More than two dozen suicides by U.S. troops in Iraq, and hundreds of medical evacuations for psychiatric problems, have raised concerns about the mental health of soldiers in Operation Iraqi Freedom. An Army Medical Department after-action report obtained by UPI suggests that the Army sent some soldiers to war who were mentally unfit in the first place.
"Variability in predeployment screening guidelines for mental health issues may have resulted in some soldiers with mental health diagnoses being inappropriately deployed," the report said. That could "create the impression that some soldiers develop problems in theater, when, in some cases, they actually have pre-existing conditions."
The October 2003 report said the Army should consider quickly changing course to prevent deploying more soldiers with mental problems. In a massive troop rotation now under way, more than 100,000 troops are heading to the region.
"Perhaps stricter predeployment screening is required to keep at-risk soldier from deploying," the report said. That would help in "identifying soldiers that may become non-functional in theater due to mental health problems."
It says that idea, among others, "must be passed on in a timely manner since units will more than likely be deploying in the near future."
A number of veterans' advocates say signs of widespread mental problems among soldiers from Iraq shock them -- one in 10 soldiers evacuated from the war on terror to an Army hospital in Germany were sent solely for mental problems. The Pentagon says that number is not out of line. It also is investigating more than two dozen suicides in Iraq and Kuwait but says the rate is not alarmingly high.
Steve Robinson, executive director of the veterans' National Gulf War Resource Center, has been pressing the Pentagon since 2001 to better screen soldiers for health issues. Robinson, a former Army Ranger, said he is worried about mental problems and suicides among troops in Iraq.
"This information indicates that pre-deployment, during-deployment and post-deployment screening is critical," Robinson said. "If done properly, it will rule in -- or rule out -- the deployability of service members."
"It is time to stop having congressional hearings on what needs to be done and have the Department of Defense step up to the plate and perform the screenings as required by law."
Army spokeswoman Martha Rudd did not respond to requests for comment made Thursday.
Since last summer, the Pentagon has been investigating a string of suicides in Iraq and Kuwait and mental issues among troops there. Top Pentagon health officials told Congress last month that personal problems -- family and money issues - appeared to be the root cause of the suicides.
Army Surgeon General James Peake told a House Armed Services Committee panel Feb. 25 that "failed intimate relationships, legal problems and financial problems -- the same kind of issues that you see back home related to suicide -- seemed to be the predominate triggers in theater as well."
Statistics show that a soldier who had mental health problems when he was deployed would be at much greater risk for suicide in Iraq. According to the American Association of Suicidology, the suicide risk among people with depression is 30 times that of the general population. About two-thirds of those who take their lives have a depressive disorder at the time of their death, the society says.
The Pentagon says at least 21 Army soldiers have committed suicide in Iraq or Kuwait, making the rate of suicides there higher than expected. Another five deaths there are being investigated as possible suicides and at least another six service-members have killed themselves after returning home.
One drug used by the Pentagon to prevent malaria in Iraq, Lariam, is unsuitable for people with mental problems, according to the Food and Drug Administration.
Assistant Secretary of Defense William Winkenwerder Jr. told Congress Feb. 25 that soldiers are carefully "screened" for mental problems before taking Lariam.
"Now we follow all the FDA guidelines for using this medication," Winkenwerder said. "Every service member is screened and receives information about possible side effects before taking this product. That's our policy, and that's what should be done."
In a number of interviews by United Press International with soldiers who served there over the past year, none said they had been screened for mental problems before taking the drug or received any warning of possible side effects. While some soldiers still had leftover Lariam pills, none of their medical records reflected use of the drug.
The FDA warns that Lariam can cause thoughts of suicide, depression, anxiety, paranoia, delusions and psychosis that can occur long after taking the drug.
The Pentagon told Congress that Lariam, invented by the Army, is not a significant factor in suicides in Operation Iraqi Freedom. "We do not believe that this (Lariam) represents the big causal factor in the suicide rates," Peak said. He said four of the 21 dead soldiers came from units that took the drug.
Pentagon and Army officials have made a variety of statements about suicides in Operation Iraqi Freedom. At issue is whether the rate of suicides is high.
- On Jan. 14, William Winkenwerder Jr., undersecretary of defense for health affairs, told reporters that there were 18 confirmed suicides by Army soldiers Iraq or Kuwait. He said that meant a rate of 13.5 suicides per 100,000 soldiers per year, which was "a little on the high side" of the 10-11 rate the Army had seen in the past.
- In a Jan. 28 speech, Army Col. Thomas J. Burke, Pentagon program director for mental health policy, said deploying to Iraq was not causing an increase in suicide. "Are soldiers killing themselves in increased numbers due to deployment? No," Burke said. Burke said media reports about an unexpectedly high rate of suicides were "false."
- On Feb. 25, Peake told Congress of 21 Army confirmed suicides there, a rate of 15.8 per 100,000. He compared that to Army suicide rates between 9.1 and 14.8 from 1995-2002. Peake told Congress that another five deaths in Iraq or Kuwait were under investigation as possible suicides.
If the Army determined that all those deaths were suicides, the comparable rate would be 19.5 per 100,000, according to a calculation by UPI.