Every Christmas Rudi Gresham, a former combat soldier in Vietnam, gets a Christmas card from a fellow veteran who was nearly pushed to the brink of suicide because of despair.
"The guy was in his late 50s and his wife had left him and he came down with cancer from Agent Orange, he was broke and he had to move in with his mom and dad--he didn't know where to go from there," said Gresham, who was then serving as senior advisor to the Department of Veterans Affairs under the George W. Bush administration.
"Everything had gone to hell," said Gresham. "But I communicated with him."
Now 68 and retired in South Carolina, Gresham was able to get the veteran the 10 years of back pay he deserved by authenticating his service with a commanding officer. Today, the man's cancer is under control and he has a new woman in his life.
Gresham said getting that thank you card for saving the veteran's life was "the most gratifying moment" in his eight-year career with the VA. "I tell my kids, this is the reward for my work."
But three other depressed friends were not so lucky and took their own lives, becoming statistics in a rising tide of suicides among baby boomers, many of them Vietnam War veterans.
Just this week the Centers for Disease Control and Prevention (CDC) released its latest statistics on suicide rates among Americans, finding that the number of middle-aged Americans who took their own lives was up more than 28 percent.
Annual suicide rates among U.S. adults aged 35 to 64 increased from 13.7 to 17.6 suicides per 100,000 people between 1999 and 2010.
The greatest increases in suicide rates were among people aged 50 to 54 years (48 percent) and 55 to 59 years (49 percent).
For the whole population, the national rate was 12.4 per 100,000 in that decade, according to the CDC. The most common mechanisms were suffocation or hanging, poisoning and firearms. Increases were seen among both men and women.
The CDC cites the recent economic downturn, a "cohort effect" among baby boomers who had unusually high suicide rates during their adolescent years, and a rise in intentional overdoses because of increased availability of prescription opiods.
But suicide rates among Vietnam veterans are the highest of any particular group, according to John Draper, project director of the National Suicide Prevention Lifeline.
Eight million Americans report suicidal thoughts, and 1.1 million will attempt suicide. An estimated 38,000 will succeed in killing themselves, according to the CDC. Most are male, by a four to one margin, and are single and lack a college education.
The suicide rate jumped higher for women (32 percent) than for men (27 percent).
"Men tend to be more lonely and have a harder time maintaining and replacing relationships than women, especially when they get into middle age," said Draper. "Men are busy working or tie their relationships to work and when they lose their job, they lose their relationships."
Those who are less stable in their personal lives are also less stable in the workforce, he said.
"I don't have all the answers," said Draper. "But we know about suicide prevention and people who are more socially connected and have a sense of belief and self-worth and are valued at work and in their relationships are way more protected and generally happier people."
Post-traumatic stress disorder and associated mental health problems are to blame for many of the suicides among war veterans, according to Draper.
"The most important thing to remember is we can do something to stop this," said Draper, who, like Gresham, said that communication and support from others can help to prevent suicide.
Since 2001, more than two million service members have been deployed to wars in Iraq and Afghanistan. The cost for treating veterans of all eras and conflicts is estimated at $48 billion, according to the Department of Veterans Affairs.
PTSD was not even recognized until after the Vietnam War, according to Gresham, who recognized at the onset of his government career in 2000 the importance of increasing the VA budget after predicting the staggering number of cases that were to follow. "I knew mental problems would exceed the physical," he said.
"I feel sorry for the younger soldiers," he said. "They are now married, got a wife and kids and suddenly come back and they can't find a job. These things all compound."
As for the Vietnam veterans, they found less support in the 1960s and 1970s, when they returned from combat service. "The older veterans don't trust the government and they don't go for help," said Gresham.
Unlike World War II soldiers who were hailed as heroes, these servicemen returned to "feel a bit outcast and rejected," according to Gresham, who sits on the Vietnam Veterans Foundation.
Many of that generation refused to acknowledge they had PTSD and are suffering the consequences later in life. "Believe me, we have a real problem," he said.
"These guys were the first generation not to trust the guys in the white coats, and they didn't trust the government," said Gresham. "A lot of the Viet vets with PTSD held it in.
"They didn't want to let their family know their dark secret. They wanted to be in the workforce and be productive like the generation of World War II, but they were not respected by society."
The VA in the 1970s was not responsive to the needs of these veterans, he said. "I've seen what has happened to a lot of these older vets."
At a town meeting in Los Angeles several years ago, Gresham said he told a group of Vietnam vets. "You know Hollywood was correct when they did the movie the 'Fourth of July' with Tom Cruise. The VA did a lousy job of taking care of vets."
But today, according to Gresham, "The VA has made "tremendous efforts to spend lots of money on [PTSD]," he said.
In 2007, the VA partnered with the Substance Abuse and Mental Health Services Administration (SAMHSA) to create a dedicated line manned by veterans on the National Suicide Lifeline.
The so-called Veterans Crisis Line has fielded more than 250,000 calls a year from veterans and active members of the military, according to Lifeline director Draper.
"It's a brilliant idea and it's saved taxpayers money and saved lives," he said.
Draper said it is too early to see the impact of this collaboration but predicts that CDC suicide numbers will eventually drop, at least among veterans.
Gresham, who was involved in the creation of the hotline, is also hopeful. "It's so much better for veterans to get help from other veterans," he said. "There is a strong bond."
"If you have suicide thoughts and there's another veteran on the line, you trust your brother, whether it's a man or a woman," he said. "If they have been in combat, there is someone who understands you."
"They didn't trust the VA for a long time and now the VA has its arms open," said Gresham. "They do very good work now. They understand the problem."
If you or a loved one are in emotional distress, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). We are here to help 24/7. You are not alone. Help is available. Veterans should press option 1.