On Wednesday April 2, 2014, Army Spc. Ivan Lopez killed three soldiers and wounded 16 others in a shooting rampage at Fort Hood, Texas. While it’s unclear what lead to the rampage, reports say that Lopez had just learned that a request for leave had been denied again which angered him, prompting him to retrieve his .45 caliber pistol and randomly open fire. After being fired upon a military police officer, he pointed his gun to his head and killed himself.
In the immediate aftermath, speculation began about Lopez’s mental heath history. On Friday, details were released about his history, including being treated for depression and anxiety. His grandfather and mother died late last year, which may have precipitated the request for leave. After enlisting in June 2008 as an infantryman he later switched his specialty to truck driver, which is the job he had in Iraq. He was not involved in direct combat according to an Army spokesperson. However, a neighbor told the Los Angeles Times Lopez said he saw three people die while there and he had trouble sleeping. Ambien was one of the number of prescription drugs he was taking.
He was seeing a psychiatrist, but there was no diagnosis of Post Traumatic Stress Disorder. Reports of a brain injury have not been confirmed. While there was “strong evidence” of a “medical history that indicated an unstable psychiatric or psychological condition,” Lt. Gen. Mark Milley said that Lopez’s mental condition was not the “direct precipitating factor” of the rampage.
The question is, did Lopez’s mental health problems exist prior to enlistment? A study released last month says there’s a very good chance it was.
A series of reports by JAMA Psychiatry showing the results of a nearly five year study of the Army indicate that 25 percent of soldiers had exhibited signs of a mental illness prior to enlistment. Many had common disorders, such as depression, panic disorder and ADHD. Within the ranks of the one million soldiers studied, bi-polar disorder, substance abuse and suicide ideation (thoughts about or an unusual preoccupation with suicide) were also very prevalent. Those joining also already had a significantly higher rate of PTSD prior to enlistment.
All of these issues would make a soldier more susceptible to the stresses of war. However, the study also noted that the rates of suicide were also high among non-deployed soldiers. While suicide attempts among soldiers are lower than the civilian population, they are much more likely to succeed. The study notes that mental disorders are the main cause of military deaths.
Beginning in 2009, researchers focused on those that enlisted between 2004 and 2009, the height of the Iraq and Afghanistan wars. The Army has traditionally had a lower incidence of mental disorders due to their screening processes. However, during this time, recruitment efforts were hampered by the needs of two wars and a dwindling supply of willing suitable recruits. As a result, the Army lowered its standards.
Beginning in 2007, the Army began issuing waivers for people who would not normally qualify for service. This included increasing the percentage of recruits that had low scoring aptitude tests, as well as those who received waivers for moral and medical reasons. Moral waivers would be for things like misdemeanor arrests and criminal behavior (including robbery and manslaughter). Medical waivers would include previous drug and alcohol problems, including previously failed drug tests. There were no changes in mental health screenings, though the recruitment process relies on self-reporting. Previous studies have linked drug and alcohol use to mental disorders as well as poor coping strategies.
The most common disorder in the study was intermittent explosive disorder, which is characterized by uncontrolled attacks of anger. More than eight percent of the soldiers of the study exhibited this disorder prior to enlistment, nearly six times the level of the civilian population. The disorder has been known to precede, and possibly predispose, depression, anxiety and substance abuse problems. The mostly males that suffer from this disorder often display sexual impulsiveness and are frequently involved in traffic accidents.
Previous drunk driving incidences were also part of the increase in moral waivers for Army enlistment.
In the end, the combination of lower standards, along with inadequate screening and a military culture that may be viewed as less than supportive of mental health issues, has created a perfect storm of sorts of soldiers with a higher risk of post-enlistment onset of depression, aggression and otherwise externalizing of already existing mental disorders. While the study did not identify causation, meaning that they did not say the act of serving in the Army led to the increase of these behaviors, they do feel there is a link. They conclude that the “evidence exists for associations of childhood stresses and mental disorders with poor soldier functioning, lending indirect support to the results reported.”
As to the higher rate of suicides, the lead author notes, “The former [preexisting disorder] gets people thinking about suicide, and the latter gets them to act on those thoughts.”
While there has been no response from the Pentagon on the report, it should be noted that new military recruiting standards went into effect in 2012 and included the elimination of waivers for misconduct, as well as drug and alcohol abuse.
A previous version of this article appeared on Care2.