WASHINGTON - A sudden increase in suicides among U.S. soldiers in Iraq last summer turned out to be a brief spike, but the overall suicide rate there last year was much higher than for the entire Army.
Those are among the conclusions of a mental health assessment team that met with soldiers in Iraq and Kuwait between August and October last year, according to officials familiar with the results.
The Army planned to publicly announce the team's findings and recommendations on Thursday.
There were at least 24 suicides among U.S. soldiers in Iraq and Kuwait last year, according to the Army's count. That number may increase because the circumstances of some other deaths are still in doubt.
That equates to a suicide rate of 17.3 per 100,000 soldiers, compared with a rate of 12.8 for the entire Army in 2003 and an average rate of 11.9 for the Army during the 1995-2002 period, according to officials familiar with the mental health study. They spoke on condition of anonymity.
The 24 suicides do not include soldiers who killed themselves after returning to the United States.
Dr. Paul Ragan, an associate professor of psychiatry at Vanderbilt University and a former Navy psychiatrist, said in a telephone interview Thursday that 24 suicides among the soldiers in Iraq is "without question a highly statistically significant elevation of the number of suicides."
"This is a milestone," he said. "I think we need to have a major shift" in the Army's approach. "We're now past (asking), `Is there a problem?'" He said the Army needs to focus harder on understanding why soldiers kill themselves and finding more effective ways of preventing it.
The overall U.S. civilian suicide rate during 2001 was 10.7 per 100,000, according to the Centers for Disease Control and Prevention. The U.S. civilian rate for the 18-34 age group - the age range of most soldiers - is 21.5 per 100,000.
Investigators found common threads in the circumstances of the 24 soldiers who committed suicide. The soldiers were faced with personal financial problems, failed personal relationships and legal problems, officials said.
They also found - as have previous Army probes of increases in the suicide rate during the 1990s - that soldiers tend to avoid seeking help with stress or other mental health problems for fear of being stigmatized.
The team of Army mental health specialists surveyed about 750 soldiers in Iraq and Kuwait between August and October. It found that while stress was an issue, as might be expected in a combat zone, 77 percent described their stress as mild or minimal. Seven percent reported severe stress.
About 80 percent of those surveyed had been engaged in combat since their arrival in Iraq.
It is highly unusual for the Army to send a mental health assessment group to a war zone, but it did so after five soldiers committed suicide in July. That turned out to be a statistical spike because the number of suicides after July leveled off at about two per month.
July was a particularly difficult month for soldiers in Iraq. The combat phase of the war had ended in May and many soldiers thought the conflict was ending, but then an Iraqi insurgency took hold in June and July. Soldiers were being killed almost daily by roadside bombs and snipers.
The summer heat, combined with sometimes primitive living conditions for soldiers, added to the stress.
Among the mental health assessment team's recommendations:
-Refocus soldier training to improve the "buddy" system in which soldiers watch out for each other's well-being. The training would be aimed at allowing soldiers to more readily recognize signs of severe stress in their "buddy."
-Place more psychiatrists and other mental health professionals in Iraq and Kuwait so help is more accessible and can prevent soldiers in the early stages of mental crisis from becoming suicidal.
Dr. William Winkenwerder, assistant secretary of defense for health affairs, told reporters in January that of the more than 10,000 troops medically evacuated from Iraq, between 300 and 400 were sent outside the country for treatment of mental health problems.
The military prefers to treat mental health problems such as depression by keeping troops in their regular duties while they get counseling and possibly medication, Winkenwerder said. Less than 1 percent of the troops in Iraq are treated for mental issues during an average week, he said.
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