CLEVELAND – One year into a 10-year, first-ever Department of Defense-funded study of Post Traumatic Stress Disorder (PTSD) in soldiers in the Ohio Army National Guard (OHARNG), initial findings suggest that thoughts of suicide within the OHARNG do not appear to be related to recent deployment to combat.
The baseline cohort of this study consists of 2,616 service members who have received one-hour research telephone interviews that will be followed up by yearly assessments through 2019. Five hundred of those participants were randomly selected and have completed a detailed, two-to-three hour in-person assessments.
Of the 2,616 service members, 1,030 (40 percent) had been deployed within the past three years. Ten percent of the 697 deployed to Iraq and 11 percent of the 79 deployed to Afghanistan met criteria for current/ongoing PTSD as compared to four percent of the 870 deployed to areas of non-conflict including Europe or within the U.S. to assist in domestic emergencies.
A little more than 10 percent, (10.2) reported a lifetime history of thoughts of suicidal ideation and 1.9 percent had thoughts of suicidal ideation within the past 30 days.
“In contrast to what was expected, a history of suicidal thoughts within the last 30 days was not associated with deployment,” said principal investigator Joseph R. Calabrese, MD, director of the Mood Disorders Program at University Hospitals Case Medical Center (UHCMC) and professor of psychiatry at Case Western Reserve University.
“Mental illnesses, such as PTSD, generalized anxiety disorder, major depression and alcohol dependence, as expected, were strongly associated with these suicidal thoughts. Certain factors were predictive of resilience to the development of suicidal ideation among those who had been deployed,” said Dr. Calabrese.
“Training-related preparedness, high levels of unit support, absence of family concerns, high levels of post-deployment support and lower levels of combat trauma were factors that predicted a soldier’s resilience.”
Psychiatry researchers at UHCMC and Case Western Reserve University, University of Toledo Health Science Campus, Columbia University, and the University of Michigan are collaborating on the ongoing study of PTSD. The research team will continue to work on the project and follow subjects for a decade as a result of the $12 million U.S. Department of Defense-funded research project.
The OHARNG itself reports having sustained 23 completed suicides since the beginning of the Persian Gulf War, including 14 in those never deployed to combat, eight not deployed at the time, and one during deployment. The average age of these soldiers was 30.6 years with 78 percent being less than 40 years old and the majority (13) in their third decade of life.
“Again, in some contrast to what was expected, completed suicides were more common in those not deployed to combat,” said Dr. Calabrese.
The OHARNG has actually had a Suicide Prevention Program in place for several years. Chaplains have historically taught on Suicide Prevention, but this past year, Commanders and First Sergeants have taken up that responsibility. Soldiers are being taught by their leaders that seeking help is a sign of strength, not a sign of weakness. This has helped to reduce the negative stigma attached to seeking help.
In the fall of 2008, the OHARNG also began a higher level of Suicide Intervention training focused on intermediate leaders. The Applied Suicide Intervention Skills Training (ASIST) Program consists of two days of training on suicide intervention and is similar in scope to intermediate level First Aid training. The OHARNG actually instituted this suicide intervention training several years before the Active Duty Army made this a priority. At present, the standard in the OHARNG is for one out of every 50 soldiers to be trained in this higher level of suicide intervention.
In addition, the state of Ohio provides its Ohio National Guard soldiers deployed to Iraq and Afghanistan the essential mental health support and resources before and after they return from battle overseas through the state’s OHIOCARES program, a collaboration of state agencies led by the Ohio National Guard that provides a behavioral health safety net of support for members of the military and their families.
“We are fortunate in Ohio to have a National Guard that prioritizes the mental health of its returning service members and implemented a suicide prevention program very early on. Ohio is way ahead of the national curve in delivering the mental health resources and support to our citizen-soldiers through the Warrior 360 and the OHIOCARES programs as well” said Marijo Tamburrino, MD, co-principal investigator of the study and professor and chair of psychiatry at the University of Toledo.
The project, known as the Kaptur Combat Mental Health Initiative, began in 2008 and is being championed by U.S. Rep. Marcy Kaptur of Toledo, who brought together the team of investigators and worked with the Department of Defense to provide the resources for the Ohio-based research and treatment.
“The Ohio National Guard serves as the national test case in prospectively studying over 10 years the mental health of the largest sample of returning veterans ever undertaken by the Department of Defense,” said Congresswoman Kaptur. “The goal is to identify these conditions, study their onset, and treatment, and do everything possible to alert Ohio vets that care is available if they are experiencing these conditions.
“When the men and women of the Ohio National Guard and Reserve units return home to Ohio, they return not to an active duty base with nearby hospitals and medical care, but to home communities that often lack the very specific medical services for careful follow up on diagnosis and treatment.”