MSRC News Details

MSRC's Dr. Tim Lineberry discusses suicide prevention in September's Mayo Clinic Proceedings

Doctors used to call it "shell shock," "soldier's heart," or "nostalgia." Soldiers would shake uncontrollably, experience heart palpitations, or go blind after witnessing trauma on the battlefield. From as far back as ancient Greece, history reveals the psychological toll of war on soldiers. Today we call the condition post-traumatic stress disorder.

Mental trauma directly associated with military service has been around since man first decided to organize and attack their neighbors. The history of the U.S. began with a war, and most of its defining moments since our inception, have been defined by military conflict; With war, brings casualties. Not all war wounds are physical. Physical wounds eventually heal or one learns to live with some form of disability, but mental wounds are often complex, affect many aspects of the soldier's life and often remain misdiagnosed or undiagnosed.

Psychological problems after active service were not recognized by the military until the Vietnam Conflict. Officials classified many soldiers as suffering from "character disorders," and focused on behavioral problems, rather than diagnosing mental illness.

After the war ended, the media began to refer to "Post-Vietnam Syndrome" to describe the psychological difficulties of returning soldiers, a term challenged by many military psychiatrists. A physician and supporter of the term described the symptoms in a 1972 New York Times article. The victims, he wrote, experienced "growing apathy, cynicism, alienation, depression, mistrust and expectation of betrayal, as well as an inability to concentrate, insomnia, nightmares, restlessness, up rootedness, and impatience with almost any job or course of study."

About 15 percent of American soldiers who served in Vietnam were still suffering from war-related mental health issues fifteen years after the war, according to a government-funded report published in 1990.

In America's most recent conflicts in Afghanistan and Iraq, our soldiers are experiencing the highest rates of mental illness and suicides ever recorded. A study of veterans with PTSD published last August by the Journal of Traumatic Stress found that 47 percent had had suicidal thoughts before seeking treatment and 3 percent had attempted to kill themselves. The US Department of Veteran Affairs (VA) has been compelled to substantially upgrade its services. Since its 24-hour, seven-days a week suicide hotline was belatedly established in July 2007, it has counseled over 185,000 veterans or their families and claims to have prevented at least 5,000 suicides. It now has 400 counselors dedicated to suicide prevention though even the Pentagon admits far more are needed.

The suicide rate in the U.S. Army now exceeds the rate in the general population, and psychiatric admission is now the most common reason for hospitalization in the Army. These concerning trends are described by Timothy Lineberry, M.D., a Mayo Clinic psychiatrist and suicide expert for the Army, in the September edition of Mayo Clinic Proceedings.

"Despite the anticipated end of large-scale military operations in Afghanistan and Iraq, the effects on the mental health of active-duty service members, reservists, and veterans is only just beginning to be felt," Dr. Lineberry says. "Moreover, the potential effect on service members of their war experiences may manifest indefinitely into the future in the form of emerging psychiatric illnesses."

Dr. Lineberry outlines four steps based on past research and emerging evidence that he believes could help begin curbing military suicide:

Reduce access to guns and other means of suicide. Nearly 70 percent of veterans who commit suicide use a gun to do it. Veterans are more likely to own firearms. All veterans with psychiatric illness should be asked about their access to firearms and encouraged to lock up guns, giving someone else the key, or remove them from the home altogether. Just slowing down gun access by a few minutes may be enough to stop the impulse.

Watch for sleep disturbances. Complaints of insomnia or other sleep disturbances in otherwise healthy soldiers, reservists, or veterans may signal the need for taking a careful history and screening for depression, substance misuse and post-traumatic stress disorder. Sleep disturbances have been previously identified as a risk factor for suicide. These complaints may also serve as opportunities for referring those potentially needing more intensive treatment.

Prescribe opioid medications carefully and monitor. Unintentional overdose deaths, primarily with opioids, now outnumber traffic fatalities in many states. Individuals with psychiatric illness are overrepresented among those receiving prescriptions for opioids and those taking overdoses. This same trend has been seen in former military personnel. A recent study found that Iraq and Afghanistan veterans with a diagnosis of post-traumatic stress disorder who were prescribed opioids were significantly more likely to have opioid-related accidents and overdoses, alcohol and non-opioid drug-related accidents and overdoses, and self-inflicted and violence-related injuries.

Improve primary care treatment for depression. Research suggests that patients who die by suicide are more likely to have visited a primary care physician than mental health specialist in the previous month. Programs developed to improve primary care physicians' recognition and treatment of depression could help lower suicide rates.

While it seems unlikely that the humans will find a way to resolve conflicts peacefully in the near future, we can take real steps to help those who put themselves in harm's way to protect us.

Original Article