WASHINGTON A major Army study has found that suicide-prevention teams were left behind when units left their home bases to go to war in Iraq, mental-health workers felt untrained to treat combat stress, and many soldiers seeking help for depression and emotional problems faced significant hurdles getting care.
The study, the first conducted in a combat zone, also determined that the suicide rate of soldiers in Iraq and Kuwait last year was much higher than in the Army overall, but lower than in comparable American civilian groups.
In one startling finding, in the survey of 756 soldiers late last summer, 52 percent of them said their personal morale was low or very low, and 72 percent said their whole unit's morale was that bad. Most of those surveyed had been in combat.
But in releasing their findings on Thursday, senior Army medical officials said they had found no connection between the suicides and the morale factors.
Army officials said the survey was taken at the peak of the fierce summer heat when many soldiers were still living in tents and did not have regular phone or e-mail access to their families. The officials suggested that morale had probably improved as living conditions did, but said they would not know for sure until they followed up this spring.
They said senior Army officials and commanders were fulfilling many of the recommendations in the 38-page study, including sending more Army psychiatrists and mental health specialists to combat zones, revamping reporting procedures for soldiers needing care, and monitoring reports of suicide attempts as well as suicides.
Col. Virgil J. Patterson III, a military social worker who led the Army Mental Health Advisory Team, which did the study, said in an interview that the Army intended "to improve the access, availability and quality" of mental health services for troops in combat zones.
The Army surgeon general, Lt. Gen. James B. Peake, ordered the study after a sharp rise in suicides in July and an influx of soldiers with mental health problems at Landstuhl medical center in Germany.
A 12-member team that included Army psychologists, psychiatrists and social workers went to Iraq and Kuwait from late August to early October, and interviewed medical and mental health specialists, chaplains and commanders.
One out of four soldiers surveyed reported problems with emotional or family issues or stress, but many of those said that when they sought help, they ran into barriers to treatment or follow-up visits, or into logistical runarounds. Soldiers sometimes had to arrange for two armed convoys, one to go be evaluated and another to get medicines.
Army psychiatrists and other mental health workers in Iraq and Kuwait complained that their work was hampered by a shortage of vehicles and radios, and by a need for a broader range of medications, including antidepressants and sleeping pills, the report said. Half of the Army mental-health specialists interviewed said they had not received adequate training in combat stress.
"Many of our behavioral health personnel demonstrated great ingenuity and creativity in finding ways to take care of soldiers, despite severe resource limitations," the report concluded.
The report was completed last December, but there were months of internal briefings and deliberations before it was released on Thursday. The delay prompted some critics to suggest the Army was trying to cover up the problem, but senior lawmakers largely praised the Army's effort.
"Any time you're dealing with suicide, the very finding that perhaps you weren't doing things as well as you'd like, in hindsight, makes for a sad part of a sadder tale," said Representative John McHugh, a New York Republican on the House Armed Services Committee. "But this lays out a pretty clear picture of what we need to do."
There were 23 suicides among American soldiers in Iraq and Kuwait last year, all but one by gunshot, and most involved young enlisted white men who faced personal financial problems, failed personal relationships or legal problems, Army officials said. The suicide rate was higher among Regular Army troops than among reservists, the study found, but it did not give exact numbers.
That number put the suicide rate at 17.3 per 100,000 soldiers, compared with 12.8 for the Army overall last year, and an average rate of 11.9 for the Army between 1995 and 2002, Army officials said. The civilian rate for 18- to 34-year-olds, the age range of most soldiers, is 21.5 per 100,000.
While there was an average of two Army suicides a month in 2003, with a high of five in July, there has been only one death classified as a suicide so far this year; one suspected case is to be reviewed, officials said.
Some veterans' groups criticized the Army for suggesting the service did not have a problem because the soldiers' suicide rate was lower than the civilian rate.
"We are concerned that the Army is equating the suicide rate in Iraq with that of the general population," said Wayne Smith, a spokesman for the Vietnam Veterans of America Foundation and a Vietnam combat medic. "This is misleading in the extreme, given that military personnel are supposed to be screened for the kind of psychiatric disturbances that can lead to suicide. To suggest that the Army's suicide rate is not worrisome, based on this comparison, only further confuses the issue."
Copyright 2004 The New York Times Company