8th Apr, 2008

Pentagon Reports More Disurbing Iraq War Suicide Data in MHAT-V

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In March the Pentagon released a report that included suicide data among Iraq War troops, but have you heard the findings? Not in the media. Not on other blogs.

These data are part of Mental Health Advisory Team (MHAT) Report V, the latest in a series of studies commissioned by the Pentagon to assess the mental health of our troops in Iraq and Afghanistan.

Earlier MHAT reports revealed alarming rates of suicide, which this blog helped to publicize. The MHAT-IV report found:

2003-2006 OIF suicide rates are higher than the average Army rate, 16.1 vs 11.6 suicides per year per 100,000.

The Pentagon officially announced the released MHAT-V on March 6, posting a “redacted” edition online at the Army Medicine website. As for the report itself, a grim graph at the opening of the section on suicides tells the story:

2007 irfaq war suicide graph

For those who don’t have their calculators handy, after remaining stable for two years, the rate climbed by 23.7% in 2007. And note the asterisk–the rates are “estimated.” The report explains the “estimated:”

The time lag in confirmation tends to underestimate current numbers. For this reason
2007 discussion will focus on “probable” suicides, whereas 2006 and prior will be “confirmed”
numbers. (p. 85)

To its credit the report does not mince words about the increase:

If this rate holds true for all of 2007, it will be the highest rate since the war began. (p. 84)

Also to its credit, the PDF document posted online does allow for copying and pasting, which the Pentagon could have suppressed to make it harder to quote directly from the report.

Since MHAT-IV the Pentagon has learned more about the circumstances of many of what are termed “in theater” suicides–that is, suicides among troops in Iraq. As might be expected it is the middle months of a deployment that are the most dangerous as the following graph shows.

iraq war suicided by month of deployment

The report notes:

People who committed suicide in 2007 are, on average, older and higher ranking than had been seen in previous years. (p. 89)

The report found that fully half of those who committed suicide sought mental health care within 30 days of the event, a finding consistent with civilian data.

The report’s findings on the reasons for these suicides echo those of MHAT-IV. The overview of the report states:

Most suicides involve failed relationships with spouses or intimate partners.

Data from the report expand on this. The Suicide Risk Management and Surveillance Office at Fort Lewis, Washington conducted a review of 2007 suicide data, concluding:

68% of lraq suicides had had an intimate relationship failure (Figure 35) versus 56% of the suicides in the non-Iraq population. This highlights the importance of the “Dear John” letter as a factor in the deployed setting.

This is an old, and quite frankly, disturbing explanation the Pentagon has advanced before. When the Pentagon released MHAT-IV, it offered a similar explanation for suicides among Iraq War troops. When asked if there was a reason for the suicides Col. Elspeth Ritchie, psychiatry consultant to the Army surgeon general, told a Pentagon press conference that the primary reason for suicide is:

Failed intimate relationships, failed marriages.

Colonel Ritchie must have been reading from the same script they used for MHAT-V. The phrasing is too close to be accidental. She went on to point out:

However, we do know that frequent deployments put a real strain on relationships, especially on marriages. So we believe that part of the increase is related to the increased stress in relationships. Very often a young soldier gets a ‘Dear John’ or ‘Dear Jane’ e-mail and then takes his weapon and shoots himself.

At that time I wrote about the disturbing nature of Colonel Ritchie’s statements. Imagine you are a woman or man who sent one of those “Dear John” letters or your significant other committed suicide, perhaps during a rocky time in your relationship. Or even imagine your significant other committed suicide and you thought things were fine, but here is none other than an Army colonel planting thoughts in your head that maybe they weren’t, because after all the MHAT report does not identify the causes of particular suicides.

In answer to Colonel Ritchie I quoted what the National Institute of Mental Health notes in its research on survivors of suicide:

Referred to as “survivors of suicide,” family and friends grieving a suicide death often struggle with their own feelings in relation to the loss as well as the stigma that suicide confers.

Now here is MHAT-V raising the same “Dear John letter” scenario. Not only is this dangerous psychiatry but it also is bad science. Why? Because at least in the data presented in MHAT-V there is only a correlation between “failed relationships:” and suicide, not a causation. The analysis would have to provide much more evidence show the causation its language implies.

I am surprised that no major psychology journal has analyzed the MHAT reports because this issue of correlation is a serious one. Note the wording of the Pentagon’s statement:

Most suicides involve failed relationships with spouses or intimate partners.

The choice of the word “involved” is critical. It is ambiguous enough that a casual reader might take it to imply causation, while a medical expert would see it as a possible correlation.

Curiously, if you read between the lines in the report you can find plenty of data that support other correlations, particularly the contention that the Bush Administration’s deployment policy is hazardous to the mental health of our troops. Interestingly, the most damaging paragraph appears in a discussion of loss as a risk factor in suicides.

It appears that long tour durations, in itself, does not increase rate of suicide, but rather, serves as a secondary factor in provoking marital disruption and in kindling the loss of relationships. (p. 91)

Read that sentence again; then connect the dots. Long deployments increase marital strife which in turn increases the risk of suicide. Forgive me if I am missing something, but doesn’t that say that in essence long deployments increase suicide?

A graph in the report shows the relationship between deployment length and mental health.

deployment and morale

This chart is based on fifteen month cycle, but what of the soldier who is on his or her third or fourth tour of duty in Iraq? Another chart answers that question.

multiple deployments and mental health

In case you find the numbers hard to read they show 11.9% of those on their first deployment scoring positive for mental health problems versus almost triple that number on their third deployment: 27.2% The report says nothing about troops on their fourth deployment.

This is followed by a single sentence:

Soldiers’ reports of suicide ideation were unrelated to the number of deployments.

No data are cited to back up this statement. Yet is it not logical to suppose that if almost a third of the troops on their third deployment experience mental health problems, that suicides should also increase? Obviously it doesn’t take a psychiatry degree to conclude that if longer deployments endanger the mental health of our troops they also have a relationship to suicides.

There is another potentially damaging consequence in the MHAT-V data. If longer deployments endanger the mental health of our troops, then we may be running out of troops to fight the war. My wife recently told me of a colleague who was within six months of retiring from the National Guard with full benefits. He had served three deployments in Iraq when last month the Pentagon tapped him for a fourth. He resigned, giving up his benefits.

John McCain and the GOP tell us we may have troops in Iraq for a long time. The question is: where will they come from? In all the grilling that General Petraeus underwent today, no one thought to ask him about MHAT-V or Iraq troop suicides or the mental health hazards of multiple deployments. Yet more than any other question asked those issues may decide the course of the war.

If troops suffer more mental health problems from multiple deployments doesn’t that make those who produced that policy decision guilty of endangering the mental health of our soldiers? If the multiple deployments were not a political decision based on the Bush Administration’s unwillingness to call for a draft to fight the war, the answer might be a bit different.

As it now stands, look forward to a feisty campaign season. And don’t expect MHAT-V to sit on a shelf.

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