Veterans Affairs committee  I think it's very important to understand, as you're saying, that with a higher level of exposure to combat and the witnessing of atrocities, there seems to be a “dose” response relationship. If you had a peacekeeping mission in which the soldier didn't see much combat or didn't observe any atrocities, he or she would not have as much of a risk.

Veterans Affairs committee  This was addressed in a study by Rona in the British Medical Journal, using U.K. data. They looked at screening for mental health problems prior to entrance into the military and whether that would predict future problems. If someone had a history of mental illness, depression, or anxiety, would that person have a higher likelihood of post-deployment mental health problems?

Veterans Affairs committee  Do you want to answer?

Veterans Affairs committee  Some of the U.K. folks tried to look at this. At this point, there isn't any evidence that pre-screening.... It makes a lot of sense to do some cognitive therapy or some skills building that helps build resilience prior to deployment. Those kinds of studies are actually very important and necessary, but they haven't been done.

Veterans Affairs committee  A post-deployment screening has been developed and is being collected. Mark Zamorski has been doing this. The challenge is more awareness for the family, as well as for the soldier, and as you were saying, the peer support. As the person leaves the military it is a challenge, and this is the difficulty.

Veterans Affairs committee  Yes. I mean, this is the real difficulty. One of the challenges, if someone is extremely depressed and a family member is concerned, is whether he should be hospitalized against his will. That becomes an issue in such cases. The challenge is that not all suicides are preventable.

Veterans Affairs committee  Right. As you're saying, it is a challenging issue, how you track and support these people. The U.K. study showed that for young soldiers leaving the military, that was the time of highest risk. Probably the first year after is the highest risk of all, but it can happen at any time.

Veterans Affairs committee  Just to be clear, these data were collected by Statistics Canada. We didn't collect the data. Statistics Canada did a mental health survey of all Canadians in 2002. As part of that, the Canadian Forces then commissioned Statistics Canada to do a representative sample. So we weren't involved in the data collection.

Veterans Affairs committee  We specifically looked at the impact of peacekeeping on the mental health of soldiers. I'm sorry, but I don't remember what he specifically recommended in his book around suicide prevention.

Veterans Affairs committee  Perhaps I may add to that comment. We were surprised by that finding, as you are. We were expecting combat and peacekeeping to be associated, but as Ms. Belik mentioned, the outcomes there were suicide ideation and suicide attempts. Deaths by suicide were not assessed. One of the important things that we didn't put in the report was that we don't have data on soldiers after the Afghanistan mission.

Veterans Affairs committee  Around suicide, there isn't any literature around that; I know that's certainly a very important part of the support to the veterans. No one has ever looked at whether an intervention through gatekeeper training, where you train people to be aware of suicide risks, would have an impact on their capacity to help.

Veterans Affairs committee  The other thing I want to add is that, as Ms. Belik mentioned in her report, motor vehicle accidents are a very common cause of death, and sometimes it's not very clear to the coroner whether the accident was a suicide or an accident. It's a challenging issue. Some work from Europe has shown that the risk factors for accidents in peacekeepers were very similar to the risk factors for suicide in peacekeepers: impulsivity and alcohol abuse in young males.

Veterans Affairs committee  We published a paper in 2007 using the Canadian Forces data set, the same data set, basically showing what Senator Dallaire really talked about in his book, that Canadian soldiers who had been involved in combat or witnessed atrocities like human massacres were at about two to three times the risk of developing not just post-traumatic stress disorder but also major depression, alcohol problems, a self-perceived need for mental health.

Veterans Affairs committee  I think that's a very difficult question. I guess in the Korean War, the families didn't hear anything, and now it's almost become a challenge. I was at a NATO meeting a few years ago where they were talking about suicide specifically. One of the issues that came up for American soldiers is that sometimes there'd be a loss of a relationship in the family, where, say, the spouse has now left the soldier and has then sent that over by e-mail, and the soldier then becomes of course quite upset and suicidal.

Veterans Affairs committee  Suicide.