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Image: Profile of a female United States Marine saluting, veteran
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According to a study in Psychiatric Services, among women ages 18 to 34, female veterans are three times more likely to kill themselves than nonveterans.
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updated 5/25/2012 1:55:26 PM ET 2012-05-25T17:55:26

Edie Bailey was shocked when her doorbell rang at 6 a.m. on a Saturday and the somber faces of uniformed soldiers greeted her. She recognized the macabre scene played out in countless movies, but how could this be happening? Her foster daughter, Galina, was home from war, safe, and hunkered down at her military base in Hawaii.

Then one of the men spoke. Galina was dead, he told her. Wait. Pause. Dead? But she hadn't yet left for her second tour abroad.

"She shot herself in the head," Edie says now, the words even and detached. "She got into her car at the base and blew her brains out."

It's been a little more than a year since Private Galina Klippel committed suicide just two months shy of her 25th birthday. For Edie, at home in Eagle River, Alaska, every day is a futile exercise in trying to understand what went so horribly wrong for a daughter who had treasured life — and loved the military.

Like so many others, Galina was searching for something when she enlisted — an adventure, a direction in life. What she got was 13 months of hell in Afghanistan, where she was assigned to assist and protect a military chaplain. Together they made the rounds at the local hospital, where he counseled severely wounded soldiers and Afghan children, some of whom were missing arms or legs, or both. The gruesome work was not the glory Galina had envisioned. And yet, while still in Afghanistan, she re-upped for another tour.

In November 2010, between deployments, the Army sent her back to the States. Linda Mattison, 44, who was Galina's staff sergeant at Fort Carson in Colorado before she went to Afghanistan, picked her up and brought her back to the barracks. To Linda, feisty Galina was like a daughter. After her return, though, Galina seemed unusually quiet. "It's overwhelming, coming home," says Linda. "I just figured it was a lot for her to process." In the weeks that followed, Linda noticed that Galina was clingy, as if she just didn't want to be alone.

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Around the holidays, Galina visited her family in Alaska. Edie sensed she was troubled. "She didn't want to talk about anything to do with her mission," she remembers. "She seemed withdrawn." Galina also ran into trouble with the law — a local spa accused her of stealing money — and when she finally arrived at her base in Hawaii, she showed up in civilian clothes, without her orders or medical records. In the military, that could be grounds for disciplinary action. "It makes no sense to me why they would allow her to reenlist if her behavior was not in line with their requirements," says Edie. Even now, Edie has more questions than answers.

Though Galina was clearly changed by her deployment in Afghanistan, nobody realized she was suicidal. Were there missed signs? Indications she was slipping? "She called me that morning to check on me — I had strep throat," says Linda, choking back tears. "I had no idea that she was really calling to say good-bye."

Edie doesn't veil her frustration with the military's lack of oversight. "They should have been more aware that Galina was having problems," she says. Edie believes not enough emphasis is placed on making sure soldiers returning from war are not only willing to return to the battlefields but also mentally and emotionally fit for a second tour — and that few regulations exist to weed out people who aren't cut out for combat in the first place.

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Falling soldiers
In 2011, there were 164 deaths of active-duty soldiers that were investigated as suicides. Adding to the horror is this surprise: According to a study in Psychiatric Services, among women ages 18 to 34, female veterans were three times more likely to kill themselves than nonveterans. (An earlier study found that male veterans were twice as likely to commit suicide as were male nonvets.)

Psychologists aren't yet sure of the reason. The Psychiatric Services study was the first time researchers estimated the suicide risk among these women. "When we broke out the statistics on females with military service, it was shocking," says Mark Kaplan, D.P.H., coauthor of the study and professor of community health at Portland State University. "Why were women killing themselves at such a disproportionate rate? Why were so many suicides occurring after they'd returned home? It's a call to action for the military to take a closer look at what women are going through."

Subtle signs of suffering

Statistically speaking, female soldiers have greater access to firearms than civilian women do. But that doesn't explain the difference between female and male soldiers' suicide rates, compared to civilians'. Psychologists theorize other causes: the number of service members suffering from symptoms of post-traumatic stress disorder (PTSD), which women develop at more than twice the rate of men; and the additional exposure to traumatic events as a result of multiple deployments.

As women become a bigger presence in the military, more women are dealing with the unique stressors of leaving families behind during their overseas tours. Their service can wreak havoc on their home lives: Enlisted women's marriages are almost three times more likely to end in divorce than enlisted men's, a study in the journal Transition to Adulthood found. One possible reason: the challenges women face transitioning back to a domestic role postdeployment.

Pedaling hope: War veterans plan 100-day bike ride for suicide awareness

Haunted at home
"You come home and everything is supposed to be 'normal,'" says Staff Sergeant Stacy Pearsall, a 32-year-old former combat photographer for the Air Force, who now lives in Charleston, South Carolina. "The problem is, you've got a new sense of normal, and it doesn't match up with your old life."

During her six years and three tours of combat duty in Iraq and Africa, Stacy saw countless scenes of death through her camera lens, as well as the images of those who survived — the screaming, sobbing, grieving parents and children mourning over bodies in the street. "I got used to the smell of death, the blood, the dead bodies," she says. "But I never got over seeing the suffering of the families."

You don't have time to think about what you're seeing when you're in the combat zone, says Stacy. "You're focused on survival." It's when your tour ends and you arrive in the safety of your own home, she says, that you begin to digest what you witnessed — and experience the fallout.

Back in the U.S. postdeployment, Stacy was required to fill out a standard self-assessment questionnaire. She remembers answering questions such as Do you have trouble falling asleep? Do you feel anxious? Do you feel jumpy? Stacy's answers revealed as little as possible —"nobody answers honestly, because it's like raising your hand and saying you have a problem" — and passed without incident. (Some psychologists doubt the usefulness of surveys like this, given that returning troops may be reluctant to answer questions in the affirmative, fearing stigmatization and infringement on their family time.)

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But Stacy was on edge, exhausted, and depressed. Stress led to sleeplessness, and she began experiencing anxiety and flashbacks, all symptoms of PTSD, a factor linked to increased risk for suicide in soldiers. Thoughts of killing herself crept into her head. "I'd be driving over a bridge and start thinking about sending the car off it," she says. "I just wanted to end things." Stacy found courage in her relationship with her future husband, Andy. "Without him, I seriously doubt I would be here right now," she says softly. "I needed a reason to keep living, and he was it." Andy, also a combat photographer, had been through war too; he understood. Their love was the life affirmation she hung on to when her world felt worthless.

Despite the stigma she feared would come from seeking counseling, she went to her Air Force medical center. "The receptionist asked me whether I'd seen my doctor," Stacy remembers. "And I said, 'No, why?' And she said, 'Because he'd prescribe you some sleeping pills.' Like that was it — the answer to feeling suicidal? Take sleeping pills? I was stunned and really angry." She left without seeing anyone.

On the advice of a Vietnam vet, Stacy eventually did seek treatment through the local Vet Center, where she found a group of veterans and counselors who took her situation seriously. "I wasn't alone anymore," she says. She began participating in weekly therapy sessions. And slowly, she started to heal.

Today, Stacy runs the Charleston Center for Photography and attends weekly therapy sessions at the VA. "It's not like you go for seven sessions and you're all better," she says. "I'll be working on this for the rest of my life."

How to manage post-traumatic stress

Role reversal
Experts agree that settling back into a typical civilian routine after combat can be tremendously difficult. Even the simplest elements of work and home life can be jarring to a soldier conditioned to a world of animal-instinct survival — someone who likely spent months, or years, on edge. Plus, the transition from order and structure to personal choice can leave many soldiers feeling overwhelmed. "They're suddenly expected to make a slew of decisions —however mundane — after spending months in an environment where it was their job to follow orders," says Michelle Kelley, Ph.D., a professor of psychology at Old Dominion University.

"I remember exactly where I had my meltdown," says Tracee Rose, a 41-year-old Army nurse from San Antonio, who was deployed in Afghanistan for 12 months in 2005 and did a six-month tour in Iraq in 2011. "I was in the yogurt aisle at Walmart, two days after I got home. I totally fell apart, crying. My husband was like, 'What's wrong? What happened?' And I said, 'It's just too much — there are too many choices, too many flavors. I can't make this decision.' Because in the Army, life is simpler. And it's stressful leaving that world and jumping straight back into this one."

For female soldiers, reestablishing domestic roles can be tough, says Marion Rudin Frank, Ed.D., a psychologist in Philadelphia who provides free therapy to returning soldiers through a program called Give an Hour. "Women may be more involved in the daily lives of their families," she says. "So when they deploy and return, the guilt of separation and responsibility of reestablishing bonds can be overwhelming."

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In crisis? Call this number

Calling for backup
The U.S. Department of Defense has been criticized for its methods of addressing soldiers' mental-health issues, but it has made an effort, as has the VA, to tackle the suicide problem. Since its launch in 2007, the Veterans Crisis Line has answered more than 500,000 calls, according to Janet Kemp, Ph.D., R.N., the national VA mental-health program director in Washington, D.C. Kemp estimates about 25 percent of the calls are from women. This may seem low compared with the percentage of male callers, but it's high when you consider that the active-duty military population is only 15 percent female.

In an effort to address the emotional strains of service, the military launched in 2009 what it calls Comprehensive Soldier Fitness, a program designed to train soldiers to be more resilient — physically, emotionally, and socially. Based on 30-plus years of scientific research, the program encourages a proactive response to stressful situations and promotes optimism.

Army program aims to predict soldiers' resiliency

As for the VA program, a 2011 study in Women's Health Issues found that over half of VA facilities that serve more than 300 female patients had adopted gender-specific services for women, including programs to address sexual trauma. Such programs are critical, according to psychologist Darrah Westrup, Ph.D., former director of the Women's Trauma Recovery Program in Menlo Park, California, a VA facility with specialized treatment programs for women. "Men and women under stress often express their emotions differently," she says. "Men often get angry, have outbursts. Women usually turn inward — they tend to have more self-blame." Because women may be reluctant to share their feelings with a unit full of male soldiers, they are unable to benefit from that social support. Even the ability to share daily gripes or discuss female-related concerns (imagine getting severe menstrual cramps in the middle of the desert, in 104°F heat, with no privacy) is lost when there are no, or very few, women to bond with.

"Women in the military can feel very alone," agrees Kelley. "They may go through an entire day without seeing another female soldier." And yet, they are confronted with experiences they may feel comfortable sharing only with another woman. Also, "the rate of harassment by male soldiers is high, and sexual assault is high," says Kelley. "And women process stressful events differently than men do. They are much more susceptible to depression."

The current system is not going to catch a lot of these women when they finish their tours. And that's the dangerous part. "There is a period of time after women who served in the armed forces return home when the risk for attempting suicide increases, and we're still trying to understand why," says Kaplan. "But we do know she is carrying all the stress of her deployment, plus the added anxiety of reintegrating into her life at home and all of the struggles that accompany that, such as paying stacks of bills that have piled up and, in some cases, finding new employment." It may be a matter of cumulative stress rather than one single event that results in her taking her own life, or attempting to.

Invisible soldiers: Women in war

Will to survive
Thirty-five-year-old Captain Emily Stehr found herself floundering through that high-risk time after she returned from Iraq in October 2008. After 15 long months there, Emily, a petite physical therapist with shiny brown hair and doe eyes, looked forward to getting home.

What a cruel surprise, then, to discover that she felt closer to death there than she'd ever felt when she was overseas. "I was walking around like a zombie," she says. "I kept waiting for the person I was before deployment to reappear. But she never came back."

Unlike most, she filled out her self-assessment survey honestly — "I was like, sleeplessness? Check. Anxiety? Check." — earning herself a trip to see the Army's behavioral-health counselors. But despite periodic check-ins with them, Emily's mental state continued to worsen. That winter, she took long walks through her church's cemetery in Pennsylvania, lingering over her family plot.

After returning to her base in Vilseck, Germany, Emily's grip on reality slipped further. It was February 2009, a few months after a fellow soldier, Randy, killed himself, and she found herself increasingly thinking about her own death. "I was numb," she says. "I felt like my family would be better off without me here." She thought it through: Slitting her own throat, Emily decided, would be the best way to go.

5 steps to stay calm in crisis

Thankfully, Emily overcame the urge to end her life and checked herself into the Army's inpatient psychiatric ward. It was an eight-day stay, and in group therapy sessions, her perspective slowly changed. "I finally realized I wasn't the only one facing these thoughts," she says. "I went in thinking I was weak, that I'd screwed up. I left understanding that I had a disease. Just like cancer, feeling suicidal is a sickness and you need help to get better."

Today, Emily speaks openly about suicide to anyone who asks. "Coming out as a suicide survivor is equivalent to getting a Pap smear in Times Square," says Emily. "You are totally exposed." There's a stigma attached to mental health issues, so people are encouraged not to talk about it, but she vows to do it again and again, if it means another soldier's life will be spared. ("Get me on Anderson Cooper's show!" she half-jokes. "I know he'd tell my story.")

In some ways, speaking out is one way Emily bonds herself to this earth. "It gives me a reason to stay," she says with a small smile. "So I can tell people, 'You are not alone. You can beat this. I did.'"

This story originally appeared in the May 2012 issue of Women's Health. To see the entire Women's Health report, click here.

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Video: Army suicide report highlights 'high-risk' behavior

  1. Transcript of: Army suicide report highlights 'high-risk' behavior

    WILLIAMS: Good evening.

    BRIAN WILLIAMS, anchor: Because of two separate stories tonight on two separate fronts, this was a dark day for many of those who proudly wear Army green. We learned today about the extent of mismanagement on some hallowed American ground, Arlington National Cemetery . This involves the remains of those who gave everything they had to this country. And something else, the number two ranking general in the Army , a man fresh from the battlefield himself, came out with a tough report today on the toll of our dual wars. Multiple combat tours, multiple wounds and deep troubles for the proud ranks of the US Army . We begin with our Pentagon correspondent Jim Miklaszewski . Jim , good evening.

    JIM MIKLASZEWSKI reporting: Good evening, Brian . Based on this new report, the Army again promises to fix its mental health problems and put the soldiers first. But it's got a long way to go . As a specialist in the Army , Jennifer Crane was sent off to Afghanistan .

    Specialist JENNIFER CRANE: Two weeks after we landed there, we were attacked for the first time .

    MIKLASZEWSKI: The war took a heavy personal toll. Once back home, she got hooked on cocaine and ended up on the streets.

    Spc. CRANE: Unfortunately didn't cope with anything that I -- anything fairly well.

    MIKLASZEWSKI: Jennifer got the necessary counseling and is back on her feet. But a devastating new report from the Army today reveals that, after nine years of war, thousands of soldiers never survive their own personal battles.

    General PETER CHIARELLI (Army Vice Chief of Staff): We have an Army that's been fully engaged for almost nine years now. I don't think that we fully understand the toll that that's taken on the force.

    MIKLASZEWSKI: The numbers are staggering. Last year more than 1700 soldiers attempted suicide; 160 succeeded, the highest number in 30 years. And drug abuse is a huge problem. Of 64,000 felonies and noncombat deaths, 72 percent were drug related. More than 1300 soldiers have failed two or more drug tests , but are still on active duty today. But how could this happen? The report suggests it's a failure of leadership. To meet the demands of two wars, the Army lowered its standards for new recruits. And Army officials admit that combat commanders were under so much pressure to get soldiers into battle, they often overlooked disciplinary problems, even criminal activity.

    Gen. CHIARELLI: Because of everything that we're doing, we have not paid the attention we need to on high-risk behavior.

    MIKLASZEWSKI: Armed with this new report, the Army pledges to restore some of the basic leadership that's been lost while fighting two wars and, more importantly, put the well-being of their soldiers first.

    But the Army came under fire for another issue today: Arlington National Cemetery .

    Senator JON TESTER (Democrat, Montana): This is not only totally unacceptable, it is a black eye.

    MIKLASZEWSKI: Angry senators grilled the cemetery's former leadership, demanding to know how more than 200 graves could have been mismarked or have no headstones at all. Senator Claire McCaskill said the actual number could be as high as 6600.

    Senator CLAIRE McCASKILL: We've lost the bodies of our fallen heroes. We've got cremated remains that we don't even know who they belong to! This is not complicated. It's called keeping track of who you bury where.

    MIKLASZEWSKI: Former superintendent John Metzler accepted responsibility. His deputy Thurman Higginbotham refused to even answer most questions, invoking the Fifth Amendment . The Army has launched its own criminal investigation, even as it promises to restore the dignity owed to the nation's fallen. And in still one more story out of the Army tonight, Pentagon officials tell NBC News that 22-year-old Private 1st Class Bradley Manning , suspected of leaking a classified video to WikiLeaks , is on his way tonight from Kuwait to Washington , DC , where he's expected to face court martial for mishandling of classified material. Now, Manning is also considered a person of interest in this latest WikiLeaks story. Pentagon officials also say that essentially Manning has been placed under suicide watch out of fear that he may harm

    himself. Brian: Jim Miklaszewski on duty for us at the Pentagon to start things off tonight. Jim ,

    WILLIAMS:

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