Editor's note: This is the first in a four-part series exploring the issue of suicide and suicide prevention in the military.

VICENZA, Italy -- The numbers are disturbing. On average, more than five U.S. active-duty service members killed themselves every week in 2016 and 20 veterans a day commit suicide, according to government figures. Published studies indicate higher rates of depression in military spouses and children than their civilian counterparts.

But there are faces behind the statistics, stories behind the numbers. And there are resources available so military families can find hope when they feel hopeless.

When a struggling Army spouse recently found herself at Army Community Service here, Cara Panzarella-Tarr, Information and Referral program manager, took time out to talk to her.

"It was the first time out of her state, first time out of her city, first time away from her family. And she was embarrassed to talk about her discomfort. She was struggling," she said. "I gave her some resources, and I told her, 'You are not alone. You are one of many people who experience the same thing.'"

After a 15-minute conversation, the spouse left with more information and a more positive outlook.
"I could see her face lightened. Her shoulders didn't sag as much. Her stress eased up, just to (know) that she's not alone," said Panzarella-Tarr.

Sometimes the problems go deeper than a simple conversation will fix, requiring assistance through Behavioral Health or other resources.

"We are a community that has a lot of different stressors that other communities don't have -- being in Italy, the (operational) tempo with the 173rd Infantry Brigade Combat Team (Airborne)," said Maj. Osceola Evans, chief of Behavioral Health at the U.S. Army Health Center-Vicenza. "The acuity here seems to be a little bit higher, but I think we also have systems in place … that are going to reduce some of the things that we've seen over the past months."

Historically, suicide rates among service members were actually lower than for civilians not connected to the military. That changed in recent years, with the number of suicide deaths per year surpassing the number of combat deaths, he said.

According to the Department of Defense Suicide Prevention Office, 275 active-duty service members died by suicide in 2016, and that number has remained relatively steady each year since 2012 when the numbers peaked at 321.

While numbers aren't tracked for families, they face many of the same stressors the Soldiers do. According to a study published on the National Institutes of Health website, military spouses suffer from higher rates of depression than those not connected to the military, and a study in the Journal of Adolescent Health indicated the same for military children.

"The operation tempo that the Soldiers experience, the family members experience also. When the Soldier is deployed, they're away from home. The stress level is higher. We tend to see more spouses and children (in Behavioral Health) in high op-tempo environments where deployments are kind of an unstabilizing factor in a family," said Evans.

That was one of the issues that led the wife of a Navy officer to attempt suicide in 2007.

"I had a husband who was never around," she said. "What can I say (to my children)? 'Wait until your dad comes home?' Their dad may not be home for six months. I felt like I had no support."

The constant stress of her high-pressure job, combined with her husband's frequent sea duty and two rebellious teenage sons, led to her attempt.

"There's definitely a crossover … when the thought of death becomes greater than the thought of life and when you lose all hope of ever having a normal life again. You can't even imagine there can be a sunny day again," she said.

It's a problem that isn't being ignored by the Army, with education and training designed to help Soldiers see the warning signs, know the resources available and help their battle buddies. But even with education and increased focus on preventing suicide, there can still be a stigma.

"Suicide seems like a four-letter word. People are so afraid to mention the word 'suicide,'" said Sandra Class, Army Substance Abuse Program manager.

There is a fear that if the word is mentioned to someone who is depressed, they will suddenly consider death by suicide.

"That is a myth. There's no truth to that," Class emphasized.

Another barrier to seeking help is a sense of shame that someone can't handle their problems.
"Sometimes people are ashamed that they're going through this," said Chaplain (Lt. Col.) James Foster, U.S. Army Garrison Italy chaplain. "(They think), 'I shouldn't be here. I shouldn't be going through this. I shouldn't be feeling like this.' But that's a normal part of life. We all go through times when we're down."

And sometimes, it's the everyday problems of life that drive someone to consider suicide. It's not necessarily related to deployment or combat experience, although those things can exacerbate stress levels, said Maj. Rebekah Broady, team lead for Embedded Behavioral Health.

"The biggest contributing factors are loss of relationship, occupational stress or disciplinary problems, as well as financial or other legal stressors," she said. "It's really not combat or (post traumatic stress disorder). Those things are not correlated with it so much."

For some people, there may be ongoing issues of mental or behavioral health, but for others, there aren't.

"Sometimes it's just that moment. It has nothing to do with lengthy things. It's just in that moment that they feel cornered, they have nowhere to go -- helpless and hopeless. They just feel that there's no way out," Class said.

Because of the increased risk among the military community, whether it's to Soldiers and veterans, spouses or adolescents, it's important to know the warning signs and available resources. Follow this Outlook series to read more personal stories and learn to recognize when someone needs help, and how to get him or her the assistance they need.

"Suicide prevention is everyone's responsibility. If you have contact with other humans, you have a moral responsibility (to help)," said Class.