WASHINGTON (Army News Service, March 21, 2013) -- "While physical injuries may be easier to see, invisible wounds such as depression, anxiety and post-traumatic stress take a significant toll on our Soldiers" and result too often in suicide, an Army leader told members of Congress.

Lt. Gen. Howard B. Bromberg, the Army's deputy chief of staff, G-1, and other DOD leaders testified Thursday to the House Armed Services, Military Personnel Subcommittee hearing on suicide prevention.


Suicide is not solely a military problem -- it is a rising national issue, Bromberg said.

"Comparison between the national suicide rate and Army suicide rate should be done with caution," he said, explaining that direct correlations are "problematic" because of age, gender and other factors.

While Soldiers in all components share some common challenges, Guard and Reserve Soldiers may face some that are particularly unique, Bromberg said. "These Soldiers may be more acutely affected by unemployment issues and other negative effects due to poor economic conditions," he said.

In addition to trying to include reserve-component Soldiers in as many outreach programs as possible, the Army has also reached out to the employers of those Soldiers to get them involved in suicide prevention strategies as well, Bromberg told lawmakers.


"The Army had traditionally perpetuated a culture in which asking for help was seen as weakness," Bromberg told lawmakers. Although the Army is overcoming "most of the stigma-related barriers, stigma still remains a challenge."

A comprehensive Stigma Reduction Campaign Plan is being developed to identify and eliminate institutional and cultural barriers and promote seeking help, he said.

The campaign will highlight Army, Defense Department, Veterans Affairs and national stigma reduction initiatives with emphasis on education, outreach, policy, evaluation and measurement, he explained.

Bromberg provided long-term statistics to illustrate that the culture is changing.

Results from the Sample Survey of Military Personnel from 1999 to fall 2012 revealed that the percentage of officers and enlisted Soldiers who felt seeking behavioral health care would harm their career dropped significantly, from 81 to 54 percent for officers and from 69 to 52 for enlisted, he said.

Bromberg said he believes the long-term changes are due in part to the Army's decision to co-locate behavioral health care with primary care. He said also playing a role are expanded use and promotion of confidential services such as the Military Crisis Line, online self-assessment programs for substance abuse and confidential treatment programs.

The Army has additionally increased access to behavioral health care services, he added, pointing out that this has contributed to an overall increase in the number of behavioral health encounters from 991,655 in fiscal year 2007 to 1,961,850 in fiscal year 2012, a 97.8-percent increase.

Although surveys show that the stigma for seeking behavioral help has been reduced, there's still a lot of work to do to get it completely removed, Bromberg told lawmakers.

"Army leaders at all levels are committed to eliminating the negative stigma associated with seeking help," he said.


During last year's suicide prevention stand-down, commanders across the Army led their personnel in team-building activities and conducted suicide prevention and resilience training to promote the buddy system and sharpen intervention skills and knowledge, Bromberg said.

The Embedded Behavioral Health Program provides community-based behavioral health care to Soldiers in close proximity to their units, he said. It is being established for all operational units in the active Army. Program evaluation indicated a statistically significant improvement in Soldiers' behavioral health.

Also, Embedded Behavioral Health has higher acceptability and satisfaction rates by both Soldiers and supported leaders than conventional systems, he said, adding that as a result, the Army will expand this program.

In other efforts, the Army is enhancing behavioral health care through tele-behavioral health, patient-centered medical home and school behavioral health focused on reaching Soldiers and beneficiaries wherever they are located, he said.

The Army has a number of suicide prevention awareness programs including public service announcements using celebrities and Army leaders, outreach messages and programs delivered through numerous non-governmental organizations and educational videos such as the "Soldier to Shoulder" series, he said.

Also, the Army continues to promote the use of confidential support programs such as Military OneSource and the Army's Confidential Alcohol Treatment and Education Pilot, he added.


The Army Strong Bonds program has been highly effective in helping Soldiers and families develop resilience and readiness by giving them the skills necessary to cope with stress within relationships, Bromberg said.

Data show that suicide rates are closely related to relationship issues, he said. Therefore, programs that support healthy relationships also potentially reduce suicides.

Strong Bonds training helps reduce relationship-related stress, thus reducing the number of failed relationships and, potentially, the number of suicides.

The chaplaincy conducted a Strong Bonds "surge" that trained 50,000 Soldiers and their families during the last fiscal year.


The Army's Comprehensive Soldier and Family Fitness, or CSF2, addresses precursors to suicide, Bromberg said.

CSF2 features master resilience trainers steeped in suicide prevention strategies, he explained. A key element is teaching Soldiers to "avoid the catastrophic thinking that leads to an emotional downward spiral, and providing them with skills to identify the positive things in their lives."

Resilience training is taught at all levels -- from basic training to the War College, he added.

CSF2 also includes a Global Assessment Tool, or GAT, which measures an individual's psychological health and level of resilience annually and after deployments. It is designed to identify additional training needs to improve resiliency.

Taking GAT is mandatory for all Soldiers at least once a year, and it is available to family members and Army civilians on a voluntary basis.

Comprehensive Resilience Modules -- short videos that provide self-development in specific areas identified by individual GAT assessments -- is another part of CSF2.

The effectiveness of CSF2's holistic approach has been verified by four independent, peer-reviewed technical studies performed between February 2011 and February 2013, he said.

Those findings, he said, were:

-- Soldiers who committed suicide were significantly less resilient, as measured by the GAT, than other Soldiers.

-- Soldiers who received training conducted by master resilience trainers improved their GAT scores (a measure of their psychological health and resilience) more than Soldiers who did not.

-- Master resilience training shows the greatest results for Soldiers 18 to 24 years old.

-- Developing master resilience skills leads to improved Soldier adaptability and optimism, which, in turn, leads to decreased anxiety, depression and post-traumatic stress disorder, or PTSD.

There are so many programs out there that it must be confusing sometimes for service members seeking help, lawmakers told the service leaders during the hearing.

Bromberg said the Army began its Ready and Resilient Campaign, or R2C, Feb. 4, to pull together multiple efforts and about 122 programs, including CSF2. As the program's name would indicate, it is designed to improve the readiness and resilience of all Soldiers, civilians and family members.


The Army Study to Assess Risk and Resilience in Service members, or Army STARRS, "is the largest study of mental health, psychological resilience, suicide risk, suicide-related behaviors and suicide deaths in military personnel ever conducted," Bromberg said.

The goal is to identify factors that put a military member at risk for suicide, and factors that provide resilience, at specific points of service and over time, he said. This information will then be used to develop evidence-based, targeted intervention strategies to decrease the frequency of suicides in the military.

During the initial years, researchers analyzed information spanning more than a billion data records, on all 1.6 million Soldiers who served on active duty from 2004-2009, he said.

Also, he said researchers are collecting data from all Soldiers who are willing to participate in surveys and psychological evaluations and provide blood samples and data from their administrative records.

To date about 112,000 Soldiers have voluntarily participated in Army STARRS and approximately 52,000 have given blood samples, he said. Researchers will analyze these samples to look at biological risk associated with a history of mental illness and these samples could be used as a baseline for future studies.

"The size of the study will help our understanding of suicide risk and protective factors and the development of mental health disorders," he explained. "The data will complement other survey and neurocognitive data to give researchers a more complete understanding of risk and resilience."

Preliminary findings, he said, include analyses in the areas of deployments, enlistment waivers, unit combat deaths, unit suicides, marriage, private housing, age and education, rank, years of service, military occupational specialties, exposure to traumatic events, head/neck/blast injury, prescription drug abuse, mental health disorders and treatment, and suicide attempts.

Researchers are using these findings to develop tools to help identify subsets of Soldiers who may be at elevated risk for suicidal behaviors, he said. Those researchers are currently working with the Army on approaches to targeting prevention and treatment interventions for Soldiers with particularly elevated suicide risk.

In conclusion, Bromberg told lawmakers that "the Army is confident that through our continued emphasis in the services, programs, policies and training that support our Army family, we will overcome this threat to our force."

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