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US Army to study suicide

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The US Army is seeing an increase of suicides among soldiers. So it’s launching the largest-ever study of suicide in the military. The study is just getting underway, but it raises some ethical concerns about privacy and consent. The World’s Katy Clark reports.

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MARCO WERMAN: I’m Marco Werman and this is The World, a co-production of the BBC World Service, PRI, and WGBH Boston. The US Army has seen a sharp rise in suicides among its troops. One hundred forty active duty soldiers killed themselves last year. That’s more than twice the number in 2004 and the tally of suicides in on track to go even higher this year. The army is trying to figure out what’s behind this disturbing trend and how to reverse it. But The World’s Katy Clark reports that getting to the bottom of this problem won’t be easy.

KATY CLARK: The spike in suicides in the army and the US military as a whole doesn’t surprise Kim Ruocco. Her husband, Marine Corps Reserve Major John Ruocco, killed himself in 2005, three months after returning from Iraq. He was 40 years old. Kim Ruocco says it was a lot easier to identify the warning signs after her husband’s death than before.

KIM RUOCCO: I knew he was having problems but when I was in the middle of it you know I could attribute his behavior and the way he was to a lot of things – you know the stress of war. He had applied for a job that he didn’t get while he was in Iraq you know. So yes I saw signs but at the time didn’t realize how serious they were.

CLARK: Determining exactly which signs indicate suicidal tendencies is one of the goals of a new study funded by the army. It’s slated to last five years. Doctor Ronald Kessler of Harvard Medical School is one of the lead investigators. He says he and his colleagues have a huge task ahead of them.

RONALD KESSLER: There’s not going to be any one, two, 10, 20 variables that together are going to definitively predict who kills themselves. It will never be more than one out of every 50 people of a certain sort. So we want to narrow it down to this small range. And then when we get the small range, go inside and see if there’s additional information we can pick up that will predict who kills themselves.

CLARK: To conduct the study Kessler and his colleagues will use a variety of strategies. They’ll examine the records of military personnel who’ve killed themselves and see in what ways they were different from similar service members who did not end their lives. They’ll survey 90,000 active duty army personnel and ask for information about suicide-related behavior and when possible researchers will collect saliva and blood samples to conduct genetic and neurobiological tests. Kessler says researchers already have some ideas where to start looking for clues thanks to the meticulous records the army keeps on its soldiers.

KESSLER: We know from the reports that the army has after the fact in studying people who did kill themselves and looking backward in time over the past few months that a very high proportion of those people saw a chaplain but not a mental health professional. They were reaching out but maybe not reaching out to the right place or possibly when they reached out they weren’t grabbed and they weren’t’ referred in the right way.

CLARK: Researchers hope to find a lot more clues like this. The new study has been widely praised but it also raises some concerns. First, if researchers see any signs that might suggest a risk of suicide will they intervene? They say they will. Second, participation in any research study is supposed to be voluntary but soldiers may see their involvement as mandatory.

PAUL APPELBAUM: Soldiers are trained to take orders.

CLARK: And that means researchers will have to take extra precautions to ensure that no one is pressured into participating says Psychiatrist Paul Appelbaum of Colombia University. He heads the ethics committee overseeing the army’s suicide study. Appelbaum says researchers will also take pains to keep the information they collect confidential.

APPELBAUM: That’s a concern in all research but it’s a particular concern in the military where the usual civilian roles that you and I are used to, particularly in health care settings, don’t necessarily apply.

CLARK: For instance when a service member discusses suicidal thoughts with his or her military health care provider that clinician is obligated to share the conversation with the person’s commanding officer. That could jeopardize the service member’s reputation and career. Kim Ruocco says it was exactly that concern that kept her husband from seeking help when he began experiencing intense anxieties 10 years before he killed himself.

RUOCCO: What soldiers hold most dear is how they appear to others because they have to be trusted and respected in battle. So I’m hoping that they’ll come forward. But I think it might difficult due to still some of the enormous stigma that we have out there.

CLARK: If military personnel are reluctant to step forward the suicide study may not produce many useful results. But the army isn’t going to wait for results before it tries to tackle the suicide problem. Starting in October it plans to phase in a new emotional resiliency training program. The program aims to help service members with potentially stressful situations. For instance if a soldier calls home and his wife doesn’t answer the program will teach him not to jump to conclusions that she’s off with another man. Military officials hope with the help of this program and others the number of soldiers ending their own lives will begin to fall well before the five-year suicide study is completed. For The World this is Katy Clark.

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