February 15th, 2015 Obama signed a bill to help with Suicide Prevention among Veterans. Suicide is often the result of extreme depression or PTSD.

Despite our resilient ability to cope with and recover from it, depression can sometimes result in grave consequences (including suicide) if left untreated. When depression co-occurs with other mental health conditions such as Post-traumatic Stress Disorder (PTSD) and substance abuse, its complication is even more compounded.

Especially among combat veterans, the prevalence of depression, PTSD, and suicide rate is even more staggering. According to 2012 VA Suicide Data Report, rates of veteran suicide are much higher than previously thought – approximately 22 veterans commit suicide every day.  It is further estimated that male veterans ages 18 to 24 are particularly susceptible as evidenced by their suicide rate still increasing.

New Measures

In direct response to the mounting concerns germane to mental health issues affecting veterans, Congress has recently stepped up and unanimously passed a bill on February 9, 2015 which was subsequently signed by President Obama on February 15, 2015. This bill marks yet another new phase of health care reform with significant implications highlighting the importance of prevention rather than intervention.

Under the legislation, there are multifaceted provisions aimed at improving suicide prevention via expanded mental health services for veterans.

One of the major provisions promised under the law is designed to create a peer-support pilot program whereby returning veterans will be matched with their counterparts in an effort to promote open dialogues about mental health concerns.

The measure also ensures the development of an interactive website accessible to all veterans and their family members, providing ongoing education with necessary mental health and suicide prevention resources.

This, again, is a major step toward creating preventive measures as a proactive attempt to curtail the soaring mental health issues among veterans.

Prevention vs. Intervention

In addressing any mental health conditions, prevention is known to be much more critical and effectual than intervention. This is particularly true when working with veterans and their families who are considered to be at higher risk of developing various kinds of emotional challenges.

According to a new study surveying 978 veterans, it was found that family support is inversely correlated with suicidal ideation. The results of this study confirmed that perceived family support serves as a significant protective factor against post-deployment suicidal ideation.

This sheds further light on the significance/possibility of promoting protective factors as an effective means of primary prevention in reducing suicidal thoughts among veterans. Primary prevention can be delivered via various training and education programs designed to prepare veterans for exposure to potentially traumatic experiences while empowering them to draw upon their own resilient power to cope. Primary prevention can also be instrumental in reducing the likelihood of development of PTSD and other trauma-related symptoms often resulting in suicide.

In addition to families, the concept of hardiness is another protective factor which can be integrated as an important part of primary prevention tools. Hardiness can be promoted via three key elements of perceived strength as follows:

• ability to perceive control over life’s adversities and events;
• ability to make strong commitment to roles and responsibilities; and
• ability to see stressful experiences as a challenge to overcome and an opportunity to grow.

More often than not, it is the perceived lack of power to cope that elevates the risk of suicide among veterans. Therefore, it is imperative that more training programs and government policies be targeted at promoting hardiness with the goal of increasing the individual's ability to resist the negative effects of traumatic stress. In particular, the following steps can be incorporated as part of pre-trauma preparation to maximize its potential outcome:

1.  Provide realistic training that includes simulated or actual exposure to traumatic stimuli that may be encountered (e.g. exposure to live weapons fire or survival training via mock training).

2.  Strengthen perceived ability to cope during the trauma and with the aftermath.  Application and practice of realistic coping skills (e.g., stress inoculation training, problem-solving, assertion, and cognitive restructuring) could further help develop high tolerance level for stressful environments.

3. Create supportive interpersonal work environments that are likely to provide significant social support during and after traumatic events. Building a strong support system is critical in mitigating the impact of any anticipated trauma or its aftermath. As mentioned earlier, families play a crucial role in post-trauma support and can be further empowered in providing necessary social support.

4. Develop and maintain adaptive beliefs about the traumatic environment and its meaningfulness so as to fortify one’s perceived power to realistically respond to the trauma.

5. Develop comprehensive traumatic stress management programs which can serve as a significant source of post-trauma support that can simultaneously minimize any residual impacts of the trauma.

Consistent with empirical research on risk and resilience factors, these specific steps of pre-trauma/pre-deployment preparation can help promote one’s ability to cope during the trauma itself while fostering post-trauma adaptation with lower risk of developing any severe mental conditions.

More specifically, research on risk factors for PTSD indicates that lack of post-trauma social support can significantly increase the likelihood of development of the disorder while the presence of protective factors can mitigate the negative effects of the stress.  Further research is in order to explore additional ways in which resilience to stress may be cultivated.

Conclusion

As a nation, we have come a long way in terms of raising public awareness and making necessary reforms in the field of mental health. All of the efforts and new initiatives notwithstanding, there are still many challenges facing the country’s suicide prevention and mental health treatment programs. The access to mental health services for veterans must be expanded and made available more readily in order to ensure timely diagnosis in conjunction with appropriate treatment plans. This will be critical from both the prevention and intervention standpoint.

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References

Evidence Based Guidelines for Treatment of Post-Traumatic Stress (2015). Retrieved http://ce4less.com/MyAccount.aspx

Oppel Jr., R. February 3, 2015. Preventing Suicides Among Veterans Is at Center of Bill Passed by Senate. The New York Times. Retrieved http://www.nytimes.com/2015/02/04/us/bill-aimed-at-improving-mental-health-treatment-for-veterans-passes-senate.html.

Science Daily. March 16, 2015. Study of Veterans Finds Family Support During Deployment Reduces Suicidal Thoughts. Retrieved http://www.sciencedaily.com/releases/2015/03/150316122715.htm

Veterans and PTSD. February 14, 2015. Veterans statistics: PTSD, Depression, TBI, Suicide. Retrieved http://veteransandptsd.com/PTSD-statistics.html.