Soldiers in Afghanistan committed suicide in record numbers in 2008, in step with a dramatic spike in combat deaths in the country, new military figures show.
Seven Army soldiers committed suicide in Afghanistan last year, compared with 15 suicides in total during the previous 75 months of Operation Enduring Freedom, according to figures from the Defense Manpower Data Center.
Col. Elspeth Ritchie, a top Army psychiatrist, said military officials during the past several years have tracked an increase in mental health problems among soldiers serving in Afghanistan. In 2004, she said, anxiety and depression were far less common among soldiers in Afghanistan, compared with those in Iraq. But by 2007 and early 2008, soldiers in Afghanistan were suffering depression and anxiety at the same rates as their counterparts in Iraq, she said.
"In Afghanistan, there are considerable barriers for providers getting to the troops due to the difficulties in travel and weather, compared to Iraq," Ritchie said.
After a spike in suicides in Iraq in the early months of the war, Army officials sent special mental health teams to the war zone in an effort to understand and prevent soldier deaths. Ritchie said the military is always looking for ways to improve suicide-prevention programs, but said she was not aware of any plans to specifically address the recent spike in Afghanistan.
The suicides last year were clustered during the summer months, when troops in Afghanistan were coping with a sharp increase in violence. Last year was the bloodiest of the Afghan war, with 133 combat-related deaths, a 60 percent jump from a year earlier.
"We know that combat stress is worse when combat is higher," said Vanessa Williamson, policy director for Iraq and Afghanistan Veterans of America, an advocacy group. "So it wouldn't surprise me at all that suicide rates are also correlated with that."
As violence has flared in Afghanistan, military and political leaders have expressed support for a massive increase in troops this year, and President-elect Barack Obama is expected to shift at least 20,000 troops to Afghanistan, supplementing the 31,000 currently serving there.
The number of Army suicides in Iraq, meanwhile, fell for the first time in four years, Pentagon figures show. The military reported that at least 26 soldiers committed suicide in Iraq in 2008, with the cause of three more deaths still under investigation. In 2007, 32 soldiers took their lives in Iraq. The number of soldiers serving in Iraq declined in 2008, however, and the suicide rate last year may end up close to 2007's record levels, an analysis of the numbers shows.
Overall, at least 200 service members have committed suicide in Iraq, Afghanistan and Kuwait since the wars began. Although Pentagon officials acknowledge that repeated deployments have increased stress on combat troops, they have consistently asserted that financial, legal and relationship problems - not exposure to combat - were the driving factors in military suicides.
Williamson does not believe that. "It's absolutely true that family problems, and the stress of being separated from your family, are enormous. But to say that that's a primary factor, as opposed to combat stress itself, I don't think that makes sense," she said.
"The amount of mental pressure we're putting on people by putting them in a combat zone - it may not be the straw, but it's definitely a lot of the burden in terms of what's pushing people to take such drastic action," she said.
The Army has not completed its analysis of suicides among all active-duty soldiers - both deployed and not deployed - in 2008. But partial-year figures show that the suicide rate was on track to exceed 2007's rate of 18.8 per 100,000, which was the highest since the Army began keeping such records in 1980.
Since the wars began, the military has made a number of changes to its suicide-prevention and mental health programs, some prompted by a Courant series in 2006 that found the military was failing to adequately screen and treat troops with psychological problems. New policies adopted since then call for closer monitoring of troops on psychiatric medications and limits on keeping troops with mental health problems in combat zones.
The military also increased the number of mental health counselors in the war zone and launched programs aimed at encouraging troops to be attuned to their colleagues' mental health and reducing the stigma associated with seeking mental health care. But the suicide rate has continued to climb.
Williamson praised efforts to reduce the stigma, but said the military still has too few mental health professionals, stateside and in the combat theaters, making it hard for stressed soldiers to access mental health care.
She also criticized paper forms used before and after deployment to screen service members for mental health problems, saying troops do not fill out the forms honestly and should be evaluated face to face by a mental health professional.
"That's the only way to know the extent of the problem, and the only way to ensure that people [going to war] are mentally ready - as ready as they can be - and it's the only way to ensure that folks coming home are getting the treatment they need."