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Repeat Iraq Tours Raise Risk of PTSD, Army Finds

"This is a concern for us," said Army Surgeon General Kevin Kiley in a briefing on the report, referring to the increase in suicides. Although the number who took their own lives remains within historical norms, "we consider one suicide to be too many," Kiley said. He said he is creating a "suicide prevention cell" to address the problem, as soldiers report having difficulty identifying comrades at risk.

Most of the suicides are impulsive and related to relationship, financial or disciplinary problems rather than combat stress, he said. "We've had young soldiers who will get bad relationship news, and the first thing they do is walk to a port-a-potty and end their lives," leaving no opportunity for anyone to intervene, he said.

The Army has significantly increased the number of mental health professionals in Iraq and Afghanistan, with the goal of treating soldiers more quickly and returning them to their units. About 20 to 40 soldiers are evacuated from Iraq each month for serious mental health problems, said Col. Cameron Ritchie, an Army psychiatrist.

As a result, one positive finding of the survey was that 95 percent of soldiers reported that mental health care was readily available to them.

In another improvement, the stigma associated with seeking help also decreased, with 28 percent of soldiers expressing concern that they would be seen as weak if they did so, compared with more than 30 percent in the 2003 and 2004 surveys.

Still, stigma remains a problem, with Army research showing that less than 40 percent of soldiers with mental disorders seek care.

In an effort to prevent soldiers returning with combat stress from being overlooked, the Army is expanding a pilot program in which primary-care doctors at Army bases are taught to screen their patients for PTSD and then coordinate specialized care, even if the patient declines to see a mental health expert.

So far, the program has screened more than 4,100 soldiers at Fort Bragg, N.C., with about 10 percent of those turning up positive for PTSD or depression, said Col. Charles Engel, director of the Deployment Health Clinical Center at Walter Reed Army Medical Center.

"Many people who are struggling with their emotions after a wartime experience have mixed feelings about seeking assistance," he said.

"We have to reach out to soldiers" through their primary doctors, Engel said.

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