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New study links pre-existing risks to rise in Army suicides

Roughly 18 out of every 100,000 Army soldiers commit suicide every year, while many more attempt or consider killing themselves. A new study on the rise in suicides found that 1 in 10 soldiers could be diagnosed for an anger impulse control disorder. Jeffrey Brown talked to Dr. Ronald Kessler of Harvard Medical School about how pre-existing mental illness may make soldiers more vulnerable.

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    As American involvement, including multiple deployments in Afghanistan and Iraq, winds down, a recent and disturbing trend is drawing new attention: an increase in the rate of Army suicides. And new research shows soldiers may be at greater risk even before they enlist.

    Jeffrey Brown has more.


    The work was published in a series of papers in "James Marks Psychiatry" and done by independent researchers funded, in part, by the Army.

    Among the key findings: One in 10 soldiers qualified for a diagnosis of what's known as intermittent explosive disorder. That rate is six times higher than in the civilian population. Soldiers also came into the Army with a higher rate of behavioral disorders such as substance abuse or ADHD than civilians.

    Dr. Ronald Kessler of Harvard Medical School is one of the principal investigators. He joins us now.

    Welcome to you.

    First, remind us of the extent of this problem. And what piece of it were you most focused on?

  • DR. RONALD KESSLER, Harvard Medical School:

    Well, the extent of the problem is that roughly 18 out of every 100,000 soldiers commit suicide every year.

    So we're talking about really still quite a small number of people, but it's higher than the civilian population. And I was involved in the part of the study that looked at surveys to try to understand what the risk factors might be for these suicides.

    And, of course, the suicides are just the tip of the iceberg. There are many more suicide attempts. There are many more people who are thinking about killing themselves, that life isn't worth living and so forth. So we have looked at the whole range of mental health outcomes.


    So, the research shows that many soldiers suffered from mental illness before coming into the military. Explain that. Tell us what you found.


    Well, that's true.

    The rates of mental illness among soldiers is considerably higher than in the civilian population, looking at people of the same age and the same sex and the same education. Part of that is because, when we look at lifetime prevalence of these disorders, some people who are soldiers today had higher rates of disorders than the civilian population even before they came into the Army.

    And they are substance disorders, ADHD, this intermittent explosive disorder you mentioned. They're what we might think of as impulsive anger kind of disorders. In comparison, rates of anxiety mood disorders and rates of suicidality were not higher among soldiers than they were the rest of the population prior to time they entered the military.


    Well, so then what happens when they do enter the military? Then what they brought with them mixes with other risk factors. Were you able to look at specific cases and to see exactly what triggered suicide or suicidal thoughts?



    Well, there's a combination of things. There are the things they come with, these impulsive anger kind of things that are more common in the population. And then, once they get in the Army, the rates of anxiety disorders, post-traumatic stress disorder, major depression, increase.

    So, it's a combination of both kinds of disorders that are strongly associated with suicidality. We find that the majority of the soldiers who are suicidal today have that accounted for by this profile of multiple emotional problems, some they brought in advance and some which they only acquired after entering the Army.


    So the one obvious question is, how much screening takes place for new recruits, and what do your findings suggest about what should happen?



    Well, you can't join the Army if you have a serious mental disorder. If you have made a suicide attempt in the past, you're not allowed to join the Army. If you're schizophrenic, have other psychotic disorders, a bipolar disorder.

    However, we don't have any national registry for these things. And the questions are pretty much just asking people to report whether they have had these problems. And if they say no, even though they have, there's not much that we can do to do anything about that.

    We don't have any objective tests for the presence of mental disorders, in the way we do blood pressure or a thermometer or blood tests or things of that sort.


    Well, that's what I was wondering. Does anything in the findings help identify those who may be more likely to make suicide attempts?


    Well, as I said, you know, the main things are the people who make suicide attempts, not surprisingly, are people who have mental disorders.

    And the most important things are mental disorders. But if the issue you're raising is, is there something we could do to figure how to not have people with mental disorders join the Army, the answer is probably not. And the reason is, there are very many people in the U.S. population who have a history of some kind of mental disorder in their life.

    Probably up to 40 percent, 50 percent of the population at some time in their life has had some mental disorder. Now, that doesn't mean they're all psychotic. You can have the common cold of mental disorders, where you could have a fear of dogs or of small spaces or a fear of speaking in public, or, after you loss a job or broke up with a girlfriend, maybe you were depressed for six weeks or so.

    Those all count as mental disorders. And if you were to exclude all of those people, there wouldn't be many people left to join the Army.




    So I think it's not practical to think in terms of excluding all those kind of folks.


    Well, I was — I was asking that in part about — about excluding, but also once people are recruited and in the Army, are there things that the military could do better if — once people have been identified as having some sort of problems as they come in to — to deal with the kind of risk factors that you talked about that come with the military?



    The military does an extraordinary job of getting people the treatment after they have been exposed to trauma. And, in fact, the number of people in the military with mental disorders who are getting treatment is higher than the proportion of the population with the same disorders who get treatment.

    So the — addressing the problems of stigma and embarrassment and so forth, the military has done an extraordinary job. I think one thing that has caught all of us by surprise with these new findings is how many people came in before they had any exposure to traumatic military experiences with problems that subsequently were deemed to be important.

    And there, I think it's more challenging. We know from other studies of disasters that, after Hurricane Katrina, after 9/11, many people came into treatment for mental disorders associated with those things.




    But, in fact, a lot of those people turned out to have problems that were preexisting. The question is, how do you get people to come in before they get…


    All right. OK.

    Ron Kessler of Harvard University, thank you so much.


    My pleasure.

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