Keeping Urban Warfare from Turning Soldiers into Suicides

Modern urban warfare veterans deployed either in Iraq (either war) or Afghanistan or both run a significant risk of suicide. The impact of today’s warfare arenas on soldiers seems to increase the risk that these soldiers will fall prey to suicide either while in the combat arena or after their return Stateside. The thesis of this report is that appropriate interventions can reduce the psychological impact of modern urban warfare, and thus reduce the likelihood that returning soldiers will succumb to suicide once they return from deployment to a war zone.

This report first considers the scope of the problem, and then considers the impact of suicides on comrades in arms. Suicide is significantly impactful that the military and the DOD have determined it to be important. They have tried several types of interventions to reduce the impact and frequency of such events. While several studies have been made of various interventions to determine their efficacy, none has been done viewing them from the perspective of a soldier rather than from a medical or command perspective. Although it is clearly infeasible to actually undergo all these various interventions in practice, the description of the various interventions can provide a guide for an experienced soldier who has done tours of duty in the war zones in question. Thus, this report will consider those interventions and attempt to determine their effectiveness and their side effects as a soldier would perceive them. From this discussion, the report concludes by considering which of these interventions have been most useful and most effective at keeping modern urban warriors alive instead of suicides.

The most successful program at addressing this appears to be the program implemented by the Army in its deployed troops, in large part because it was tailored to the specific population, because it was accompanied by a clear mandate from senior commanders that suicide prevention is a high priority within their command structure, and because it made mental health care professionals available even to troops remotely deployed. This program also had different focuses based on the soldiers’ phase of their deployment (i.e., pre-deployment, deployment, re-deployment, and reintegration). Certainly from the soldiers’ perspectives, the needs do differ in each of those periods of an assignment. Because this intervention was so highly tailored, however, it is not clear how easily it could be extended to other units in other services. It is clear, however, that in order to accomplish that, a clear priority from senior command staff would be required. That command priority seems to be essential to successful suicide prevention interventions.

A second issue is the dependence on psychoactive drugs to implement individual interventions, despite their documented history of side effects, including increasing suicide in young adults. Ideally, such interventions should be limited to those in extremis rather than arbitrarily applied across the board. While not everyone receiving those medications will be vulnerable to their suicide-causing results, other side effects, including a loss of alertness, or the possibility of stimulating mania, violence, or aggression makes them problematic for use in a war zone where there are weapons at hand at all times. As one author stated, “antidepressants should be avoided in the treatment of military personnel.”

While it is important to reduce the psychological impact of modern combat operations on soldiers, overreliance on medications appears to be a bad idea. On the other hand, programs that de-stigmatize mental health care that does not rely on medications and that make such care available to soldiers even in remote postings appear to have great potential for reducing suicides in combat personnel.

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