Attrition: Stress And Suicide

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June 24, 2013: The mass media in the United States makes much of the suicide rate in military. It was 9 per 100,000 in 2001 and 17.5 last year. This was declared to be a health emergency, and too a certain degree it was. What was missed in all the discussion was the higher suicide rate in the army was far below the rate for civilians of military age (17-60), which was 25 per 100,000. The fact of the matter is that the military seeks to recruit only people who have an above average ability to deal with stress. It’s not just combat stress the military worries about, because only 15 percent of troops in the ground forces have combat jobs. The rest are doing civilian type jobs but often under stressful (combat zone) conditions. In fact, most of the military suicides are of men who were never in combat or even overseas. But since the military suicide rate is so much lower than those of comparable civilians, it hardly matters. There are so few actual suicides in the military each year that a few soldiers having family problems can cause the rate to seemingly spike.

The military has been doing a lot to keep their suicide rate down. That rate peaked at 23 in 2009, and has been declining since. Some of the increase was from the impact of so many troops suffering from PTSD (post-traumatic stress disorder). In addition to higher suicide rates, growing PTSD resulted in more troops using anti-stress medications. These increased 76 percent between 2001 and 2009. By then, some 17 percent of all troops took these drugs, including six percent of those in combat zones. In 2001, the troops used these drugs to about the same degree as the civilian population (ten percent).

The losses to stress have been growing in the last decade. For example, for every soldier killed in a combat zone, one is sent back home for treatment of acute stress. For every one of those cases, there are several less serious ones that are treated in the combat zone. Many of these stressed troops are no longer able to perform all their duties. This is sometimes the case with troops taking anti-stress drugs. Some of these medications slow you down, which can be fatal if you find yourself in combat or an emergency situation. Many troops on these medications are no longer sent overseas. They can perform well back in the United States but this complicates the job of finding enough troops to go perform combat jobs.

All this was seen as an inevitable result of so many NCOs and officers doing their third or fourth combat tours (in Iraq or Afghanistan). Thus, a PTSD epidemic has been created by the unprecedented exposure of so many troops, to so much combat, in so short a time. Once a soldier has PTSD they are often no longer fit for combat, and many troops headed for Afghanistan are falling into this category. PTSD makes it difficult for people to function or get along with others. With treatment (medication and therapy), you can recover from PTSD. But this can take months or years.

Nearly a century of energetic effort to diagnose and treat PTSD (including much recent attention to civilian victims stressed via accidents or criminal assault) made it clear that most troops eventually got PTSD if they were in combat long enough. During World War II it was found that, on average, 200 days of combat would bring on a case of PTSD for American troops. After World War II, methods were found to delay the onset of PTSD (more breaks from combat, better living conditions in the combat zone, prompt treatment when PTSD was detected). That's why combat troops in Iraq and Afghanistan often slept in air conditioned quarters, had Internet access, a lot of amenities, and a two week vacation (anywhere) in the middle of their combat tour. This extended their useful time in combat, before PTSD set in. No one is yet sure what the new combat days average is, and new screening methods are an attempt to find out. But more troops appear to be hitting, or approaching, the limits.

What the army does know is that a large percentage of its combat troops have had over 200 days of combat. Some have three or four times that. A major reason for army generals talking about the army "needing a break" (from combat) is the growing loss of many combat experienced troops and leaders (especially NCOs) to PTSD. The army won't give out exact figures, partly because they don't have much in the way of exact figures. But over the next decade, the army will get a clearer picture of how well they have coped with PTSD among troops who have, individually, seen far more combat than their predecessors in Vietnam, Korea, or World War II.

The army is dealing with PTSD head on, believing that a lot of troops have experienced a lot of combat stress. Experience so far has shown that PTSD can be delayed, perhaps for a long time. When a soldier does come down with it, PTSD can often be treated and its effects reversed. This has large ramifications for non-military medicine, for many civilians suffer from PTSD. That's why military recruits are screened for their ability to handle stress and resist PTSD. In the civilian community, there are far more people who can acquire PTSD after exposure to much less stress.

 

 


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