health services in the military.

“This is an epidemic that cannot be ignored,” she said in a statement. “As our newest generation of service members and veterans face unprecedented challenges, today’s news shows we must be doing more to ensure they are not slipping through the cracks.”