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People experience emotional and mental health crises in response to a wide range of situations—from difficulties in their personal relationships to the loss of a job. For Veterans, these crises can be heightened by their experiences during military service. Many Veterans may not show any signs of intent to harm themselves before doing so, but some actions can be a sign that a Veteran needs help. Veterans in crisis may show behaviors that indicate a risk of harming themselves.

 

 RISK FACTORS

"Risk factors" refers to an individual's characteristics, circumstances, history and experiences that raise the risk for suicide.

HOW TO READ THE 'NEGATIVE LIFE EVENTS THAT INCREASE SUICIDE RISK' LIST: Having experienced any one (or even several) of the items listed in the Negative Life Events list does not necessarily mean that a person is suicidal or contemplating self-harm. However, these negative experiences do increase the risk of suicidal behavior when compared with individuals who have not experienced such events.

INCREASED DISPOSITION TO ENGAGE IN SELF-HARM: When compared with individuals who have not experienced these events, the occurrence of an immediate "precipitating event" such as a personal crisis may increase the suicide risk for people who have previously encountered the life events noted in the Negative Life Events list.

 

NEGATIVE LIFE EVENTS THAT INCREASE SUICIDE RISK:

  • History of one or more prior suicide attempts.
  • Family history of suicide.
  • Exposure to the suicidal behavior of others.                                                                                                                          
  • History of violence or hostility.
  • History of family violence.
  • History of physical or sexual abuse.
  • Psychiatric illness.
  • Family history of mental disorder or substance abuse.
  • Chronic physical illness, including chronic pain.
  • Loss of health (real or imaginary).
  • Recent, severe loss (especially a marriage or relationship), or threat of significant loss.
  • Being faced with a situation of humiliation or failure.
  • Recent or impending incarceration.
  • Difficult times: holidays, anniversaries, and the first week after discharge from a hospital; just before and after diagnosis of a major illness; just before and during disciplinary proceedings.
  • Assignment or placement into a new and/or unfamiliar environment.
  • Difficulty adjusting to new demands and different workloads.
  • Lack of adequate social and coping skills.
  • Academic, occupational, or social pressures.
  • Loss of job, home, money, status, self-esteem, personal security.

OTHER RISK FACTORS RELEVANT TO MILITARY LIFE:

  • Male gender.
  • Caucasian race.
  • E-1 to E-2 rank.
  • Younger than 25 years of age.
  • GED/less than high-school education.
  • Divorce or recent relationship failure.
  • Regular component.
  • Drug and Alcohol Abuse.
  • Relationship Problems.
  • Legal, administrative, and financial problems.

 

PROTECTIVE FACTORS

Protective factors are skills, strengths, or resources that help people deal more effectively with stressful events. Protective factors enhance resilience and help to counterbalance risk factors (negative life events such as academic, occupational, or social pressures). Protective factors may be personal, external, or environmental. A protective factor reduces the likelihood of attempting or completing a suicide. Increasing protective factors can decrease suicide risk. Strengthening protective factors should be an ongoing process to increase resiliency when increased risk factors or other stressful situations occur. Positive resistance to suicide is not necessarily permanent; programs that support and maintain protection against suicide should be ongoing.

Personal Protective Factors

  • Attitudes, values, and norms prohibiting suicide, for example strong beliefs about the meaning and value of life.
  • Positive social skills, such as decision-making, problem-solving, and anger management.
  • Good health and access to mental and physical health care.
  • Strong connections to friends, family, and supportive significant others.
  • Cultural, religious or spiritual beliefs that discourage or prohibit suicide.
  • A healthy fear of risky behaviors and pain.
  • Hope for the future; optimism.

Sobriety

  • Medical compliance and a sense of the importance of health and wellness.
  • Impulse control.
  • Strong sense of self-worth or self-esteem.
  • Sense of personal control or determination.
  • Good frustration tolerance and ability to regulate emotions.
  • Positive beliefs about the future, ability to cope and life in general.
  • Access to a variety of clinical interventions and support for help-seeking.
  • Coping skills.
  • Resiliency.
  • Reasons for living.
  • Being married or a parent.

External/Environmental Protective Factors

  • Strong relationships, particularly with family members.
  • Opportunities to participate in and contribute to school and/or community projects/activities.
  • A reasonably safe and stable environment.
  • Restricted access to lethal means.
  • Responsibilities/duties to others.
  • Pets.
  • Spirituality.
  • Sense of Belongingness.

 

WARNING SIGNS

Definition: Suicide is the deliberate taking or ending of one's own life. It is often associated with a severe crisis that does not go away, that may worsen over time, or that may appear hopeless. Friends or loved ones in crisis may show signs that indicate that they are at risk of attempting or committing suicide.

Warning Signs:

  • People who are considering suicide often show signs of depression, anxiety, or some form of crisis in their overall self-esteem. Specific signs include:
  • Appearing sad or depressed most of the time.
  • Clinical depression - deep sadness, loss of interest, trouble sleeping and eating - that doesn't go away or that continues to get worse.
  • Feeling anxious, agitated, or unable to sleep, or sleeping all the time.
  • Neglecting personal welfare; deteriorating physical appearance.
  • Withdrawing from friends, family, and society.
  • Loss of interest in hobbies, work, school, or other things one used to care about.
  • Frequent and dramatic mood changes.
  • Expressing feelings of excessive guilt or shame.
  • Feelings of failure or decreased performance.
  • People who are considering suicide:
  • Feel hopeless, helpless, worthless.
  • Feel that life is not worth living or see no reason for living.
  • Have no sense of a life purpose.
  • Have feelings of desperation, and say that there's no solution to their problems.
  • Talk about feeling trapped - like there is no way out of a situation.
  • People who are thinking about ending their lives are often preoccupied with death or suicide. They may:
  • Talk of a suicide plan or making a serious attempt.
  • Frequently talk or think about death, or say things like "It would be better if I wasn't here", or "I want out".
  • Talk, write, or draw pictures about death, dying, or suicide when these actions are out of the ordinary for the person.
  • Talk about suicide in a vague or indirect way, saying things like: "I'm going away on a real long trip"; "You don't have to worry about me anymore"; "I just want to go to sleep and never wake up"; or "Don't worry if you don't see me for a while".
  • A person who is contemplating ending their life may show behavior that looks as though he or she is "getting ready", and do things like:
  • Give away prized possessions.
  • Put affairs in order, tie up loose ends, and/or make out a will.
  • Seek access to firearms, pills, or other means of harming oneself.
  • Call or visit family and/or friends as if to say goodbye.
  • People who are considering suicide may show dramatic changes in behavior, such as:
  • Performing poorly at work or school.
  • Acting recklessly or engaging in risky activities - seemingly without thinking.
  • Looking as though one has a "death wish" such as tempting fate by taking risks that could lead to death, or driving fast or running red lights.
  • Taking unnecessary risks; behaving in a reckless and/or impulsive manner.
  • Show violent behavior such as punching holes in walls, getting into fights or self-destructive violence; feeling rage or uncontrolled anger or seeking revenge.
  • Show a sudden, unexpected switch from being very sad to being very calm or appearing to be happy, as if suddenly everything is okay.
  • People who are considering suicide may be experiencing severe loss or potential future lossthat may intensify suicidal thoughts, such as:
  • Real or potential loss or break-up of marriage or important relationship.
  • Combat-related losses.
  • Loss of one's health.
  • Loss of job, home, money, status, self-esteem, personal security.
  • Being faced with a situation of humiliation or failure, such as loss of status or position due to injury or impending disciplinary actions.
  • Other warning signs of suicide risk may include:
  • Increasing tobacco, alcohol or drug use.
  • Signs of self-inflicted injuries, such as cuts, burns, or head banging.
  • May be unwilling to "connect" with potential helpers, i.e., counselor, chaplain, etc.

 COPING

WHAT IF I LOSE SOMEONE TO A SUICIDE?

Individuals experience grief uniquely and at their own pace. For some, the experience of grief following a loss can be intense, complex, and long term, while others are able to more readily ‘move on’. The grieving process varies from individual to the next because of many factors: having coped with prior losses; the quality of the relationship with the deceased; the availability of a support system, and so on. What is certain is that the lives of the survivors will be different. At first, and periodically during the next days and months following the loss, survivors may feel an array of sometimes overwhelming emotions. The expression of varying emotions, sometimes accompanied by tears, is a natural part of grieving. Common feelings experienced during grieving include: abandonment, depression, hopelessness, sadness, anger, despair, loneliness, self-blame, anxiety, disbelief, numbness, shame, confusion, guilt, pain, shock, denial, helplessness, rejection, and, of course, general life stress.

WITH SO MANY FEELINGS TO MANAGE, HOW CAN I COPE?

  • Take things one day at a time.
  • Know you can survive; you may not think so, but you can.
  • Consider getting professional help.
  • It is okay to not understand "why" it happened; suicide may be difficult to understand and we often are left with unanswered questions.
  • Know you may feel overwhelmed by the intensity of your feelings but that all your feelings are normal.
  • Contact a support group or organization for survivors such as TAPS. TAPS is the 24/7 tragedy assistance resource for anyone who has suffered the loss of a military loved one. Their toll-free hotline number is 1-800-959-TAPS (8277).
  • Find a good listener with whom to share. Call someone if you need to talk.
  • Don't be afraid to cry. Tears are healing.
  • Give yourself time to heal.
  • Remember, the choice was not yours. No one is the sole influence on another's life.
  • Expect setbacks. If emotions return like a tidal wave, you may only be experiencing a remnant of grief, an unfinished piece.
  • If possible, delay major decisions.
  • Be aware of the pain your family and friends may be feeling too. Talking about the person and grieving together can be healing.
  • Be patient with yourself and others who may not understand.
  • Set limits and learn to say no.
  • Avoid people who want to tell you what or how to feel.
  • Call on your personal faith to help you through.
  • It is common to experience physical reaction to your grief, e.g. headaches, loss of appetite, inability to sleep.
  • It is okay to laugh; it may even be healing.
  • Accept your questions, anger, guilt or other feelings until you can let them go.
  • Letting go doesn't mean forgetting.
  • Know that you will never be the same again, but that you can survive and even go beyond just surviving.

FAMILY AND FRIENDS

  • Trust your instincts that the person may be in trouble.
  • Communication needs to include mostly listening.
  • Talk with the person about your concerns.
  • Ask direct questions without being judgmental, such as:
  • "Are you thinking about killing yourself?"
  • "Have you ever tried to end your life?"
  • "Do you think you might try to kill yourself today?"
  • Determine if the person has a specific plan to carry out the suicide. The more detailed the plan, the greater the risk:
  • "Die by suicide?"
  • "Have you thought about ways that you might kill yourself?"
  • "Do you have pills/weapons in the house?"
  • Do not leave the person alone.
  • Do not swear to secrecy.
  • Do not act shocked or judgmental.
  • Do not counsel the person yourself .
  • Get professional help, even if the person resists.

SERVICE MEMBERS AND VETERANS

  • Calling old friends, particularly military friends, to say goodbye.
  • Cleaning a weapon that they may have as a souvenir.
  • Visits to graveyards.
  • Obsessed with news coverage of the war, or the military channel.
  • Wearing the military uniform or part of the uniform, boots, etc., when such dress is not indicated.
  • Talking about how honorable it is to be a soldier.
  • Sleeping more (sometimes the decision to commit suicide brings a sense of peace of mind, and sleep is used as a means of withdrawing).
  • Becoming overprotective of children.
  • Standing guard of the house, perhaps while everyone is asleep; staying up to "watch over" the house; obsessively locking doors, windows.
  • Stopping and/or hording medication.
  • Hording alcohol (not necessarily hard alcohol, could be wine).
  • Spending spree, buying gifts for family members and friends "to remember by."
  • Defensive speech, for example: "You wouldn't understand."
  • Stop making eye contact or speaking with others.

Defense Suicide Prevention Office

                                                                                                    WHO WE ARE

Established in November 2011, the Defense Suicide Prevention Office (DSPO) is part of the Department of Defense’s Office (DoD) of the Under Secretary of Defense for Personnel and Readiness.

DSPO oversees all strategic development, implementation, centralization, standardization, communication and evaluation of DoD suicide and risk reduction programs, policies and surveillance activities. To reduce the impact of suicide on Service members and their families, DSPO uses a range of approaches related to policy, research, communications, law and behavioral health. DSPO works with the Army, Navy, Air Force, Marine Corps, Coast Guard and National Guard Bureau to support our Service members and strengthen a resilient and ready force. DSPO strives to help foster a climate that encourages Service members to seek help for their behavioral health issues.

MISSION

Serve as the DoD oversight authority for the strategic development, implementation, centralization, standardization, communication, and evaluation of DoD suicide and risk reduction programs, policies, and surveillance activities to reduce the impact of suicide on Service members and their families.

VISION

Enable total force fitness through suicide prevention and resilience programs and policies to ensure Service members and their families overcome risk factors and are mission ready from entry on duty to retirement or separation.

Acknowledgments:

http://www.suicideoutreach.org/                            http://www.suicidepreventionlifeline.org/