Thursday, October 6, 2011

Bending the Curve on Suicide By Thomas Insel, M.D. NIMH Director There has been so much concern in the mental health community about cutbacks in services and potential changes in funding, it’s easy to overlook an important, positive change in policy. Earlier this month, the White House announced that henceforth, soldiers who die by suicide while deployed in a war zone will be recognized just as others who die in service to this country. In an extraordinary statement, the President noted, “They didn’t die because they were weak.”

 This statement was followed by a White House Blog post from the Army Vice Chief of Staff General Peter Chiarelli, who stated, “Many are struggling with the ‘invisible wounds’ of this war, including traumatic brain injury, post-traumatic stress, depression and anxiety. Any attempt to characterize these individuals as somehow weaker than others is simply misguided.”

Why this change in our approach to soldier suicides? Partly, this reflects recognition of the increasing rates of suicide in the military, rates that have doubled for the Army since 2004. While soldiers traditionally have lower rates of suicide relative to age and gender-matched civilians, the rates in the Army began exceeding civilian rates in 2008. Since 2010, more soldiers have died from suicide than in combat. What is driving this increase in suicide? An NIMH-Army collaboration, the Army Study to Assess Risk and Resilience in Soldiers (Army STARRS), has been reviewing recent suicides, as well as mounting a prospective study of new and active duty soldiers, to answer this question.

The results from reviewing 389 suicide deaths defy any simple or single explanation. There has been an understandable tendency to attribute the increasing rate to the rigors of a continuing war, with many soldiers experiencing multiple deployments and many affected by post traumatic stress disorder and traumatic brain injury. The risk for suicide has risen for all soldiers, regardless of whether they have been deployed, but the data show that a soldier’s risk for suicide is greatest while deployed. Army STARRS, modeled on the Framingham Heart Study, is still in its early phase, but over 17,000 soldiers have now enrolled.

We expect that the prospective study can build on these retrospective results to define risk factors for suicide, just as the Framingham study identified risk factors for cardiovascular disease…. By Thomas Insel, M.D. NIMH Director

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