In a war, death comes in many forms: jury-rigged bombs, sleek fighter jets, assault rifles, rocket-propelled grenades. But a stealthier killer lingers long after the fighting is done, in the psychological toll that combat exacts. More than 6,000 veterans take their own lives every year – about 20 percent of the 30,000 American suicides annually.

In an effort to quantify the psychological cost of war, a recent report from the National Bureau of Economic Research has come up with the magic numbers. They estimate that lower-bound costs of mental health problems from the global war on terror are between $750 million and $1.35 billion annually.

Despite trying everything from portable weatherproof brain scanners to drug treatments with ecstasy and MDMA, service members are still suffering with post-traumatic stress and other mental health issues.

In fact, 26 percent of returning soldiers from Iraq and Afghanistan are depressed, drug and alcohol-dependent, homeless or suicidal, says the NBER report. This quoted number was independently calculated in a study done by the Rand Corporation, a non-profit policy and research think tank.

The NBER report brings some fresh insights to the table. Rather than assessing the mental impact of war through a measure of soldiers' deployment length as other studies have done, this report assesses trauma through the type of combat soldiers have been involved in.

Although the results are pretty intuitive, the report establishes that those soldiers who "engage in frequent enemy firefight or witness allied or civilian deaths are at substantially increased risk for suicidal ideation, psychological counseling, and post-traumatic stress disorder (PTSD)."

So, when the military decides which soldiers to deploy for active combat, they should be cognizant of where and not necessarily for how long, the soldier has been deployed before.

Also interesting: This report is the first military mental health study to use longitudinal data, from the National Longitudinal Study of Adolescent Health, conducted by the University of North Carolina, Chapel Hill.

The dataset is a collection of health information from high school kids in 1994. The study did its most recent follow-up in 2008. It's useful for diagnostic PTSD research because it includes and reflects childhood mental health of many current troops from their pre-service days, allowing scientists to look for early portents of PTSD development.

The signs of mental health deterioration have been red flag for a few years now.

The number of soldier suicides (129) reported in the first seven months of 2009 by The New York Times was higher than the number of active troops killed during combat in that time.

Vets from Iraq and Afghanistan, young soldiers between 18 and 34 years old, found themselves unable to deal with their post-war nightmares and insomnia, said a *Navy Times *report in 2010. Their solution: popping pills with frightening regularity to treat depression, psychosis and anxiety. This pill-popping translated to a 42 percent increase in prescription drug use between 2005 and 2009.

The cost of psychological damage by active warfare is now a real number, but it doesn't represent the unquantifiable ripple-effect costs on socioeconomic outcomes like psychological health of military children, impact on marriages or the future labor market, says the NBER report. This invisible, burgeoning effect of PTSD begs ever more Pentagon research into prevention, diagnosis and treatment of the silent killer.

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Photo: Spencer Ackerman*

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