The U.S. military has intensified its suicide prevention (search) efforts here as a result of an investigation into the self-inflicted deaths of 23 U.S. soldiers in Iraq (search) and Kuwait (search) last year, the U.S. Army said Thursday.

The Army is requiring all soldiers to take a suicide prevention class within three months of arriving in Iraq or Kuwait, said Capt. Jeff Greenlinger, an Army mental health expert. Previously, soldiers had to take the class within a year.

The Army's four combat stress teams in Iraq have also begun closely monitoring suicide attempts and visiting U.S. military units that suffer deadly attacks, Greenlinger said.

"When we hear a unit has suffered any losses, say soldiers are wounded or killed in an attack, we're trying to get Combat Stress Control (search) services to go out to them within a few days," said Greenlinger, of the 2nd Medical Brigade's mental health team. "We don't want to wait until it becomes a problem."

There were at least 23 suicides among U.S. soldiers in Iraq and Kuwait last year, according to the Army's count. That number may increase because there also are three deaths whose cause is still being investigated.

That equates to a suicide rate of 17.3 per 100,000 soldiers, compared with a rate of 12.8 for the entire Army in 2003 and an average rate of 11.9 for the Army during the 1995-2002 period, according to officials familiar with the mental health study. They spoke on condition of anonymity.

The 23 suicides do not include soldiers who killed themselves after returning to the United States.

The overall U.S. civilian suicide rate during 2001 was 10.7 per 100,000, according to the Centers for Disease Control and Prevention.

Two soldiers have killed themselves in 2004, according to the U.S. military. At that rate, soldiers appear to be taking their own lives less frequently than last year. Greenlinger said it is unclear whether prevention efforts or other factors are responsible for the drop.

Col. Bruce E. Crow, the chief psychologist at Madigan Army Medical Center at Fort Lewis, Wash., told reporters that there is very little historical data with which to compare the Iraq suicide statistics. The only wartime data the Army can find is a military-wide suicide rate for the Vietnam War that averaged 15.6 per 100,000 troops throughout the course of the war, and for the 1991 Gulf War a rate of 3.6 percent 100,000.

Col. Virgil J. Patterson III, who headed a 12-member Army mental health assessment team that visited Iraq and Kuwait between August and October last year, said their survey found that 50 percent of mental health providers reported a shortage of anti-depressant medications. The survey also found inadequate training for mental health providers and ill-defined standards of care.

The Army's efforts are the first time suicide counseling units have been stationed in a combat theater, Army Brig. Gen. Mark Kimmitt said Thursday.

"We typically see many solders who are crying out for help demonstrate suicidal [ideas] and we do what we can," Kimmitt told reporters.

He said soldiers are encouraged to keep an eye on their buddies and report signs of depression. Chaplains and commanders also watch for warning signs of suicide, Kimmitt said.

"I've seen as commander many times that a soldier will come up to their senior noncommissioned officers and say 'Hey sergeant, soldier X just isn't the same. He's drinking more than necessary and he's gotten very quiet and I know he's having some family problems,"' Kimmitt said.

When necessary, depressed troops are treated by four Army mental health units: the Army's 785th Combat Stress Control Company, and three combat stress control detachments.

The units have treated 2,008 soldiers, of whom 1,919 -- about 95 percent -- were sent back to duty, according to figures from the Army's 2nd Medical Brigade.

Some patients spend a few days or weeks away. Those sent home usually had existing mental health problems that were exacerbated by deployment, rather than combat stress, Greenlinger said.

The stress control units also conduct classes on conflict resolution, stress management and relaxation techniques.

Investigators found common threads in the circumstances of the suicides last year. The soldiers were faced with personal financial problems, failed personal relationships and legal problems, officials in Washington said.

Greenlinger said a possible reason for the drop in suicides was that the military has been notifying soldiers when their tours of duty end, instead of leaving the date open.

"When they know how long their deployment will be, that makes it a lot easier," he said.

Soldier suicides in Iraq are often reported as deaths by "non-hostile gunshot wound," leaving it unclear whether the death was self-inflicted or the result of an accident.