Suicides in the U.S. military increased to a record 349 last year, far exceeding the 295 American combat deaths in Afghanistan, and some private experts are predicting the trend will grow worse this year.
Hawaii faces its share of the problem, which Defense Secretary Leon Panetta and others have characterized as an epidemic in the ranks.
State Rep. K. Mark Takai, a Hawaii National Guardsman and organizer of the annual state Medal of Honor recognition for service members killed in action, said he is aware of at least 18 suicides involving Hawaii-born or Hawaii-based active-duty, Guard and Reserve service members in the past seven years.
"I think we are all worried about the current trends," said Takai, who said he was speaking as a legislator. "To have more people die as a result of suicide than the war in Afghanistan for the previous years suggests that we have another war that we have to deal with."
Suicides that have become public — and show just how wide-ranging the problem is — include the death in March of Army Capt. Michael McCaddon, 37, a nondeployed doctor at Tripler Army Medical Center who worked in obstetrics and gynecology.
McCaddon hanged himself at the hospital.
His wife, Leslie McCaddon, said her husband had been depressed and suicidal for years, and she warned military officials, with varying degrees of success and support.
Marine Lance Cpl. Harry Lew, a 21-year-old from Santa Clara, Calif., was on his first combat deployment when he was subjected to a series of physical tasks, had sand dumped on his face and was kicked and punched in the helmet after falling asleep on guard duty for the fourth time in Afghanistan, according to an investigation.
Lew, who was with the 2nd Battalion, 3rd Marine Regiment at Kaneohe Bay, killed himself on April 3, 2011, with his automatic weapon as he crouched in a new fighting hole he had been ordered to dig that night.
The problem reflects severe strains on military personnel burdened with more than a decade of combat in Afghanistan and Iraq, complicated by anxiety about the prospect of being forced out of a shrinking force.
But the deaths also occur to nondeployed service members, like McCaddon, who face demons of other sorts.
Pentagon figures obtained Monday by The Associated Press show that the 349 suicides among active-duty troops last year were up from 301 the year before and exceeded the Pentagon’s projection of 325.
The Pentagon says that although the military suicide rate has been rising, it remains below that of the civilian population. It says the civilian suicide rate for males age 17 to 60 was 25 per 100,000 in 2010, the latest year for which such statistics are available. That compares with the military’s rate in 2012 of 17.5 per 100,000.
Statistics alone do not explain why troops take their own lives, and the Pentagon’s military and civilian leaders have acknowledged that more needs to be done to understand the causes.
Last year’s total is the highest since the Pentagon began closely tracking suicides in 2001. It exceeds the 295 Americans who died in Afghanistan last year, by the AP’s count.
Takai said steps taken by the Department of Defense and veterans organizations are beneficial, but more needs to be done.
"I think many of these people that choose suicide over staying alive feel that they are at the end of their rope. They have no other options," Takai said. "And I think part of it stems from economic issues. You have people that come home without jobs. So we need to continue our work ensuring that our service members have job opportunities after they come back."
In an acknowledgement of the complexity of the problem, President Barack Obama in 2011 reversed the former policy and started sending condolence letters to the families of service members who took their own lives.
Takai said he’s proposing that suicide deaths be recognized in the annual state Medal of Honor recognition.
Military suicides began rising in 2006 and soared to a then-record 310 in 2009 before leveling off for two years. It came as a surprise to many that the numbers resumed a climb this year, given that U.S. military involvement in Iraq is over and the Obama administration is taking steps to wind down the war in Afghanistan.
"Now that we’re decreasing our troops and they’re coming back home, that’s when they’re really in the danger zone, when they’re transitioning back to their families, back to their communities and really finding a sense of purpose for themselves," said Kim Ruocco, whose husband, Marine Maj. John Ruocco, killed himself between Iraq deployments in 2005. She directs a suicide prevention program for a support group, Tragedy Assistance Program for Survivors, or TAPS.
The Army, by far the largest of the military services, had the highest number of suicides among active-duty troops last year at 182, but the Marine Corps, whose suicide numbers had declined for two years, had the largest percentage increase: a 50 percent jump to 48. The Marines’ worst year was 2009 with 52 suicides.
The Air Force recorded 59 suicides, up 16 percent from the previous year, and the Navy had 60, up 15 percent.
All of the numbers are tentative, pending completion later this year of formal pathology reports on each case.
Suicide prevention has become a high Pentagon priority, yet the problem persists.
"If you have a perfect storm of events on the day with somebody who has high risk factors, it’s very difficult to be there every moment, fill every crack, and we just have to continue to be aware of what the risk factors are," Ruocco said.
David Rudd, a military suicide researcher and dean of the College of Social and Behavioral Sciences at the University of Utah, said he sees two main categories of troops who are committing suicide at an accelerating pace: Iraq and Afghanistan war veterans suffering from depression, post-traumatic stress or substance abuse, and those who have not gone to war, but face troubled personal relationships, money problems or legal woes.
He is not optimistic about a decline soon.
"Actually, we may continue to see increases," he said.
Officials say they are committed to pursuing ways of finding help for service members in trouble.
Army suicides in July were so alarming that the service in September held a worldwide "stand-down," or pause in activities, to try to deal with the problem.
The Army also held a suicide prevention stand-down in 2009.
At the time of the September effort, Lt. Col. Stephen Morris, the residency training director in the psychiatry department at Tripler, said Army suicides were a "very complex" phenomenon.
"It’s at record numbers, but it’s very hard to get a handle on that, and I think what you have to do … is what the Army is doing, which is, you tackle it from all the points that you can," he said.
That included "resiliency" training for soldiers and their families, and trying to catch behavioral problems early. It used to be the case that every battalion had a doctor, he said.
"Now we’re moving to a model where every battalion has a battalion behavioral health specialist," Morris said. "We’re putting those people as close to the units as we can."
Tripler was not able to provide any immediate follow-up comment Monday.
Two retired Army generals, Peter W. Chiarelli and Dennis J. Reimer, have spoken out about the urgency of reversing the trend.
"One of the things we learned during our careers," they wrote in The Washington Post last month, "is that stress, guns and alcohol constitute a dangerous mixture. In the wrong proportions, they tend to blow out the lamp of the mind and cause irrational acts."
As recently as 2005 the Army’s suicide total was less than half of last year’s.
Joe Davis, spokesman for the Washington office of the Veterans of Foreign Wars, said veterans have faced difficulty adjusting to the less intense environment of their home bases. Others struggle with leaving the military in search of work in a tight civilian job market.
"It’s difficult to come back from a war footing to garrison life," he said, where more mundane problems intrude on troops who had been focused almost entirely on their war mission.
Each year, the Pentagon performs an in-depth study of the circumstances of each suicide. The most recent year for which that analysis is available is 2011, and among the findings was that those who took their own lives tended to be white men under the age of 25, in the junior enlisted ranks, with less than a college education.
The analysis of 2011’s 301 military suicides also found that the suicide rate for divorced service members was 55 percent higher than for those who were married. It found 60 percent of military suicides were committed with the use of firearms — and in most cases the guns were personal weapons, not military-issued.
That study also found that most service members who attempted suicide — about 65 percent — had a known history of behavior problems, whereas 45 percent of those who completed the act and killed themselves had such a history.
Leslie McCaddon, whose husband killed himself at Tripler, said in April that her husband did at times seek and receive help for his depression, but he was a "good soldier" and "duty came first, so he would never say, ‘Hey, I need to take an hour off to go to therapy,’ because he’s just not that kind of guy."
She said she brought his depression to the attention of command, and "they didn’t seem to believe me because he had a very different personality at work."
They were separated, and she was told at one point it appeared that the real problem was family issues, McCaddon said.
"I never felt like enough was done," she said. "I had a lot of explanations given to me as to why they were handling it the way they were, but as his wife I really cared a heck of a lot less about his career than about his life."
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Star-Advertiser reporter William Cole and The Associated Press contributed to this report.