The unseen costs of Bush’s war. In January 2009, the military reported 7 confirmed suicides with 17 others under investigation. For 2008, 128 suicides were reported with 15 other deaths still under investigation. 108 active duty military personnel committed suicide in 2007. There were 102 suicides in 2006. 52 in 2001. This does not tell the whole story. There is no national tracking of suicides among veterans. A CBS investigation using data from states for 2005 into this aspect showed that veterans in general commit suicide at a rate roughly twice that of non-veterans (18.7 to 20.8 per 100,000 versus 8.9 per 100,000). However, among young veterans ages 20 to 24 who served during the war on terror (data from 2004-2005), the suicide rate was 2 1/2 to nearly 4 times as high as for the general population (22.9 to 31.9 per 100,000 versus 8.3 per 100,000).
In the period 2001-2007, the military discharged 22,500 service people from the armed forces for a “pre-existing” personality disorder. Those who were so discharged lost healthcare and disability benefits and in some cases were forced to repay re-enlistment bonuses. In fact, many of them were suffering from problems they acquired during their service, such as PTSD and traumatic brain injury.
A study* in the November 14, 2007 edition of the Journal of the American Medical Association (JAMA) compared a health questionnaire given to service people immediately after leaving Iraq and again at a median of 6 months later. 88,235 Army soldiers were found to have responded to both questionnaires in the time period between June 1, 2005 and December 31, 2006. The cohort obtained contained both active duty and National Guard and Reserve. Marines were not included because few had completed both questionnaires. Both active duty and reserve soldiers reported similar rates of traumatic combat experiences (69.6% vs 66.5%). Based on the two questionnaires, clinicians identified 20.3% of active duty and 42.4% of reserve/National Guard who required mental health treatment. Increasing problems between the two questionnaires included:
- Intrapersonal conflicts: active duty 3.5% to 14.0% and reserves 4.2% to 21.1%
- PTSD: active duty 11.8% to 16.7% and reserves 12.7% to 24.5%
- Depression: active duty 4.7% to 10.3% and reserves 3.8% to 13.0% Overall mental health risk: active duty 17.0% to 27.1% and reserves 17.5% to 35.5%
Of those who reported a high rate of PTSD symptoms on the first questionnaire 59.2% of active duty and 49.4% of reserves reported improvement by the second questionnaire. However, twice as many new cases of PTSD showed up on the second questionnaire.
While the Bush Administration and Congressional Republicans recite endlessly the mantra of supporting the troops, the reality is that beyond using them in their wars they have no interest in them.
As a March 2007 story in Salon relates, women in the military in Iraq also faced physical and psychological injury from rape and sexual assault by fellow soldiers.
A March 2008 Army study based on 2,295 anonymous surveys completed in October/November 2007 of NCOs (sergeants also known as the backbone of the Army) on their third and fourth tours in Iraq found that 27.2% of them reported mental health problems. 11.9% reported such problems after a first deployment and 18.5% after a second one. Soldiers also reported significant problems with relationships, morale, and effectiveness.
A RAND study “Invisible Wounds of War” released April 17, 2008 estimated that 300,000 of the 1.64 million US military personnel who have served tours in Iraq or Afghanistan suffer from Post-Traumatic Stress Disorder (PTSD) or major depression. Based on a survey of 1,965 of these from 24 communities, only 53% had sought medical help in the last year. About half of those that did received minimally adequate care. This represents a grossly underserved population and a costly long term public health problem. Additionally, the report found 320,000 troops have experienced a probable traumatic brain injury during their deployments with as yet unknown health consequences.
An April 21, 2008 CBS story uncovered a February 13, 2008 email by Dr. Ira Katz the VA’s head of mental health entitled “Not for the CBS News Interview Request.” It read “Shhh! Our suicide prevention coordinators are identifying 1,000 suicide attempts per month among veterans we see in our medical facilities. Is this something we should (carefully) address in some sort of release before someone stumbles on it?” Katz wrote his email a few days after the VA had given CBS data showing that there had only been 790 suicide attempts in all of 2007. Katz had previously criticized a November 2007 CBS story (see above) which had suggested that the VA faced an epidemic of suicide. In the story, CBS estimated some 6,200 suicides in 2005. Yet in a December 13, 2007 email Katz stated that the VA was seeing 18 suicides a day in its facilities or 6,570 a year, in keeping with the CBS numbers. The VA appears more interested in avoiding its own embarrassment than in seriously addressing what is an acute healthcare problem.
A March 2008 study by the Army’s Mental Health Advisory Team based on anonymous questionnaires (so likely underreporting the numbers) found 12% of combat troops in Iraq and 17% in Afghanistan were on either an anti-depressant or a sleeping pill. The split was about 50-50 between the two medications.
Given that we are having more and more compensation seeking veterans, I’d like to suggest that you refrain from giving a diagnosis of PTSD straight out. Consider a diagnosis of Adjustment Disorder, R/O [Rule out] PTSD.
Additionally, we really don’t or have time to do the extensive testing that should be done to determine PTSD.
Also, there have been some incidence where the veteran has a C & P [Compensation and Pension exam], is not given a diagnosis of PTSD, then the veteran comes here and we give the diagnosis, and the veteran appeals his case based on our assessment.
This is just a suggestion for the reasons listed above.
In testimony on June 3, 2008 before the Senate Veterans’ Affairs Committee, Perez said her “suggestion” was meant “unequivocally to improve the quality of care our veterans received.” As the email makes clear, however, Perez’s concern was not with care (which the email does not address) but with reducing the number of PTSD diagnoses and compensation claims associated with them.
*Milliken, Charles, Auchterlonie, Jennifer, and Hoge, Charles. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq War. JAMA. (November 14, 2007) pp. 2141-2148.