● Find palliative care providers. Palliative care is specialized medical care that is focused on providing relief from the symptoms, side effects and stress of a serious illness to improve the quality of life for the patient and the family. Unlike hospice care, which is offered when a person is approaching the end of life, usually defined as having a life expectancy of 6 months or less, palliative care can be offered earlier in the disease process. (Rapaport, 2017) important questions for researchers: Which veterans will turn to suicide, and why? While risk increases for many reasons, PTSD has emerged as one of the strongest predictors, but not every veteran develops PTSD or becomes suicidal (Moran, 2015). The veteran population tends to be affected by these factors or has access to these risk factors, thereby increasing their risk. Middle-aged male veterans are at the highest risk for suicide and rates for men older than 65 is increasing. This number may be influenced by the fact that that these individuals represent Vietnam-era veterans who are a cohort at higher risk for suicide caused by ongoing social, economic, or psychiatric difficulties. Fortunately, over the last decade substantial research has been directed toward assisting the military and veteran population, and major improvements in suicide risk detection have been made with this group (Gutierrez et al., 2019). Additionally, a number of novel intervention approaches have been generated for military personnel and veterans, such as text and smartphone app interventions (Bush et al., 2017; Comtois et al., 2019), with very promising findings that are expected to continue. ○ Delaying gratification. ○ Controlling impulses. ○ Reducing stress. ○ Knowing the difference between feelings and actions. ● Cognitive factors ○ Self-talk: conducting an internal dialogue as a way to cope with a topic or challenge or reinforce one’s own behavior. ○ Reading and interpreting social cues: for example, recognizing social influences on behavior and seeing oneself in the perspective of the larger community. ○ Using steps for problem-solving and decision-making: for instance, controlling impulses, setting goals, identifying alternative actions, anticipating consequences. ○ Understanding the perspectives of others. ○ Understanding behavioral norms (what is and is not acceptable behavior). ○ A positive attitude toward life. ○ Self-awareness: for example, developing realistic expectations about oneself. (UCLA, 2016) Social protective factors ○ Expressing feelings ○ Assessing the intensity of feelings. ○ Managing feelings. In addition to individual factors, there are social protective factors that include families, peers, communities, and schools. Positive social influences serve to strengthen, enhance, and reinforce individual protective factors. Indeed, involvement in religious activities and church attendance have been linked to reduced suicidal behavior, with social integration being an important component of this particular protective factor (Moksony & Hegedus, 2019). Other social protective factors include: ● Community and school protective factors ○ Clarity of norms and rules about behavior (e.g., drugs, violence). ○ Social organization such as links among community members, capacity to solve community problems, and attachment to community.
suicides among older adults,” Choi says (p. 777. Suicidal thoughts tend to subside over time, so making it more difficult for individuals to act on suicidal thoughts by restricting access to highly lethal suicide means such as guns is a helpful preventive measure. ● Restrict access to alcohol. Research shows that older adults often use alcohol to reduce their inhibitions about taking action on suicidal thoughts. Military personnel and veterans For military and veteran populations, suicidal behavior has become a central concern since the start of the century. Those who have served in the military have frequently been exposed to incredibly intense and frightening environments and have undergone intense psychological and physiological training that may increase their vulnerability to suicidal ideation and their ability to enact suicide plans (Bryan & Rozek, 2018; Pruitt et al., 2019). The following factors have been found to increase risk for suicidal behavior: male sex, depression, bipolar disorders, heavy drinking and alcohol-related problems (Ringer, Soberay, Rogers, Hagan, Chu, et al., 2018), and exposure to death and killing (Bryan et al., 2015). Veterans of the conflicts in Iraq and Afghanistan have a 41 to 61% higher risk of suicide than the general U.S. population, according to a 2014 study (Moran, 2015). This is higher than seen in veterans from earlier wars, prompting the U.S. Senate and the House of Representatives to unanimously pass a bill in early 2015 to improve suicide prevention programs at the U.S. Department of Veterans Affairs (VA). The numbers raise Protective factors against suicidal behavior Although the bulk of this section has focused primarily on risk factors for increased likelihood of suicidal behavior, it is also important to consider the other end of the risk spectrum and be aware of protective factors that reduce the risk for suicidal behavior. Indeed, understanding the factors that help humans flourish will improve understanding of why some people experience increased suicide risk, and how intervention factors might help them overcome future suicide risk. Protective factors should be harnessed in the suicide risk intervention process as much as possible, with clinicians bolstering existing protective factors (e.g., family support) when possible. Individual protective factors The following individual factors have been linked to reduced likelihood of experiencing suicidal thoughts and behaviors: ● Social and emotional competency. ● Resilient temperament. ● Belief in societal rules. ● Cultural and religious beliefs that discourage suicide and support instincts for self-preservation. ● Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes. ● Negative attitudes toward delinquency. ● Negative attitudes toward drug use. ● Positive academic performance. ● Attachment and commitment to school. ● Negative expectations related to drug effects. ● Perceived norms regarding drug use and violence. (McClatchey, Murray, Chouliara, & Rowat, 2019) The focus on protective factors and assets reflects the long- standing concern about how clinics, hospitals, and schools should play a greater role in promoting socio-emotional development and is part of a renewed and growing focus on youth development. After reviewing the best programs focused on preventing and correcting social and emotional problems, a consortium of professionals created the following synthesis of fundamental areas of competence and separated individual protective factors into categories of emotional, cognitive, and behavioral: ● Emotional factors ○ Identifying and labeling feelings.
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