For John Helfert, the problems started with the mortar shells screaming into the Abu Ghraib prison compound, the explosions sending furious shock waves.
"You don't feel like there is any place to go," said Helfert, then a Marine lance corporal in an infantry unit at the infamous prison. "You are sitting in a building or a tower, not knowing where the mortars are coming from. You feel like you are going to die."
Then there was the stress from the patrols escorting convoys.
By the time he left the service in 2008, Helfert said he was suffering from depression and Post Traumatic Stress Disorder that strained his marriage and nearly ruined his life.
"I had road rage really bad," said Helfert, 31, a full-time student at the University of Tampa. "Things would bother me. Dogs barking. Helicopters flying. Planes from MacDill."
The stress got so bad that last October, he began thinking about ending his life.
Life-and-death struggle
Once every 36 hours, a US service member commits suicide, according to the US Department of Defense. In Tampa, the James A. Haley Veterans' Hospital sees about 20 patients a week identified as being at risk for committing suicide.
Statewide, more than 3,700 people identifying themselves as having been in the armed services committed suicide between 2004 and 2009, according to a study to be released in November by the University of South Florida's College of Behavioral and Community Sciences.
As the war in Afghanistan drags on, service personnel make multiple deployments and antipathy toward U.S. involvement abroad increases at home, suicides in the military have reached alarming proportions, military officials and health professionals say.
The issue gained national attention last month with the news of four suicides in a week at Fort Hood in Texas.
But for veterans such as Helfert, and those who continue to serve, it is a life-and-death struggle that has been taking place in the shadows for years.
"I was contemplating suicide," he said. "Self-medication was my way out of this. That was kind of when I knew I really needed to get help."
Hundreds died last year
With so many service people taking their own lives - 309 last year, 267 in 2008, according to the US Department of Defense - the military has publicly ramped up its efforts to address the issue.
Since 2003, the US Army has been sending Mental Health Advisory teams to Afghanistan and Iraq to gauge soldiers' stability.
Last year, the US Army, in conjunction with the National Institute of Mental Health, launched a $50 million study to find new ways to prevent suicides. At a news conference, Gen. Peter Chiarelli, the US Army's vice chief of staff, voiced a need for change by the service most affected by suicides.
"In the past, our training programs were ones of avoidance," he said. "We tried to avoid. And we then would treat or discipline soldiers. That has changed today. The goal is to assess, educate, train and intervene early in an effort to identify and mitigate issues before they can become significant concerns."
Despite efforts to improve mental health services, the military admits that it is having trouble keeping pace.
The Department of Defense Task Force on The Prevention of Suicide by Members of The Armed Services released a report in August offering a dire view of the military's ability to cope as suicide rates increase.
PHOTO CAPTION
US soldiers relax at the "Resiliency Campus" which opened in early September at Contingency Operating Base Basra in southern Iraq, on September 2010.
Source: Agencies