Weillcornellmedicine - Weill Medical College - Cornell University

Talk of the Gown
Casualties of War
Depression expert tapped to help curb veterans’ suicides
Martha Bruce, PhD, MPH
18 WEILL CORNELL MEDICINE
Over the past year, the issue of suicide
in the military has made national
headlines—particularly last spring,
when it was revealed that a top
mental health official with the
Department of Veterans Affairs had noted in an
internal e-mail that the agency was seeing about
1,000 suicide attempts per month among its clients.
In the wake of the Iraq invasion, an increase in
the suicide rate among veterans and active-duty
military was already a matter of public concern. The
previous summer, the National Institute of Mental
Health (NIMH) had reported that male veterans
were twice as likely as their civilian peers to take
their own lives. Shortly after the e-mail imbroglio,
the U.S. Army acknowledged that the suicide rate
among its active-duty personnel was on the rise,
nearly doubling since before the Iraq war to about
19 per 100,000. In October, the Army and the
NIMH announced a five-year, $50 million study on
the causes and risk factors of suicide by soldiers.
Among the efforts to curb suicides among veterans
was the establishment of a five-member
“blue-ribbon working group” to address the issue
and make recommendations. The group met for
two days in June in Washington, D.C., where they
heard advice from an expert panel of nine leading
scientists in the field—including Weill Cornell pro-
ABBOTT
fessor of sociology in psychiatry Martha Bruce,
PhD, MPH. “We gave presentations about different
aspects of suicide risk and prevention, especially in
terms of how the research can help shape the V.A.’s
services,” says Bruce. “The V.A. is pretty sophisticated
in its own prevention and intervention efforts; I
was impressed by what they were doing.”
Those efforts, which the blue-ribbon group
praised in a draft report issued in September, have
included the hiring of suicide prevention coordinators
at each of the V.A.’s 153 medical centers
and the creation of a twenty-four-hour-a-day hotline.
(According to the V.A., in its first year the
hotline received 33,000 calls and enabled 1,600
“rescues.”) The report included a list of recommendations
for additional prevention efforts such
as screening for suicidality among veterans with
depression or PTSD, increasing training on the
warning signs for V.A. chaplains, and developing a
gun-safety program. (The NIMH reports that veterans
are 58 percent more likely than civilians to
end their lives with a firearm.) “It’s not always
trendy to praise the V.A.,” Bruce says. “But the V.A.
has been increasingly taking a leadership role in
many areas of health care—so now, in many ways,
they are on the cutting edge.”
Based at NewYork-Presbyterian Hospital’s
Westchester campus, Bruce is an expert in depression
among older adults, particularly homebound
seniors; over the past decade, she has expanded
her interest to include suicide prevention. “We discovered
in talking with older people, especially
those with disabilities or medical burden, that
there was a surprisingly high number who were
thinking about death, wanting to die, or had a
high risk of suicide—it became something I couldn’t
ignore,” she says. “I realized that the providers
who work with seniors in their homes were
extremely scared of the topic of suicide risk. So
we’ve done a lot of work with home health-care
nurses about how to ask questions and what to do
with the answers.”
In her presentation at the Washington meeting,
Bruce talked about integrating detection of suicide
risk into general medical care and discussed programs
for improving treatment of patients deemed
to be in danger. “A lot of people think that if they
ask a person about suicide, it will make that person
suicidal,” she says. “This is absolutely not true.
People may not volunteer information about wanting
to die—but if asked, they will talk about it. So
the recommendation was to teach clinicians that