Identifying and preventing suicidal behaviors in service members and veterans

Post Tramatic Stress Disorder



Among Veterans and





"Not since the great military suicide epidemic of the American Civil War have we seen so many of our heroes, our soldiers and veterans, die by suicide"





Dr.  Antoon Leenaars

President of the American Association of Suicidology


Table of Contents


  • Taps  
  • Prologue
  • History
  • Chapter 1: Identifying the Problem
  • Chapter 2: Statistics
  • Chapter 3: Characteristics
  • Chapter 4: Who is susceptible 
  • Chapter 5: Who does suicide affect
  • Chapter 6: Responsibilities
  • Chapter 7: Headlines Around the World
  • Chapter 8: Ideas at work
  • Chapter 9: Ideas for Improvement
  • Bibliography
  • Photo Citations
  • Video Citations


Honoring the Fallen






Everyday 1 service member and 19 veterans commit suicide.


Post Traumatic Stress Disorder (PTSD) has been linked as a major factor in the suicide rate among our servicemembers and veterans


Finding a solution to this epidemic has got to become a priority among all veterans, service members, their families, the VA, as well as military and civilian leadership


PTSD is not a new problem among our returning soldiers, nor is PTSD solely an American problem.


There is no cure, we can only hope to understand people deal with their issues.



This story of a young Corporal in the Union Army shows the effects PTSD under one name or another has had on our returning soldiers for a lot longer than people realize.


During the Civil War Angelo Crapsey enlisted into the Union Army from Roulette, Pennsylvania. At the age of 18 Angelo had the world at his feet, he had a good job, close friends and did very well with the ladies. Shortly after the start of the war at Fort Sumter, Andrew enlisted for as he said "fighting for the Stars and Stripes, strange as it is I love that old flag dearly" (Bateson).


During his time serving the in the Union Army, Andrew wrote letters home on a regular basis. He would talk about everything from the lousy rations, sleeping in the mud to his personal accounts from the battlefields. Throughout his time tone changed from the bright eyed zealot to one slowly overshadowed by darkness.


Surviving through many battles including Cedar Mountain, Fredericksburg and Antietam he saw a lot of death and destruction. Still through it all he maintained his esprit de corps. After one battle his unit was overrun and he was taken prisoner, and held as a prisoner in an old fish warehouse in Richmond Virginia called Libby Prison. 


Libby Prison was a cesspool, with over 1,000 Union prisoners of war being held in the same cramped environment. The stench of the filthy men and sickly bowels mingled with that of the rotten fish smell that came with the warehouse. If they were fed at all they consisted on 6 ounces of bread per day. To make conditions even more miserable, the warehouse was infested with lice. 


After 5 months in captivity Andrew became part of a prisoner exchange. Upon returning to his unit his fellow soldiers noticed the change in him immediately. "His gregariousness has disappeared, he doesn't say much except to comment on the treatment of prisoners. Most disturbing of all is this habit of scraping away at phantom lice" (Bateson)  


During the battle of Gettysburg, Andrew developed dysentery, his condition became so grave that his family was summoned to administer the last rights. Andrew however did not die, after recovering he was sent home.


Corporal Andrew Crapsey, cont


Upon arriving home his family and friends immediately recognised that this was not the same Andrew who left to joined the Union Army. Andrew was just a shell of the man they had known, he was now withdrawn and nervous. He spentmush of his time trying to rid himself of the lice from Libby Prison by cutting himself, dove through a window and he even tried to drown all in an effort of rid homslef of the lice. 


On August 4, 1864 Corporal Andrew Crapsey a man who made through 3 years, and multiple battles in the American Civil War unscathed, put the rifle barrel  in his mouth and committed suicide (Bateson).


PTSD and Suicide are not new problems, they have been around for generations. PTSD has gone by many names, Shell Shock, Battle Fatigue, Combat Stress Reaction to name a few. The only thing different is in recent years the suicide rate has climbed. 


Corporal Andrew Crapsey, cont

The rate of suicide among servicemembers and veterans is reaching historic levels.


Since 2003 the suicide rate among active duty service members has more than doubled from a rate in 2002 of 10 per 100,000 active duty personnel to just over 21 per 100,000.


In 2012, 349 active duty service members committed suicide. That number surpassed the death toll of 295 from combat operations in Iraq and Afghanistan. (DOD)








PTSD has been blamed as the major cause in rising tide of suicides 


As studies have shown, PTSD alone is not the only contributor. Most cases involved people with a history of suicidal ideations, suicidal actions and attempts at suicide prior to being diagnosed with PTSD.


Suicidal ideations are the thoughts and preoccupation with suicide. There is a popular belief in the difference between Passive and Active ideations. 


In the Passive most will not try to commit suicide, rather they will injure themselves. Being a cutter (repeatedly cutting oneself), habitually getting into fights one cannot hope to win, and simply injuring oneself repeatedly. 


Just because someone has Passive ideations, does not mean they will not eventually try to commit suicide. 


Active is an existing wish and may even have a plan to die.

Identifying the Problem

To try and some up PTSD in a few words or sentences would be disrespectful to those who suffer from it and to those who treat it. 


PTSD stems from a traumatic or life-threatening event or series of events. The effects vary from person to person, some will have difficulty sleeping, some will have constant troubling memories as known as flashbacks, and some will have a jitteriness or be very jumpy. Just because you have the symptoms doesn't necesarily mean you have PTSD, but if these feeling persist you may want or need to seek help and advice in dealing with it.


Not everyone will garner the same symptoms nor will they generate in the same time frame. Some people show signs and symptoms rather quickly while others may take years for any symptoms to appear.


If in doubt seek advice, it can't hurt to ask questions. The ability to recognize the signs and symptoms in others may help you to recognize them within yourself as well. (PTSD)

Identifying the Problem cont'

Often times people who are uninformed about PTSD are willing to brush it under the rug, as something that will go away, as the saying goes "time heals all wounds".


"existing processes for psychological assessment are insufficient to overcome the stigma" (Oldham)


As the a generation of Vietnam Veterans retires from the workforce, there has been a large influx of them seeking help for PTSD, which has proven that time actually does not heal all wounds. Distractions like work may hold those wounds at bay, but they do not heal on their own. Once these veterans finally retired, they are finally giving their minds time to reflect and in doing so are seeking they help they have always needed in the first place (Dooley).


When friends and family members are knowledgeable about PTSD and are more engaged with loved ones who suffer from PTSD, they usually have a better ability to recognize the signs and symptoms of those who are struggling with it.


Identifying the Problem cont'





One of the reasons that these statistics go largely unnoticed in todays environment, is people are able to forget the nation is engaged in war.


Today 2.7 million people have served in the military in support of the current wars in Iraq and Afghanistan.  That is fewer than 1 percent of the population of 314 million, has served in the military. 


Family members of account for another 1 percent of the population.


That is 98 percent of the population who have no close ties to the problems associated with PTSD and suicide among returning service member and veterans. (Bateson)





Some characteristics of PTSD are as follows: 

  • Repetitive and persistent memories of traumatic events
  • Constant dreams or nightmares of traumatic events
  • Acting as if the traumatic event is happening over and over again
  • Excessive anxiety over events that remind one about traumatic events 
  • Avoidance of thought, feeling, actions, and verbalization associated with the traumatic event
  • failure to remember certain facets of the tramatic event
  • Lack of interest or participation in activities normally associated with
  • feeling isolated and or alienated from friends, family and colleagues
  • unable to have certain feelings or emotions
  • trouble sleeping
  • sudden angry outburst
  • inability to concentrate
  • hypervigilance


Characteristics cont'

Some characteristics of suicidal behaviors:


  • Verbalizing about suicide, "I am going to kill myself, I wish I was dead, I wish I was never born"
  • Acquiring the means, such as purchasing a gun, pills....
  • Pulling away from normal social circles family, friends and colleagues
  • Severe mood changes, deep depression followed one day, and super happy the next
  • Preoccupation with death
  • Sensation of being trapped or severe hopelessness
  • Alcohol and drug abuse
  • Changing the normal routine, eating, sleeping, studying...
  • Self destructive actions
  • Telling people goodbye as if you will not see them again
  • Giving one stuff away, couch, car, money...


Who is Susceptable



Who is Susceptable

PTSD and Suicide have no standard cause.


Anyone who has witnessed and or experienced a traumatic event has the possibility of contracting PTSD. 


There is no blueprint for who will become suicidal. 


The most determinate factor in suicidal behavior is depression. 


Some other risk factors may include


  • Mental Disorders
  • Alcohol and Drugs
  • Physical Problems
  • Personality Disorders
  • Severe Economic problems
  • Traumatic experiences



Who Does Suicide Affect


Who does suicide affect?


Families carry the largest burden in cases of suicide. Feelings of guilt accompany most family members especially parents. Those guilty feeling many times turn into depression and possibly even turning to suicide as well. 


Friends also carry a significant burden after a suicide. In self reflection friends start to see the patterns that they believe they should have recognized and believe they could have prevented it.


The burden of suicide is also carried among colleagues. Included with feelings of guilt there is increased workload created by the loss of a colleague. That increase will be in a heavy environment due to the loss.






Who  Does Suicide Affect


And finally the individual, suicide will affect the one who committed it the least. Once suicide has been committed it is over.


Other than affecting individual emotions of family and friends, suicide also has an effect on the mindset of them. Usually questions such as what could I have done, why didn't I stop him/her, and I should have known, are all some of the questions that they will continually ask themselves. By not being able to answer those questions many people will start to feel guilty as if it was there fault.  (Leenaars)

Who Does Suicide Affect cont'




It is an individual's responsibility to seek help when necessary, but anyone who believes they recognize the need for assistance in someone should advise them to seek the help they may need.


If you believe someone may be suffering from PTSD the following will tips will help you to help them:

  • Be Patient
  • Educate yourself about PTSD
  • Don't pressure them into talking
  • Always accept and expect them to be irrational 
  • Always accept and expect them to have mixed emotions regarding their issues
  • Remember to take care of yourself, it is hard to assist someone else if you are in need help at the same time








If you believe someone may be Suicidal the following guidleines should be followed:


  • Never dismiss talk of suicide always assume the worst
  • Never leave them alone
  • Seek immediate professional help (911) 
  • Never judge them
  • Allow them to tell you what is wrong
  • Do not grill them 
  • Do not keep it a secret tell family members and friends


Responsiblities cont'



Supercedes Friendship



Around 1 million Australians experience PTSD in any one year, and 12 per cent of Australians will experience PTSD in their lifetime. Serious accidents are one of the leading causes of PTSD in Australia.


Statistics on Suicide in Australia

Suicide remains the leading cause of death for Australians aged between 15 and 44


As these headlines show PTSD abd Suicide are not just problems here in the U.S. but it is an issue that every country is facing.



Headlines Around the World

Ideas at Work 


Ideas for Improvement


Education and training are the keys to improvement. 


All military members receive annual training in Suicide Prevention, and recognising possible signs of PTSD, family and friends however do not.


Instilling a policy for training family on recognising the signs and symptoms of PTSD and Suicide. 


By teaching family what signs to look for in both PTSD and Suicide can only not only help to prevent Suicide, but will also help them cope in the event they are not successful in stopping the attempt.









Ideas for Improvement


Ideas for Improvement cont'



All former service members who have been diagnosed with PTSD, and or Suicidal Behaviors could be REQUIRED to report for counseling on a certain scheduled basis. 


As with active service members, veterans respond very well to requirements in lieu of availability. By placing a requirement that they visit professionals at certain intervals may help in the prevention of suicide.


If any idea is successful in preventing even one veteran or service member from committing suicide it must be deemed a success.

Bateson, John. The Last and Greatest Battle: Finding the

    Will, Commitment, and Strategy to End Military Suicides.

    New York: Oxford, 2015. Print.

This book examines different aspects of suicidal behaviors identified in current and former service members. Using personal stories of soldiers from the Civil War through the Wars in Iraq and Afghanistan, Bateson tries to answer the following questions; why did he do it? Was there anything I could have done to prevent it? Is there anyway of knowing who is susceptible to these behaviours? Bateson is trying to ask as many questions as possible in order to shine the light on an old and growing concern in the military.


DOD. "DoD 2012 Annual Report on Suicide." Annual Report

     on Suicide NR-207-14 (2012): n. pag. DoD. Web.


The Department of Defense is the headquarters of all military personnel and actions. The DOD is responsible for funding, manning, training, planning of operations and the welfare of its personnel.



Dooley, Thomas M. MSW Readjustment Outreach      

     Coordinator/ 4020 N.20th St, Phoenix, AZ


Thomas Dooley has a Masters in Social Work, and has been the lead counselor at the Pheonix Vet Center since 2010. A retire Army 1SG, Thomas has first hand experience in dealing with service members suffering from PTSD as a leader as well as a counselor. 


Leenaars, Antoon A. Suicide among the Armed Forces.

     Understanding the Cost of Service. Amityville, NY:

     Baywood Pub., 2013. Print.


Dr. Leenaars is a psychologist specializing in the Suicidology and has been named as one of the 12 most influential psychotherapist on suicide. He has been recognized for his international efforts in suicide prevention.




Oldham, John. "PTSD and Suicide." Journal of Psychiatric

     Practice 14.4 (2008): 195-96. 14 July 2008. Web.


This article is in essence a report on the status and training required to be able to provide effective and evidence based support to those who may be suffering from PTSD. 


"PTSD: National Center for PTSD." Home. N.p., n.d. Web.


The National Center for PTSD is a branch of the Veterans Administration that is dedicate to the research and education of PTSD.
























Photo Citations 



a. Taps,







d. Jake Woods,


Video Citations