Let 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)

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.