The U.S. Army is funding a $50 million study that will involve half a million soldiers, in an effort to figure out why record numbers of troops are committing suicide and what can be done to reverse the trend. The five-year study is being managed by a civilian agency, the National Institutes of Mental Health, and involves senior researchers from several prestigious universities. They will focus on soldiers, but hope their findings will benefit civilians as well.
Experts call suicide a "rare phenomenon," but in the U.S. Army it has not been rare enough in recent years.
The number of Army suicides hit a record of 115 in 2007, and another record last year, 139. And this year, the Army is on pace to significantly surpass that figure.
"Today the numbers are higher than they were in 2008," said General Peter Chiarelli. "There is no doubt about it."
That is General Peter Chiarelli, the Vice-Chief of Staff of the U.S. Army. He was alarmed by a very large number of suicides in the Army during the first two months of the year, but he says the pace has eased since then.
"We started out in January and February with 41 suicides," he said. "In the past four and a half months we have had 51 suicides, they are not all confirmed, for a total today of 92."
The Army has launched several programs designed to train leaders and soldiers to watch for signs of desperation among themselves and their comrades, and to bring those in distress to clinics for professional help.
"In the past, our training programs were ones of avoidance, we tried to avoid [problems]," said General Chiarelli. "And we then would treat or discipline soldiers. That is changed today. The goal is to assess, educate, train and intervene early in an effort to identify and mitigate issues before they can become significant concerns."
But the efforts have not stemmed the tide of suicides, so Army leaders want to get some scientific evidence that details the causes, individual vulnerabilities and best treatments. The director of the U.S. National Institutes of Mental Health is Dr. Thomas Insel.
"Suicide is really the tip of the iceberg here," said Dr. Insel. "Through this study, we will learn a lot about both vulnerability, that is risk, and resilience, and how to modify and improve resilience. And that is something that the nation needs, not just the Army."
Many people inside and outside the Army assume that the rise in its suicide rate can be attributed to the stress of multiple deployments to war zones, where the soldiers experience daily danger and long separations from their families. But the doctor who will direct this huge study, Robert Ursano, says scientists can not draw a direct line from deployments to suicides, at least not until they do their research.
"Depression, PTSD [Post-Traumatic Stress Disorder], alcohol abuse, increased risky driving, family conflict, disrupted social relationships - we know that all of these are along the trajectory toward suicide," said Robert Ursano. "So our goal is to better understand this course, this line, and what are the factors that increase risk, and of course what are the factors that can protect."
In fact, Dr. Ursano says the most frequent factor believed to contribute to suicides is not unique to the military, although it can be made worse by deployments.
"There are predictors that we know, in terms of suicide, and the number one is actually the breakup in a relationship," he said. "That is true whether one is civilian or whether one is military. The problem is, of course, there are thousands and thousands of altered relationships that do not end in suicide. So which of those do?
Dr. Ursano says the same stress affects different people in different ways. While one person will shrug off the stress of a relationship breakup or a combat deployment, others will be significantly affected, and a small number will commit suicide.
Through this study, Dr. Ursano and his fellow-researchers from Harvard and Columbia Universities and the University of Michigan hope to be able to identify personality, genetic, demographic, medical or other factors that can predict a tendency toward suicide among both soldiers and civilians. Then they will look for treatments for people with that tendency to reduce the likelihood that some sort of stress will trigger a suicide attempt.
"The study offers the opportunity to address this problem in the Army and also to draw attention to what really is a national problem," said Robert Ursano. "Health is a national security issue in general, and it is a particularly national security issue within out defense forces."
Dr. Ursano and his team will interview every new recruit coming into the U.S. Army during the next three years - more than 250,000 mostly young people, and mostly men. They will also interview a cross-section of older soldiers of all ranks. They will focus particularly on troops who have attempted suicide. And they will look at the personnel and medical files of soldiers who did kill themselves and interview their family members and friends.
The National Institutes of Mental Health Director, Dr. Insel, says he believes this could be a "landmark" study that will change the way America, and perhaps the world, deal with a significant, but not very well understood problem.
"We have nearly doubled the number of suicides as homicides [in the United States]," he said. "There are more deaths from suicides than from AIDS. There are more deaths from suicide than all but three forms of cancer in the United States. So this is a very large problem for the civilian sector. And it is our hope that by working closely with the Army and having this extraordinary laboratory of 1.1 million people, we will be able to also have some information that would be of great use for the larger population."
In the meantime, the Army is continuing to expand its training programs, and to open more centers designed to reduce stress and provide professional counseling, in an effort to reverse its rising suicide trend well before the study ends in five years. Indeed, the researchers plan to release their findings as they become available in an effort to provide what Dr. Insel calls "actionable information" for Army leaders to use as soon as possible, as U.S. troops continue their high-stress multiple deployments to Iraq and Afghanistan.