David is a 52-year-old White male who has spent the last 24 years in the human resource field. Most recently, he held the position of supervisor in the billing department of a midsized hospital in a rural state. He worked hard to obtain a master's de- gree while on the job at the hospital and always had high aspi- rations for himself professionally. David has three children from his first marriage, which ended in divorce. His first wife Anne, who is 50, works as a preschool teacher in another part of the state. Their children's ages are 16, 20, and 22. Both older children started to attend college but may have to drop out temporarily due to financial difficulties. David feels that it is his responsibility to support his children's education, and he has been paying as much of their tuition as he can afford. David and his second wife live in a new, but modest home in a community on the outskirts of the state capital close to David's job. David's second wife, Sandy, has twin 14-year-old boys. One of the twins has a serious learning disability and needs extra tutoring and a great deal of parent support to keep up academically. Sandy works part time in a department store to be home to help her sons. David and Sandy have a good relationship. Sandy's widowed mother lives nearby and helps with the twins on a regular basis.

Recently, the hospital system that employs David merged with a large network of medical providers to cut costs and use resources more efficiently. David's job at the hospital is becoming more complicated, requiring more and more processing of information that involves advanced computer technology. At a recent professional meeting, David learned from others in his network that many jobs were being cut and many tasks redistributed to the employees that remained. David feels that this has already happened in his workplace. He has noted a dramatic increase in the amount of paperwork required and a distinct decrease in the time allotted to meet deadlines. His supervisory responsibilities have expanded to include workers from another unit that merged with his own in a major departmental realignment. David's direct supervisor will be retiring soon, and David will be a candidate for that position. He knows that this promotion would mean more income, but it would also mean even more work responsibility. David now spends his weekends going to the office to catch up on tasks. He is not as available as he once was to spend time with his children, and this has caused some problems in his relationship with his wife. He is starting to feel that all the paperwork his job requires is not meaningful in ways that are important to him.

David has recently begun to suffer from significant pain in his lower back that he believes might be related to a traffic accident that happened when he was younger. The pain keeps him from sleeping well and has contributed to his feeling more "on edge" during the day. David's physician prescribes two medications to help him sleep better and to reduce anxiety. David has started to drink a few beers when he comes home at night to "calm himself down" as well. The sleep medication he has been taking helps him fall asleep, but now he wakes up at 3:00 am with his mind racing. He's recently learned that his 16-year-old son has been cutting classes and failing tests. His ex-wife, who has custody of their teenage son, has been pressuring him to help her with this problem situation.

Question: Identify the risks and protective factors that are present in David's life story. What information, not presented here, would be helpful to know if you were to make a more comprehensive list of risks and protections?

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