Amid a raft of Pentagon initiatives to slow its suicide crisis, a new Army report Thursday showed the pace of self-inflicted deaths among soldiers — and all service members — has barely budged so far this year from the record rate the military suffered during 2012. 

Through April, the U.S. military has recorded 161 potential suicides in 2013 among active-duty troops, reservists and National Guard members — a pace of one suicide about every 18 hours. The Army, the largest contingent of the armed forces, sustained 109 reported suicides during the first four months, according its latest report.

Last year, when self-inflicted military deaths outstripped the number of troops killed in combat, there was one suicide every 17 hours among all active-duty, reserve and National Guard members, according to figures gathered from each branch. 

"We are still continuing to fight this problem with the same intensiveness," said Cynthia O. Smith, a Pentagon spokeswoman. "We are still focused on preventing suicides from occurring in the Department of Defense. We are doing everything we can to ensure that service members are getting the proper health care they need to prevent this type of event from happening. 

"It concerns us deeply." 

The number of suicides the military has suffered in recent years has brought new initiatives and programs aimed at stemming the epidemic. But advocates fear the rate will climb in coming years as more troops are drawn down in Afghanistan.

And research published last week has experts concerned that American troops who survived multiple nearby IED blasts while in Afghanistan and Iraq now are at greater jeopardy for harming themselves.

People who have suffered numerous mild traumatic brain injuries — or concussions — carry a higher suicide risk, according to the first study to make that connection. 

"We’re starting to see now: It’s the build up, it’s the accumulation of brain injuries that increases the risk for suicide,” said Craig Bryan, the study’s lead author, assistant professor of psychology at the University of Utah, and associate director of the National Center for Veterans Studies.

The research team made that correlation by surveying 161 troops who served in Iraq, were evaluated for TBIs — some reporting as many as 15 — and who acknowledged later enduring suicidal thoughts or behaviors, according to the study, published last week in the medical journal JAMA Psychiatry.

Courtesy of Jeremy Lattimer

Marine Sgt. Jeremy Lattimer, far left, stands with members of his squad in Iraq. Lattimer received a mild TBI from an IED blast. He has not struggled with suicidal thoughts but he is working through the symptoms of his TBI at a military hospital.

One in five surveyed veterans who had sustained more than one TBI also experienced thoughts about — or preoccupation with — suicide, the study found. For patients who received one TBI, 6.9 percent reported having suicidal thoughts. And the soldiers surveyed who never were diagnosed with a TBI reported no suicidal ideations, the study showed.

Marine Sgt. Jeremy Lattimer, 26, who earned a Bronze Star for his 2009 actions in Afghanistan, can count at least three concussions he’s sustained through sports and combat — moments when he briefly lost consciousness. 

Military doctors believe he sustained a mild TBI in 2005 during an IED detonation. Six years later, he developed speaking, hearing and sleep problems often affiliated with mild brain injuries. A brain scan later confirmed that Lattimer had suffered a past TBI, he said.

But some of “the biggest blasts” that he and his fellow unit members experienced in combat came from their own outgoing rockets, added Lattimer, an outpatient at Walter Reed National Military Medical Center where he’s receiving TBI treatment and therapy.

Courtesy Jeremy Lattimer

Marine Sgt. Jeremy Lattimer, right, receives the Bronze Star in 2011. He earned the award for his 2009 actions in Afghanistan: While under machine gun fire, he maneuvered his squad in a position to help other troops escape an enemy ambush.

“They put out a tremendous blast wave. One (firing episode) was close enough to ring my bell more intensely than the IEDs that went off in my vicinity,” Lattimer said. “To get back into my train of thought, to read my GPS, it took a minute or two before my brain kicked back in. It’s like you’re in a daze.”

The Pentagon’s own tally shows 266,810 service members received a traumatic brain injuries between 2000 and 2012. More than 80 percent of those TBIs were not deployment-related cases. Many occurred amid crashes of privately owned cars and military vehicles. 

In March, more than 50 members of Congress formally asked Defense Secretary Chuck Hagel to investigate whether mild TBIs sustained in American troops may be fueling the military’s suicide crisis.

Slideshow: Boston Marathon explosions

Charles Krupa / AP

See images from the scene of the explosions.

Launch slideshow

Cops called the twin bombs “IEDs” and a Boston ER doctor said the wounds included “traumatic amputations” normally seen on Iraq battlefields, but now another combat comparison has emerged: Some civilian survivors of the terror attack will suffer PTSD as a result of Monday’s carnage.

A number of the bystanders, runners and public-safety personnel near the blasts — those close enough to see, hear and feel the detonations, those who witnessed or aided the wounded, and the injured themselves — now have a higher risk for developing the same anxiety symptoms known to affect tens of thousands of Iraq and Afghanistan veterans, said a leading expert on Post Traumatic Stress Disorder.

“Absolutely. To be precise, it is called Acute Stress Disorder at the beginning and usually involves some or all of the symptoms of PTSD. If it lasts more than a month, and has enough symptoms, it is then described as PTSD,” said Dr. Harry Croft, a San Antonio-based psychiatrist who has talked with more than 7,000 veterans diagnosed with PTSD.

Common PTSD symptoms include an inability to sleep, nightmares, a craving for isolation and a disquiet when in crowds. Following a decade of wars, experts like Croft have developed a keener understanding of these side effects.

“We know that for some people intensive debriefing after a trauma does not help, and may worsen symptoms in the long run. But getting survivors to safety, helping them understand what has happened, helping them talk — or be quiet but around others — may be of great value,” Croft said. “Mental health professionals are (now) better trained in handling the emotional needs of survivors and passers-by.”

The earlier symptoms to emerge often include a sense of disbelief — in which the event doesn’t seem real — and either no emotion or gushes of emotion, including sadness, fear, anger, Croft said. Typically, people with PTSD have either recurrent memories of the event, or no memory at all. People may discover they are easily startled or abnormally agitated.

Civilians more susceptible?
How prevalent is PTSD among people who have witnessed or were wounded in a sudden and violent situation? The figure most commonly cited by experts is 20 percent, although that rate is known to vary widely among civilians and can depend on the severity of the event, Croft said, adding: "Long term, the amount of PTSD is greater with man-made traumas as opposed to those caused by hurricanes, floods and fires.”

Civilians are “probably” more susceptible to PTSD than military members, he said. 

Veteran Brennan Mullaney, 30, an Army veteran who witnessed some explosions during two tours of Iraq, was between mile marker 24 and 25 when the blasts occurred. He lives in Boston and goes to graduate school at Tufts University. He did not hear the concussions and was not allowed by authorities to get close enough to help the injured.

“My initial concern was with civilians who haven’t witnessed scenes like that,” Mullaney said. “So many of us who have spent time deployed — and I’m not trying to overlook the severity of what transpired yesterday — but we’ve seen it before. It’s infinitively more horrific and disturbing when you see it in your hometown.”

He knows of several Tufts students who were far closer to the finish line when the bombs were detonated and he already has offered to talk with those runners about some side effects they're perhaps feeling two days later.

“Maybe my experience can help them through that. Veterans have been sloughing [PTSD] off for years. The better way is to talk to someone about it. It’s a process. You can talk to them, be empathetic. You can tell them: 'It’s tough; you’re going to have those visions of what you saw for days to come,'” Mullaney said. “How you synthesize that information, [how you] manage and process that, is going to be a big determination in whether that thought re-entering your mind is entirely a negative thing or if there is some type of silver lining to it.

“My share of what I saw in Iraq was probably less than a lot of guys who played combat roles. Yes, I did see some explosions and some aftermath of what that looks like,” Mullaney said. “A lot of times, we didn’t know the people who were hurt or killed. They were Iraqis — a father, mother, a son. They were people, and that human feeling [about them] is there, whether you’re in war zone or whether you’re home and it’s a fellow American.” 

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Who is the man in the hat at the finish line?

Traumatic brain injuries sustained by more than 200,000 U.S. troops may be fueling the military’s suicide crisis, according to a letter co-signed by 53 congressional members who are seeking additional data to investigate the new theory.

In the letter, sent Tuesday to Defense Secretary Chuck Hagel and Veterans Affairs Secretary Eric Shinseki, the lawmakers urged both agencies to provide Congress with a raft of figures, including the number of Iraq and Afghanistan service members and veterans who committed suicide or tried to end their lives after being brain injured by the detonation of an improvised explosive device — “the weapon of choice” in both wars.

“Evidence has suggested that blast injuries, including but not limited to those causing damage to vision or hearing, can have a severe psychological impact ... that can play a major contributing role in suicides,” read the bi-partisan letter.

Between November 2011 and October 2012, there were more than 15,000 IED attacks against U.S. service members in Afghanistan, and 58 percent of all coalition casualties during that span were caused by the hidden bombs, the letter states.

At least three veterans groups, including the Blinded Veterans Association, are backing the congressional push to — as the letter to DOD and VA states — “get a better understanding of the connection between blast injuries and suicide.”

“I’ve talked to a lot of neurologists, military neurosurgeons and trauma surgeons who have all started to ponder if the IEDs that have caused the TBIs are the real cause of the suicides, versus the traditional approach that suicides are all caused by the psychological stresses of combat,” said Thomas Zampieri, head of government relations for the Blinded Veterans Association.

“Let’s collect more information and maybe the epidemiologists will find a way to unlock some of this mystery: Are military suicides actually more related to the brain injuries? I think there may be a big connection,” added Zampieri, who served as a Vietnam-era Army medic. “As the numbers of TBIs go up, the numbers of suicides continue to go up.”

The portion of U.S. service members who sustained TBIs increased each year from 2001 to 2011 — with a total of 266,810 brain injuries diagnosed in American troops between 2000 and 2012, according to the Defense and Veterans Brain Injury Center, part of the DOD. More than 80 percent of those injuries were not deployment-related cases, with many occurring amid crashes of privately owned cars and military vehicles. 

Army soldiers account for the vast majority of diagnosed TBI cases, and those injuries range from “mild” (a concussion) to “severe.” Within the Army, the suicide rate among active-duty members has risen from 9 per 100,000 in 2001 to nearly 23 per 100,000 in 2011, according to the American Foundation for Suicide Prevention.

During that same span, according to the DOD’s brain injury center, the number of annual TBI diagnoses among American troops has ballooned from 11,580 in 2001 to 32,609 in 2011 — an increase of 182 percent.

“What is significant is that we are looking at a potential paradigm shift of significant proportion if the link between low-level TBI from IEDs emerges,” said retired Army Col. Bob Morris, founder of the Global Campaign against IEDs.

“The current automatic approach is to connect everything to Post Traumatic Stress Disorder and look at it all as psychological when it may be a physiological,” Morris added. 

The lawmakers additionally asked the DOD and VA to supply "specific autopsy findings (of service members or veterans) potentially indicative of prior TBI." The members said they want to know whether such post-mortems found "chronic traumatic encephalopathy", which has been detected in the brains of a number of NFL players who recently committed suicide. 

Numerous Iraq and Afghanistan veterans have been diagnosed with both TBIs and PTSD, as well as with hearing loss — the most common disability among the men and women who served in those wars. 

"There is no higher priority for VA than the mental health and well-being of our courageous men and women who have served the nation," said a VA spokesman, responding to the congressional letter. "Under the leadership of Secretary Shinseki, VA has made significant progress in providing increased access to mental health care services and strengthening our suicide prevention efforts, but there is more work to do. VA is committed to providing all Veterans the care and benefits they have earned and deserve.”

A Pentagon spokeswoman said Hagel "responds directly to correspondence received" and that it would inappropriate for her comment on the letter. 

Rep. Dan Benishek, R-Mich., a surgeon who worked at a VA medical center for 20 years, led the effort to collect congressional signatures for the letter to Hagel and Shinseki.

“Far too many of our veterans and military personnel have taken their own life after bravely serving our nation. Frankly, it’s tragic and unacceptable,” Benishek said in a statement Tuesday. “I am hopeful that by working together we can make sure our guys and gals in the military and the VA have the support they need to recover from the damaging psychological effects of war.”

"There is particular evidence linking suicide to those wounded by IEDs," added Rep. Richard Hanna, R-N.Y. "It is my hope that through additional research we will be able to identify and reverse this painful trend. One suicide is too many and we should do all we can to address this as quickly as possible."

Related:

• Why modern soldiers are more susceptible to suicide
• Home from war, troops face 'white-knuckled' first month
• Soldier Hard's hip-hop lyrics reveal PTSD's rough edges

Lucas Jackson / Reuters file

SKYDEX makes blast-absorbing plastic sheets that line military vehicles like the Mine Resistant Ambush Protected trucks used by American personnel in Iraq.

In the lobby at SKYDEX Technologies, just south of Denver, there’s a stunning, inside-facing wall that approaching visitors can't see.

Departing employees, however, can take long, slow gazes at all the imagery blanketing that wall: in short, it’s a glimpse of the immense, human cost of war.

Pictures show a U.S. Army soldier missing one full leg below his hip and a portion of his second leg under the knee – body parts abruptly shredded by an IED in Afghanistan two years ago. That soldier, still on active duty, is undergoing rehab at Walter Reed National Military Medical Center in Bethesda, Md.

“We placed the photographs there, a lot of photographs,” said Peter Foley, chief technology officer at SKYDEX. (The pictured soldier prefers to remain anonymous). “You can’t help but look at those photos and not think about how not only his life has changed but his family’s lives as well. SKYDEX people see it as they leave. It will often make us turn around and go back inside and work harder.”

A look at the innards of the SKYDEX "Convoy Deck," now installed on the floors of most MRAP vehicles used by U.S. military forces in Afghanistan. If it looks like the inside of a sports shoe, there is good reason.

Foley said the company’s patented, blast-absorbing plastic sheets now line more than 18,000 military vehicles – including Mine Resistant Ambush Protected (MRAP) trucks used by American personnel in Afghanistan and Iraq. Similar cushioning materials developed by SKYDEX also reinforce the floors of military interceptor boats and the padding in troop helmets.

In an IED attack that’s large enough to carry a 100 percent chance of seriously injuring a soldier who's riding above the explosion, the odds of bad wounds drop to 10 percent if that vehicle’s flooring is covered with a SKYDEX application, according to Foley.

The core of this danger-soaking science involves thin mats filled with thermoplastic, opposing “twin hemispheres” that collapse into one another during a nearby bomb burst, sucking up the rapid, violent energy waves emitted by an IED.

When the company’s “convoy decking” is viewed from the side, however, it somewhat resembles the guts of a sports shoe.

There’s a logical reason for that bouncy, about-to-dunk look.

“We started the company thinking we were a sporting goods material,” Foley said. “That’s my background. I’m actually a biomechanist.”

Plainly put, that means he is a sports scientist trained to apply the laws of mechanics and physics to human performance.

“The early inventors (of the SKYDEX material) were early guys at Nike, pioneers in the shoe industry. This absorbs so much more shock than foam,” which has lined many athletic shoes over the years. 

But within about six months of the 2001 launch of SKYDEX Technologies, the company was approached by researchers from the Marines, the Army and the Navy – “to work on different problems the military had,” Foley said.

Among those problems: IEDs.

“Because we absorb so much force, it makes sense for them to go this route,” Foley added.

“Yes, we use SKYDEX blast-attenuating floor mats in many of our MRAP vehicles,” said Elizabeth Robbins, a Pentagon spokeswoman. “A majority of the MRAPs in Operation Enduring Freedom have them installed. 

“It is accurate to say that both in test results as well as the results from IED events in theater, the technology demonstrates the ability to significantly reduce forces to the legs of people in the vehicles,” Robbins added.

At SKYDEX, the research-and-development team is examining next-generation head protection for American troops, Foley said, “really looking at what we can do to prevent injuries from blunt trauma and blast waves.”  (The company also employs 11 veterans).

But the whirlwind career detour Foley has taken - from trying to engineer a more buoyant sports shoe a decade ago to trying to protect the heads and bodies of soldiers today - isn’t lost on a man who has his name on more than 10 patents.

“The veterans who work here were, by and large, boots on the ground. They have a difficult time telling their stories,” Foley said. “So it’s really easy to remember why we’re doing this.

“I’m the son of a retired Navy captain. Like a lot of older parents, he will often talk a long, long time on the phone. Then we’ll talk about SKYDEX, what it can do to save live and limbs. And he’ll suddenly tell me that I’ve got to get off the phone and go to work.”

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