In the meantime, experts are expressing concern over stresses on soldiers and veterans of the conflict from prolonged and multiple tours of duty. In the most telling statistic, the suicide rate among soldiers in Iraq and Afghanistan nearly doubled last year from 2004, surpassing 2003's alarming rate.
"We care about our soldiers, we are concerned about this issue, and we are working hard to keep safe every soldier America has entrusted to our care," Lt. Col. Brian Hilferty, an Army spokesman, told United Press International.
Twenty-five soldiers engaged in Operations Iraqi Freedom and Enduring Freedom were confirmed to have committed suicide in 2005, a rate of 19.9 per 100,000.
The suicide rate for 2005 is nearly twice 2004's rate of 10.4 per 100,000. The relatively low rate in 2004 -- 14 suicides in OIF and OEF -- was credited in part to the Army's Suicide Prevention Program, put in place after 2003's rate of 18.8 per 100,000 caused widespread public concern.
An Army Mental Health Advisory Team report noted the significant improvement from 2003 to 2004, saying the 2004 rate was below recent Army historical rates. The MHAT released comprehensive reports on mental health in OIF in December 2003 and January 2005. A report addressing the 2005 numbers has not yet been released; Army Medical Command Media Relations Officer Jaime Cavazos said leaders are being briefed on the findings of the report and it will be released in the next few weeks.
Some experts say the reason for the renewed rise is clear.
"What's causing this increase, most importantly, is operational tempo, folks going back for a third and fourth tour," Paul Rieckhoff, an Iraq war veteran and executive director of Iraq and Afghanistan Veterans of America, told UPI.
"It causes breakdowns on the individual and institutional level. Imagine being at your job with no vacations or weekends. It starts to wear on you, and compounded with increase in attack frequency, the insurgency continues to be an issue, divorce rates are up -- all these factors go into a complex cauldron to increase the likelihood of suicide."
Numbers for 2006 show the possibility of improvement, with eight soldiers having committed suicide through the end of June -- less than one-third of 2005's 25 suicides. This number is not entirely conclusive, however, as troop levels in Iraq have decreased by more than 30,000 since 2005 and an unknown number of non-combat deaths remain under investigation.
While the Army makes up the vast majority of U.S. troops deployed to Iraq and Afghanistan and therefore has suffered the highest numbers of suicides, the Marines have also sustained self-inflicted casualties. Unlike the Army, the Marine rate of suicide spiked in 2004, with seven suicide deaths compared to just two in 2003. The Marines list suicides by calendar year and do not calculate rates.
In a statement, the Marine Corps described the 2004 increase as likely caused by "increased operational tempo reducing the capacity of Marines to deal with other stressors, such as relationship, financial, or work-related problems, through all points of the deployment cycle."
The report also says the biggest challenge to suicide prevention in the Marine Corps is making it acceptable to seek help for mental-health problems without being seen as weak or non-promotable. The report, put together by Lt. Cmdr. Aaron Werbel, a behavioral health affairs officer for the Marine Corps Personal and Family Readiness Division, said the Marine Corps is working to reduce the stigma against getting help, in addition to more traditional suicide prevention tactics promoting early identification and intervention.
The Army's Mental Health Advisory team similarly identified stigma as an impediment to suicide prevention in a January 2005 report. The report emphasized the role of leaders in increasing awareness of mental-health issues and encouraging those needing help to take advantage of available resources.
"Most cases of suicide are related to a mental health issue like depression, whether it's recognized or unrecognized in that individual," James Radack, senior vice president of public affairs for the National Mental Health Association, told UPI. "In general in society there is a stigma against mental health issues, and it exists even more so in the military. There is still an attitude that these people should be able to get over these issues themselves."
Cavazos said the Army's Mental Health Advisory team is well aware of this stigma against seeking healthcare and is working to reduce it.
"That's being addressed and is continued to be addressed," Cavazos told UPI. "The MHAT I and MHAT II reports indicate that the stigma is being minimized. The programs and commanders that are responding to it are helping minimize the stigma and encouraging the soldiers that need help to seek help."
Radack believes a top-down approach would be most effective, with military leaders going out ahead to ensure their subordinates that they will not be penalized for seeking help for mental-health issues.
"The military brass needs to talk about it and make it clear that these are real conditions and people can get help without fear of their careers being hurt," Radack said. "Again, that goes a little bit against some of the military culture that has existed for an extremely long time but it has to be treated like any other health condition."
The all-Army suicide rate is traditionally well below the national average of 19.8 per 100,000 once adjusted for military demographics. While the all-Army suicide rate remains below the demographically adjusted average, the Army suicide rate for OIF/OEF in 2005 just surpassed it.
"In 2003, the latest data point that (the Centers for Disease Control and Prevention) has made publicly available, 31,484 Americans committed suicide -- 76 soldiers did," Army spokesman Hilferty pointed out. "We hope to use the lessons learned in society to bring the Army rate even lower."
Suicide prevention programs may continue to fall short in Iraq, especially if ground conditions remain extremely dangerous and if the timeline for withdrawal remains unclear.
"They're exhausted and they don't know where the goal line is," Rieckhoff said. "The administration hasn't been clear in setting the goal line, and that contributes to anxiety and a sense of unease."
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