February 4, 2008: The stress of repeated trips to combat zones like Iraq and Afghanistan is having an effect on the troops. This can be seen by the increase in U.S. Army suicides. The rate in 2007 was 17.5 per 100,000 troops. The rate in 2006 was 12.8, and for the last decade, has fluctuated between 10-13 per 100,000. The suicide rate for troops in Iraq has always been about 40-50 percent higher than for soldiers stationed elsewhere. The suicide rate for the entire U.S. population is about 11 per 100,000.

The suicide rate in the military is known to be linked to stress. Back in 2006,the U.S. Navy was concerned when ofsuicide rate among submarine crewmen went to35 per 100,000. At the time, the rest of the U.S. military Army had a rate about a third of that (about ten per 100,000 uniformed personnel). In 2004, the suicide rate for submariners was 20 per 100,000. It's always understood that the suicide rate among the 20,000 submarine sailors will be higher, simply because it's more stressful work.

The suicide rate in the U.S. Army took a dive in 2004, going from 18 per 100,000 troops in 2003, to 7.9 per 100,000 in 2004. The army attributes the drop to better screening for suicidal tendencies, and widespread attention to the problem after the media ran many stories on the "suicide problem." Typically, suicides account for 5-10 percent of army personnel deaths each year. Most deaths are the result of accidents, both on duty, and off duty (usually while driving). Over the last 25 years, the army has always lost one or two thousand dead each year to accidents, disease and suicide (in that order). That meant about two troops per thousand died each year. In Iraq, the risk of getting killed in combat is 2-3 percent for a one year tour. For the army overall, the risk of death from combat is less than one percent. Suicides have always been higher in combat zones, yet another risk in a very dangerous job.

It was during World War II that researchers began compiling lots of data on troop stress and its effects. It was discovered that most troops were likely to develop debilitating PTSD after about 200 days of combat (that is, the stress of having your life threatened by enemy fire). But today there are other factors. Israel noted, after the 1982 war in Lebanon. That reservists were more sensitive to the aftereffects of combat. The Lebanon conflict used a larger number (than previous wars) of older reserve troops, who tended to be more prone to coming down with stress disorders. This was probably due to the fact the full time soldiers are constantly conditioned to deal with stress. While this is often referred, often derisively, as "military discipline," it has been known for thousands of years that such practices reduce stress and panic during combat. Apparently it reduces the chances of coming down with stress problems as well.

In Iraq, army combat troops often get 200 days of combat in one 12 month tour, which is more than their grandfathers got during all of World War II. And some troops are returning for a third tour in Iraq, which is now fifteen months. The army has found ways to avoid the onset of stress problems (better accommodations, email contact with home, prompt treatment for any problems), but many troops are headed for uncharted territory, and an unprecedented amount of time in combat. Thusnew programs to spot stress related problems, as early as possible, and new treatments as well. The stress angle has been more intensively studied in Iraq than in any previous war. Naturally, the more you look, the more you find. A recent survey of troops who had served in Iraq and Afghanistan, found half of them still had some mental or physical health problems six months after returning from overseas.

Then there's the money factor. Combat pay and re-enlistment bonuses for combat troops provides a temptation to ignore stress symptoms and stay in a combat job. There are plenty of non-combat jobs you can transfer to, and for many of those, there are also large re-enlistment bonuses. This problem largely affects senior NCOs, who take a decade or more to develop, and provide essential combat leadership. Given the experience and maturity of these men, problems are not expected. But the army and marines have to keep a close watch, because it's a unique situation and no one is sure how it will all turn out.