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The rate of U.S. Army suicides has doubled since 2004. In June, a study released by the Army indicated that nearly as many American troops at home and abroad committed suicide in the first six months of 2006 as the number who had been killed in combat in Afghanistan during the same time period.
The Army has begun investigating its mental health programs. But one hurdle to improving services is that many soldiers fail to ask for help because of a culture that prides itself on mental toughness.
"Unfortunately, in the vast majority of cases, when a veteran comes forward for help, it's usually when they're in extremely bad shape," says psychologist Dr. Craig Bryan. "The military culture is not quite amenable in going and asking for help from others. ... Right now in the military, depending on the branch of service, about three-quarters of service members who kill themselves never come into a mental health provider [and] never reach out and ask for help. They're out there somewhere but most of us don't know where they're at."
Dr. Bryan, who studies suicidal behaviors and prevention strategies, advises both the Air Force and the Department of Defense on PTSD prevention and treatment research. He joined Terry Gross for a discussion about combat stresses, the growing number of military suicides and his role as a psychologist who has treated both active-duty service members and returning veterans. From February to August of 2009, he directed the Brain Injury and Combat Stress Center in the primary Level III trauma hospital in Iraq, where he studied mental resiliency and combat stress.
"The most eye-opening experience I had when I was deployed was what service members were most concerned about -- their most pressing needs on a day-to-day basis -- actually wasn't the traumatic events," he says. "It wasn't the combat, seeing the dead bodies, shooting people, being shot, being injured. Yes, those were definitely important but what most service members talked about the most was the day-to-day benign stressors. It was the not being able to sleep in a comfortable bed, not having access to warm, cooked food, not being able to communicate with loved ones easily. Those day-to-day stressors slowly degrade their mental resources and their resiliency so that when big things happen -- the explosions occur, when the gun battles happen -- they don't have as much energy in their battery to get through that and that's where we started to see more of the problems."
Bryan and his colleagues started working with combatants on dealing with their day-to-day stressors: how to make sure they were sleeping well and maintaining physical health in order to keep them mentally fit on the battlefield.
"Back here in the States, when you're working with a service member with PTSD or some other combat-related stressor or injury, it usually happened months or years in the past," he says. "Whereas, when I was in Iraq, the explosion happened yesterday, so I was seeing them in the hospital when they were getting the shrapnel removed from their bodies. We were doing [assessments] very quickly and providing interventions geared towards preventing long-term problems that we often talk about and see here in the United States."
For his contributions to primary care behavioral health and military suicide prevention, Dr. Bryan was recognized in 2009 by the American Psychological Association's Society for Military Psychology with the Arthur W. Melton Award for Early Career Achievement. He is an assistant professor in the department of psychiatry at the University of Texas Health Science Center and the lead risk management adviser for the $25 million Department of Defense funded Strong Star Consortium, focused on PTSD prevention and treatment research.