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Post by Former NIMH Director Thomas Insel: Serving Those Who Served

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NIMH was established nearly 65 years ago to help the nation address the mental health issues of veterans after World War II.  Several wars later, we are still committed to helping those who have served, but today the problems are different.  At the One Mind for Research meeting last week at UCLA, the differences were clear.

Fewer than one percent of Americans have served in Iraq or Afghanistan – 2.7 million men and women over this past decade.  Most were under 25, many had never traveled before, and all were volunteers.  Over 5,000 died in combat.  For many more, war has meant so called “invisible wounds”: the improvement in body armor has protected limbs and lives, but not brains and minds. Since the beginning of these wars in 2003, there have been at least 126,000 cases of traumatic brain injury and 70,000 cases of PTSD.  At the One Mind meeting, Patrick Kennedy, stressing the urgency of these injuries, called these soldiers “medical prisoners of war.”

Today more soldiers are dying from suicide than combat.  Suicides have traditionally been lower in the Army than in age and gender matched civilians.  In 2004 the suicide rate in the U.S. Army began to climb, surpassing the civilian rate in 2008, and when combined with deaths from high-risk behavior, surpassing the mortality from combat in 2009.  The suicide rate has continued to increase, with 164 deaths among active duty soldiers in 2011.  Since 2009, NIMH has been collaborating with the Army to understand the drivers for this increasing rate of suicide and rapidly provide interventions to reduce mortality.  This Army Study To Assess Risk and Resilience in Servicemembers (Army STARRS) is our largest single project at NIMH.  It is an unprecedented effort to understand and modify the factors driving the suicide rate.

So far, 65,000 soldiers have volunteered for Army STARRS, on target to reach 100,000 soldiers by the end of this year.  The study includes psychological and cognitive assessments, biosamples, and a vast range of administrative data.  Analyses of over 500 suicide deaths have already taught us that the problem is complex: no single factor has emerged as a consistent predictor,   and many apparently likely factors appear less important than originally thought.  For instance, many of these suicides preceded deployment; and some groups, identified by administrative data, are at much higher risk.  Our immediate goal is to provide the Army a “risk calculator”, a set of factors that will identify the highest risk soldiers.   By intervening with those at highest risk, we can save lives.

This Memorial Day, 1.4 million men and women are serving in the Armed Forces.  For those who have served in the past, as well as those who currently serve, we at NIMH are committed to supporting the best science for prevention and treatment – that’s our commitment to you to repay your commitment to us.