By Jane O'Brien

Washington DC

Being exposed to stressful combat situations is a factor Half a million soldiers are being asked to take part in the biggest ever investigation into the number of suicides in the US armed forces. Last year, 143 soldiers killed themselves and there were 113 suicides in the other armed services - the highest number since records began 30 years ago. Already this year there have been more than 100 reported suicides among soldiers on active duty. During the study, set to take three years, new recruits will be asked for personal information that will be used for psychological assessments. Researchers will also interview serving soldiers. Some will be asked to provide saliva and blood samples to try to establish whether there is a genetic reason why some people are more likely than others to take their own lives. Rate doubled "The army sees the suicide rate as the canary in the coalmine. It's telling them that the force itself is strained," says Robert Heinssen, director of the $50m (£30m) study, which is being conducted by the National Institute of Mental Health. "Over the last several years, the rate of suicide in the army has doubled. Before 2001 it was about half of what it is in the civilian population for the same demographic. Now it's caught up. "So these are individuals that start out as being very resilient and it's in the face of these tremendous stressors - the war, the training cycles, the separation from family - that we're seeing wear and tear on the force in general." There is still a tremendous stigma around seeking help

Steve Robinson

National Gulf War Resource Center But he says being exposed to high stress and combat situations is just one of many complex factors that can lead to suicide. The way people solve problems and how they deal with stress also play a part, and there could be genetic and neurobiological links. Unlike most studies of its type, doctors will not wait for its completion to publish their conclusions. They will report results as they emerge so that the army can make immediate use of the information. The first findings are due in November. But veterans' advocacy groups and families of suicide victims say extra research is not necessary to prevent more deaths. They say the suicides are due to a military culture that deters vulnerable soldiers from seeking help for mental health issues. "This is a real issue - not something that happens once in while. But until the culture is changed and the stigma is taken away, all the reports and questions won't make any difference," says Charles McKinney, whose son Jeff shot himself while on patrol in Iraq. First Sergeant Jeff McKinney had served in the army for more than 19 years and had no history of mental health disorders. Then, in the space of one week in June 2007, a series of roadside bombings killed and maimed several members of his brigade. One bomb exploded just in front of his vehicle which, his father believes, caused an injury to his brain. Felt responsible "As well as him suffering post traumatic stress disorder (PTSD) his brain had been physically affected by this," says Mr McKinney, a resident of Bedford, Texas. "All the signs were there. Everybody saw them but I don't know whether they recognised what to do about them." Sgt McKinney served in the US Army for 19 years. Sgt McKinney stopped eating and did not sleep for days on end. His comrades say he felt personally responsible for every death and believed he was failing his company, but he declined to see an army physician. The day before he died, his commanding officer ordered him to sleep and later said he would have stopped him going on patrol but was afraid that the soldiers would have lost confidence in Sgt McKinney's leadership. "When his company commander said he shouldn't have gone, he should have forced him not to," says Mr McKinney. "He said Jeff would have lost the respect of his men and his career would have been ruined. I would rather have ruined his career than lost my son." Mr McKinney is himself a Vietnam War veteran and says soldiers then were expected to suppress their feelings. Many returned to civilian life without being treated for PTSD and developed behavioural symptoms that included drug and alcohol abuse, domestic violence, homelessness - and suicide. "It's happening now to soldiers in Iraq and Afghanistan. We didn't learn the lessons of Vietnam," says Mr McKinney. Early intervention Former Army Ranger Steve Robinson agrees. He works for the Swords to Plowshares Iraq Veteran Project and has testified to Congress on mental health issues and suicide in the military. Soldiers who commit suicide didn't die in combat but they died fighting their own war

Charles McKinney "There is still a tremendous stigma around seeking help," he says. "Because there is no education and training in the military to teach people how the brain and body react in war, leaders are left without knowledge of what to do." He says mental health training should become as integrated as weapons training, and that commanders should be taught to recognise problems and to intervene early. The army says it has implemented a number of improvements to the force's suicide prevention programmes in recent weeks. There have been changes to the army's health promotion policy and extra staff have been employed to improve access to counselling services for soldiers and their families. "It's not that the army lacks programmes to confront the problem of suicide," says Brig Gen Colleen McGuire, director of the Army Suicide Prevention Task Force. "The long-term challenge is determining which programmes are most effective for our soldiers and ensuring that army leaders, from junior non-commissioned officers to the most senior leaders, know how to help their soldiers take advantage of these programmes." Recently Mr McKinney flew to Germany where his son's wife and children live. There he visited Jeff McKinney's grave and says he managed to find peace. "Soldiers who commit suicide didn't die in combat but they died fighting their own war," he says. "I'm proud of my son. He was our hero."



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