May 5, 2008 – The number of suicides among veterans of wars in Iraq and Afghanistan may exceed the combat death toll because of inadequate mental health care, the U.S. government’s top psychiatric researcher said.
Community mental health centers, hobbled by financial limits, haven’t provided enough scientifically sound care, especially in rural areas, said Thomas Insel, director of the National Institute of Mental Health in Bethesda, Maryland. He briefed reporters today at the American Psychiatric Association’s annual meeting in Washington.
Insel echoed a Rand Corporation study published last month that found about 20 percent of returning U.S. soldiers have post- traumatic stress disorder or depression, and only half of them receive treatment. About 1.6 million U.S. troops have fought in the two wars since October 2001, the report said. About 4,560 soldiers had died in the conflicts as of today, the Defense Department reported on its Web site.
Based on those figures and established suicide rates for similar patients who commonly develop substance abuse and other complications of post-traumatic stress disorder, “it’s quite possible that the suicides and psychiatric mortality of this war could trump the combat deaths,” Insel said.
Post-traumatic stress disorder, known as PTSD, is the failure to cope after a major shock, such as an auto accident, a rape or combat, Insel said. PTSD may remain dormant for months or years before it surfaces, and in about 10 percent of cases people never recover, he said.
Difficult to Predict
“We don’t yet know how to predict who is going to be the person to be most concerned about,” Insel said.
The Pentagon didn’t dispute Insel’s remark.
“The department takes the issue of suicide very seriously, and one suicide is too many,” said spokeswoman Cynthia Smith in an e-mail.
The department has expanded efforts to encourage soldiers and veterans not to feel stigmatized if they seek mental health treatment, Smith said.
Soldiers who’d been exposed to combat trauma were the most likely to suffer from depression or PTSD, the Rand report said. About 53 percent of soldiers with those conditions sought treatment during the past year. Half of those who got care were judged by Rand researchers to have received inadequate treatment.
Failure to adequately treat the mental and neurological problems of returning soldiers can cause a chain of negative events in the lives of affected veterans, the researchers said. About 300,000 soldiers suffer from depression or PTSD, the report said.
Researchers aren’t sure whether it’s appropriate to treat such patients with selective serotonin reuptake inhibitors, a class of medications that include Prozac, and other anti- depressants, Insel said. His institute is examining that question and novel treatments for PTSD, including using so-called virtual reality technology.
The psychiatric association reported last week that a survey of 191 military members and their spouses found 32 percent said their duty hurt their mental health, and six in 10 believed seeking treatment would damage their careers.
More than 15,000 psychiatrists are attending the professional group’s meeting.