As bad as the suicide rate in Alaska already is, the situation could grow even worse once thousands of new veterans return home from combat duty in Iraq. That's the warning local public health officials are culling from a new study that finds male veterans twice as likely to die by suicide as men with no military service -- and even more so if they're physically or mentally impaired.
Such news is particularly worrisome now, veteran advocates say, with hostilities in Iraq having left 52,000 U.S. troops either wounded or hospitalized for ailments ranging from insect-borne boils to severe depression.
According to the Department of Defense, 111 active-duty U.S. troops in Iraq have committed suicide since the beginning of the war. With one of the highest concentrations of veterans in the U.S. -- and suicide rates that often lead the nation -- Alaska was already at risk for suicide, according to Portland State University public health specialist Mark Kaplan, lead author of the new study. But now Iraq adds a new factor. "That's the perfect storm," Kaplan said of the convergence of Alaska and an influx of newly disabled vets. "This (study) foreshadows some ominous trends."
Tracking the lives of more than 320,000 U.S. men -- about a third of whom were veterans -- the Oregon-based research team found that over a period of 12 years (from 1986 to 1997) more than 500 members of the study group committed suicide, including 197 veterans. Those with the highest risk for suicide were veterans who were white, college-educated and living alone in a rural area, most often in a Southern or Western state, the study found. Veterans were half again more likely than non-vets to kill themselves with guns.
Notably, those whose daily activities were limited by physical or mental impairments were 4.4 times more likely to take their lives than vets who were unimpaired. "They had problems functioning at school, at work, at home," Kaplan said. "That really stood out in our analysis."
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If the government fails to adequately care for its returning vets, expect to see skyrocketing rates of divorce, homelessness and suicide, says Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America, based in New York. "Veterans will show the psychological scars of these wars for years to come."
Hoping to prevent that, the VA has conducted an extensive survey of Vietnam-era vets who committed suicide. It hasn't yet released its findings.
But Jonathan Shay, a psychiatrist with the U.S. Department of Veterans Affairs in Boston, estimates that more Vietnam vets have died by suicide than all of the 58,000-plus troop casualties listed on the Vietnam memorial wall -- if you define suicide broadly as death by deliberately reckless behavior. Like the previously rational soldier who decides to walk across a minefield at night. "The multitude of (vet suicide) deaths are ambiguous," Shay said in a telephone interview. "They're single-vehicle accidents. Single motorcycle accidents. They have shoot outs with police. They're bar fights, where somebody goes in, unknown, and picks a fight with the biggest, meanest looking person in the room."
One deeply depressed vet he knew didn't do drugs, Shay says -- until one night he killed himself with a heroin overdose. Says Shay: "I am morally certain that was a suicide."
VETS TOUGH TO TRACK
Across the U.S., more than 30,000 people kill themselves each year -- almost double the number of homicides -- and approximately one-fifth of those cases involve veterans, according to Kaplan. Suicide is the eighth leading cause of death among all U.S. men.
With its small population, Alaska contributes relatively few suicide cases (about 140 a year) to the national total. But the suicide rate (20.8 per 100,000 people from 2003 to 2005) is almost twice the U.S. average.
One more bit:
Alaska's death statistics don't record the veteran or military status of people who commit suicide, says Ron Perkins, executive director of the Alaska Injury Prevention Center, which conducted the follow-back study.
But according to Kaplan, lead-author of the Oregon research, the number of vets who commit suicide nationwide is much larger than reported in previous studies, since most were based on data provided by the VA. "One thing we found is that three-quarters of veterans are not served by the VA," Kaplan said. So a huge portion of the vet population was previously ignored.
Co-authored by Nathalie Huguet, Bentson H. McFarland and Jason T. Newsom, the veteran suicide report is due to be published in the July issue of "Journal of Epidemiology and Community Health."
Suicide risks for veterans
Male veterans: 2 times more likely to kill themselves than male non-veterans.
Disabled: 4.4 times more likely than unimpaired vets.
Living alone: 3.4 times more likely than vets living with others.
White: 3.2 times more likely than non-white vets.
College-educated: 2.7 times more likely than less-educated vets.
Western state: 1.9 times more likely than Northeastern state vets.
Rural: 1.5 times more likely than urban vets.
Underweight: 2.4 times more likely than normal-weight vets.
Source: "Suicide among male veterans: a prospective population-based study."
U.S. veterans by state
RANK STATE PERCENT TOTAL
1 Alaska 17.1 71,552
2 Montana 16.2 108,476
3 Nevada 16.1 238,128
4 Wyoming 16.0 57,860
5 Maine 15.9 154,590
Total U.S. veteran population: 26,403,703 (12.7 %)
Source: 2000 U.S. census
U.S. suicides by state
RANK STATE PER 100,000 TOTAL
1 Alaska 23.6 155
2 (tie) Montana 18.9 175
2 (tie) Nevada 18.9 440
4 New Mexido 18.7 356
5 Wyoming 17.4 88
Total U.S. suicides: 32,439 (11.1 per 100,000 people)
Source: Suicide State Data Page (2004), American Association of Suicidology Suicide in Alaska
Suicide in Alaska
Interviews with relatives of 56 people who committed suicide -- out of a total of 426 cases in the past three years -- provides the following small-sample portrait of Alaskans who take their own lives:
• 54 percent had an illness or disability.
• 61 percent were born outside Alaska.
• 62 percent were taking prescription medication for mental or behavioral health problems.
• 43 percent drank alcohol daily (63 percent drank at least weekly).
• 66 percent expressed thoughts of hopelessness or a wish to die.
• 84 percent owned one or more firearms (compared to 32 percent who own firearms in the general U.S. population, according to the Centers for Disease Control).
• 87 percent had verbal fights or arguments with others.
Source: Alaska Suicide Follow-Back Study, Sept. 1-2003 to Aug. 31, 2006
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