Apr. 5—After years of rising suicides among troops in America's armed forces, the Pentagon has some good news.
Suicides were down in 2022, falling by 35 self-inflicted deaths from 2021 and by even larger numbers going back well into the previous decade.
Experts who track suicides and research to counter them can't explain why things improved last year.
"This is good. I mean, it's good in the sense that it's not as bad as the previous years," said retired Army Col. Carl Castro, professor and research director of the University of Southern California's Center for Innovation and Research on Veterans and Military Families.
"But if you're looking to say, 'Has (the Department of Defense) figured this out? 'I think the answer is no. Those numbers are still really, really high," he added.
The Defense Suicide Prevention Office reported late last week that 488 soldiers, sailors, airmen and Marines had died in suspected and confirmed suicides last year, dropping from 523 in 2021 and 581 in 2020. That made the 2022 mark the lowest for total suicides since 2016, when 480 service members took their lives, though the numbers overall have been bad over the past three decades and trending worse.
Castro noted the drop from 2020 to 2022.
"I look at it from the standpoint of lives. Those 90, close to, I think, 100 lives are really important, and so I wouldn't in any way minimize that," he said.
Castro and Alan Peterson, division chief of behavioral medicine and director at UT Health San Antonio's STRONG STAR Consortium, saw the downturn in suicides as positive but added they couldn't infer much from the data. The consortium is the nation's largest combat-related research effort on post-traumatic stress disorder.
"I think it's hard to draw conclusions from that," said Peterson, a retired Air Force lieutenant colonel who served in Iraq and Afghanistan. "It's nice to see the numbers moving in the direction we want in the downward trajectory that's there. It's hard to say what that is related to."
Suicides defy simple solutions
After two decades of research in the wake of a tide of military suicides that accompanied the repeated deployment of troops to Iraq and Afghanistan, no one has found a solution.
But there has been promising research, including a study by Ohio State University researcher and psychiatry professor Craig Bryan. Bryan found that well-crafted messaging from the right sources — such as those in law enforcement — can convince troops to secure their weapons safely and possibly save lives.
Bryan also was involved in a study released earlier this year by an independent committee that sought feedback from troops and their families on what does and does not work in suicide prevention. Established last spring by Defense Secretary Lloyd Austin, the Suicide Prevention and Response
Independent Review Committee looked at clinical and nonclinical suicide prevention and response programs.
A Pentagon spokesman told reporters in March that Austin had directed "multiple, immediate actions" following the committee's recommendations. Air Force Brig. Gen. Pat Ryder said the defense secretary agreed to 10 recommendations made by the panel, one of which was expediting the hiring process for behavioral health professionals.
The panel issued an additional 117 recommendations.
"While we recognize that suicide has no single cause and that no single preventative action, treatment or cure will eliminate suicide altogether, we will exhaust every effort to promote the wellness, health and morale of our total force, be there for one another and save lives," Ryder said.
Bryan cautioned that those examining the trends over the past two decades have noted brief downward dips that prompted false hope that things might be changing.
"One of the recommendations that we have in the report is to stop trying to interpret these numbers in these impossibly short, meaningless time frames," he said Monday. "We realize that actually there's a lot of external pressure for the ( Defense Department) to do that. They're asked by the media, Congress, 'What does it mean that the numbers went down this year? ' and the correct answer to that is it's too soon to tell."
A growing focus on guns
Researchers haven't found a way to accurately predict or prevent suicides in a way to intervene successfully, but reducing self-inflicted gunshots could make a huge impact. That's because most military suicides involve firearms — roughly eight in every 10 fatalities, far higher than in the civilian world, where women are less likely to use guns than men.
In his study, Bryan noted that more than half of the 45,979 people who died by suicide in the United States in 2020 did so with a gun.
A recommendation not followed by the Defense Department was the panel's call for tightening access to firearms for those considered at risk for suicide, an issue that goes to the heart of research for Bryan, who once worked in San Antonio.
He said there's still a task force looking at what can and can't be implemented.
Some of the recommendations strongly emphasize firearm availability and access on base to include firearm purchases on military installations and taking steps to encourage secure storage of guns — as well as limits on who can buy them on installations.
"And another related recommendation there was waiting periods," said Bryan, an Iraq veteran who did his clinical psychology residency at Wilford Hall Medical Center. "So after someone has purchased a firearm legally, he'll be required to wait several days to actually acquire it, like to pick it up or receive it, because that has been shown to be a really, really effective way to reduce suicides."
Other recommendations include a seven-day waiting period for any firearm purchased on Defense Department property and raising the minimum age for purchasing firearms and ammunition on installations to 25 years.
Committee members also suggested requiring anyone living in military housing to register all privately owned firearms with the installation's arming authority and to store all privately owned firearms securely in a locked safe or with another locking device, and establishing a Defense Department policy restricting the possession and storage of privately owned firearms in military barracks and dormitories.
The recommendations go to the heart of the gun culture that pervades the armed services and promise to be controversial among troops across the service.
Panel calls for fixes in pay, working conditions
Castro, former director of the Defense Department and Army's Military Operational Medicine Research Program, has seen the evolution of suicide research since the Iraq War era and called it a complex matter that defies simple solutions — more than a few of which were used by the services for years with little impact on the numbers.
At one time, people in the military were far less likely to die by suicide, but as the war on terrorism ensued, it soon became the other way around.
"My own personal view is that there are certain things you have to do in the military to get this fixed because people die by suicide for a lot of reasons," he said. "That's the one thing we know from the literature. If you look at people who tried to take their lives and asked them why, there's a variety of reasons why people take their lives."
"It's not just one thing," Castro added. "But at the fundamental level, people die by suicide because they cannot live with themselves or what they think other people will think about them. Fundamentally, that's why people are dying. And we've got to give people reasons to live. You've got to treat people with dignity and respect."
The commission also pointed to issues they and their families are likely to want changed, such as required moves to new units and bases every few years, a signature in the promotion system often called "up or out" — either earning a higher rank or being pushed back into civilian life.
It recommended reducing the frequency of assignments and extending the time commanders spend in their jobs.
The commission called on the Defense Department to reassess the pay scale for junior enlisted service members to ensure it is competitive with comparable civilian jobs and take on short staffing issues that have worn out troops and badly degraded family life.
Peterson, a psychiatrist and deputy chair of the Military Collaboration Department of Psychiatry at UT Health San Antonio, said the committee underscored the daily stress of life in the armed services. For example, Peterson said waiting for delayed reimbursements can add to the stress of moving.
"We know these individuals do things like go to combat and that type of thing, but this report was more like hassles. What are all the hassles that people deal with that can add up to significant stress? As you know, the trends over time have been not specifically related to combat necessarily, but the kind of stresses of the military ... and that's what that report seems to indicate," he said.
In another likely controversial recommendation, the panel urged senior leaders to ban the promotion of alcohol and energy drinks on installations and educate troops on healthy sleep habits during military training and regularly scheduled unit formations.
Energy drinks and booze are real problems, Bryan said.
"There's actually a lot of data showing that military personnel are significantly more likely to consume energy drinks with high levels of caffeine, about twice as likely as civilians. Heavy energy drink consumption has been shown to increase compulsive behaviors, and they correlate with aggression, sleep problems, suicidal ideation, and so all of these things are risk factors for suicide," he said.
'Delaying access' saves lives
Air Force spokeswoman Laurel Falls said she couldn't comment on trends based on the 2020-22 figures but "can tell you that we're focused on connectedness and a shared sense of purpose as key factors in suicide prevention."
She said the Air Force, which set a record in 2019 with 112 suspected and confirmed suicides among active-duty, Reserve and Air National Guard personnel, encouraged using safes, locks or outside storage of lethal means such as firearms, toxic chemicals and pharmaceuticals.
The 2019 deaths were adjusted to 110 after further analysis but remain a record dating as far back as 2016.
"We've found that delaying access to lethal means by as little as five minutes can save the lives of airmen and guardians who are having thoughts of self-harm," Falls said.
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