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WEDNESDAY, April 1, 2015 (HealthDay News) -- In a study of almost 4 million American military personnel, serving in Iraq or Afghanistan was not associated with suicide risk, a new study finds.
The suicide rate among members of the military has increased over the past decade and seeing action in Iraq and Afghanistan seemed a likely culprit. But that appears not to be the case, said lead researcher Mark Reger, a clinical psychologist at Joint Base Lewis-McChord in Tacoma, Wash. Rather, it is the separation from the service and readjustment to civilian life that plays a greater role, he said.
"Everyone wants a simple answer to the suicide problem in the military," Reger said. "As the suicide rate started increasing, we were also deploying people to Iraq and Afghanistan, so it was reasonable to assume deployment was causing the increase in the suicide rate."
But there is no data to support that assumption, Reger said, and "even though it's an easy answer, it doesn't appear to be correct."
Reger's group did find an association between suicide risk and separation from military service, especially for those who served less than four years, he said. However, the study did not prove a cause-and-effect link.
Reger explained that leaving military service can result in a loss of identity. "A lot of service members talk about the importance of being connected to their unit, having a sense of a really important mission. And when they leave military service, that is gone," he said.
People separating from the military are also often confronted with financial, family and social problems that can be extremely stressful, Reger said. For example, returning to civilian life means finding a job, not only to pay bills, but to give meaning to their lives, he explained.
And some of those who left the service early may have left with dishonorable discharges or because of a mental health issue, he added.
Service members with an honorable discharge had about half the suicide rate compared with those who did not have an honorable discharge, the researchers found.
"Whatever the challenges were that led to that early separation may be important to understating suicide risk," he said.
Reger thinks that preventing suicides might start by targeting those who leave military service early and connecting these individuals with mental health professionals. "Our data suggest that if we are going to target some prevention efforts, that group who leaves military service early would be a reasonable group to target," he said.
The report was published online April 1 in the journal JAMA Psychiatry.
Mark Kaplan, a professor of social welfare at the Luskin School of Public Affairs at the University of California, Los Angeles, said, "A study like this gives us a better handle on where to target funds for suicide prevention."
Kaplan said that part of the increase in military suicides might also be a reflection of who volunteers for service. The Army and Marines had the highest suicide rates, he said. "The question is did those entering those two branches have any type of pre-service vulnerability to suicide," he said.
"We know that during the Iraq War, the Army was very aggressive in its recruitment tactics and many people joined for reasons that had less to do with joining the military and more to do with escaping hardships like socioeconomic problems," Kaplan said. "So, there may have been some vulnerability before they joined the military."
Kaplan thinks a better system is needed to help military personnel transition back to civilian life. In addition, former service members, especially men, who are often reluctant to seek help, should be encouraged to see mental health professionals for their emotional and mental difficulties, as well as for family and financial problems, he said.
These problems can cause a crisis that can lead to a suicide attempt, Kaplan said.
For the study, Reger's team used administrative data to identify the dates of deployment for members of the Army, Navy, Marines and Air Force from October 2001 through December 2007. They also collected suicide data from October 2001 through December 2009. Among the nearly 4 million service members, almost 32,000 died, slightly more than 5,000 by suicide.
Being sent into war zones was not associated with these suicides, Reger said. Of the 5,000 suicides, just over 1,000 were service members who were sent to Iraq or Afghanistan, while close to 3,900 were among those who were not.
One expert noted that re-entering civilian life is a vulnerable time.
"Leaving the military is a critical period," said Rachel Yehuda, director of the traumatic stress studies division at the Icahn School of Medicine at Mount Sinai in New York City.
"Even though people think they are home safe, they are not completely home safe. The next few years are going to be a critical time," she said.
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SOURCES: Mark Reger, Ph.D., clinical psychologist, Joint Base Lewis-McChord, Tacoma, Wash.; Mark Kaplan, Dr.P.H., professor, social welfare, Luskin School of Public Affairs, University of California, Los Angeles;Rachel Yehuda, Ph.D., professor, psychiatry, and director, traumatic stress studies division, Icahn School of Medicine at Mount Sinai, New York City; April 1, 2015, JAMA Psychiatry, online