Reports of harsh living conditions and deployment strain aboard aircraft carriers like the USS Abraham Lincoln have brought renewed attention to military mental health. Addressing these challenges, psychiatrists Ronald Kessler of Harvard Medical School and Harold Kudler of Duke University discuss the realities of screening and care at sea.
In a recent JAMA Psychiatry study, Kessler’s team demonstrated how predictive algorithms can flag service members at risk for suicide or suicide attempts using administrative data. While Kessler suggests pairing these models with shipboard interventions such as resilient “battle buddies,” an approach that remains untested, Kudler, previously the chief consultant for mental health at the U.S. Department of Veterans Affairs, emphasizes that even robust onboard care can falter when extreme operational conditions push personnel beyond human endurance.
The following is a transcript of their remarks:
Kudler: There probably is no more dangerous work site than the flight deck of an aircraft carrier. How many clinician hours is it going to take to touch 5,000 people? It’s not going to happen.
The Stigma and Disclosure Gap
Kessler: Medical records are not confidential the way they are in the general population. Soldiers know this. If a service member says they are depressed and their unit is slated to deploy to Germany, they might be excluded from that deployment because the commander is aware of the disclosure.
So in an earlier paper, we found that over 90% of suicide attempts and deaths occurred when individuals were asked during annual physicals, “So tell me, you ever think about killing yourself?” Their responses were “Nope, never.” Those questions do not work.
Kudler: The military has developed multiple levels of mental‑health intervention, but a powerful social pressure remains. Military culture prizes fitness and readiness, and the mission is paramount. Admitting feelings of being unprepared or losing edge is discouraged.
These cultural barriers impede the use of otherwise excellent programs, whether in military treatment facilities or aboard ships.
Predictive AI and On‑Deck Support
Kessler: We built a machine‑learning model that outperforms traditional periodic health assessment self‑report data. The model showed that roughly 10% of soldiers at highest risk account for about 50‑60% of all suicidal behaviors.
Commanders could use this risk information, but operational constraints remain. One idea is to assign a high‑risk individual a “battle buddy” with strong resilience. The concept is untested and would be a natural experiment, yet it could be a small tweak with a big positive impact.
Kudler: The USS Abraham Lincoln likely fields a mental‑health team that includes psychiatric technicians. These personnel are peers—noncommissioned officers or lower—who are more approachable than senior officers. Talking to someone of the same rank makes disclosure easier.
Even at the VA, World War II veterans told me they avoided telling an officer about problems because it would not end well. A conversation with a fellow seaman, however, works far better.
The Limits of Endurance
Kudler: Living with 5,000 people in cramped quarters on an aircraft carrier creates intense stress. It is a high‑intensity environment where every job affects personal and unit safety.
These timeless lessons about human limits must be respected, regardless of medical advances or cultural changes.
Kessler: The world is chaotic and stressful everywhere. We can strengthen resilience in vulnerable individuals to help them cope, or we can try to change the environment. Both approaches matter.
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