USA — Services Work to Learn More About Brain Ailments, Suicides

WASHINGTON — Post-trau­mat­ic stress, trau­mat­ic brain injury and sui­cides among ser­vice­mem­bers are inter­re­lat­ed prob­lems requir­ing holis­tic pre­ven­tion meth­ods and more sci­en­tif­ic study, mil­i­tary lead­ers told a Sen­ate pan­el today.

“The real­i­ty is, the study of the brain is an emerg­ing sci­ence, and there still is much to be learned,” Gen. Peter W. Chiarel­li, Army vice chief of staff, told the Sen­ate Armed Ser­vices Com­mit­tee dur­ing a hear­ing about how the ser­vices are deal­ing with brain injuries and men­tal health prob­lems.

The vice chiefs of the Navy and Air Force, the Marine Corps’ assis­tant com­man­dant and a Vet­er­ans Affairs Depart­ment health offi­cial also spoke before the com­mit­tee. All agreed with Chiarel­li that the Defense and Vet­er­ans Affairs depart­ments are coor­di­nat­ing bet­ter than ever to diag­nose and treat brain injuries and men­tal dis­or­ders, and that much more is known about such con­di­tions today than when com­bat oper­a­tions began after Sept. 11, 2001.

Still, they acknowl­edged, much more needs to be done. They not­ed that sui­cides are high­est among ground forces. The Army report­ed 162 con­firmed sui­cides last year, up from 140 in 2008 and 115 in 2007. The Marine Corps report­ed 52 sui­cides last year – more per capi­ta than the Army, and up from 42 in 2008 and 33 in 2007. Last year’s num­bers are expect­ed to rise as more inves­ti­ga­tions are com­plet­ed, they said.

While the mil­i­tary offi­cers cit­ed increased deploy­ments and less time at home as one area of stress, many more risk indi­ca­tors such as per­son­al prob­lems with rela­tion­ships, legal mat­ters and careers also are fac­tors, they said.

In the Army, Chiarel­li said, 79 per­cent of sui­cides were by ser­vice­mem­bers who had one or no deploy­ments, and 60 per­cent were on their first deploy­ment.

Also, Chiarel­li said, sui­cides among active-duty sol­diers have dropped while simul­ta­ne­ous­ly increas­ing among reserve-com­po­nent sol­diers, espe­cial­ly Nation­al Guard mem­bers. The Guard sol­diers require a dif­fer­ent approach toward inter­ven­tion, he said, since no stan­dard­iza­tion exists for ser­vices and treat­ment once they return to their home states. One improve­ment, he said, would be for Guards­men to remain on Tri­care Plus health care cov­er­age for a con­tin­u­um of treat­ment.

The senior offi­cers out­lined risk fac­tors for sui­cide among sevice­mem­bers, but only the Marine Corps has seen wide com­mon­al­i­ty in those who took their own lives. Among Marine sui­cides last year, 92 per­cent were between the ages of 17 and 23, and most­ly were white men, Gen. James F. Amos said. He added that 67 per­cent of the Corps is 25 or younger.

“We are woe­ful­ly more imma­ture in years,” the gen­er­al said. “That, in and of itself, is a prob­lem.”

Of the 52 sui­cides among Marines last year, nine had nev­er been in com­bat, Amos not­ed.

“While there is no sin­gle answer,” he said, “we are com­mit­ted to explor­ing every poten­tial solu­tion and every resource we have avail­able. We will not rest until we turn this around.”

In the Air Force, only 20 per­cent of sui­cide vic­tims had been deployed in the year before they died, Gen. Car­rol H. Chan­dler told the com­mit­tee. But 70 per­cent of those who com­mit­ted sui­cide were found to have prob­lems in their per­son­al rela­tion­ships, he said, and many had legal prob­lems.

Sui­cides in the Navy have come from sailors with enough dif­fer­ent demo­graph­ics and risk fac­tors that “our Navy mes­sage is that no one is immune,” Adm. Jonathan W. Green­ert said.

The offi­cers out­lined the increas­ing­ly num­ber of pro­grams the ser­vices have adopt­ed to try to curb sui­cides. They include train­ing that begins in boot camp, focus­es heav­i­ly on non­com­mis­sioned offi­cers, and extends to senior flag offi­cers; increas­ing pre- and post-deploy­ment eval­u­a­tions; embed­ding men­tal health work­ers in deployed units; reach­ing out to fam­i­lies with train­ing and tele­phone hot­lines; and try­ing to improve the diag­no­sis and treat­ment of TBI and post-trau­mat­ic stress dis­or­der.

And the ser­vices increas­ing­ly are extend­ing pro­grams to build resilience in mil­i­tary mem­bers and their fam­i­lies to cope with what­ev­er stress­es might arise, the mil­i­tary offi­cers told the com­mit­tee.

Chiarel­li said it is impor­tant to rec­og­nize the con­nec­tion between TBI and PTSD and the high rate of “co-mor­bid­i­ty,” or co-exist­ing con­di­tions in an indi­vid­ual. That, cou­pled with a lack of med­ical under­stand­ing about the dis­or­ders, and the dif­fer­ing drugs to treat them and prob­lems like anx­i­ety and depres­sion, com­pli­cates diag­no­sis and treat­ment, he said.

“There is no doubt that you can go to any of our posts and find sol­diers strug­gling because [doc­tors] can’t nail down and diag­nose their con­di­tions,” he said. “But I promise you it is not from lack of try­ing. We are doing every­thing we can.

“Our sci­ence on the brain is just not as great as it is on oth­er parts of the body,” Chiarel­li con­tin­ued, not­ing vast med­ical opin­ions about diag­nos­ing and treat­ing the dis­or­ders. “It’s not this well-devel­oped sci­ence like you find with heart surgery.”

Of the Army’s most severe­ly wound­ed sol­diers – those at least 30 per­cent dis­abled – at least 60 per­cent are diag­nosed with PTSD or TBI, Chiarel­li said.

There still is no con­clu­sive test to diag­nose TBI, Dr. Robert L. Jesse, a physi­cian and act­ing prin­ci­pal deputy under­sec­re­tary of health for VA’s Vet­er­ans Health Admin­is­tra­tion, told the com­mit­tee. “It may just be the com­plex­i­ty of this dis­ease that it takes time to man­i­fest in ways we can diag­nose,” he said.

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)