Combat deployments affect place of suicide
Source: New York Times
Published: Monday 30 May, 2016
FORT WORTH -- An analysis of Army data shows that the risk of suicide for soldiers with multiple tours of combat duty actually drops when they are deployed and rises after they return home.
For the 85 percent of soldiers who make up the rest of the service and were deployed, the reverse is true.
"It's exactly the opposite of what you see in the trauma literature, where more exposure predicts more problems," said Ronald Kessler of Harvard University, who led the study.
After 14 years of war, the number of veterans with multiple tours of combat duty is the largest in modern U.S. history -- more than 90,000 soldiers and Marines, many of them elite fighters who deployed four or more times.
The findings may shed a clearer light on the needs of this important group of veterans, whose experience is largely unparalleled in U.S. history, in their numerous exposures to insurgent warfare, without clear fronts or predictable local populations. Researchers are finding that these elite fighters do not easily fit into the classic mold of veterans traumatized by their experience in war.
The veterans' primary difficulty is not necessarily one of healing emotional wounds; they thrived in combat. It is rather a matter of unlearning the very skills that have kept them alive: unceasing vigilance; snap decision making; intolerance for carelessness; the urge to act fast and decisively.
"I don't even leave my house much," said Jeff Ewert, who served with the Marines in Iraq and now lives in Utah. "I'm scared, not because I'm an uber-killer or anything. I just minimize my exposure because I know how easy it is to cross that line, to act without thinking."
Alan Peterson, a U.S. Air Force veteran who oversees two large research consortia studying combat stress at the University of Texas Health Science Center at San Antonio, is aware of the challenges.
"Turning off this hyper-hardwiring after returning from a deployment is not an automatic function of the brain," he said. "We have virtually no science to guide us in managing these instincts. We need to figure that out, or we're going to end up with a generation that struggles for much of their lives."
The Pentagon has spent hundreds of millions of dollars on testing and analyzing the psychological factors that make a high-performing fighter, but its researchers publish very few of their findings and refuse to speak in specifics on the record.
Psychiatrists and psychologists who have worked with the military say the sought-after mental profile is based largely on two well-known kinds of testing. One is a 44-item questionnaire that assesses personality. The other test is intended to gauge performance.
People who excel in combat tend to be assertive, active, excitement-seeking and enthusiastic.
"I hate to use the cliche, but these are guys who love to be at the tip of the spear," said a psychologist who works with the military; he asked that his name be omitted to protect that relationship. "It's more than the camaraderie; there's a need to protect life, directly -- and if necessary, to take life."
The performance measure has more to do with attention and decision making. It is based in part on a theory of concentration "styles," developed by researchers studying athletes.
Charles Morgan III, a psychiatrist at the University of New Haven in West Haven, Conn., has worked extensively with special operations forces.
"They immediately take in their surroundings; they have a high degree of external focus," he said. "But they're able to switch internally, make a quick decision -- then act and adjust as they go."
In training and in combat, this intense awareness and decision making become much sharper.
"Essentially, the decision making and acting become second nature," said Bret Moore, the deputy director of the Army's Warrior Resiliency Program, of the Regional Health Command-Central, in San Antonio. "You do not want these guys thinking too much."
That may help explain the recent suicide findings. The research team, led by Kessler of Harvard and Dr. Robert Ursano of the Uniformed Services University of the Health Sciences, analyzed 496 suicides among men in the Army between 2004 and 2009. The risks for two jobs -- infantryman and combat engineer -- were higher across the board, at 37 per 100,000 each year. But the rate was 30 per 100,000 while deployed, compared with 40 per 100,000 when back home. The rate across the rest of the Army was much lower at home, 15 per 100,000, compared with during deployment, where it was 22 per 100,000.
"These are the guys, we think, who are getting into fights, or in trouble with the law, who are impulsive and don't manage well when they're back in a civilian world that seems boring and frustrating," Kessler said.