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Army releases findings of first-ever Soldier well-being study in combat arena

Army News Service

Release Date: 3/25/2004

By Spc. Lorie Jewell

WASHINGTON (Army News Service, March 25, 2004) -- A mental health advisory team sent to Iraq and Kuwait last year to study the well-being of Soldiers, amidst concern over the increasing number of suicides, concluded the Army's behavioral health care system works overall but can be improved, officials said.

There were 23 suicides in the Operation Iraqi Freedom theater in 2003, a rate of 17.3 percent for every 100,000 Soldiers, according to a team report released to media Thursday in the Pentagon. That's higher than the Army-wide rate of 12.8 percent for the 75 suicides that occurred in 2003 -- including those in Iraq and Kuwait -- but lower than the U.S. national average of 21.5 percent for young men, which is the Army's largest demographic group and the one most at risk for suicide, the report said.

The cause of three OIF deaths has not been determined. This year, one suicide has been reported in OIF and one death has yet to be categorized. Seven Soldiers have committed suicide since returning from Iraq, the report said.

Of the 2003 suicides, which started in April, 21 were men -- mostly young and in lower enlisted ranks -- and two were women, working in a variety of military occupational specialties. Three were combat engineers, two infantrymen, two automated logistical specialists, two food service operators, one unit supply specialist, a field artillery automated tactical data systems specialist, a human intelligence collector, an air traffic control operator, a civil affairs specialist, a signals intelligence analyst, a petroleum supply specialist and a military policeman.

Two were reserve component Soldier; nine were married. One suicide was attributed to an overdose of an over-the-counter pain reliever, the rest were from gunshot wounds, the report said.

The 12-member advisory team of Army psychiatrists, psychologist, social work officer, occupational therapist, psychiatric nurse, researchers, personnel specialist, chaplain and mental health specialists were in theater from Aug. 27 through Oct. 7, 2003. They surveyed 756 Soldiers -- 82 percent had engaged in combat - and talked with 34 focus groups of Soldiers, 116 behavioral health providers, 41 unit commanders, 154 primary care providers and 94 unit ministry teams.

The survey showed 87 percent of the Soldiers reported high levels of stress over not knowing how long they would be deployed. The length of deployment (71 percent), separation from family (57 percent) and lack of privacy and personal space (55 percent) were also causes of high stress.

Combat-related stress rose from seeing dead bodies (67 percent), being shot at (63 percent), being attacked or ambushed (61 percent) and knowing someone who was killed or seriously wounded (59 percent).

Additionally, 72 percent of the Soldiers said their unit morale was low and 52 percent said their own morale was down.

Because this is the first such study done in a combat environment, health care officials do not have any previous data to compare to when examining the issue of stress, said Col. Virgil Patterson, who headed the advisory team.

"During combat, Soldiers are very isolated in an austere environment,'' Patterson said, noting that many Soldiers were living in tents in the sand while the team was there with little to no ability to communicate with their families. "It was a pretty miserable set of conditions at that time."

Living conditions, meals, and access to telephones and the Internet have since improved for many Soldiers, he added.

The team also found that getting help for mental health issues like depression, anxiety or traumatic stress was a problem for some Soldiers. Getting time off to seek help was the number one barrier, followed by finding a way to get to a behavioral health specialist, or not knowing where to find such help.

For every 900 Soldiers in OIF, there is one behavioral health specialist, said Col. Virgil Patterson, who headed the advisory team. That ratio is good, but problems arose with the way the specialists were assigned by sector. Some sectors had hundreds of Soldiers close together, while Soldiers and units in other sectors were scattered. The team recommended placing the specialists by geographic areas instead, Patterson said.

Soldiers without immediate access to a specialist would have to travel in a convoy to reach one, the team reported. If the Soldier was given a prescription and a pharmacy wasn't available in the specialist's location, the Soldier would have to convoy to yet another location.

The team recommended behavioral health specialists adopt a "circuit-rider" approach -- making periodic trips to smaller camps where Soldiers don't have immediate access to their services.

They also suggested bringing in one person to be a theater-wide consultant who will provide better coordination of services to Soldiers. That recommendation is being implemented, with Col. Chris Piper, a psychiatric nurse currently stationed at Tripler Army Medical Center in Hawaii, scheduled to arrive in Iraq next month.

Other recommendations that have either been implemented or are in the process of adoption include: refresher training for behavioral health specialists; emphasize awareness, vigilance and the battle buddy system in training for Soldiers, to include suggestions on what to do and say if they believe a fellow Soldier is suicidal; and a rewrite of the Combat and Operational Stress Control doctrine and procedures, using the results of the study to improve services to Soldiers.

The anti-malaria drug Larium has been questioned in news reports as a possible contributing factor in suicides. Col. Bruce Crow, a clinical psychologist and member of the advisory team, said that reports from medical examiners showed that only one Soldier who committed suicide had Larium in his system. Just four of the Soldiers who killed themselves were from units in which Larium was given, Crow added.

The advisory team plans to repeat the survey in a second visit to Iraq and Kuwait this summer.