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Troops who have deployed to war zones two or more times have a higher risk of committing suicide than those who have deployed once or never deployed, a new Army report shows.

The report—“Army 2020: Generating Health & Discipline in the Force”—shows the suicide rate among active-duty soldiers reaching a new high in 2011 of about 24.1 per 100,000—up from 9.6 per 100,000 in 2004. In terms of stressors, military work stress was the leading factor in suicides in 2010, replacing relationship problems, which had been considered the prime factor in suicides from 2003-09.

In the report, Army officials acknowledge that some of the suicides were preceded by warnings that went unheeded by leaders.

“To be sure, the Army has investigated numerous suicide cases that, in hindsight, seemed to present a clear trail of behavioral indicators that may have afforded leaders or others in the social circle an opportunity to respond,” the report said. “However, post‐mortem suicide investigations can never truly capture the subtlety of pre‐ suicide indictors, nor truly judge the appropriateness of the response within the pre‐suicide context.”

The Army has improved mental-health services and taken myriad other steps to stem suicides since 2005, as pressure on soldiers increased with long, repeated deployments. The new report shows that the percentage of suicides committed by soldiers who had deployed multiple times increased steadily from 2009 through 2011.

Army officials said that while the increase in suicides over the last six years has been “dramatic,” self-inflicted deaths among active-duty troops appear to be “stabilizing at approximately 160 deaths (per year)” in the last several years.

Among other findings in the report:

• Research indicates that Iraq and Afghanistan veterans in general are at higher risk for suicide immediately following the transition from active duty, with risk decreasing over time.  Following separation from active duty, veteran suicide rates were 23.1 per 100,000 in the first two years, 18.1 in years two through four, and 12.9 in years four through six.

• Approximately 950 veterans under VA care attempted suicide each month between October 2008 and December 2010.

• The Army reported an increase in sex crimes by active-duty troops—28 percent overall from 2006 to 2011. The increase was especially steep for violent sex crimes: from 665 in 2006, to 1,313 in 2011, (more than 90 percent).

• Domestic violence crimes increased 85 percent, to 2,699 incidents, from 2001 to 2011. Child abuse rose 44 percent, to 2,201 incidents, in the same period.

• Prescription drug use among soldiers has climbed, including psychotropic and controlled substances, which were used by 358,203 active-duty troops in fiscal year 2011—up from 337,932 service members in 2010. The report says, however, that research ” counters the assertion that the Army is overmedicating the Force ” compared to the civilian population.

• The Army provided outpatient behavioral health services to 280,413 soldiers in the 2011 fiscal year—up from 253,773 the year before. Incidence rates of mental-health diagnosis doubled from 2000 to 2009. Forty-four percent of soldiers who committed suicide in 2010 had received outpatient behavioral healthcare, with about 37 percent of suicide victims having been seen at a
military treatment facility within 30 days of the event.

• Reported depression among soldiers can be attributed at least in part to deployments, with about one-third of soldiers reporting depression symptoms three to six months after returning home.  Research by the Institute of Medicine found that 27 percent of those who deployed three to four times received diagnoses of depression, anxiety or acute stress, compared to 12 percent of those who deployed just once.

The report cites several new programs designed to improve mental-health care, including pre- and post-deployment screenings and embedding behavioral health providers in combat units and in primary-care clinics. The Army pledged to continue seeking ways to improve soldier healthcare, including better detection and treatment of mental health issues and improvements to its transition services, to provide a “warm hand-off” of troops to VA healthcare programs.

“Leaders at all levels must recognize that while our Army has completed operations in Iraq and will eventually do the same in Afghanistan, this does not equate to less responsibility or fewer demands on them in coming days,” the report says. “To the contrary, arguably more will be asked of them during upcoming periods of reintegration and reset…The challenges facing our Army’s leaders in the days ahead are incredibly complex and consequential.”

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