Even though he's retired from active military duty, CSM Samuel Rhodes still suffers from deep emotional wounds.
"I had to take this afternoon off from work today because of anxiety," he said. "And sometimes, if I'm going through a really tough time, I think about suicide."
He spent nearly 30 years in the Army and recently spent 30 straight months deployed in Iraq where he, like many soldiers, witnessed some of the horrors of war.
"In April 2005, it started to eat me up because I started losing one soldier after another," Rhodes said. "We lost 37 soldiers that were in my unit."
He was command sergeant major of his brigade, and over the 30 months he was there, he lost 37 of his soldiers. As time wore on, the loss of life wore him down.
"In April 2007, it came full circle. I considered suicide as an option. I felt guilty about losing those soldiers, even though I had no control over it," he said.
"And I was sleepwalking. I had to tie myself to my cot to prevent it," he added.
Later, during his 24th month in Iraq, he was found unconscious, and doctors diagnosed him with exhaustion. At that time, the combat stress doctor told him he was also suffering from post-traumatic stress disorder.
"He started explaining it to me, and I realized he was right," Rhodes said.
And according to a new study conducted by researchers at Walter Reed Army Institute of Research, Rhodes' mental health problems are common among soldiers returning from Iraq.
Between 2004 and 2007, researchers gave out anonymous surveys to four active duty brigade combat teams and two National Guard combat team three months and 12 months after deployment. The surveys screened soldiers for PTSD, depression, alcohol misuse and aggressive behavior and asked them to report whether these problems impacted their ability to get along with others, take care of things at home or perform their job duties.
"A high number of those that had symptoms of PTSD and depression also reported some aspect of impairment," said Jeffrey L. Thomas, one of the study's co-authors. "The range was about 9 to 14 percent." Depression rates ranged from 5 percent to 8.5 percent.
But by using a less stringent definition of PTSD, they found between 20 and 30 percent of soldiers showed symptoms of PTSD, while they found between 11.5 to 16 percent of them were depressed.
National Guard Soldiers Experienced an Increase in SymptomsThe most surprising finding was that the rates of depression and PTSD symptoms among the National Guard soldiers increased sharply 12 months post-deployment, while those same problems remained stable among full-time active duty soldiers.
That doesn't surprise Daniel Hutchison, a former Army National Guard medic who served in Iraq from September 2006 to September 2007.
"I felt like I came back to a world that didn't care," he said of his post-deployment return to civilian life. "It's hard to adjust to being a civilian and re-integrating."
Thomas theorized it could also be due to the temporary nature of their lives as soldiers.
"National Guard soldiers demobilize, go back to their civilian lives and drill once a month, so they lose peer support and unit support," he said.
Rhodes agreed. Now that he counsels other soldiers dealing with mental health problems, he meets al lot of National Guard soldiers who are having post-deployment struggles.
"You go back to the community and don't see your fellow soldiers for 30 days, and then you only see them twice a month," he said.
The study also found that of the soldiers who had PTSD or depression, about half of them reported problems with alcohol or aggressive behaviors.
This increased between 3 months and 12 months after deployment among National Guard soldiers, but stayed about the same among full-time, active duty veterans.
Hutchison also had problems with alcohol after he came back his tour of duty in Iraq.
"I came back home and drank a lot. I was sitting on my couch with a pistol in my mouth," he said.
Soldiers Are a "Band of Brothers" on DutyHutchison and Rhodes said soldiers on active duty get at least some comfort from their comrades.
"They can see a combat stress counselor and at the same time, they've got their buddies. They've got their own counseling," Rhodes said.
"It was a 'Band of Brothers' environment. We didn't really talk to each other about it, but we could look into each others' eyes and see we were going through the same thing," said Hutchison.
It's that support that's vital to helping soldiers understand and manage their PTSD and other mental health problems.
"The first step is to admit you have PTSD," Hutchison said.
"A lot of soldiers are in denial because they're scared and they want to have a career, and if you have a weakness, they think the Army is going to get rid of you," said Rhodes.
The results of the current study as well as past research suggest that there's definitely a need for treatment. Left untreated, PTSD and other mental health problems can have disastrous consequences.
Data from the U.S. Marine Corps show that through the month of May, 89 Marines tried to kill themselves.
"Untreated depression or PTSD can cause you to spiral downward," said Mary Hibbard, professor of rehabilitation medicine at The Rusk Institute of Rehabilitation Medicine at NYU Langone Medical Center in New York.
"They become more withdrawn and detached and have an increased inability to hold down any job and an increased use of substances as an attempt to cope," Hibbard added.
Army Working to Address the IssuesIn response to the growing body of research, the Army says it is "continually advancing its understanding of the scope of the complexities of PTSD/TBI [traumatic brain injury] to improve soldier care," according to its website.
Among the new initiatives is Comprehensive Soldier Fitness, a program designed to help soldiers become more resilient to the mental and physical stresses of combat.
The Army has also implemented a "Battlemind Training" program to help soldiers deal with stress.
"It's a resilience training package that's been shown to reduce PTSD symptoms," said Dr. Jeffrey Lewis, the co-author of the current study.
Colonel Dave Romine, a physician and the Army National Guard's chief surgeon, said there are resources available for post-deployment National Guard soldiers who need help.
"Every state has a director of psychological health," he said. "They provide full-time assessment and referral as well as crisis intervention, and in the past two months, we've assessed more than 2,700 soldiers and their families and have been able to triage them to the proper level of care."
CSM Rhodes lauds the Army's efforts to confront this growing problem.
"They're doing a lot more now. They've got all these studies going on. The Army's really going after it," he said.
"At least the military is acknowledging the problem and they're tracking the problem," said Hibbard.
But she also said they fall short in one major area.
"They are not aggressively treating. We need more aggressive long-term treatment," she added.
But Romine said that while the system is still evolving, many National Guard soldiers can get the treatment they need through TRICARE Reserve Select, a low-cost insurance plan.
As far as counseling or therapy sessions are concerned, "it's usually limited to 16 visits. They are then reassessed and if there's a need, they may be able to continue with it. It's open-ended," he said.
They can also call Military OneSource and anonymously speak with an experienced counselor.
"If there's not an acute need for them to go to the hospital, they're set up with somebody in their community at no cost for up to 11 sessions," Romine said.
But Daniel Hutchison, the former National Guard combat medic said he relies on assistance from Vet Centers, offices that provide counseling and other resources to veterans. They are funded by the government and staffed by former veterans.
Despite the progress he's made with the help of his local Vet Center, he still thinks the government is acting too slowly.
"They're putting a lot of their focus on suicide briefings – once you get to a point where you get suicidal, you call this number," he said.
He wants more education on PTSD so soldiers know what they're going through and can get the help they need.
That's something military leaders are taking seriously.
"Our senior leadership acknowledges that there's fixing to be done," said Romine.
And that puts Hutchison's mind at ease.
"Last year, we lost more troops on U.S. soil to suicide than we lost in combat."