key: cord-0721051-xzs97p9n authors: Levine, Joshua; Sher, Leo title: The prevention of suicide among military veterans during the COVID-19 pandemic date: 2021-01-02 journal: Eur Arch Psychiatry Clin Neurosci DOI: 10.1007/s00406-020-01217-9 sha: 3ed4f3b0769acaf033ecd0d6848d15c8ce0ecfa4 doc_id: 721051 cord_uid: xzs97p9n nan alcohol abuse, PTSD, depression, and psychosocial stressors [2] . Another study that reviewed healthcare records of 2,674 nonveterans who died by suicide concluded that physical health conditions increased suicide risk in these individuals, most prominently TBI, sleep disorders, and HIV/AIDs [7] . The current COVID-19 pandemic may have profound impacts on population mental health and suicide risk, and could have lingering effects [5, 6] . Multiple researchers have identified social isolation, economic problems, anxiety, and uncertainty as factors that can increase suicide risk during a pandemic [5, 6] . These factors may also result in new mental health problems [5, 6] , exacerbate pre-existing psychiatric disorders [5, 6] , or lead to increased alcohol consumption and illicit substance abuse [6] . Military veterans are already at heightened risk of psychiatric disorders and substance abuse [3] , and the negative impacts of the pandemic may increase their risk of suicide. Sadly, the COVID-19 pandemic has already contributed to the suicide death of a decorated U.S. combat veteran [8] . This veteran who served in the Marines and lost his leg in 2011 from an IED blast in Afghanistan, took his own life on May 1, 2020 [8] . His family attributed his suicide to the social isolation caused by the pandemic [8] . Unfortunately, mental health treatment may not be prioritized at this time due to overcrowded and overwhelmed healthcare systems, and some hospitals turning people away without appointments [5] . Mental health professionals should take a proactive approach and conduct frequent and regular outreach [6] , especially with military veterans who have a history of suicidal behavior or attempts. Military veterans should be encouraged to stay in touch with their mental health providers, and engage in social contact with family, friends, and other veterans. Mental health treatment needs to be adjusted to accommodate the use of technology [5, 6] . In addition, there should be more crisis helplines staffed by mental health professionals with knowledge of military veteran suicide risk factors, and evidence-based online mental health resources freely available on a large scale [5] . The pandemic has been receiving mass media attention. Media reports on the COVID-19 pandemic can be traumatizing and anxiety-inducing [6] . Military veterans may be sensitive to new traumatic experiences because of their higher rates of trauma histories or psychiatric diagnoses [1, 3] . In this atmosphere of anxiety and uncertainty, reports on suicide need to be reasonable and responsible. Media coverage should follow specific guidelines on suicide reporting [9] . Economic crisis resulting from the pandemic may increase suicide risk [5, 6] . Military veterans who are experiencing economic problems should be provided with financial help. Gunnell et al. recommends that governments provide 'financial safety nets' such as food, housing, direct payments, and tax credits [5] . A major risk factor for suicide is access to lethal means [5, 6] . This is concerning, because military veterans frequently own firearms, and know how to use them. Military veterans should be assessed to see if they have access to a firearm, and measures should be taken to reduce access [5, 6] . These measures may include the use of gun lockers, or unloading the gun and storing ammunition in a safe [6] . The COVID-19 pandemic may negatively impact population mental health and increase suicide rates. Suicide prevention efforts should be focused on vulnerable populations including military veterans since they are at heightened risk of suicide. Mental health professionals should take a proactive approach to prevent suicide, and optimize treatment for military veterans. Suicide safety planning, an intervention used to mitigate suicide risk can be conducted in-person or via-telepsychiatry, and should include the veteran's coping mechanisms [10] . Military veterans should be routinely screened for suicide risk with frequent and regular outreach [6] . In addition, telemedicine can be utilized to increase support and reduce suicide risk during the COVID-19 pandemic [5, 6] . Funding Not applicable. Suicide risk and prevention in veteran populations Risk and protective factors associated with suicidal ideation in veterans of operations enduring freedom and Iraqi freedom Post deployment care for returning combat veterans National Veteran Suicide Prevention Annual Report Suicide risk and prevention during the COVID-19 pandemic An infectious disease pandemic and increased suicide risk Major physical health conditions and risk of suicide Decorated combat vet who died highlights pandemic's effect on mental health Responsible reporting of suicide Safety planning intervention: a brief intervention to mitigate suicide risk Conflict of interest On behalf of all authors, the corresponding author states that there is no conflict of interest.