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MANDY MARTIN still feels the "cockroaches" in her stomach—the sweat, the panic—of the day her world fell apart.

Martin, a sergeant in the U.S. Army reserves, raced north from Kuwait with other coalition forces in 2003 and served 14 months in a town just 75 miles north of Baghdad. Martin was on a crew that maintained Chinook helicopters. She came home to Portland in 2004.

Months later, Martin found she couldn't leave the war behind. She was experiencing nightmares, feeling hyper-vigilant, and drinking heavily.

Martin sought counseling. But as the hour of her appointment approached, she started sweating. Then crying. Then crying harder. Wave after wave of panic swept over her. "I was out of control," she remembers.

Ultimately, Martin was lucky. With counseling, she has reclaimed her life.

Many who have served in the nation's military—overwhelmingly men—have not been so fortunate.

A GROUNDBREAKING STUDY led by Mark Kaplan, professor in the School of Community Health, has found that men who served in the military are twice as likely as non-veterans to commit suicide. While Kaplan did not include women in his study because of the small number of women veterans represented in the data, a colleague did extrapolate the information and found that women veterans also are twice as likely as non-veterans to commit suicide.

Nonetheless, Kaplan, a nationally recognized authority on the cause and prevention of suicide, was surprised—and troubled—by the study's findings.

Published in the July issue of the Journal of Epidemiology and Community Health, the study is the first large-scale look at veteran suicide rates. The study compared suicide rates for 104,000 men who had served in the military from World War I through the Persian Gulf War with men who had not served in the armed services.

The results were clear.

"Veteran status is a risk factor for suicide above and beyond a whole host of (other) factors," says Kaplan.

The study, funded by the National Institute of Mental Health, uses data from U.S. National Health Interview Surveys from 1986 to 1994 and national death data from 1986 to 1997. Even though the earliest surveys are from 1986, men who served in World War I were represented. Kaplan worked on the study with Bentson McFarland, professor of psychiatry at Oregon Health & Science University, and PSU faculty members Nathalie Huguet and Jason Newsom.

The study's findings conclude that veterans:

• who are white are at a higher risk of suicide;
• who have 12 or more years of education are also at a higher risk;
• have the same risk of death from disease and accident as non-veterans;
• who are overweight have a lower risk of suicide;
• who commit suicide are more likely to live in rural areas;
• are 58 percent more likely to use firearms to commit suicide than non-veterans; and
• who are physically impaired are more likely to commit suicide.

And it's this last point that Kaplan finds especially troubling.

As battlefield medicine has improved, the number of soldiers who survive severe wounds has soared. During the Vietnam War, for every soldier killed in action, three were wounded in action, says Travis Wright '01, readjustment counseling therapist at the Portland Vet Center. Today, the ratio of deaths to injuries is 1 to 16—meaning that thousands more soldiers who would have died on the battlefield from their injuries, now are coming home.

Ironically, that good news also implies a heartbreaking burden.

Not only is life now harder, says Wright, but a veteran's injuries serve as a reminder every day for the rest of his or her life of all that happened and of all that was lost.

Kaplan is of the same mind, and says that the study may well foreshadow trends for veterans of Iraq and Afghanistan.

"In light of current veterans coming home with serious physical disabilities and psychiatric problems," says Kaplan, "their families and health care providers need to be more attentive to the early signs of depression and suicidal behavior."

THE MEDIA HAS been quick to pick up on Kaplan's findings. Journalists from the Anchorage Daily News to National Public Radio and the BBC have reported on the study and its implications for the current conflicts in Iran and Afghanistan.

After 15 years of working out of the spotlight on suicide prevention, Kaplan finds the sudden attention encouraging.

"I find it often frustrating that mental health issues—suicide especially—don't get the attention of other issues," says Kaplan. "I'd like the study to serve as a wake-up call."

Melissa Steineger, a Portland freelance writer, wrote the article "Up in the Air" in the spring 2007 Portland State Magazine.

Mike Goldade

A trip to the dedication of the Vietnam War Memorial in Washington, D.C., was the turning point for Mike Goldade '84. A lance corporal in the U.S. Marines during the Vietnam War, Goldade hadn't talked about the war for nearly 15 years. But traveling with veterans from Oregon to D.C., he found people who understood without words. On the way home, they decided to create a memorial in Oregon. The resulting garden, paths, amphitheater, and wall of names sit on 3.25 acres in Portland's Washington Park. Through his work with the group, Goldade, 58, became involved in support groups. Today, he is relatively happy and plans to retire within the next few years from his job as a community service officer for PSU's Campus Public Safety Office. He and his fiancée will be getting married at that time.

"It really helps to know you have things in common with people who are really close to your heart. There's something about a look of understanding. You don't get it a lot, but when you do, you know it. It helps an awful lot."

Don Cohen

Don Cohen, 74, a sergeant in the Korean War, still wakes up sweating from nightmares about his military experience. At times he has felt suicidal, asking himself, "Why did I survive?" To help him answer this and other questions, Cohen has met weekly since 1992 with a VA-sponsored support group. In 2000, he made a lasting contribution to his fellow veterans. He spearheaded the successful effort to build a Korean War Memorial in Wilsonville. Today, he is retired from a successful career in sales, including co-owning his own marketing business, and is busier than ever. He and his wife, Mayre Lee, are remodeling a second home, he's chair of an effort to build a Korean War Memorial in Vancouver, Washington, and he acts as a liaison between the Vancouver and Oregon memorial volunteers.

"It's not for me," says Cohen of the Korean War Memorial in Wilsonville. "It's for them: the guys who didn't make it. They deserve it."

Chris Goodrich

Chris Goodrich, coordinator of veteran services and undergraduate adviser at PSU, comes from a military family but was unable to serve because of physical limitations. However, his older stepbrother, Kurt Schurr, was a U.S. Marine lance corporal in Vietnam. Schurr saw horrendous carnage and suffered from Agent Orange poisoning and post-traumatic stress disorder. He never fully recovered. Two years ago, Schurr arrived on Goodrich's doorstep skeleton thin, using a cane, missing all his teeth, and clearly dangerously ill. Goodrich arranged medical appointments, but his brother had reached the end. One day Schurr walked into Goodrich's backyard and shot himself. "His note," says Goodrich, "said, 'I can't live with the pain any longer.'"

"Whenever he started going through an episode," says Goodrich in recalling his stepbrother, "he just packed up what he could carry on his back and disappeared."

Mandy Martin

Three years after coming home, Mandy Martin, a sergeant in Operation Iraqi Freedom, still hesitates before she crosses open lawns. "Explosives," she says matter-of-factly. Such hypervigilance is key to staying alive in a battle zone and hard to stop even in the safety of home. Martin, who has a 10-year-old daughter, Katrina, received counseling for post-traumatic stress disorder. Today she works for the Portland Vet Center as an outreach coordinator, speaking to veteran and civic groups about the services offered by the center.

"Counseling is a bad word in the military," says Martin. "It's a sign of weakness. But counseling helped me. I absolutely respect the strength it takes to walk through our door." Martin calls such steps 'touching the spider'—taking a step toward something you're afraid of.

Helping veterans in Portland

Two area groups offer free help for veterans and their families who experience negative effects from military service—or who simply want to talk about their experiences with people who understand or have gone through similar experiences.

The Portland Vet Center, an arm of the Veterans Administration, provides a nonjudgmental environment for veterans to connect with others who have served in the military.

The Returning Veterans Resource Project NW also provides veterans and their families with one-to-one counseling that's completely confidential—meaning that the therapy is not listed in military records or otherwise made known.

Therapist Carol Levine, MSW '72, founded the project in 2005 when she felt compelled to offer help to those who have served or had loved ones serve in Iraq and Afghanistan. She began calling colleagues and quickly had more than 30 therapists, including 13 PSU alums and one retired faculty member, eager to participate.

Now the group has become a focal point for others who want to contribute to veterans and their families, Levine says. The Web site's resource page lists everything from fishing trips to acupressure, offered free by people who have heard about the project and want to help.

For more information, contact the Returning Veterans Resource Project NW, 503-402-1717 or visit www.returningveterans.com. For Portland Vet Center resources, call 503-273-5370.