NIMH Livestream Event on Suicide Prevention During COVID: A Continuing Priority
Stephen O’Connor: Hello. Thank you for joining us today. I'm Dr. Steven O'Connor, chief of the Suicide Prevention Research Program in the National Institute of Mental Health, or NIMH, Division of Services and Intervention Research. September is suicide prevention awareness month. Suicide is a major public health concern and NIMH is committed to bending the curve of suicide in the United States. And together with the National Action Alliance for Suicide Prevention, NIMH pledge to reduce the suicide rate by 20% by 2025. During the next half hour together, we are discussing suicide prevention during the COVID-19 pandemic, focusing on unemployment, youth, and other population subgroups who may be experiencing elevated risk. It's important to note that we cannot provide specific medical advice or referrals. Please consult with a qualified health care provider for diagnosis, treatment and answers to your personal questions. If you need help finding a provider, please visit nimh.nih.gov/findhelp. We've also posted that link in the Facebook chat. If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK or 8255 or visit SuicidePreventionLifeline.org. You can also ask for help in the comments section of this feed, and someone from NIMH will assist. All of the websites and phone numbers I just mentioned will also be posted in the comments section of this feed so that you can easily access them.
Stephen O’Connor: So let's start with some good news. According to data from the Centers for Disease Control and Prevention, overall suicide death rates have remained steady or have even fallen during the pandemic. However, the pandemic has not affected all Americans equally. To further discuss these topics today, I'm joined by my colleague, Dr. Lynsay Ayer, senior adviser on youth and suicide prevention at NIMH. I also want to note that our colleague, Dr. Rajeev Ramchand, is unfortunately unable to join us because of a pressing scheduling conflict of high importance. So to begin, Lynsay, what specific groups have documented changes in risk for self-injurious thoughts and behaviors during COVID? And do we have any indication as to what might be driving elevated risk in certain groups?
Lynsay Ayer: Well, unfortunately, our official national data on suicides lags by about a year, so we won't know official 2020 numbers until the end of 2021. But based on other available data, we do know that there are some groups we need to be focusing on when it comes to suicide prevention. Youth in general might be vulnerable due to all of the disruptions that many of them have experienced over the course of the pandemic, both at home and at school. And that's especially true for those who were already struggling with mental health concerns even before the pandemic. And based on recent data, one group of youth we're particularly concerned about right now is actually adolescent girls. There is some research that came out from the CDC showing that this year, in the February to March timeframe of 2021, emergency department visits for suspected suicide attempts were about 50% higher for adolescent girls compared to the same period in 2019. Whereas for boys, it was also higher, but only by 3.7%. So adolescent girls do seem to be having an increased suicide attempts based on those data. And then another group of youth that we are concerned about is LGBTQ youth. There are some data that just came out from The Trevor Project showing that these youth, who we already knew were at higher risk for suicide, have also been experiencing increased stress and suicidal thoughts this year.
Stephen O’Connor: Right. And we also have concerning data on BIPOC youth in adults. So for instance, we know racial and ethnic minority youth and families have been disproportionately impacted by the pandemic, and there were concerning trends seen in 2019, which occurred before the pandemic, for black Asian Pacific Islander youth. We weren't sure or we aren't sure if they're going to continue, and we can't attribute those increases in rates of suicide to COVID. But the trends are worrisome. We have some state level data from Maryland, Connecticut, and Massachusetts that indicates that there were no significant increases in total suicides. However, there is concern from Maryland and Connecticut that suicide rates did increase for non-white populations, and that echoes the trend that we saw between 2018 and 2019, when the total suicide rate actually decreased, but that this decrease was not seen among black, African-American, Asian-American, or Hispanic individuals. As you describe, Lynsay, we aren't yet sure what is driving the risk in these groups, but experiences of discrimination may be part of the explanation for racial, ethnic minority groups at risk. Many researchers have been collecting data on these questions over the course of the pandemic, and we're looking forward to learning from their efforts. I will say, also, the NIMH, in an effort to inform near-term advancements in suicide risk reduction, created a series of funding opportunity announcements focused on system-level risk detection and interventions to reduce suicide ideation and behaviors in black youth and youth from underserved populations.
Lynsay Ayer: That's wonderful. I'm looking forward to learning from those studies. And Stephen, we also know that this past year and a half, there's been a lot of upheaval in employment and a lot of economic distress that have strained some communities more than others. So do we have a sense for how those factors impact suicide, either through recent research or older research?
Stephen O’Connor: It's a really important topic. I will say that at the start of the pandemic, many thought deaths due to suicide in the United States would increase. They based this primarily on the complicated relationship between unemployment rates and suicide rates. I say it's complicated because there's lots of conflicting evidence out there about the relationship between unemployment and suicide risk. We are actually going to post a link to an APA webinar series that we helped organize where our colleague, Rajeev Ramchand, does a really nice review of that literature on the relationship between unemployment and suicide risk. That said, there are some concerning trends. There are four groups in particular that do concern us. One, those who lost their jobs and are looking for work. There were buffers that were put in place to ease the financial burden of job loss, like the moratorium on evictions. As these programs expire, it's unclear what may happen for those who lost their jobs. Second, health care workers on the front lines. We've heard anecdotal reports of severe distress and suicide risk among health care workers on the front lines of COVID-19. Third, racial, ethnic minority groups. COVID-19 has disproportionately affected racial, ethnic minority groups. They were more likely to have been affected by the virus itself, and those who experienced job disruption due to COVID. As I said earlier, historic and emerging evidence suggests these individuals may have experienced adverse mental health impacts. And then fourth, women. There is emerging evidence that adverse health behaviors like hazardous drinking and distress increased during COVID for women. We also know that women workers have been disproportionately affected, especially as they leave the job market altogether due to childcare responsibilities.
Lynsay Ayer: Yeah, that's a great point. And building on that, because a lot of what we know about the stressors women face has to do with their childcare responsibilities and the way society often relies on women to take on much of that load-- and we know that parents and caregivers' mental health and wellbeing impacts the whole family, including kids. So when parents are stressed and irritable and depressed, whether it's from job-related or other concerns, that is going to trickle down to the kids and affect their mental health too. Now, the flip side of that, though, is that when parents' mental health improves, for example, when parents get effective treatments such as cognitive behavioral therapy or antidepressant medication, we actually have studies showing that kids' mental health also improves. So when parents get help, that can have benefits for everybody in the family. Another thing that I think is a glaring issue during this pandemic for mental health is the loss of social connection and what that does to social support, which we know from many, many studies is really important for our mental health. Social support provides a means of coping, it can be a real protective factor for kids and adults. And so over the pandemic, we've lost our options for social support as we've had to do social distancing and kids have been remote-schooling, many parents have been [inaudible] working. And many of us have found ways to maintain some connection with others, like through online interactions, but we don't yet really know whether those connections can truly replace face-to-face, in-person connections with others. And there are some, like younger children and those who do not have internet access, who may not have even that option.
Stephen O’Connor: Right. Well, I think that's really important information to convey, and I imagine that a lot of people who are watching today are here to learn about ways to contribute to suicide prevention in the context of COVID. What suggestions do you have for them, for caring for themselves or for a close family member or friend for whom they may be concerned?
Lynsay Ayer: Yeah, well, that is the ultimate question, I think. And one thing we always try to remind people is that it is safe to ask others, including youth, if they are having thoughts about suicide. We have evidence to show that it is safe. So if you're worried about a loved one, we strongly encourage you to ask them if they are having thoughts of suicide. And so the next question is, what do you do if they say, "Yes, I am having those thoughts." And so you should try to stay with them and help them to get help. That could be through a mental health provider. Many folks might already have a mental health provider, so you could call that person. And if not, you could try calling that National Suicide Prevention Lifeline that we showed at the beginning of this, 1-800-273-TALK. And then just building on what you were saying about unemployment, I think employers have a role in all of this. So we're going through difficult times. And if there are ways for employers to help accommodate workers, particularly those who may be caring for children or adults, those who are caregivers and have to balance many things, employers can try to figure out how to best for employees.
Lynsay Ayer: And then, I'm a clinical psychologist, so I also want to just encourage everybody to be non-judgmental and compassionate, not only with others but also with ourselves. What we're experiencing is not at all normal. Hopefully, this is a once-in-a-lifetime event. Drawn-out, long event, but one that comes not very frequently, but with significant disruption and uncertainty. And we're feeling exhausted or impatient. Many are feeling discouraged. And those are just really understandable reactions, and it is okay to not be okay all the time. On the other hand, though, it is also important to check in with ourselves and with each other regularly to sort of take a pulse on how we're doing. So if you're struggling or someone else is struggling, find help. And we're fortunate to have a lot of tools for kids and adults that are proven to improve our abilities to cope with stressful experiences. We're going to put a link to some NIMH resources, including some guidance for how to recognize when somebody might need help, whether that's recognizing in yourself or somebody else. So we'll put those links out there. And then, just finally, one silver lining to this pandemic is that it really has expanded access to telehealth, including teletherapy, which has made it slightly easier for folks to get mental health care. So we want to note that, so far, the evidence suggests that mental health care provided by video or telephone is effective. So if you're in need, try to find care that is right for you.
Stephen O’Connor: Thanks. Those are great recommendations for people. I would add it's really important to be mindful of your daily schedule, to try to include meaningful behaviors throughout your day, and the importance of scheduling in advance versus letting your mood dictate your behavior. Because what can happen is sort of a slow decline in engagement and, maybe, over time, a worsening of mood and less engagement in activities that make you feel good, that remind you of those important reasons for living. And these are effective strategies not only for preventing depression, but actually for helping people who might be experiencing a depressed mood, to reduce the intensity of that experience. So I would encourage people to think about that. And one other point is the concept of contributing to other people. Kind of overlaps in some ways, but sometimes people who experience suicidal thoughts feel like a burden to others. I would say, look for opportunities, where if you are in a position where you're struggling and friends and family are offering additional support, number one, to allow them to do that because that's their choice, but number two, look for ways that you can also provide some way of contributing so that it feels like you're not just in a position where you're receiving the care, receiving resources from other people. Everybody, at certain times in their life, requires more support. And the reality is, maybe that puts a little bit more of a burden or expectation on your social support network. But if you check with those people, generally, they'll say that this beats the alternative, of seeing you struggle or not seeing you at all. And so it might feel uncomfortable to be in a position where you receive extra support from other people, but look for opportunities that you can not have that be the only thing that defines you, but also ways that you can contribute as well.
Lynsay Ayer: Yeah, that's a great point. And I think, also, we want to underscore that getting formal mental health care through a therapist or a psychiatrist is not the only way to get mental health support. There have been a lot of studies funded by NIMH and others that have shown that a lot of the most effective, helpful support is found just in our communities, in churches or schools or places of work and informally through your friend networks. So I think that's another thing to note, because sometimes it can feel really discouraging to reach out, to try to get an appointment of a mental health provider. And so, in many cases, there's a long wait. So we want to encourage folks to seek out support in other places, but also think about that as somebody who might be able to offer that support in the community.
Stephen O’Connor: Right. One of the things that you mentioned was the importance of what employers can do to be supportive of their employees. Recent research funded by NIOSH to-- a psychologist named Leslie Hammer, who was actually the moderator for our APA webinar series on meeting the mental health needs of unemployed individuals, conducts research where she focuses not so much on helping the employees directly who might be experiencing some type of additional stress or mental health challenge or problems with sleep, but thinking of addressing the issue more systematically, upstream, with supervisors and thinking about ways that supervisors can support employees through flexible work arrangements, by checking in with them, by looking for ways to support healthy living habits, and of course, modeling what healthy work behavior looks like. And I think that that's been a real challenge, probably, for a lot of employers, as people have had to pivot to non-traditional work arrangements. And sometimes it might feel to an employee that you're always kind of on the clock. In some ways, you might have more flexibility where you work, but because we're also digitally connected, it might be hard to have a clean separation between work and your personal life. So for the the organizations out there and for the supervisors who might be engaged, I'd encourage you to think about that, about how not only can you identify and encourage the employees to seek out mental health services if they need it, which is an important aspect, but also think about what your organization, the policies and procedures that you have in place, can actually do to support people as everybody continues to try to be as adaptive as possible with this ongoing pandemic as it unfolds.
Lynsay Ayer: That's a great point.
Stephen O’Connor: So let's see. I can identify a few questions here. One evidence-based approach to helping people that we always encourage people to think about is safety planning. Could you talk a little bit about what the purpose of a safety plan is and how families and individuals might be able to use this to help people that are at elevated risk?
Lynsay Ayer: Sure. Yeah, this is a good tool to have available, if or when you do ask a loved one if they're having thoughts of suicide, which, again, we encourage and know that it won't like the idea and so [inaudible]. So safety planning is where if somebody is having thoughts of suicide, you want to go over things that they can do to keep themselves safe, in a nutshell. And that could be making sure that lethal means, as we call them, so things that the person could use to attempt suicide are stored safely so that the person would not be able to easily access them. It could include making a list of different coping strategies, which could be things like a close friends who you could call for support or going for a walk or whatever coping strategies the person has found to be successful or thinks could be successful in helping them deal with those feelings of distress. And you want to write it all down, basically, so that it's available. So should the person be having those suicidal thoughts again, they can turn to this document and it's concrete and it's in front of them, "Here are some of the steps I would take to keep me so safe." And of course, on there somewhere it needs to be a crisis line, what to do if none of those things work. You can call the suicide prevention crisis line or even call 911 if it's a life-threatening emergency.
Stephen O’Connor: Right. Thank you. And the reason that that is so important is because although the safety plan might not address the things that are making someone suicidal, they are evidence-based strategies that can keep people safe so that they can survive dark moments, gives people time to engage in treatment that can help address those things that are making them suicidal. And it's a plan that you think of in advance, so that when you are kind of in the eye of the hurricane, you don't have to all of a sudden come up with some really great ideas about how you're going to survive. You've already done that work. You've identified in advance what your warning signs might be, how to engage your social network, how to use internal coping strategies, and very importantly, like you mentioned, ensure that your environment is safe so that any type of potential lethal means has been safely stored so that you can survive the crisis window and then continue on recovery. Thank you.
Stephen O’Connor: Okay. Well, this has been such a great conversation. I really enjoyed speaking with you about this today. Thanks for sharing all of your expertise with everybody out there. And so we've come to the end of our discussion today. And I thank all of you for joining us today for this important discussion. Stay safe and please reach out for help if you need it. The National Suicide Prevention Lifeline phone number, again, is 1-800-273-8255 or 273-TALK. For more on suicide prevention, you can visit our web pages at NIMH. You can land on nimh.nih.gov/suicideprevention. We'll include a link in the Facebook chat. And thank you, Dr. Ayer, for participating. Take care.