More than four times as many troops and veterans of the wars since 9/11 are believed to have died by suicide than were killed in the wars themselves, a new study from Brown University has found.
In a paper released Monday as part of its Costs of War series, Brown's Watson Institute for International and Public Affairs estimates that 30,177 active-duty personnel and veterans of the wars in Iraq and Afghanistan have taken their own lives over the last nearly 20 years.
That is far greater than the 7,057 service members who died in war operations since 9/11, the institute said in the report, "High Suicide Rates Among United States Service Members and Veterans of the Post-9/11 Wars."
The military's rising suicide rates have caught up to the growing problem across the U.S. population, the institute said.
This represents a significant -- and "deeply alarming" -- shift, it said. In the past, active-duty service members have died by suicide less frequently than civilians.
But the suicide rate in the military now has surpassed the age-adjusted civilian rate, the report said, and suicide rates among post-9/11 war veterans surpass civilian rates.
The report said some elements unique to the wars of the past two decades may have led to a "suicide epidemic."
One of the wars' signature weapons, the improvised explosive device, led to a wave of traumatic brain injuries or "polytraumas" -- cases where wounded troops sustained multiple injuries or severe injuries in at least two areas of the body.
Studies suggest that between 8% and 20% of post-9/11 service members have sustained at least one -- frequently more -- TBIs throughout their career, the report said. A 2012 study of U.S. allies in Afghanistan, cited by the report, found that nearly half of all deployed service members had experienced at least one TBI, and nearly 13% had suffered more than three TBIs.
Improving medical treatment has also kept wounded service members in uniform longer than previously, allowing some to redeploy after sustaining severe trauma, the institute said.
"These compounding traumas contribute to worsening suicide rates as service members deploy and redeploy after sustaining severe injuries," it added.
But there are other factors at play as well. While the nation has been at war nearly two decades, the Watson Institute said, the public is largely disinterested.
The high level of trauma of all kinds -- mental, physical, moral and sexual; stress and burnout troops and veterans have been exposed to; the military's culture and training; access to guns; and difficulty reintegrating into civilian life are also contributing to high suicide rates, the institute found.
"High suicide rates mark the failure of the U.S. government and U.S. society to manage the mental health costs of our current conflicts," the report said.
Of the troops who die by suicide, the report said, a disproportionate number are young white, non-Hispanic men in their 20s, in the Army or Marine Corps. Suicide rates are also higher for those who were divorced or separated, or facing financial difficulties.
The Watson Institute said the military must reconsider and change the parts of its culture that "overburden" service members with moral responsibility or blame for actions or consequences that were largely out of their control, and "overwhelmingly produces feelings of self-blame, guilt and weakness." The military also trains service members to put the needs of accomplishing the mission above their own well-being, the report said.
The military's masculine culture may make service members less likely to reach out for help for their trauma, because they don't want to look weak in front of others, it added.
The Watson Institute recommended that the military limit deployments to reduce troops' exposure to traumatic events, and improve its screenings for conditions such as post-traumatic stress, TBIs, depression and suicidal ideation so they are universal and taken seriously.
The military and Veterans Affairs Department are trying to help service members and vets who may be at risk of suicide, the report said, but their efforts haven't been enough. Some branches of the military still treat those who seek help with their mental health "like criminals," it added.
The VA also needs to cut bureaucracy that holds up access to care, hold ineffective and inefficient employees accountable, expand its specialized health care, hire more post-9/11 veterans, and update the technology used at medical care centers, the report said.