Suicides in military hit a record high

Experts don’t blame pandemic as continuing increase defies explanation

Suicides across the armed services rose sharply in the first year of the coronavirus, hitting a record 571 in 2020, but a Pentagon official and others say the stress of the pandemic isn’t the likely culprit.

Just what is behind the steady rise during years of Defense Department efforts to reduce self-inflicted deaths baffles experts. It is a mystery nowhere near to being solved.

The latest mark, released in a report last week, was above the 503 suicides recorded in 2019 and the previous record of 543, set in 2018.

The suicide total since 2003 now exceeds the 7,038 military lives lost in action or accidents in Iran and Afghanistan.

Suicides among uniformed personnel rose sharply after the invasion of Iraq and were once thought to be a byproduct of a military at war. The past six years have challenged that notion.

In that period, a near-peacetime era for the armed forces, the number of troops dying by their own hand has gone up almost every year and is nearly half the total of 7,491 military suicides from 2003 to 2020.

“It’s frustrating to see soldiers struggle and to die by suicide. It certainly is,” said James Helis, head of the Army Resilience Directorate. “It’s frustrating in trying to understand a very complex human behavior, but that does not discourage us from continuing to try to find better ways to prevent it from happening.”

The Pentagon has attacked the problem intensely since the Iraq War, establishing the Army’s $50 million Study to Assess Risk and Resilience in Servicemembers — STARRS — and creating the Defense Suicide Prevention Office in 2011.

In 2008, the Pentagon

launched UT Health San Antonio’s STRONG STAR, a multidisciplinary consortium to study posttraumatic stress disorder, as well as myriad initiatives to raise awareness among troops and civilian workers.

STARRS morphed into a study meant to reduce suicides and other mental health issues and identify “resilience-building” skills. The Pentagon also opened a Military Crisis Line for troops, veterans and families. It includes a confidential hotline, 800-273-8255, a website, www.militarycrisisline.net, and a text message number, 838255, for support.

Despite that, the Pentagon in 2019 acknowledged that activeduty suicides were still on the rise and that self-inflicted deaths in the National Guard during the previous five years were higher than among civilians in comparable communities. The suicide prevention office’s director, Karin Orvis, told a Senate subcommittee that year that the numbers “are not going in the desired direction.”

‘No one knows’

The Centers for Disease Control and Prevention said 47,511 civilian suicides were recorded in 2019, accounting for 14.5 deaths per 100,000. The Pentagon’s annual report for 2019 said the suicide rate among active-duty troops increased from 20.4 to 25.9 suicides per 100,000 from 2014 to 2019. Among reservists, the 2019 suicide rate was 18.2 per 100,000. In the National Guard, it was 20.3 per 100,000.

The suicide prevention office said military rates of self-inflicted deaths were comparable with the U.S. adult population after accounting for age and sex, but that’s cold comfort — troops were less likely to kill themselves than were civilians prior to the late 2000s.

As troop suicides continued to rise, the CDC reported in a Journal of the American Medical Association article published March 31 that civilian suicides fell in 2020 to 44,834, down 2,677 from the previous year.

“No one knows what to make of it,” said Craig Bryan, a clinical psychologist who researches military suicides and is a professor of psychiatry at Ohio State University.

Most recent Pentagon prevention research has focused on identifying and predicting risk factors, some of which are well known. Young men are most at risk of suicide, especially those who are just beginning their military careers; in the Air Force, 8 in 10 victims are male.

Suicides are often driven by broken marriages and other relationship woes, financial problems or legal trouble that risks courtmartial and separation from the armed forces. While some interventions are known to reduce suicides, no one has come up with an approach that consistently prevents such deaths.

“I haven’t read anywhere where anybody has been able to accurately predict who in a group that is facing these risk factors is going to commit suicide,” the Army Resilience Directorate’s Helis said.

UT Health’s consortium received $45 million from the Veterans Affairs Department and the Defense Department from 2008 through last year, and it was the nation’s largest combat-related research effort devoted to PTSD. It’s produced around 200 studies, but an expert there has a hard time explaining why suicides have grown worse.

“I wish I had an easy explanation,” said retired Air Force Lt. Col. Alan Peterson, who leads the consortium and is chief of UT Health’s division of behavioral medicine. “To some extent, it’s a bit baffling. It’s difficult to understand … the big increase in suicide in the military for the last five years.”

‘Same failed approach’

Retired Army Col. Carl Castro, professor and research director of the University of Southern California’s Center for Innovation and Research on Veterans and Military Families, wrote in 2014 that “the definitive causes of military suicides remain elusive” and that effective prevention and treatment hadn’t been developed.

That’s still the case seven years later, he said, agreeing with Ohio State’s Bryan and the Air Force’s Peterson that the current approach, which focuses on warning signs of self-destructive behavior, requires a makeover.

“I can only speak in detail with the Army’s approach, and their approach is one of basically blaming the buddy,” Castro said. “It blames the leader, like somehow they’re supposed to detect when someone is suicidal and intervene, and not doing that means you didn’t do your job. And if you said there were no signs, then it means you didn’t know your soldier well enough to intervene.

“But maybe there isn’t anything you could have done.”

Troops in all the services are taught to spot red flags that suggest someone is thinking of suicide, such as giving away important personal items and talking about ending their lives.

The Army conducts annual training in how to face challenges and setbacks and adapt to change. Soldiers learn about “emotional regulation,” a term that means not reacting negatively or impulsively when confronted with a difficult situation. They’re taught tips for communicating that are at the heart of relationships.

“What we can say is that we do know from soldiers and enough episodes (that) the training on intervention is effective, that understanding the warning signs is helpful,” Helis said. “The challenge is that in many cases, the warning signs either aren’t observed or visible.”

Peterson called that “a logical approach,” but added, “The question is, why isn’t it stemming the tide?”

Then there’s the “ACE” card, an old standby in the Pentagon’s war on suicides. A playing card that’s been handed out to hundreds of thousands of soldiers over the years, it breaks the advice down to Ask, Care, Escort — “Ask your buddy,” “Care for your buddy” and “Escort your buddy.”

“Have the courage to ask the question, but stay calm,” it states. “Ask the question directly, e.g., ‘Are you thinking of killing yourself ?’”

Castro recalled asking, when he was a lieutenant colonel in the Army, if leadership intended to evaluate the effectiveness of the card after it was distributed. He said he was told no. He also remembered that the first mock-up used the ace of spades — the death card.

It was changed to the ace of hearts.

“You can’t make some of this stuff up,” Castro said. “Just looking at it the other day, I was reading the Army regulation on wellness, and it still has the ace of hearts in there. I said, ‘My God, it’s been 20 years ago!’ Literally, almost 20 years ago. They’re still using the same failed approach. And I get it, but it’s not going to get us out of the pickle we’re in.”

Pandemic’s role a mystery

Bryan said much of suicide prevention has focused on mental health, which he believes plays a smaller role in the problem than do normal reactions to external factors and stressful events. While some therapies and treatments work, a focus on the warning signs of suicide often falls short. In many cases, he said, there are no signs to observe.

The Army trains junior officers and noncommissioned officers to get to know their soldiers and what is happening in their lives — and not just to help them intervene in a moment of crisis, Helis said. Required resilience training is designed to help GIS not only bounce back from difficult moments, but to confront the myriad stresses of life.

“And while that contributes to suicide prevention and it’s part of an overall program for suicide prevention, it’s not simply an element of suicide prevention,” he said. “It’s intended to improve soldiers’ performance, their selfconfidence, their optimism and mental agility.”

The pandemic has caused anxiety and depression and possibly knocked spouses out of work, ratcheting up financial and family stress. That doesn’t explain the rise in military suicides, but it might generate ideas for research, Peterson said.

Bryan noted that 2020 was marked not just by the pandemic but by widespread social unrest, raising the prospect that “there’s something about social conditions within the military that is making it hard, that’s blocking our ability to reverse the trends.”

“Suicide is not something that comes solely from within individuals. It’s affected by our environment, our social systems and our context,” he said. “As long as we keep saying suicide is caused by mental illness, it’s caused by these risk factors that individuals experience, we’re never really going to come to a satisfactory answer.”