Suicides are surging among America's troops, averaging nearly one a day this year - the fastest pace in the nation's decade of war.
The 154 suicides for active-duty troops in the first 155 days of the year far outdistance the U.S. forces killed in action in Afghanistan - about 50 percent more - according to Pentagon statistics obtained by The Associated Press.
The numbers reflect a military burdened with wartime demands from Iraq and Afghanistan that have taken a greater toll than foreseen a decade ago. The military also is struggling with increased sexual assaults, alcohol abuse, domestic violence and other misbehavior.
Because suicides had leveled off in 2010 and 2011, this year's upswing has caught some officials by surprise.
The reasons for the increase are not fully understood. Among explanations, studies have pointed to combat exposure, post-traumatic stress, misuse of prescription medications and personal financial problems. Army data suggest soldiers with multiple combat tours are at greater risk of committing suicide, although a substantial proportion of Army suicides are committed by soldiers who never deployed.
The 2012 active-duty suicide total of 154 through June 3 compares to 130 in the same period last year, an 18 percent increase. And it's more than the 136.2 suicides that the Pentagon had projected for this period based on the trend from 2001-2011. This year's January-May total is up 25 percent from two years ago, and it is 16 percent ahead of the pace for 2009, which ended with the highest yearly total thus far.
Suicide totals have exceeded U.S. combat deaths in Afghanistan in earlier periods, including for the full years 2008 and 2009.
The suicide pattern varies over the course of a year, but in each of the past five years the trend through May was a reliable predictor for the full year, according to a chart based on figures provided by the Armed Forces Medical Examiner.
The numbers are rising among the 1.4 million active-duty military personnel despite years of effort to encourage troops to seek help with mental health problems. Many in the military believe that going for help is seen as a sign of weakness and thus a potential threat to advancement.
Kim Ruocco, widow of Marine Maj. John Ruocco, a helicopter pilot who hanged himself in 2005 between Iraq deployments, said he was unable to bring himself to go for help.
"He was so afraid of how people would view him once he went for help," she said in an interview at her home in suburban Boston. "He thought that people would think he was weak, that people would think he was just trying to get out of redeploying or trying to get out of service, or that he just couldn't hack it - when, in reality, he was sick. He had suffered injury in combat and he had also suffered from depression and let it go untreated for years. And because of that, he's dead today."
Jackie Garrick, head of a newly established Defense Suicide Prevention Office at the Pentagon, said in an interview Thursday that the suicide numbers this year are troubling.
"We are very concerned at this point that we are seeing a high number of suicides at a point in time where we were expecting to see a lower number of suicides," she said, adding that the weak U.S. economy may be confounding preventive efforts even as the pace of military deployments eases.
Garrick said experts are still struggling to understand suicidal behavior.
"What makes one person become suicidal and another not is truly an unknown," she said.
The military services have set up confidential telephone hotlines, placed more mental health specialists on the battlefield, added training in stress management, invested more in research on mental health risk and taken other measures.
The Marines established a counseling service dubbed "DStress line," a toll-free number that troubled Marines can call anonymously. They also can use a Marine website to chat online anonymously with a counselor.
The Marines arguably have had the most success recently in lowering their suicide numbers, which are up slightly this year but are roughly in line with levels of the past four years. The Army's numbers also are up slightly. The Air Force has seen a spike, to 32 through June 3 compared to 23 at the same point last year. The Navy is slightly above its 10-year trend line but down a bit from 2011.
As part of its prevention strategy, the Navy has published a list of "truths" about suicide.
"Most suicidal people are not psychotic or insane," it says. "They might be upset, grief-stricken, depressed or despairing."
The renewed surge in suicides has caught the attention of Defense Secretary Leon Panetta. Last month he sent an internal memo to the Pentagon's top civilian and military leaders in which he called suicide "one of the most complex and urgent problems" facing the Defense Department, according to a copy provided to the AP.
Panetta touched on one of the most sensitive aspects of the problem: the stigma associated seeking help for mental distress. This is particularly acute in the military.
"We must continue to fight to eliminate the stigma from those with post-traumatic stress and other mental health issues," Panetta wrote, adding that commanders "cannot tolerate any actions that belittle, haze, humiliate or ostracize any individual, especially those who require or are responsibly seeking professional services."