Tuesday, August 13, 2013

PTSS and suicide: it's (not) the combat stupid

StrategyPage has a lot of stuff on the prevention and treatment of post traumatic stress syndrome, but today's article is about suicide and combat.

August 13, 2013: Military epidemiologists (experts on medical statistics) have long sought to convince people outside the military that the rise in suicide rates within the military had little to do with the stress of combat and mostly to do with the stresses of military life for all those in uniform during wartime. In other words, the increased suicides were not concentrated among the combat veterans (who make up less than 15 percent of those in the military) but more evenly distributed among all service personnel. For example, 77 percent of suicides were among troops who had never gone overseas.
the stories are not going to examine the evidence, because the stories are written first to prove their point.

These revelations were not well received by the mass media in the United States, which makes much of the rising suicide rate in military (but pays less attention to rising suicide rates among civilians of the same age and education). It was 9 per 100,000 in 2001 and 17.5 last year. This was declared to be a health emergency, and to a certain degree it was. What was missed in all the discussion was the higher suicide rate in the army was far below the rate for civilians of military age (17-60), which was 25 per 100,000 but was catching up.
The fact of the matter is that the military seeks to recruit only people who have an above average ability to deal with stress, especially for the minority headed for combat jobs. It’s not just combat stress the military worries about, because less than 15 percent of troops in the ground forces have combat jobs. The rest are doing civilian type jobs but often under stressful (combat zone) conditions. In fact, most of the military suicides are of men who were never in combat or even overseas. But since the military suicide rate is so much lower than those of comparable civilians, it hardly matters. There are so few actual suicides in the military each year that a few soldiers having family problems can cause the rate to seemingly spike. That’s largely what has been happening.
another "meme" is that suicide/violence is due to drugs used to treat the psychiatric problem, not due to the psychiatric problem itself (suicide, for example, is more common in the recovery phase of severe depression, and this was known before drugs became available...the reason is that if you are very depressed, you are too apathetic to kill yourself, but as you recover, you get the energy back but not the insight that you are getting better, so they act on the plans they had already made).

So what about the drugs?

The danger of suicide led to many PTSD sufferers, or those who might have it, to be given anti-stress medications. Use of these medicines increased 76 percent between 2001 and 2009. By then, some 17 percent of all troops took these drugs, including six percent of those in combat zones. In 2001, the troops used these drugs to about the same degree as the civilian population (ten percent).
what is the real problem: repeated deployments of the same people to a combat zone.

During World War II it was found that, on average, 200 days of combat would bring on a case of PTSD for your average American soldier. After World War II methods were found to delay the onset of PTSD (more breaks from combat, better living conditions in the combat zone, prompt treatment when PTSD was detected). That's why combat troops in Iraq and Afghanistan often slept in air conditioned quarters, had Internet access, a lot of amenities, and a two week vacation (anywhere) in the middle of their combat tour. This extended their useful time in combat, before PTSD set in. No one is yet sure what the new combat days average is, and new screening methods are an attempt to find out. But more troops appear to be hitting, or approaching, the limits.
 they also note that PTSS is common among civilians, and that what the military is learning can be used for civilians too.

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