WASHINGTON, - Post-traumatic stress, traumatic brain injury and suicides among servicemembers are interrelated problems requiring holistic prevention methods and more scientific study, military leaders told a Senate panel today.
"The reality is, the study of the brain is an emerging science, and there still is much to be learned," Gen. Peter W. Chiarelli, Army vice chief of staff, told the Senate Armed Services Committee during a hearing about how the services are dealing with brain injuries and mental health problems.
The vice chiefs of the Navy and Air Force, the Marine Corps' assistant commandant and a Veterans Affairs Department health official also spoke before the committee. All agreed with Chiarelli that the Defense and Veterans Affairs departments are coordinating better than ever to diagnose and treat brain injuries and mental disorders, and that much more is known about such conditions today than when combat operations began after Sept. 11, 2001.
Still, they acknowledged, much more needs to be done. They noted that suicides are highest among ground forces. The Army reported 162 confirmed suicides last year, up from 140 in 2008 and 115 in 2007. The Marine Corps reported 52 suicides last year - more per capita than the Army, and up from 42 in 2008 and 33 in 2007. Last year's numbers are expected to rise as more investigations are completed, they said.
While the military officers cited increased deployments and less time at home as one area of stress, many more risk indicators such as personal problems with relationships, legal matters and careers also are factors, they said.
In the Army, Chiarelli said, 79 percent of suicides were by servicemembers who had one or no deployments, and 60 percent were on their first deployment.
Also, Chiarelli said, suicides among active-duty soldiers have dropped while simultaneously increasing among reserve-component soldiers, especially National Guard members.
The Guard soldiers require a different approach toward intervention, he said, since no standardization exists for services and treatment once they return to their home states. One improvement, he said, would be for Guardsmen to remain on Tricare Plus health care coverage for a continuum of treatment.
The senior officers outlined risk factors for suicide among sevicemembers, but only the Marine Corps has seen wide commonality in those who took their own lives. Among Marine suicides last year, 92 percent were between the ages of 17 and 23, and mostly were white men, Gen. James F. Amos said. He added that 67 percent of the Corps is 25 or younger.
"We are woefully more immature in years," the general said. "That, in and of itself, is a problem."
Of the 52 suicides among Marines last year, nine had never been in combat, Amos noted.
"While there is no single answer," he said, "we are committed to exploring every potential solution and every resource we have available. We will not rest until we turn this around."
In the Air Force, only 20 percent of suicide victims had been deployed in the year before they died, Gen. Carrol H. Chandler told the committee. But 70 percent of those who committed suicide were found to have problems in their personal relationships, he said, and many had legal problems.
Suicides in the Navy have come from sailors with enough different demographics and risk factors that "our Navy message is that no one is immune," Adm. Jonathan W. Greenert said.
The officers outlined the increasingly number of programs the services have adopted to try to curb suicides. They include training that begins in boot camp, focuses heavily on noncommissioned officers, and extends to senior flag officers; increasing pre- and post-deployment evaluations; embedding mental health workers in deployed units; reaching out to families with training and telephone hotlines; and trying to improve the diagnosis and treatment of TBI and post-traumatic stress disorder.
And the services increasingly are extending programs to build resilience in military members and their families to cope with whatever stresses might arise, the military officers told the committee.
Chiarelli said it is important to recognize the connection between TBI and PTSD and the high rate of "co-morbidity," or co-existing conditions in an individual. That, coupled with a lack of medical understanding about the disorders, and the differing drugs to treat them and problems like anxiety and depression, complicates diagnosis and treatment, he said.
"There is no doubt that you can go to any of our posts and find soldiers struggling because [doctors] can't nail down and diagnose their conditions," he said. "But I promise you it is not from lack of trying. We are doing everything we can.
"Our science on the brain is just not as great as it is on other parts of the body," Chiarelli continued, noting vast medical opinions about diagnosing and treating the disorders. "It's not this well-developed science like you find with heart surgery."
Of the Army's most severely wounded soldiers - those at least 30 percent disabled - at least 60 percent are diagnosed with PTSD or TBI, Chiarelli said.
There still is no conclusive test to diagnose TBI, Dr. Robert L. Jesse, a physician and acting principal deputy undersecretary of health for VA's Veterans Health Administration, told the committee. "It may just be the complexity of this disease that it takes time to manifest in ways we can diagnose," he said.