As British soldiers prepare to leave Iraq, Laura Miller asks what is it about the conflict that has led so many soldiers to take their own lives?

A sun blushed soldier in desert fatigues and freckles kneels and smiles into the camera. His nose is pink, suggesting he has only recently arrived into the heat from Britain. Staged behind him and leaning in are a gaggle of Arab children, curious if a little unsure. In the middle of the composition,  the last four inches of the barrel of the soldier's rifle are just visible.

The professionally shot image dominates the  'deployment and working overseas' page of the British Army recruitment website, above phrases that echo a holiday brochure: 'International travel is a key part of Army life, giving you the opportunity to experience different places and cultures, with the full support of a team.'

Nowhere on the site does it give an indication as to why within a ten week period from December 2008 to February 2009 three British army personnel would commit suicide, bringing the total number of soldier suicides in Iraq to at least 15 since the 2003 invasion – 8% of all British military deaths in the war.

But then nowhere on the site are the pictures of the bloody, dead and dying that UK news channels streamed daily out of the war ravaged country during the last six years, and now, as British troops prepare to leave, appear less and less. The only allusion to the realities of soldering is in 'Tough Questions', a list of pre-prepared answers to frequent enquiries.

Number three -  'Will I have to go to war and if so will I have to kill?' – seemingly demands either a yes, no, or several volumes of existentialist philosophy. The website gives: 'As a member of the Army you may be required to carry out operational duties around the world which may involve  hostile conflicts.'

Corporal Lee Churcher, 32, Lance Corporal David Wilson, 27, and 21 year old Private Ryan Wrathall all took their lives in what reports suggest to be unrelated incidents at the British Army headquarters in Basra. Conchi Bullen, mother of Private Wrathall, the youngest and most recent to die, told her local her Surrey paper: “It is unbelievable. I just don’t understand it because he had so much going for him. I was always there to help Ryan so I don’t know why."

Little official explanation has been given as to why the two current wars have caused such depressing figures. The number of American soldiers who have taken their own lives is even more startling. A report by the US Defense Department revealed 177 'self inflicted' deaths between 19 March 2003 and 28 February 2009.

The icasulties website, which counts Iraq coalition casualties, puts the figure at 181. In March this year the US Senate Armed Services Committee met to discuss the rising suicide rate among U.S. ground troops in Iraq and Afghanistan after 2008 saw the US Army experience its highest suicide rate on record – 140 soldiers across both war zones. 48 active American military personnel have already killed themselves this year, including one US sergeant who while serving in Bagdad in May murdered five colleagues before turning the gun on himself.

At that rate the suicide toll is expected to jump to 225 by the end of 2009. And in the case of all allied forces, the number of attempted suicides among soldiers serving and returned from the Middle East is estimated to run into the thousands.

Both the British and American defence ministries are notoriously adept at giving anything but the brightest picture of the daily realities of life in a war zone. And military personnel are not allowed to give out details of their experiences without permission from their commanding officers.

The passing of the Freedom of Information Act (2000), however, has forced the Ministry of Defence (MoD) to make public more of its statistics. In a report just released last week by the MoD reveals nearly 7000 new attendances at MoD Departments of Community Mental Health between January 2007 and March 2008.

Of those, nearly 5000 were assessed as having a mental disorder. In a study of 659 new patients seen between 1^st January and 31^st March 2008 who had been deployed in Iraq or Afghanistan since October 2005, 489 were assessed by the MoD as having a mental disorder, the majority of which had served in Iraq.

The report stated: The rate of neurotic disorders was higher in those who had deployed to the Iraq or Afghanistan theatres of operation than in those who had not deployed there. This finding was echoed in the sub-groupings PTSD [post traumatic stress disorder] and adjustment disorders.'

Dr Robert C Scaer, psychologist, neurologist, and author of The Body bears the Burden: Trauma, Dissociation and Disease, describes PTSD as a natural emotional reaction to a deeply shocking and disturbing experience. It is a normal reaction to an abnormal situation: 'When the trauma is inflicted by another person, is especially intense, or the traumatized person is extremely close to the trauma, the severity of traumatization may be especially profound.'

Suicide is a widely recognised symptom of PTSD. Yet only one comprehensive study has examined the mental health impact of the wars in Afghanistan and Iraq (Hoge et al., 2004). Published in the New England Journal of Medicine, the study evaluated US Army and Marine Corps soldiers' reports of their experiences in the war zones and reports of symptoms of psychological distress.

The results indicated that the estimated risk for PTSD from service in Afghanistan was 11%. For the war in Iraq that rose to 18%.

The study's authors noted: 'Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage [showing] major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq than after duty in Afghanistan or before deployment to Iraq (9.3 percent).'

Back in Britain, Michael Ivatt is waiting for the true PTSD picture to hit: "It takes many years, maybe up to ten years to come through. We haven't even begun to see the spike yet."

Michael works for SSAFA, the Soldiers', Sailors', Airmen and Families Association (SSAFA), a largely voluntary group that has been providing practical support for current and ex-British service personnel and their families for over a century.

The idea that war can inflict deep and lasting psychological wounds is not new. But what is it about the Iraq conflict that is driving so many soldiers to suicide? Writing for the National Center for Post Traumatic Stress Disorder website at the US Department for Veterans' Affairs (VA) – the UK has no similar formal body – Professor William Hudenko cites multiple wounding, frequent hospitalisation, the intensity of the combat trauma, and the number of times it occurred, as key factors that influence suicide risk in veterans with PTSD.

Many of the soldiers serving in Iraq who have committed suicide have never been hospitalised, including the most recent case of Private Ryan Wrathall.

But Professor Hudenko acknowledges another correlation, one more likely to affect a greater number of soldiers: 'Other research on veterans with combat-related PTSD suggests that the most significant predictor of both suicide attempts and preoccupation with suicide is combat-related guilt.

Many veterans experience highly intrusive thoughts and extreme guilt about acts committed during times of war. These thoughts can often overpower the emotional coping capacities of veterans.' Michael agrees with the professor's findings but doesn't believe the war in Iraq is a special case:

"Any conflict has it, people are going to come back with experiences, it's how they deal with it that matters. War is always going to be a nasty business, but people sign up for the challenges. Most people are proud to do it." Asked about how good the MoD is at dealing with cases of PTSD he is quick to say they do a lot more now than they used to.

"The armed forces have a macho culture, but now people are being encouraged more to talk about it."

In the 2004 American study out of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. The main reason the remaining 60% did not seek help, the authors found, was that they were twice as likely as those who didn't present symptoms to report concern about possible stigmatization, loss of career advancement opportunities and other barriers as a result of seeking help.

Despite changes in practice, the British military have been slow to address the impact of stigmatisation.

As recently as March this year, in the wake of the death of Private Wrathall and its quick succession from the two prior suicides at the base, the British Army took the unprecedented step of launching a "suicide watch" at Basra.

According to the Daily Telegraph, preventative measures now include a poster campaign calling for troops to look out for colleagues who appear to be exhibiting suicidal behaviour, mood swings and symptoms of PTSD. One of the posters states: 'Never let your mate fight alone. Worried about someone in your team? Be willing to listen. Not all wounds are visible.'

In the absence of recent measures many have resorted to alcohol, drugs, and other obsessive behaviour such as gambling, using self-medication as a refuge from emotional or mental distress. Medication is also often the military's first line of defence against PTSD. The US National Center for PSTD Iraq War Clinician Guide states:"We recommend Selective Serotonin Reuptake Inhibitors (SSRIs) as first line medications for PTSD pharmacotherapy in men and women with military-related PTSD.

Findings from subsequent large-scale trials with paroxetine [Paxil] have demonstrated that SSRI treatment is clearly effective both for men in general and for combat veterans suffering with PTSD." But Martha Rosenberg, a writer on the impact of the pharmaceutical industry on the public's health, argues the current trend for pumping soldiers and ex-soldiers full of pills is not the answer to lowering military suicide rates: 'Why are suicides among Iraq war soldiers twice that of other wars?

One reason could be that 80 percent of troops with PTSD are given drugs that didn't exist during other wars. Antidepressants like Prozac, Zoloft, Paxil and Celexa (SSRIs) and Cymbalta and Effexor (Serotonin Norepinephrine Reuptake Inhibitors or SRNIs) that are so closely associated with suicide they carry suicide warnings.'

Rosenberg is not alone in linking the modern method of treating PTSD with its cause. Colonel Kathy Platoni, chief clinical psychologist for the Army Reserve and National Guard, told CNN in February that combined with multiple deployments and the stigma associated with seeking treatment, the excessive use of anti-depressants are a concern for mental health professionals who work with soldiers: "The anti-depressants prescribed to soldiers can have side effects that include suicidal thoughts.

Those side effects reportedly are more common in people 18 to 24." Her statement followed a January in which 24 US soldiers took their own lives, more than those who died in combat.

Of course, the number of Iraqi and Afghan civilians killed as a result of the two conflicts dwarfs that of those from the allied forces; over a million are estimated to have been killed so far. It is a startling number for a military operation sold as war to liberate the peoples of those two countries, and one that sits uneasily with the British army website's image of a benevolent soldier next to smiling local children.

As British soldiers prepare to leave Iraq it will be many years before the true cost of the Second Gulf War, to both the soldiers who carried it out and the population they leave behind, will ever truly be counted.