November 1, 2019: Over the last five years the suicide rate among active duty American military personnel has been rising, even though there has been a lot less combat duty. Most American troops withdrew from Iraq in 2011 and Afghanistan in 2014. This suicide increase is apparently from the stress of being overseas, not in combat.

In 2013 suicides for the 520,000 active duty U.S. Army personnel declined from 35.6 to 29 per 100,000 personnel. At that time the suicides for the entire military were down 16 percent. The navy experienced the sharpest drop (25 percent). In 2013, after more than a decade of heavy combat, the military knew that these fluctuating suicide rates had little to do with combat. This is being demonstrated now because the suicide has been rising at about six percent a year since 2014. So has the rate among civilians. Current rates are 30 per 100,000 for the army, 31 for the marines, 20 for the navy and 18 for the air force. The rate is higher in some job categories that are particularly stressful. Thus SOCOM (Special Operations Command), which has paid particular attention to reducing suicides, hit a high of 33 per 100,000 in 2012. That was reduced to 18 by 2014 and was down to 8 per 100,000 personnel in 2017. Suddenly it went up to 22 in 2018. SOCOM only has 70,000 personnel so a few suicides a year can shift the rate dramatically. But going from 8 to 22 in one year is extraordinary. Then again so was reducing the rate from 33 to 18 in two years. SOCOM is a special case in several ways. For one thing about a third of its personnel are combat troops and they have been spending a lot of time overseas since 2014 because of ISIL (Islamic State in Iraq and the Levant) and the fact that, while fewer troops are fighting in Iraq and Afghanistan, there are still plenty of Islamic terrorists to deal with and that is done largely using SOCOM personnel. Commanders have long warned that year after year of overseas deployments for SOCOM operators (the combat specialists) takes its toll, even on this carefully selected (for the ability to handle stress) and trained group of specialists. There have also been problems with some special operations commanders, who have made mistakes while trying to keep their men combat capable. As long predicted this intense use of SOCOM personnel since 2001 has made suicide, morale and readiness problems worse. That said, SOCOM is a small part of the American military, comprising about five percent of active duty personnel. The vast majority of military personnel and suicides are non-combat troops.

Military epidemiologists (experts on medical statistics) have long sought to convince people outside the military that the rise in suicide rates within the military has little to do with the stress of combat and mostly to do with the stresses of military life during wartime or peacetime. In other words, the increased suicides were not concentrated among the combat veterans, who make up less than 15 percent of those in the military but are more evenly distributed among all service personnel. For example, during the last decade over 75 percent of suicides were among troops who had never gone overseas. The military, especially the army, has long documented all deaths and the Department of Defense in 2013 released a study of all suicides since 2001, when more troops saw combat, to 2008, when the heavy fighting in Iraq ended. A similar study for 2009-2012 suicides found little change. The researchers also point out that the reasons for suicides in the military are quite similar to those for civilian suicides, especially when victims are of the same age, education, and other factors as their military counterparts. In other words, periods of intense combat for the military have little impact on the overall suicide rate because so few troops are exposed to combat.

These revelations were not well received by the mass media which makes much of the rising suicide rate in the military but pays less attention to rising suicide rates among civilians of the same age and education. That was 9 per 100,000 in 2001 but had risen to 17.5 in 2013 and by 2016 was 26 per 100,000 men aged 25-44, which is the age of most men in the military. This was declared to be a health emergency, and to a certain degree, it was. What was missed in all the discussion was that the higher suicide rate in the military is usually below the rate for civilians of military age.

The fact of the matter is that the military seeks to recruit only people who have an above average ability to deal with stress, especially for the minority headed for combat jobs. It’s not just combat stress the military worries about, because so few troops in the ground forces have combat jobs. The rest are doing civilian type jobs but often under stressful (combat zone) conditions. In fact, most of the military suicides are of men who were never in combat or even overseas. But since the military suicide rate is so much lower than those of comparable civilians, it hardly matters. There are so few actual suicides in the military each year that a few soldiers having family problems can cause the rate to seemingly spike. That’s largely what has been happening. The question now is what factors have caused the rate to creep up steadily since 2014.

The military has been doing a lot to keep their suicide rate down. That rate peaked at 23 in 2009 and then declined. Some of the increase was from the impact of so many troops suffering from PTSD (post-traumatic stress disorder), but the recent studies of that show this was a small factor in suicides. The danger of suicide led to many PTSD sufferers or those who might have it, to be given anti-stress medications. The use of these medicines increased by 76 percent between 2001 and 2009. By then, some 17 percent of all troops took these drugs, including six percent of those in combat zones. In 2001, the troops used these drugs to about the same degree as the civilian population (ten percent).

The losses to stress for troops overseas have been growing since 2003. For example, for every soldier killed in a combat zone, one was sent back home for treatment of acute stress. Most of these are not combat troops. For every one of those cases, there are several less serious ones that are treated in the combat zone. Many of these stressed troops are no longer able to perform all their duties. This is sometimes the case with troops taking anti-stress drugs. Some of these medications slow you down, which can be fatal if you find yourself in combat or an emergency situation. Many troops on these medications are no longer sent overseas. They can perform well back in the United States but this complicates the job of finding enough troops to go perform combat jobs.

Problems with stress and mental health, in general, were seen as an inevitable result of so many NCOs and officers doing their third or fourth combat tours (in Iraq or Afghanistan). Thus, a PTSD epidemic has been created by the unprecedented exposure of so many troops to so much combat in so short a time. Once a soldier has PTSD they are often no longer fit for combat, and many troops headed for Afghanistan after 2008 fell into this category. PTSD makes it difficult for people to function or get along with others. With treatment (medication and therapy) you can recover from PTSD. But this can take months or years.

Nearly a century of energetic effort to diagnose and treat PTSD, including much recent attention to civilian victims, stressed via accidents or criminal assault, made it clear that most troops eventually got PTSD if they were in combat long enough. During World War II it was found that, on average, 200 days of combat would bring on a case of PTSD for your average American soldier. After World War II methods were developed to delay the onset of PTSD. These included more breaks from combat, better living conditions in the combat zone and prompt treatment when PTSD was detected. That's why combat troops in Iraq and Afghanistan often slept in air-conditioned quarters, had Internet access, a lot of amenities, and a two-week vacation (anywhere) in the middle of their combat tour. This extended their useful time in combat before PTSD set in. No one is yet sure what the new combat days average is, and new screening methods are an attempt to find out. But more troops appear to be hitting, or approaching, the limits.

What the army did know by 2011 was that a large percentage of its combat troops serving in Iraq and Afghanistan had over 200 days of combat. Some have three or four times that. A major reason for army generals talking (starting in 2007) about the army "needing a break" (from combat) was the growing loss of many combat experienced troops and leaders (especially NCOs) to PTSD. The army won't give out exact figures, partly because they don't have much in the way of exact figures. But over the next decade, the army will get a clearer picture of how well they have coped with PTSD among troops who have, individually, seen far more combat than their predecessors in Vietnam, Korea, or World War II.

The army is dealing with PTSD and combat stress head-on, believing that a lot of troops have experienced an unhealthy amount of combat stress. Experience so far has shown that PTSD can be delayed, perhaps for a long time. When a soldier does come down with it, PTSD can often be treated and its effects reversed. This has large ramifications for non-military medicine as many civilians suffering from PTSD. That's why military recruits are screened for their ability to handle stress and resist PTSD. In the civilian community, there are far more people who can acquire PTSD after exposure to much less stress.