Air Force suicides set a record in 2019

The Air Force set a record for suicides in 2019, a stark reminder that a Pentagon all but invincible on the battlefield has struggled to protect its troops from themselves.

There were at least 112 suspected and confirmed suicides among active-duty, Reserve and Air National Guard personnel last year. That was a 40 percent jump from the year before and the highest total since the Air Force began tracking suicides in 2003.

The previous record was set in 2015, when 94 airmen took their own lives.

The pace of suicides in 2019 so alarmed Air Force leaders that the service’s top commander, Gen. David Goldfein, ordered a “tactical pause” in operations in July to raise awareness of the problem. He warned suicides could exceed 150 by the end of the year if nothing was done.

Goldfein’s action appears to have had an effect. By year’s end, 136 suicides that included 24 Air Force civilian employees were recorded. Suicides occurred at a rate of about 13 per month before the pause and dropped to an average of 9.3 a month for the rest of the year. There was a downside, though: Suicides among airmen rose sharply in the final quarter, with 54 reported — almost as many as the rest of the year combined.

The record 2019 total was shown in an Air Force graphic displayed on a Facebook group of airmen, noncommissioned officers and senior NCOs (called “Air Force amn/nco/snco”).

The graphic was marked for official use only within the Pentagon. A Pentagon official, speaking on condition of anonymity, confirmed its authenticity to the San Antonio Express-News.

The graphic included a note that 68 deaths in the 2019 total were suspected suicides, not yet confirmed.

Asked for comment, the Air Force released a statement from Lt. Gen. Brian Kelly, deputy chief of staff for manpower, personnel and services.

“The Department of the Air Force has been and continues to pursue immediate, mid-term, and long-range suicide prevention initiatives for the total force that focus on connections between individuals, units, and Air Force family; protections in environments, services, and policies; detection of risk in individuals and units; and equipping the total force and family members to mitigate risk and increase resilience,” the statement said.

“Suicide is a difficult national problem without easily identifiable solutions that has the full attention of leadership.”

The Pentagon official who spoke on condition of anonymity said the rise in suicides couldn’t be attributed to an increase in the number of service personnel. That number generally has held steady at about 510,600 airmen on active duty and in the Reserve and Air National Guard.

‘Quite puzzling’

Retired Air Force Lt. Col. Alan Peterson, director of UT Health San Antonio’s STRONG STAR Multidisciplinary PTSD Research Consortium, said the cause of the increase was a mystery. The consortium is the nation’s largest combat-related research effort devoted to post-traumatic stress disorder.

“The most common reasons why people will kill themselves are things related to financial problems, relationship problems, legal problems, military career problems,” said Peterson, a psychologist who served in Iraq and Afghanistan. “Those are the biggest factors, but there’s nothing that I’m aware of to suggest that those risk factors have somehow increased over the past year.”

He added, “It’s really quite puzzling why there’s this big increase.”

In ordering the “tactical pause” last summer, Goldfein said in a July 3 letter to Air Force commanders that suicide was “killing more of our airmen than any enemy on the planet.”

Rallying his subordinates to confront the problem, he said: “You and I have sworn to ‘defend against all enemies, foreign and domestic.’ Suicide attacks sometimes with and often without warning. Make this tactical pause matter. Make it yours and make it personal.”

On ExpressNews.com: San Antonio bases to pause as Air Force suicides rise

There was reason for alarm. At Air Force installations in San Antonio alone, five suicides were recorded through summer 2019 — as many as had been logged in all of 2018.

‘A drastic increase’

Air Force suicides have been stubbornly high since the invasion and occupation of Iraq in 2003. From then through 2019, 1,257 airmen killed themselves.

Though the numbers fluctuate from year to year, they show a broad increase over the past two decades. From 2003 through 2009, suicides averaged 60 per year. For 2010 through 2019, the average was 84 per year.

Something similar was happening across the U.S. military. Suicides in all service branches reached 4,839 in 2015, eclipsing the total number of American troops killed in Iraq.

On ExpressNews.com: Grim toll of military suicides reaches a new milestone

Retired Army Col. Carl Castro, professor and research director at the University of Southern California’s Center for Innovation and Research on Veterans & Military Families, said that although year-to-year changes may not mean much, “the entire pattern of data … clearly shows a drastic increase over the last two decades.”

“My guess is that for the first decade the Air Force was arguing over whether the increases were real or an aberration, similar to what the Army and Marines did,” said Castro, who served two tours of duty in Iraq. “And then by the time they recognized the increase was real, they were unable to identify the causes.”

Overwhelmingly men

There are many stress points that can contribute to suicide. A portion of the Air Force graphic titled “Suicide Deep Dive Lessons Learned” said nine in 10 suicides was by a male. Men account for 80 percent of Air Force personnel.

Women account for one in five airmen and 35 percent of all attempted suicides.

A third of all suicide victims were involved in a failing relationship in the final three months of their lives and communicated their intention to kill themselves to a “significant other,” the Air Force graphic said.

The Air Force also found the percentage who used drugs and alcohol was higher among those who attempted suicide than among those who succeeded in killing themselves.

Airmen in aircraft maintenance and Security Forces were among the most likely to commit suicide. The graphic went on to say personnel in those two fields tend to be younger, male and familiar with lethal weapons.

“We’ve known for two decades now … that the highest risk group in the military is young men, and we know that firearms are the most common method used for suicide, and in the military it’s more common than what we see in the general population,” said Craig Bryan, an associate professor of clinical psychology at the University of Utah and a former faculty member at UT Health Science Center. “So in the U.S. as a whole, about half of all suicides involve firearms, and in the military it’s like two-thirds.”

USC’s Castro, a former director of the Military Operational Medicine Research Program, said that until about 35 years ago, suicide rates in the military were much lower than for civilians.

That has changed.

“Studies have been done that showed that even when matched for important demographics, military suicide rates are higher than civilians,” Castro said. “I think the suicide rates bottomed out in the mid-’80s, and then begin to steadily climb through all the peacekeeping deployments, Iraq and Afghanistan to the present.”

The risk of suicide doesn’t end when troops leave the armed services. A study of 1.3 million veterans who had been on active duty during the Iraq and Afghanistan wars found they had higher suicide rates than for the overall U.S. population. Of those 1.3 million veterans, about one-fourth were deployed to war zones.

Before the Iraq and Afghanistan wars, suicide rates among active-duty and former military personnel were 20 to 30 percent lower than for their civilian counterparts.

The Army Study to Assess Risk and Resilience in Service members, or STARRS, is trying to identify factors that contribute to suicide. But Peterson, director of the PTSD Research Consortium at UT Health San Antonio, said getting to the heart of how to stop someone from killing himself is difficult.

Grounds for hope

“It’s very complicated,” he said. “Two or three things go on, and if they hit a person it tips the scale and the person becomes acutely suicidal.”

Still, there have been hopeful developments.

Peterson was involved in a study that found one form of therapy reduced suicide attempts by 60 percent among 152 active-duty soldiers at high risk of killing themselves. The two-year study found the soldiers benefited from a kind of counseling called brief cognitive-behavioral therapy.

A 2016 study by Bryan suggested health care providers could intervene to prevent suicides by monitoring troops’ comments on social media accounts. It described a growing consensus that insomnia, agitation and social withdrawal are warning signs of an imminent suicide.

Another recently published paper by Bryan found that military personnel who reported recent thoughts about wanting to die and or about harming themselves were less likely to have guns at home. But if a suicidal service member did have a gun at home, he was less likely to lock it up or employ other safe storage practices, the study found.

“Access to firearms is a very, very well-known risk factor for suicide,” Bryan said. “We also know that safe storage practices — using gun locks, using gun safes, basically storing firearms in those ways — reduce suicide by about half, and so if you have someone who’s actively suicidal, in crisis and they have easy access to loaded weapons, a moment of despair can become deadly.”

At Fort Hood, researchers Brian Marx and Denise Sloan from Boston University and the National Center for PTSD are working with Peterson to study whether “written exposure therapy,” a form of intervention for PTSD, might help inpatients at high risk of suicide. In the therapy, the patient writes about a traumatic event while a therapist observes his or her reactions.

Research conducted through the STARRS program has shown many in the military are at greatest risk of suicide during their first six months of active duty. Still, prevention has proved elusive.

“If there’s something like post-traumatic stress disorder, we’ve got a number of treatments,” Peterson said. “We can treat people (who) are acutely suicidal … but many individuals (who) commit suicide are not seen by mental health professionals. They don’t receive any type of intervention. And sometimes the switch from being nonsuicidal to suicidal — sometimes, that happens very rapidly.”