Category Archives: Centers for Disease Control and Prevention

States Move To Restrict Parents’ Refusal To Vaccinate Their Kids. Our Goal and the Rest of the World!

50201675_1876827435780240_8947739925063663616_nI don’t know whether you all remember my last few sentences of last week’s post but I was so encouraged this week because it seems that maybe some of the politicians are reading my blog (yeah right!?!?) or they recognize the severity of the measles problem today. So, I want to continue the discussion starting with a number of States who get the message.

Patti Neighmond wrote that all U.S. states require most parents to vaccinate their children against some preventable diseases, including measles, mumps, rubella, and whooping cough, to be able to attend school. Such laws often apply to children in private schools and day care facilities as well as public schools.

At the same time, beyond medical exemptions, most states also allow parents to opt out of this vaccination requirement for religious reasons. And 17 states permit other exemptions — allowing families to opt out of school vaccination requirements for personal or philosophical reasons.

Michelle Mello, a professor of law and health research and policy at Stanford University, says the bar for claiming an exemption from vaccine requirements has been very low in many states. “You can believe that vaccines don’t work or that they are unsafe or they simply fly in the face of your parenting philosophy,” she says.

But this winter’s outbreaks of measles across the nation are resulting in challenges to many exemptions: At least eight states, including some that have experienced measles outbreaks this year, want to remove personal exemptions for the measles vaccine. And some states would remove the exemption for all vaccines.

Most of this year’s measles cases have been among children who were not vaccinated against the virus.

Once considered eradicated in the U.S., measles has sickened at least 159 people since the start of 2019, according to the Centers for Disease Control and Prevention, in outbreaks ranging from Washington and Oregon to Texas and New York. Last year, there were 372 reported cases of measles nationwide.

The move among state legislatures to tighten vaccine requirements is good news to Diane Peterson, the associate director for immunization projects with the pro-vaccine advocacy group Immunization Action Coalition.

“Measles is not like a common cold,” Peterson says. “Children get very, very sick and can be hospitalized,” she says, adding that measles can even lead to death.

The virus is highly contagious, airborne and easily spreads. It can survive in the air for a couple of hours.

“A patient with measles can go to the doctor, cough in the exam room and two hours later another patient coming into the same exam room can be infected,” Peterson says.

The virus is spreading fast this winter, she says, because of the “pockets of children who have not been vaccinated, mostly due to parents who have decided not to vaccinate them.”

This leaves not only those unvaccinated school children vulnerable to the virus but also many adults who have suppressed immune systems and infants who are not old enough to be vaccinated.

According to the Association of State and Territorial Health Officials, bills to restrict exemptions are now pending in a growing number of states.

None of this sits well with activists who want their states to maintain personal and philosophical exemptions.

“Nobody should sit in judgment of another person’s religious and spiritual beliefs,” says Barbara Loe Fisher, a spokesperson for the National Vaccine Information Center, a group that lobbies against mandatory vaccination and thinks parents should have a choice. “No person should be allowed to force someone to violate their conscience when they’re making a decision about the use of a pharmacological product that carries a risk of harm.”

The scientific consensus about any risk from vaccines is that serious side effects are extremely rare. A suggestion that immunization might be tied to severe consequences like autism was debunked years ago after findings supporting that link were proved fraudulent.

Mello, the Stanford law professor who has been following the exemption debate, notes that the courts have repeatedly held that when a public health intervention is necessary to safeguard the public, individuals generally can be required to give up some personal liberty, particularly if that liberty is tied to a government benefit like school.

So far, only three states — Mississippi, West Virginia and California — prohibit nearly all vaccine exemptions, including the one exempting families who say their religious belief conflicts with vaccination. (All states allow medical exemptions when, for example, a child has a compromised immune system.)

The California state Legislature made that decision in 2015, less than a year after the state experienced a significant measles outbreak that got its first foothold among unvaccinated children visiting Disneyland.

A measles outbreak in the US has triggered debate on the ease with which parents can opt out of mandatory vaccine rules.

I noted last week that a total of 159 people have come down with the disease in 10 states since January, but one small area, in particular, Clark County in Washington State, has illustrated the dangers of these exemptions, which are sought for religious, personal or philosophical reasons.

Just north of Portland, Oregon, Clark County accounts for 65 measles cases, 47 of them among children under age 10. In almost all 65 cases, patients had not been vaccinated.

Fifteen years ago, 96 percent of school children aged five in Clark County got measles shots. But in 2017-2018, the proportion was down to 84 percent.

In some schools, mainly private ones, the rate of use of the so-called MMR vaccination against measles, mumps, and rubella was only 20 to 30 percent. In some of the schools, more than half the students had received exemptions.

Local lawmakers in Washington State have responded to the outbreak by advancing legislation that would do away with exemptions on personal or philosophical grounds. Opt-outs for religious reasons would still be allowed.

Such exemptions are widely available in the United States. Only three of the 50 states—California, Mississippi, and Virginia do not allow them.

California did away with exemptions for personal reasons in 2015. In the most populous US state, exemptions are permitted only for medical reasons.

In recent years other states have toughened their laws. Connecticut, for instance, requires parents claiming an exemption for religious reasons to provide a yearly, notarized statement to this effect. Since 2015, Delaware has allowed schools to temporarily exclude non-vaccinated kids.

Vermont wants to get rid of religious exemptions, after eliminating those sought for philosophical reasons four years ago, according to The Washington Post. Arizona, Iowa, Minnesota are also debating stricter laws.

Congressional hearing

The US Congress will hold a hearing Wednesday on the issue of vaccinating children.

Overall, the vaccination rate of kids in the US has remained stable, according to the Centers for Disease Control and Prevention, which monitors such trends closely.

It reports that in the 2017-2018 school year, around 95% of American kindergarteners were vaccinated against MMR, chicken pox and diphtheria, tetanus and whooping cough.

But the national rate masks wide disparities from state to state and even from one school to the next, as the case of Clark County illustrates.

And health authorities are alarmed because the previous school year was the third in a row in which requests for exemptions from vaccination increased, even though the rises were small.

And the proportion of kids reaching age two without having received any kind of vaccination is also growing, albeit slowly: 0.9 percent of children born in 2011 to 1.3 percent among those born in 2015. Vaccination-free kids were practically unheard of at the turn of the century.

Exemptions alone do not explain why children are not vaccinated. Many vaccines are recommended for American children in their first two years of life—the CDC advises they be used for 14 diseases—and this is hard for parents to keep up with, especially for vaccines that require three or four shots.

Another problem is access to health insurance. Children in families without such insurance make up a disproportionate amount of those who go without shots, according to the CDC.

In Congress, the measles outbreak has prompted lawmakers to act.

The disease routinely infected American kids before a vaccine was introduced in 1963. Before that, it killed 400 to 500 people a year in the US. In 2000 it was declared eliminated. But since then, over the years anywhere from 50 to 600 cases have been reported annually.

Two US senators recently called on the CDC to explain what it is doing in response to what they called “pockets of unvaccinated people.”

‘We Need to Get to Zero’ on Measles: NIAID Chief to House Panel

I think we all agree and members from both parties express support for measles, mumps, and rubella vaccine

Our friend Joyce Frieden, the News Editor of MedPage Today, reported that the views that some House committee members expressed Wednesday in favor of vaccination brought to mind a line from a character on a British television show: “I am unanimous in this.”

“It wasn’t until the development of the MMR [measles, mumps, and rubella] vaccine that we as a country were able to stop this horrific illness,” said Rep. Diana DeGette (D-Colo.), chairman of the House Energy & Commerce Subcommittee on Oversight and Investigations, at a hearing on recent measles outbreaks in the U.S. “But despite that success, here we are again 20 years later.”

Rep. Greg Walden (R-Ore.), a ranking member of the full Energy & Commerce Committee, noted that one in four people diagnosed with measles will end up being hospitalized. “If we don’t reverse the downward trend in vaccination, we risk bringing back measles in full force,” he said.

DeGette called the recent measles outbreaks “a real cause for national concern” and pointed out that the national measles vaccination rate for children stands at 91%.

“That may seem high to some, but it’s well below the 95% vaccination rate required to protect communities and give them herd immunity,” she said. “And while the overall national rate of MMR vaccines is currently at 91%, the rate in some communities is much lower — some as low as 77%. Outbreaks like the one we’re seeing with measles remind us of just how interconnected our communities are … As a nation, to stop the spread of deadly diseases, we have to address the root cause of the problem and we have to define concrete steps … We need to support additional research into vaccine safety to further increase consumer confidence in these vaccines.”

Nearly 160 Cases This Year

Once again the numbers are important and so from Jan. 1, 2019 to Feb. 21, 2019, there have been 159 confirmed measles cases in 10 states, Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, told the committee. The states reporting outbreaks include California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New York, Oregon, Texas, and Washington. In 2018, 372 people in 25 states and the District of Columbia were reported to have measles; most of those cases involved unvaccinated people, she added.

Although measles was officially eliminated in the U.S. in 2000, and the rate of measles vaccination coverage is fairly high nation-wide, “there are pockets of people who are vaccine hesitant who delay or even refuse to vaccinate themselves and their children,” which can cause outbreaks, Messonnier said. Many of those live in close-knit communities where they share the same religious beliefs or ethnic backgrounds as their neighbors. Others simply have a strong personal belief against vaccination.

“In the past 5 years, there have been 26 measles outbreaks of more than five cases, 12 of which were in close-knit communities, including a Somali community in Minnesota in 2017 and Orthodox Jewish communities in New York City and New York state in 2018; these 12 outbreaks account for over 75% of cases in the past 5 years,” she said, adding that “Vaccine hesitancy is the result of a misunderstanding of the risk and seriousness of disease combined with misinformation regarding the safety and effectiveness of vaccines. However, the specific issues fueling hesitancy vary by community” and must be attacked locally with the help of the CDC.

The federal government’s Vaccines for Children (VFC) program is a “critical component” of the fight against vaccine-preventable diseases, Messonnier said. “Because of VFC, we have seen significant decreases in disparities in vaccination coverage … For each dollar invested [in the program], there are $10 of societal savings and $3 in direct medical savings.”

‘I Am a Measles Survivor’

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Maryland, said that measles was “one of the most contagious pathogens we know of” and explained that since the virus has been well sequenced, “we can tell, when the virus is reintroduced into our country, from where it comes.” For example, researchers were able to determine that a measles virus that led to an outbreak among a community of Hasidic Jews in Brooklyn in New York City came from Israel.

“I consider it really an irony that you have one of the most contagious viruses known to man, juxtaposed against one of the most effective vaccines that we have, and yet we don’t do and have not done what could be done — namely, completely eliminate and eradicate this virus.” Fauci showed a slide delineating the recent outbreaks. “This slide is really unacceptable; this is a totally vaccine-preventable disease … What we all should strive for, that measles in the United States, we need to get to zero.”

A few hearing participants shared their own experience with the disease. “I am a measles survivor,” said Rep. Michael Burgess, MD (R-Texas). “I was at an age where the measles vaccine was not available. Even though I was very young when that happened, I still remember … the heart-shaking chills, the muscle pain, and the rash that’s [emblematic] of measles.” Fauci said he also had the disease and that it was “very uncomfortable and very scary.” Rep. Brett Guthrie (R-Ky.), the subcommittee’s ranking member said that one of his close childhood friends “was essentially born without a hand” after the friend’s mother contracted rubella during her pregnancy. “I’ve always thought of measles and how devastating it can be.”

Guthrie also asked Fauci whether people could “self-medicate” with vitamin A to prevent measles. Fauci responded that children with vitamin A deficiency who get measles “have a much more difficult course, so vitamin A [supplements] can actually protect you from some of the toxic and adverse effects,” but that doesn’t apply in developed countries where such deficiencies are rare. “It doesn’t prevent measles, but it’s important in preventing complications in societies in which vitamin A deficiency might exist,” he said.

The Thimerosal Question

Burgess asked about whether thimerosal — a mercury-containing preservative often mistakenly claimed to cause problems with vaccines — was in the measles vaccine. “No, it’s preservative-free,” said Fauci. Burgess asked whether there was ever any evidence that mercury or thimerosal was unsafe. Messonnier said thimerosal had been removed from vaccines “out of an abundance of caution at a time when there wasn’t enough evidence, but evidence since then has been very conclusive” that thimerosal is safe.

The hearing was also marked by a few disruptions, including some shouts from the audience when Fauci, responding to a question, said that the measles vaccine couldn’t cause encephalitis. DeGette told the audience that such disruptions were in violation of House rules; Messonnier then said that the vaccine doesn’t cause brain swelling or encephalitis in healthy children.

Guthrie remarked that whether or not parents choose to vaccinate their children, they do so with the best of intentions. “Whatever decisions they’re making, they’re making it in the love and best interest of their child,” he said. “So I think it’s important we do have the science … and people with credentials and reputations to present this evidence, and hopefully people have the opportunity to see it and read it.”

Measles cases soar worldwide, UN warns of ‘complacency’

Outside of the U.S., I think it is necessary to see how this disease is affecting other countries. I brought up the statistics regarding the incidence and the deaths in the Philippines but on a broader scale Cynthia Goldsmith reviewed the statistics with regard  of the measles problem in the world and noted that just 10 countries were responsible for three-quarters of a global surge in measles cases last year, the UN children’s agency said Friday, including one of the world’s richest nations, France.

Ninety-eight countries reported more cases of measles in 2018 compared with 2017, and the world body warned that conflict, complacency and the growing anti-vaccine movement threatened to undo decades of work to tame the disease.

“This is a wakeup call. We have a safe, effective and inexpensive vaccine against a highly contagious disease—a vaccine that saved almost a million lives every year over the last two decades,” said Henrietta Fore, executive director of UNICEF.

“These cases haven’t happened overnight. Just as the serious outbreaks we are seeing today took hold in 2018, lack of action today will have disastrous consequences for children tomorrow.”

Measles is more contagious than tuberculosis or Ebola, yet it is eminently preventable with a vaccine that costs pennies.

But the World Health Organization last year said cases worldwide had soared nearly 50 percent in 2018, killing around 136,000 people.

Ukraine, the Philippines, and Brazil saw the largest year-on-year increases. In Ukraine alone, there were 35,120 cases—nearly 30,000 more than in 2017.

Brazil saw 10,262 cases in 2018 after having none at all the year before, while the Philippines reported 15,599 cases last year compared to 2,407 in 2017.

Taken together, the ten nations accounting for 75 percent of the increase from 2017 to 2018 account for only a tenth of the global population.

The countries with the highest rate of measles last year were Ukraine (822 cases per million people), Serbia (618), Albania (481), Liberia (412), Georgia (398), Yemen 328), Montenegro (323) and Greece (227).

While most of the countries that experienced large spikes in cases are beset by unrest or conflict, France saw its caseload jump by 2,269.

In the United States, there was a 559 percent year-on-year increase in cases from 120 to 791.

Misinformation and mistrust

The resurgence of the disease in some countries has been linked to medically baseless claims linking the measles vaccine to autism, which have been spread in part on social media by members of the so-called “anti-vax” movement.

The WHO last month listed “vaccine hesitancy” among the top 10 most pressing global health threats for 2019.

“Almost all of these cases are preventable and yet children are getting infected even in places where there is simply no excuse,” Fore said.

“Measles may be the disease, but all too often the real infection is misinformation, mistrust and complacency.”

In war-torn Yemen, where health services in many regions have collapsed, UNICEF and the World Health Organization joined with local authorities last month in a campaign to vaccinate some 13 children aged six months to 15 for measles and rubella.

UN officials estimated that 92 percent of the targeted children were jabbed during the one-week push, which ended on February 14.

Yemen also figured on UNICEF’s “top 10” list of countries showing the largest increases last year in measles cases with a 316 percent hike, from 2,101 cases in 2017 to 8,742 cases in 2018.

Other countries with huge jumps last year compared to 2017 are Venezuela (4,916 more cases, up 676 percent), Serbia (4,355 more cases, up 620 percent), Madagascar (4,307 more cases, up 5,127 percent), Sudan (3,496 more cases, up 526 percent) and Thailand (2,758 more cases, up 136 percent).

A few countries saw declines in the number of confirmed cases of measles.

In Romania, reported cases dropped 89 percent from 8,673 to 943, and in Indonesia, the number declined by 65 percent from 11,389 to 3,995.

Nigeria, Pakistan, Italy, and China also saw drops of 35 to 55 percent.

So, the number of worldwide resurgence of cases of measles is huge and we as a community need to step up and push our healthcare community and the government to step up and demand that we protect our youth both here in the U.S.A. and yes, in the world. Also, we need to ignore the politics and the misinformation and mistrust and get the job done for our kids, and future generations!

 

 

 

 

Suicide Kills 47,000 Men, Women and Children a Year. Society shrugs, the Discussion We Need to have and Those Who Suffer the Most; an Association to Screen Time and Social Media?

47430587_1812958915500426_7411626721117470720_nLet us first remember Pearl Harbor Day and the men and women who lost their lives and the battles that followed. Now, let’s continue with the second edition of the suicide post. I am interested in the discussion of the epidemic and those who are left behind to suffer who someone commits suicide. The Editorial Board at USA TODAY noted that though suicide is the 10th leading cause of death, efforts to understand and prevent it falls short. But this could be changing.

If a killer roaming America left 47,000 men, women and children die each year, you can bet society would be demanding something be done to end the scourge.

Well, such a killer exists. It’s called suicide, and the rate of it has steadily risen.

Yet the national response has been little more than a shrug, apart from raised awareness whenever celebrities — fashion designer Kate Spade and renowned chef Anthony Bourdain, to name two this year — are tragically found dead by their own hand.

USA TODAY’s comprehensive look at this public health crisis and its ripple effect, published Wednesday, includes a daughter’s heart-wrenching narrative of losing a mother to suicide, as told by former Cincinnati Enquirer Managing Editor Laura Trujillo.

Although suicide is the 10th leading cause of death in America, efforts to understand and prevent it fall dismally short. The National Institutes of Health, by far the world’s largest underwriter of biomedical study, spent $68 million last year on suicide — a relatively small amount compared with NIH funds devoted to other leading killers.

NIH and NIMH: We’re deeply committed to reducing suicide

Kidney disease leaves about as many dead, yet it receives nine times the research funding. Indeed, the NIH spent more than twice the suicide research sum to better understand inflammatory bowel syndrome and even more on dietary supplements.

Suicide rates across the U.S. (Photo: USA TODAY)

Screen Shot 2018-12-09 at 11.02.10 PM

The NIH says that it spends billions on mental health research and that this indirectly prevents suicide, but that’s misleading: Millions of Americans suffer emotional problems and relatively few resorts to suicide. Society needs to know why this is, and only further study can answer the question.

Federal government priorities often mirror what matters to politicians and, ultimately, the general public, which for too long has seemed mired in complacency about suicide. There have been no concerted campaigns similar to those targeting leading killers such as HIV or breast and prostate cancers.

This could be changing.

A new survey funded by the American Foundation for Suicide Prevention shows that 94 percent of Americans believe that suicide is preventable, and the foundation is advocating an increase in NIH suicide funding, to $150 million.

“The public is starting to get it,” says foundation CEO Robert Gebbia.

Even limited investments have borne fruit:

►The military and the Department of Veterans Affairs invested hundreds of millions of dollars after suicide rates tripled in the Army during recent wars, then kept climbing among a generation of young veterans. The VA has developed an algorithm to identify the most at-risk patients as a way to focus more intensive care. Preliminary results have been encouraging, with lower mortality rates.

►Studies show that reducing access to lethal means saves lives, and states with stronger gun control laws now see reduced rates of suicide. Construction began this year on a massive, stainless steel net slung under the Golden Gate Bridge to end that San Francisco landmark’s dark history as a prime site for suicide.

►With proven benefits of intervention, President Donald Trump this year signed a bill to examine the feasibility of creating a 911-style, three-digit emergency number for more easy access to the National Suicide Prevention Lifeline (1-800-273-8255).

Scientists have established that the self-destructive urge is often fleeting. Where counseling, better coping skills and reduced access to a lethal means help the distraught to endure this moment, people can survive. It’s one of the reasons why nine out of 10 people who attempt suicide, studies show, do not ultimately kill themselves.

Where there is life, there is hope.

We need to talk about suicide more

USA TODAY has published an extensive story by Laura Trujillo on her mother’s suicide. Editor Nicole Carroll explains why and the precautions are taken.

I called Laura the minute I heard.

We had worked together in Phoenix for more than a decade, and she had recently moved to Cincinnati.

She answered, sobbing.

“Oh, Laura, I’m so sorry.”

My heart was broken for Laura, her mom, her family. And over the following years, I watched as Laura tried to absorb, understand and even explain her mother’s suicide. She began writing about it in spurts on Facebook.

“It can feel impossible to understand,” she once posted. “And you can’t until you can. Until you, too, have felt alone in a way so overwhelmingly strong that you would do anything to escape it. It can be gone and return, consuming you. But sometimes there is luck. Good doctors and medicine. Time, people and faith.”

Laura and I talked about how someday when she was ready, she should share her story more widely.

Because every time Laura told her story, others would tell theirs.

And we need to talk about suicide.

On average, there are 129 suicides each day, according to new data from the Centers for Disease Control and Prevention. And for every person who dies, about 29 more attempt it. It’s the 10th leading cause of death in the United States.

We all know someone touched by suicide. Myself included.

I lived with my grandparents until I was 2. I stayed close to my grandfather; he never stopped looking out for me, even as I started college, work, a family. Then, in 2001, he killed himself. It wasn’t a secret, but no one ever talked about it.

That was 17 years ago. And still today, we just don’t talk about suicide.

The media rarely share stories of suicide, in part because we don’t want to make things worse. The practice in newspapers for decades was not to write about suicide at all unless it was done in public or was a public figure.

When the media cover high-profile suicides, especially when they include specific details of the death, the exposure can lead to suicide contagion. In the months after Robin Williams’ death in 2014, suicides rose 10 percent higher than expected, according to a Columbia University study.

But the answer can’t be to ignore suicide and the effect it has on so many. In addition to Laura’s personal essay, we felt it important to explore suicide as a broader public health problem. In our reporting, we learned that while suicide rates are up 33 percent over the past 18 years in the USA, funding for it lags behind that of all other top causes of death, leaving suicide research well behind the nation’s other top killers.

There is much about suicide we don’t know. And in an effort to protect people, news organizations have allowed misconceptions to persist, including the belief that there’s nothing you can do to help someone who is contemplating suicide.

So we know we need to report on suicide, but we must do it carefully. Because when we write about suicide responsibly, we can help save lives.

We’ve talked about this – constantly – in the writing and editing of Laura’s story.

We shared the story with two psychologists who study suicide. They advised us on language to avoid, details to omit and ways to offer support. Stories of survival help, they said. Make sure to include the suicide lifeline number with every story. Talk about warning signs.plans.

Not all psychologists agree on exactly how we should or shouldn’t write about suicide. And we didn’t do everything those experts suggested. We felt it was unrealistic to avoid talking about how Laura’s mother killed herself and to avoid every detail of where it took place. We did, however, avoid descriptions of the method in our other reported stories on suicide. Our intent is to inform, not to sensationalize, and we felt these stories were compelling without them.

We discussed language to use on social media if vulnerable readers reached out to us and how to keep the conversation going after this story published.

We then shared the story with Kelly McBride, senior vice president at the Poynter Institute and an expert on responsible media coverage of suicide. She reviewed the story, headlines, and photos, giving further advice on sensitive phrasing, and suggestions for more details of Laura’s personal journey that could help.

Because the goal of Laura’s story is to help.

Help those who’ve been touched by suicide.

Those who’ve considered suicide.

And those who are worried – right now – that someone they love is thinking about suicide.

So let’s not be afraid. Let’s find ways to share our stories.

Let’s talk.

After a suicide, here’s what happens to the people left behind

To me, this is the most important part of this post. I consider suicide a loser’s way to solve their problems and I have been through it with fellow physicians and friends who have lost family members. The people who suffer are those left behind to wonder what they did wrong or what they could have done to prevent the suicide.

Loss survivors – the close family and friends left behind after a suicide – number six to 32 for each death, according to the Centers for Disease Control and Prevention, meaning that in 2017 alone, as many as 1.5 million people unwillingly became part of this group.

They are forced to cope with the loss of a loved one and navigate uncertain futures, often caring for confused children as they struggle to accept they may never know “why.”

Suicide can affect a wider community of individuals, including members of a person’s church or school. One study estimates roughly 425 people are exposed to each suicide in this way.

After a loved one’s death, those left behind face an increased risk of suicide themselves. According to a report in 2015 from the Action Alliance for Suicide Prevention:

  • Losing any first-degree relative to suicide increased the mourner’s chance of suicide by about threefold.
  • Young people appear to be particularly vulnerable after the suicide of a peer, which can lead to a phenomenon sometimes referred to as suicide clusters or contagion.
  • Men who have a spouse die by suicide have a 46-fold increase in their chances of dying by suicide. Women have a 16-fold increase.

Kim Ruocco, whose husband, Marine Corps Maj. John Ruocco, died by suicide in 2005, said she never seriously considered killing herself, but she often wondered how she would make it through each day.

“After his death, I cannot say that I was suicidal, but I can remember being in so much emotional pain that I would think, ‘I really don’t want to wake up,'” Ruocco said. “Because you can’t figure out how to live your life with this kind of grief.”

‘My whole world turned upside down’

When Ruocco’s husband died, she said, she lost her sense of reality.

“My whole world was turned upside down,” she said. “What I thought I knew to be true may not have been true. … It made me question everything in my life, from my spirituality to my instincts, to my decision-making, to my marriage, to my family relationships.”

Grief, she learned, was not linear. Some days were terrible. Some were OK, even good. She had to learn, she said, to embrace it all.

“It’s not one feeling, it’s a whole bunch of feelings, and I think the advice for anybody who’s experiencing grief is that whatever you are feeling, it’s OK, it’s normal, and it’s going to come,” she said. “I let it come, I look at it, I feel it, I express it, and then I try to let it go.”

Stories of hope:

  • Stepping back from the ledge
  • Suicide never entered his mind. Then 9/11 happened.
  • Young, transgender and fighting a years-long battle against suicidal thoughts
  • She worked in suicide prevention. Then one day she had to save herself.

When Debbie Baird lost her 29-year-old son, Matthew, to suicide in 2009, she didn’t think she would ever let go of her grief.

Debbie Baird said she didn’t think she would ever recover from the grief over her son Matthew’s suicide. (Photo: Debbie Baird)

“If you had told me in the early days that I would feel better again, I would never have believed you,” she said.

She went to counseling, found a support group and journaled for years, which the Suicide Prevention Lifeline recommends as a way to process things you weren’t able to say before your loved one’s death. Slowly, Baird said, she began to heal. She could see it in the pages.

“I kept thinking if I could write a letter to him, maybe he’d write back to me. Maybe he’d let me know the reason why this happened. I felt like I needed to find a way to connect with him,” she said. “It went from wanting to know why, and how hurt and sad I felt and how my heart was broken and all the physical pain that I was going through and my depression and how I was feeling too, ‘Hey, Jen’s going to have another baby.’ I could see my life changing.”

Baird is now a community educator and support specialist for loss survivors at the National Alliance on Mental Illness.

The American Psychological Association said that after a suicide, it’s important for survivors to:

  • Accept your emotions.
  • Not worry about what you “should” feel or do. There’s no standard timeline for grieving and no single right way to cope.
  • Care for yourself. Do your best to get enough sleep and eat regular, healthy meals. Taking care of your physical self can improve your mood and give you the strength to cope.
  • Draw on support systems.
  • Talk to someone. There is often stigma around suicide, and many loss survivors suffer in silence. Speaking about your feelings can help.
  • Join a group.
  • Talk to a professional.

How to help

The bereaved can heal, suicide prevention experts said, but their pain is often underestimated. The stigma around suicide creates an additional burden. Loss survivors commonly experience a range of emotions as they grieve, including shock, fear, shame, and anger. As they work to cope with these feelings, many simultaneously deal with the pressure to keep their loved one’s suicide a secret or with the mistaken belief that they did something to cause their loved one’s death.

Thomas Joiner, who lost his father to suicide and went on to become a leading suicide researcher, wrote in his book “Why People Die by Suicide” that some people’s inability to intellectually make sense of suicide kept them from showing sympathy after his dad’s death.

“To some people … understanding didn’t matter and wasn’t a barrier to acting with a real generosity of spirit,” he wrote. “To others, the lack of understanding seemed an insurmountable barrier, so that instincts toward compassion were short-circuited.”

According to the American Association of Suicidology and the National Suicide Prevention Lifeline, people can help loss survivors by:

  • Listening without judgment
  • Using the lost loved one’s name to show that person is not forgotten
  • Accepting the loss survivor’s feelings, which can include shock, shame, and abandonment
  • Avoiding phrases such as “I know how you feel,” unless you, too, are a loss survivor
  • Avoiding telling them how they should act or feel
  • Being sensitive during holidays and anniversaries

“People need the education to understand that it is OK to talk about their loved one,” Baird said. “It is OK to mention their name. It is OK to say, ‘I’m sorry.’ ”

Loss survivors should be encouraged to get help for themselves. Grief counselors, faith leaders, social workers, and doctors may be trained in how to respond to suicide.

Ruocco became vice president of suicide prevention and postvention at the Tragedy Assistance Program for Survivors (TAPS) after her husband’s death. “Postvention” describes efforts to prevent suicide among loss survivors and help them heal. Ruocco said postvention doesn’t just decrease risk, it can help survivors find a new purpose.

“They can really have post-traumatic growth and make meaning out of this kind of loss,” Ruocco said.

It’s impossible for survivors to return to the way things were before their loved one’s death. Ruocco said she misses her husband every day, but she’s managed to build a life for herself that, although not what she imagined is full of joy.

“You look at the world in a different way,” she said. “Not only did I have meaning in my life because of his death, but I also cherished the world in a different way. My relationships with my children were more intense, more purposeful. I was more present and connected to the outside world, whether that’s nature or other people. I found joy in little things and appreciated little things and moments with people that I may not have discovered prior to my husband’s death, and I was able to honor his life lived by telling other people about him and preventing suicide in honor of him.”

Suicide Lifeline: If you or someone you know may be struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time of day or night or chat online.

If you have lost a loved one to suicide, visit Alliance of Hope to find support resources.

If you are grieving the death of a loved one who served, you can contact the Tragedy Assistance Program for Survivors (TAPS) at 800-959-8277.

‘Screen time’ causing, exacerbating childhood psychiatric disorders

U.S. teens now spend 6 hours, 40 minutes per day using screens for entertainment. Fifty percent report they feel “addicted” to their devices.

Working in the world of child and adolescent psychiatry as an advanced practice nurse, I frequently hear about symptoms of irritability, anger, isolation and poor sleep from my patients. These symptoms are common to many childhood psychiatric disorders. These disruptive symptoms baffle parents, teachers and clinicians alike, and can lead to incorrect diagnoses for these children with dysregulated moods.

I have been a steadfast believer in the importance of good diet, exercise and adequate sleep as being elementary steps one can take to improve moods. I now also consider the fourth tenet for youth mood regulation to be limited electronic screen exposure.

Excessive screen time stresses the brain, and electronic devices of all types have taken over our modern everyday life by storm in an insidious manner. The typical U.S. teen now spends 6 hours, 40 minutes per day using screens for entertainment. Fifty percent of U.S. teens say they feel “addicted” to their devices.

Recently, I saw a 12-year-old male in my office who presented with symptoms of isolation, nightmares, anxiety, anger, academic decline and poor sleep. What followed my evaluation was a discussion about how electronic devices tend to produce mood disturbances. Excessive screen time can disrupt the production of melatonin, which helps to regulate sleep-wake cycles. Light at night has been linked to depression and/or suicide in numerous studies.

Typical gaming and social media interfaces induce stress reactions with hyperarousal, provoking a “wired and tired” state. Gaming interfaces desensitize the brain’s reward system and release the “feel-good” chemical dopamine. Dopamine is critical in regulating focus and moods. Brain scans have shown that those playing video games are similar to those using cocaine.

Screen time overloads the senses

Screen time overloads the senses, fractures attention and depletes mental reserves. Emotional meltdowns can then become a coping mechanism. And lastly, excessive screen time reduces a time for “green time” — physical activity outdoors in a natural setting, which can reduce stress and restore attention.

“Pervasive design” is the practice of combining psychology and technology to change behavior. The pervasive design is increasingly employed by social media and video gaming companies to pull users onto their sites and keep them there for as long as possible. Several Google and Facebook executives have voiced their concerns about social media sites negatively affecting human psychology.

Utilizing an “electronic fast” for children in my practice has shown drastic improvement in psychiatric symptoms. I suspect those without underlying psychiatric disorders may show an even more marked improvement. As parents/guardians of children, please consider the negative impact screen time may be impacting your child.

And it is my impression after reviewing all the data that this increased screen time and social media may be the reason for this increase in suicide rates. Whether you believe President’s Trump’s tweets and outlandish suggestions that the media lies, kids and adults are measuring themselves to impossible comparisons in behavior, aesthetics, levels of social measures etc.