Much Stronger Focus Needed on Diagnosing Brain Injuries to Curtail Military Suicides

This nation is haunted by the aching loss of recent military suicides. A spate of suicides on a Navy aircraft carrier and several more among Army troops stationed in Alaska made headlines across the country, underscoring that the ongoing crisis in the military and among veterans continues to cut through the ranks and the families left behind.

Coming on the heels of those high-profile suicides, the Department of Defense in late May named the members of a new panel charged with studying suicide prevention. While not in response to the recent deaths but rather to the years-long arc of tragedies among vets and service members, the panel is led by a mental health expert and includes experts in substance abuse, mental health services and lethal weapons safety.

The concern among many of us who have been working to reverse this tragic trend is that the panel, while an important tool for highlighting any deficit in mental health services and approaches, may not be sufficiently focused on the physiological contributors to suicide. Specifically, the commission should include in its assessment the impact of undiagnosed brain injuries that service members can sustain during regular training and operations. 

Experts at the Veterans Administration acknowledge the connection between brain injury and suicide. As the VA noted in its 2020 annual report on suicide among veterans, “Veterans Health Administration patients who died by suicide are more likely to have sleep disorders, traumatic brain injury or a pain diagnosis than other VHA patients.”

A 2018 study published in the journal Psychological Services found that post-9-11 veterans with a history of traumatic brain injuries were at much greater risk for considering suicide. The researchers found that Iraq and Afghanistan veterans who suffered multiple traumatic brain injuries were nearly twice as likely to report suicidal thoughts over the prior week compared with vets with one traumatic brain injury or none at all.

The questions that need answering, guided by much more research, are: 

  • What is the aggregate impact of mild traumatic brain injury, or mTBI, that service members sustain over their careers, including concussions and sub-concussions, and
  • At what level of typical training and operations are they sustained?

In the military, mBTIs are common place and can be sustained in many ways, “including athletics, recreational activities, physical training, falls, motor-vehicle accidents and exposure to explosive blasts,” researchers reported in the Journal of the Alzheimer’s Association.

“Military mTBI is also random and unpredictable, ranging from a single injury to many thousands of traumatic injuries over similar time periods depending on an individual’s chance exposure to blasts and impacts … mTBI is the most common traumatic brain injury affecting military personnel; however, it is the most difficult to diagnose and the least well understood,” researchers said.

A 2017 study published in the American Journal of Epidemiology concluded that “mild traumatic brain injury is considered one of the signature injuries of the wars in Iraq and Afghanistan, with as many as 23 percent of U.S. veterans who served in these conflicts reporting at least one mTBI during their military service.”

Importantly, service members suffering military-related mTBI can present as having other ailments, such as post-traumatic stress disorder, and can go misdiagnosed. 

With the initiative I lead, we are raising awareness about the problem through an effort known as National Warrior Call Day, which asks that all Americans connect with veterans and service members and in turn get them connected to supports and services. Connection is essential, because up to two-thirds of veterans who take their own lives have had no contact with the Department of Veterans Affairs. 

Equally important is a robust focus on understanding the prevalence of mTBI in the armed forces and developing better screening to treat personnel and veterans well before they spiral into a suicidal abyss.

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