Note to New Congress: To Tame Suicide in the Military, Take Aim at Brain Injuries

When the new Congress convenes in early January, one of its top priorities should be to direct much more extensive research into the prevalence of brain injuries among U.S. military personnel and veterans and into what can be done to mitigate them in an effort to reverse spiraling suicide rates.

Members of Congress should focus on all forms of brain injuries sustained by service members, but especially on what are known as mild traumatic brains injuries. These can be sustained during training or routine exercise, the aggregation of which over time can cause serious injury and debilitation, including suicidal ideation. Mild traumatic brain injuries predominantly occur at the microscopic level, challenging medicine’s ability to diagnose them with current imaging technology.

Traumatic brain injuries, as the Pentagon acknowledges, “are the signature injuries from recent combat operations” since the onset of the Global War on Terror in 2001. “These injuries can have short-term or delayed effects on warfighter physical and cognitive performance and health that can lead to degraded readiness, loss of operational capability, lost duty days and decrease in quality of life.”

Brain injuries are linked to suicide in the military

TBIs in the military are extensive – they have been diagnosed nearly 460,000 times among the 3.7 million Americans who have served in the U.S. military since Sept. 11, 2001, reports

What’s more, the link between brain injuries and suicide is a strong one and may help explain the tragically high suicide rates among veterans and service members. The Department of Veterans Affairs noted in its annual report on suicide among veterans that “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.”

Similarly, a study 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. Those findings were also echoed in another study published this year by the JAMA Network Open, a medical journal published by the American Medical Association.

Mild TBI’s present a unique danger in the military, where they 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.

Undiagnosed traumatic brain injuries often complicate other conditions of war such as post-traumatic stress disorders, moral injuries and substance use. Experts characterize this complex rubric of conditions as “invisible wounds.”

Pentagon (finally) begins to focus on brain injuries

Pentagon only now is getting around to studying the impact of TBIs on service members —this after 20-plus years in the global war on terror and as suicide rates among vets and service members have soared.

In August, the Department of Defense published a plan for its Department of Defense Warfighter Brain Health Initiative. It seeks to develop policies that prevent, identify and treat brain damage caused by combat or by repeated shakes and blasts during training.

The promising news is that the Pentagon acknowledges the growing data that brain injuries are a major problem. “There is emerging evidence to suggest exposure to repetitive blast overpressure in training and in the deployed setting may have an effect on warfighters’ physical and cognitive performance,” the plan states.

Also promising is that the plan seeks to develop standards for acceptable levels of exposure and develop exposure frequency guidelines for commonly used weapons and munitions. It also seeks to require companies developing new weapons to identify and mitigate potential threats and hazards to brain health.

What is less promising is that it will require a cultural shift to get the armed forces to achieve these goals – and then stick to them.

This is where Congress is essential. Lawmakers in the new Congress must hold the Pentagon accountable. They must ensure sufficient funds are set aside to develop screening to assess all types of brain injuries sustained during training and deployment, that the Pentagon develops as soon as possible the new protocols and guidelines for blast exposure and that the military finally takes aim at this pervasive problem that is contributing to surging suicides.



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