Category Archives: Suicide

In isolation, worries and stress are magnified During the Coronavirus Pandemic. COVID-19 could lead to an epidemic of clinical depression!

Jonathan Kanter wrote in the Conversation that Isolation, social distancing and extreme changes in daily life are hard now, but the United States also needs to be prepared for what may be an epidemic of clinical depression because of COVID-19.

We are clinical psychological scientists at the University of Washington’s Center for the Science of Social Connection. We study human relationships, how to improve them, and how to help people with clinical depression, emphasizing evidence-based approaches for those who lack resources.

We do not wish to be the bearers of bad news. But this crisis, and our response to it, will have psychological consequences. Individuals, families and communities need to do what they can to prepare for a depression epidemic. Policymakers need to consider – and fund – a large-scale response to this coming crisis.

A perfect storm of depression risks

Most of us know the emotional components of depression: sadness, irritability, emptiness and exhaustion. Given certain conditions, these universal experiences take over the body and transform it, sapping motivation and disrupting sleep, appetite and attention. Depression lays waste to our capacity to problem-solve, set and achieve goals and function effectively.

The general public understands depression as a brain disease. Our genes do influence how easily we may fall into clinical depression, but depression is also, for most of us, substantially influenced by environmental stress. The unique environmental stressors of the COVID-19 crisis suggest that an unusually large proportion of the population may develop depression. This pain is likely to be distributed inequitably.

Stress and loss

Exacerbating the widespread stress of this crisis, many of us are suffering significant personal losses and grief reactions, which are robust predictors of depression. The ongoing and unpredictable course of these stressors adds an additional layer of risk.

As this crisis unfolds, death tolls will rise. For some, especially those on the front lines, acute experiences of grief, trauma and exhaustion will compound the stress and place them at even greater risk.

Interpersonal isolation

Prolonged social isolation – our primary strategy to reduce the spread of the virus – adds another layer of risk. Our bodies are not designed to handle social deprivation for long. Past studies suggest that people forced to “shelter in place” will experience more depression. Those living alone and lacking social opportunities are at risk. Loneliness breeds depression.

Families, who must navigate unusual amounts of time together in confined spaces, may experience more conflict, also increasing risk. China experienced an increase in divorce following their COVID-19 quarantine. Divorce predicts depression, especially for women, largely due to increased economic hardship over time.

Financial difficulties

The biggest stressor for many is financial. Unemployment and economic losses will be severe. Research on past recessions suggests that rising unemployment and financial insecurity lead to increased rates of depression and suicide. debt and financial deprivation during recessions are at significant risk for depression due to increased stress and difficult life circumstances. Minority-owned businesses may be at particular risk for buckling under the strain.

Recovery will be harder

Home foreclosures during the 2008 recession produced a 62% increased risk of depression among those foreclosed.

The mental health burden of economic recession will be distributed inequitably. When the stock market crashed in 2008, the rich experienced large wealth losses but not increased rates of depression. In contrast, those who experience unemployment,

While the COVID-19 crisis increases risk for depression, depression will make recovery from the crisis harder across a spectrum of needs.

Given depression’s impact on motivation and problem-solving, when our economy recovers, those who are depressed will have a harder time engaging in new goal pursuits and finding work. When the period of mandated social isolation ends, those who are depressed will have a harder time re-engaging in meaningful social activity and exercise.

When the threat of coronavirus infection recedes, those who are depressed will face increased immunological dysfunction, making it more likely they will suffer other infections. Depression amplifies symptoms of chronic illness. The inequitable distribution of the burden of the crisis will exacerbate existing racial health disparities, including disparities in access to depression treatment.

What to do?

Self-help suggestions are readily available. A good list, more evidence-based than most, is here. It is our experience, however, that such self-help encouragements for depression are not enough, and at times even insulting, for those who are truly struggling.

We need higher-level shifts in policy and how we approach the problem. Economic relief measures from the federal government are crucial responses both to economic recession and psychological depression. We call for a public health campaign to increase awareness of depression and treatment options, and for improvements in mental health sick-leave policies and insurance reimbursement to minimize barriers to treatment access.

How we talk about depression must change. The distress we feel is a normal human response to a severe crisis. Acknowledging and accepting these feelings prevents distress from turning into disorder. Describing depression solely as a brain disease increases helplessness and substance use among those who are depressed and decreases help-seeking. Emphasizing the causal role of our environmental context, in contrast, matches how depressed individuals across different ethnicities view the causes of their suffering, decreases stigma and increases help-seeking.

Finally, we recommend specific treatment options be prioritized. As we have discussed elsewhere, easy-to-train, cross-culturally applicable and effective treatment options exist. We wish for an army of practitioners to be trained and embedded in community and treatment centers across the country, and this army should represent the great diversity of our country.

Some specific suggestions to help us all:

Protect Your Family’s Mental Health During the COVID-19 Pandemic. 

Begin the Day with Gratitude

Before your feet hit the floor in the morning, think of something that you’re grateful for. Making this a focus for yourself, and teaching your kids to do the same, can have a significant impact on your emotional health. The heaviness of our current situation can quickly weigh us down, and if we begin our day with doom and gloom, then we have set the negative feeling pendulum into full swing.

A study published in the journal Psychotherapy Research found that writing a gratitude letter can improve a person’s outlook and emotional well-being. It even seems to change brain activity in a positive way, based on MRI scans of study participants.

Get into a Routine and Make a Daily Schedule

Depression and anxiety can keep you from feeling in control of your life. One way to counteract that feeling is by making a regular schedule and sticking with it. When you organize and structure your life, you know what to expect. Make sure you have a family routine.

Remember, kids are used to routine and structure in schools. Many thrive on having consistency in their lives, which consequently helps them feel in control, something kids need now more than ever.

Not only will having a plan can help you stay centered, it will keep you focused on the tasks at hand. A study published in the Annual Review of Psychology on psychological habits showed people rely on their routines and habits when they are stressed. That helps them get through difficult times, suggesting that establishing healthy routines could help with physical, emotional and mental health during difficult times like these.

So, go ahead and make a schedule. The first item on the list should be to make your bed. According to a survey by OnePoll and Sleepopolis, which provides mattress reviews, people who make their beds regularly tend to report feeling happier and more productive. Plus, if making your bed is on your to-do list, you can accomplish your first goal of the day.

How to Cope with Coronavirus Anxiety. 

Get a Good Night’s Sleep

According to the National Sleep Foundation, adults need between seven and nine hours of sleep each night. And research shows the amount and quality of sleep we get has a significant impact on mental health. The amount of sleep kids need varies considerably by their age. That ranges from newborns snoozing away most of the day (14 to 17 hours recommended), to preschoolers splitting time awake and asleep (11 to 13 hours in la la land recommended), to teens who are advised to get eight to 10 hours of sleep daily, though they rarely do.

Researchers have discovered that those suffering from mental health conditions, such as anxiety and depression, are at an increased risk of insomnia. And not getting adequate rest can raise one’s risk for mental health problems.

So, during times of high stress, sleep is of utmost importance. In addition to following a routine, another way that you can ensure a healthy night’s rest for you and your kids is by making sure the whole family is active during the day.

Go Outside

Research from Sweden suggests that being outside is associated with a lower risk of developing psychiatric disorders. In a separate study published in the International Journal of Environmental Health Research, researchers showed that spending about 20 minutes in the park can improve your overall well-being.

Even if you can’t get to a park, just getting some fresh air – while keeping 6 feet from others outside your household – can do you a world of good.

Eat Healthy

During this stressful time, it’s important to watch what you eat. That’s because what you put into your body will affect how you think and feel. Research has long documented the positive impact nutrition has on mood and that eating well is associated with lower levels of anxiety and stress.

Research has demonstrated the benefits of eating unprocessed food and having a diet that’s high in vegetables, fruits, unprocessed grains, with fish and only modest amounts of lean meats and dairy. Studies suggest that those who eat this way have depression rates 25% to 35% lower than those who consume a traditional Western diet characterized by processed foods, lots of red meat and high intake of unhealthy fats and carbs. The saying “you are what you eat” applies as much to mental health as it does to your physical health.

In a time of uncertainty, you need to take care of your mental health. Sure, you may be more confined than you usually are, but you don’t have to let anxiety and depression consume you. Make your mental health a priority by following the measures outlined above.

Also, if you need professional help, please reach out, as there are trained professionals who would like to assist you. Don’t forget, with COVID-19, you are not alone in how you are feeling. More importantly, remember this, too, shall pass.

Depression costs the U.S. economy US$210 billion yearly. That is under normal conditions. An epidemic of depression requires a multi-faceted, multi-level response.

Are We Only Going to See More Substance Abuse and Bad Behavior Including Gambling?

I was amazed that when our Governor of the great state of Maryland shut done businesses yesterday that the liquor stores were exempt, but not my medical offices. I also noticed that the substance abuse/methadone clinic next store to my office was still open for business and as usual, very busy. I continued to wonder when my oldest daughter asked how the pandemic will affect individuals suffering from substance use problems, particularly now that many of these individuals are in forced isolation.

Yale University professor Adrian Bonenberger noted that the coronavirus quarantine means different things to different people: A necessary inconvenience. A fusion of work and home life. A leap into social media, or virtual meetings once held face-to-face. For some, it’s possible to see a silver lining: more time with one’s family, and a change to the regular routine. But for people who suffer from substance use disorder, gambling addiction, or problematic video gaming—otherwise known as internet gaming disorder—the quarantine is fraught with danger.

“People will likely be practicing social distancing per the government’s recommendation,” said Marc Potenza, Ph.D., MD, HS, professor of psychiatry, who directs Yale’s Center of Excellence in Gambling Research, the Women and Addictive Disorders Core at Women’s Health Research at Yale, and the Yale Research Program on Impulsivity. “Oftentimes stress is linked to addictive behaviors, and there can be little question that the social distancing around coronavirus or COVID-19 has been a stressful interruption of routine for many.”

For people in treatment for substance use disorder, COVID-19 could lead to the type of stress and isolation most likely to result in risky behavior.

“Everyone is trying to protect the vulnerable from COVID-19, and the only way to make that happen is social distancing,” said Ellen Edens, MD, MPH, associate professor of psychiatry. “But social distancing can also be especially harmful for people with mental conditions or substance use disorder.”

According to Edens, there is a related concern: those who depend on medications to treat a substance use disorder may fall through the cracks. Like those with an opioid use disorder who take methadone or buprenorphine, both of which block cravings, treat opioid withdrawal and prevent opioid overdose; or those with a prescription for disulfiram, a medication that causes people to become sick if they drink alcohol and is most effective when taken under direct observation. Disulfiram is unavailable nationwide, according to Edens, though the intensively monitored in-person treatment often required for best outcomes, particularly early in treatment, is also unlikely in the current context.

Edens also notes that the most vulnerable moment for someone with substance use disorder is at the beginning of treatment, when they are deliberately and intensely plugged into group therapies and peer support groups like those popularized by Alcoholics Anonymous or AA. “With social distancing, one of the key components of addiction treatment—the reforging of family, social, or professional connections that may have been severed, exemplified by ‘network therapy’ or a ‘community reinforcement approach’—is lost,” she said. “The psychiatric community is doing what it can to make up for the sudden disruption of tested and effective in-person programs with things like old fashioned telephone calls. But between the technology gap with older patients and specific challenges faced by patients for whom disconnection is essentially the greatest danger, it’s difficult. Many AA groups that have closed their doors to comply with the injunction against gatherings of numerous people, and while it’s certainly prudent, it also leaves many attendees adrift.”

Another possible fallout from COVID-19 stems from the shutdown of casinos across the United States, coupled with the postponement or cancellation of professional sporting events including the NBA, NHL, MLS, and MLB (suspended), the Masters (postponed), the Boston Marathon (postponed), and the NCAA men’s and women’s basketball tournaments (canceled). Although gambling and sports gambling have been online and lightly regulated for years, there has never been an absolute vacuum of physical gambling locations. It’s likely that in the absence of a physical space in which to gamble, and without many of the typical outlets for gambling in place, some people with gambling addition will make their way to the internet.

The rise of e-sports is one possible place where online gambling and problematic video gaming could converge. A growing field with audiences for a single event in the millions, and over $1 billion in revenue as of 2019, e-sports, in which people play video games online competitively, requires no crowds, and can be accessed by anyone with a smartphone or laptop.

“A quarantine, particularly at home, may lead to bingeing on video games, alcohol, or drugs given the significant change to routine life. It could also lead to a relapse for those who had been doing well previously. Second, those who may have been considering coming to treatment now may suddenly be hesitant given possible exposure to the virus in a hospital or treatment setting and have decided to delay getting help,” said Brian Fuehrlein, MD, Ph.D., FW ’13, associate professor of psychiatry and director, Psychiatric Emergency Room, VA Connecticut Health Care System. Fuehrlein was careful to echo his colleagues in underlining the necessity of home quarantine and the importance of following it, and was unequivocal about the dangers posed to vulnerable populations like those who will be significantly economically impacted by social distancing.

There has already been an observable change in normal behavior at the VA, according to Fuehrlein—and the opposite of what one might expect, which is more cases. Fewer patients have been coming in for any reason, which does not bode well for long-term mental wellness. “Currently, we are seeing an uptick in those who were considering treatment for substance use disorder but have now decided to stay home instead (and thus are likely continuing to drink or use). Our census in the psych ER has actually been running lower than average,” said Fuehrlein.

In the long run, this will almost certainly turn into a large problem, or even a secondary epidemic for people already suffering from the various diseases of addiction. “I think in the long run we will see a sharp increase in depression, anxiety, and addictions of all types as a direct consequence of the current pandemic,” said Fuehrlein. “This may be due to the death of a loved one, a financial crisis, the loss of a job or housing, or some related tragedy. At the moment those consequences have yet to play out.”

Potenza echoes Fuehrlein and Edens’ concerns for people suffering from substance use or gambling problems at home, away from the usual forms of treatment. He brought up another population that will be at risk—in addition to the tens of millions of American workers (over 18% of the work force, according to an article published March 17, 2020 in the Los Angeles Times), millions of school children who have been cut loose with weeks of unstructured time. Without supervision, these groups will be especially vulnerable to what the DSM-5 defines as internet gaming disorder, on top of the better-known associated substance use disorder.

Said Potenza, “Oftentimes, it appears that people who are experiencing negative mood states or life stressors may turn to gambling, gaming, or use various substances including alcohol and drugs. COVID-19 is almost certainly creating more stress, and while health professionals and the government are mobilizing to address the threats posed by the virus, some of the recommended actions like social distancing and staying at home seem likely to lead to more gambling, more gaming, and more substance use.”

Almost 20 million American adults suffered from substance use disorder in 2017, while nearly 10 million American adults struggled with a gambling problem as of 2016. Both groups, in which there is almost certainly some overlap, rely on a therapeutic model that relies on person-to-person meetings. Potenza, Edens, and Fuehrlein all agreed that patients suffering from mental illness and substance use disorder could receive effective treatment via phone or computer, and that technology was racing to keep up with the changing demands of quarantine and the patient population. Any mechanism by which a connection could be forged, according to them, was preferable to isolation during the search for an effective vaccine and perhaps a cure.

“Ultimately,” said Potenza, “we don’t know what will happen. And that’s a source of stress for most if not all of us.”

It’s stockpiling, but not as you know it. Why coronavirus is making people hoard illegal drugs

Ms. Emma Reynolds of London (CNN) wrote that it’s not just toilet roll that people are panic buying. Some illegal drug users are reportedly stockpiling their substance of choice as restrictions intended to stop the spread of coronavirus disrupt the international supply chain.

And the consequences could be devastating, with experts concerned that people will adopt riskier habits, substitute unfamiliar drugs or enter withdrawal, which can be dangerous if unmanaged. Since heavy users often have other health problems, this could mean increased strain on services that are already near breaking point.

UK drug policy and crime experts told CNN they were worried over a growing number of reports of shortages and escalating prices for drugs, as international borders close and supply lines are cut off.

“There are reports coming through of people stockpiling their favorite drug or their drug of choice, and of course, that just creates a shortage, which has inevitably led to price increases,” Ian Hamilton, senior lecturer in addiction and mental health at the University of York, told CNN. He said he expected to see heroin “disappearing very, very quickly” in the UK.

Steve Rolles, senior policy analyst at the Transform Drug Policy Foundation, told CNN there was “anecdotal evidence of price rises… and that doesn’t seem surprising.”

“It does seem likely that the supply of drugs that these people are using, in particular heroin, is going to be restricted … it’s going to be more challenging to move drugs around.

“As weeks stretch into months, I think we’re likely to see a drought, a heroin drought.”

Alex Stevens, criminal justice professor at the University of Kent, told CNN that in areas including Birmingham and Bristol, users of heroin and synthetic cannabinoids “are reporting that they’re getting less in a £10 ($12) bag than they would have done four or five weeks ago.”

But this is an industry that operates on supply and demand. The dark web and sites including Craigslist are still active, with many users buying drugs through the mail at a time when police are not focused on monitoring post, according to several experts. “If the heroin isn’t available, they will probably find another route, whether it’s alcohol or inhalants, or benzodiazepines or something else,” said Rolles.

Rolles has even heard reports of dealers dressing in nurse’s uniforms and supermarket uniforms to make deliveries unnoticed.

What happens during a drought?

When the UK last experienced a heroin drought in 2010-11, the drug’s purity at “local dealer level” fell to 18%, according to the National Crime Agency. Street prices reportedly increased, and there was a reduction in the number of deaths involving heroin and a simultaneous (but smaller) increase in deaths involving methadone.

That may sound positive, but the experts say the effects could be different this time. Users may move from less dangerous drug-taking methods to injecting. They may use lethal combinations of drugs. They may use too much of their stockpile. And they may be more likely to overdose alone because of social distancing.

Women are using code words at pharmacies to escape domestic violence during lockdown

One vital difference between 2010 and 2020 that is causing anxiety among the experts is the proliferation of fentanyl, a synthetic opioid that is up to 50 times stronger than heroin and can therefore be transported in much smaller quantities. The drug has not yet become widespread in countries including Britain, but is wreaking havoc in the United States.

Fentanyl is the drug most often involved in overdoses in the US, according to the National Center for Health Statistics. The rate of overdoses involving the opioid skyrocketed by about 113% each year from 2013 through 2016. If you’re used to heroin and you take fentanyl, “the risk of overdose is extreme,” said Hamilton.

The drug is often manufactured in China, but little is moving out of the original coronavirus epicenter. It is also manufactured in Mexico and possibly Eastern Europe.

With many drug users dealing with mental health issues such as depression and anxiety, coronavirus isolation presents an unprecedented challenge.

“People who have an active disorder, addiction disorder, they’re going to look for ways to get a drug,” Cynthia Moreno Tuohy, executive director at NAADAC in the US (National Association for Alcoholism and Drug Abuse Counselors), told CNN.

Asking for help

The suicide rate in the United States has seen sharp increases in recent years. Studies have shown that the risk of suicide declines sharply when people call the national suicide hotline: 1-800-273-TALK.

There is also a crisis text line. For crisis support in Spanish, call 1-888-628-9454.

The lines are staffed by a mix of paid professionals and unpaid volunteers trained in crisis and suicide intervention. The confidential environment, the 24-hour accessibility, a caller’s ability to hang up at any time and the person-centered care have helped its success, advocates say.

The International Association for Suicide Prevention and Befrienders Worldwide also provide contact information for crisis centers around the world.

Tuohy expects more “poly-use” of readily available marijuana and alcohol, which is already seeing increased consumption worldwide.

It takes longer to build up data on illegal drug consumption, but analysts are watching closely.

Federal confidentiality laws in the US have been relaxed to allow people to access counseling and peer support faster. NAADAC is offering telehealth training, and resources to help clients find services available in their state.

“Whenever there’s a natural disaster, we know that relapse goes up, because of anxiety, the fear of the unknown,” said Tuohy. “Now we have an ongoing, natural disaster, if you will.

“The longer a crisis goes on, the less hope that people see … it doesn’t feel like there’s going to be a light at the end of the tunnel.

“Long term, we’re likely to see suicide go up as a result of depression. So I know that the suicide centers are gearing up and the suicide hotlines already are taking calls.”

A vulnerable population

Any disruption to the illicit drug supply will have the biggest effect on the most vulnerable populations. Heavy drug users are more likely to live with multiple people, have respiratory or other health issues or be homeless — and are therefore more at risk of contracting Covid-19.

“They are in a double tier of vulnerability in that they’re more likely to get the virus and they’re more likely to be affected negatively by it,” said Rolles. “So there’s a big responsibility, I think, on society to look after and protect those populations.”

If that doesn’t happen, hospitals and treatment facilities will face a huge additional strain, he warns.

Governments are conscious of the risks. The UK government has asked local authorities to house all homeless people. Low risk and pregnant prisoners are being released across the world.

Facilities in the US, UK and Canada are allowing stable users to pick up supplies of addiction treatment medications like methadone and buprenorphine once a week or every two weeks instead of daily, but this also presents risks.

Mat Southwell, a drug user and global advocate from Bath in southwest England, told CNN he was delivering a methadone prescription to a woman who cannot pick it up for herself, is suicidal and self-harms. She had gone three days without it.

Coronavirus is revealing how badly the UK has failed its most vulnerable

Will Haydock, from Public Health Dorset also in southwest England, told CNN that UK clinics were seeing an increase in people accessing treatment. He said this was encouraging but warned that for providers already making “significant changes to service design” this was adding to pressure. “It’s going to be a real challenge to deal with that influx of people who want support,” he said.

“This is a particularly vulnerable group of people, and you’re looking at services that are already really stretched.

“If we’re not able to offer the kind of level of support that we would like to, we will see more people die earlier than they need to.”

A spokesperson for the UK’s Home Office told CNN it is “monitoring the impacts of coronavirus” and law enforcement are “continuing to prevent drug trafficking and are successfully disrupting the drugs supply within the UK.”

The world was already facing a drug crisis before the coronavirus pandemic. The US is in the throes of an opioid epidemic. An estimated 10.3 million Americans ages 12 and older misused opioids in 2018. In 2017, there were more than 70,200 overdose deaths in the US and 47,600 of those deaths involved opioids.

The UK has seen near-record levels of drug-related deaths for six years in a row, and Scotland’s death rate is the highest in the European Union.

“I’m very apprehensive about what’s happening right now and what’s going to happen over the next few weeks to this group of our society who are extremely vulnerable, who’ve been exposed to adverse experiences, neglect and abuse from childhood onwards, and now risk being put at the back of the queue for support when in fact, they should be in front of it,” said Stevens, from the University of Kent.

The coming weeks and months will be crucial in identifying the effects of coronavirus on illegal drug use, alcoholism, suicide, domestic abuse, anxiety, and depression — and what it means for all of us as well as how we need to compromise, care and treat each other.

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.

 

Suicide Rate Up 33% in Less than 20 years, Yet Funding Lags Behind Other Top Killers!

Screen Shot 2018-12-02 at 8.35.40 PM

First let us all take a minute to remember Past President 41, George H.W. Bush, probably one of the most respected past presidents. is experience, knowledge, and experience was amazing and so welcomed and useful to run a country. This former president has inspired us all with his toughness mixed with judiciousness and kindness. We could all learn much from 41! Now a moment of silence…………………..

Suicide rates are up 33% in the U.S., yet funding lags behind that of all other top causes of death — leaving suicide research in its “infancy.”

More than 47,000 Americans killed themselves in 2017, the Centers for Disease Control and Prevention reported Thursday, contributing to an overall decline in U.S. life expectancy. Since 1999, the suicide rate has climbed 33 percent.

Americans are more than twice as likely to die by their own hands, of their own will, than by someone else’s. But while homicides spark vigils and protests, entering into headlines, presidential speeches, and police budgets, suicides don’t. Still shrouded in stigma, many suicides go unacknowledged save for the celebrities – Robin Williams, Kate Spade, Anthony Bourdain – punctuating the unrelenting rise in suicide deaths with a brief public outcry.

And research suggests our ways of living may be partly to blame, in ways that don’t bode well for the future.

Alcohol and substance abuse are risk factors, and both are increasing. Isolationraises the risk, and nearly half of Americans say they sometimes or always feel alone. Increasing smartphone use has been linked to suicidal thoughts in teens. Even climate change has been found to have roughly the same effect on increasing suicides as an economic recession.

The leading causes of death have declined since 1999

The Suicide rate has increased more the 33%

Screen Shot 2018-12-01 at 10.16.49 PM“We’re trying to reduce suicide death rates in the face of a culture that’s ever more fascinated with violence, that has a bunch of opiates around left and right, where family structure isn’t getting more cohesive and neither is community structure,” said Thomas Joiner, a leading suicide researcher. “That’s a lot to fight against.”

Suicide is the 10th leading cause of death in the U.S. and is often called a public health emergency.

But money to research and combat suicide continues to lag behind other leading killers and even non-fatal conditions. The National Institutes of Health, the largest public funder of biomedical research in the world, spent $68 million on suicide last year. It spent nearly five times that studying sleep and 10 times more on breast cancer, which killed fewer people in 2016.

“What I’m just painfully aware of is that all of the areas where the top 10 causes of death in the United States have gone down have received significantly more attention,” said John Draper, director of the National Suicide Prevention Lifeline. “There’s been so much more put into every one of those causes of death than suicide. … If you didn’t do anything for heart disease and you didn’t do anything for cancer, then you’d see those rates rise, too.”

NIH officials say they do not expressly budget by disease, and research funding in other categories could affect suicide without being suicide-specific. The NIH spent $2.7 billion on mental health, for example.

“A large portion of the research is not disease-oriented but based on human biology. For instance, if we’re studying brain function, it might be pertinent to suicide, but we might not necessarily categorize it as suicide,” said Michael Lauer, NIH deputy director for extramural research. “Same with depression, which obviously is linked to suicide.”

Still, many in the field wish for dedicated spending. Jill Harkavy-Friedman, vice president of research for the American Foundation for Suicide Prevention, advocates for $150 million a year for suicide research, still far less than the $592 million the NIH allocated to fight kidney disease, the nation’s No. 9 killer.

“We are happy that other health conditions are getting the money. … It’s not an either/or,” Harkavy-Friedman said. But “the cost of suicide is enormous, and people don’t realize it.”

The cost — in dollars, in suffering, in science

Suicides and suicide attempts cost $93.5 billion a year, most of it in lost productivity, a 2016 study estimated. And that’s nothing compared with the cost in human lives and suffering.

Joiner recognized the human toll 30 years ago – even before his own father died by suicide.

As a graduate student in psychology in 1990, Joiner had begun focusing on depression. That summer, his father, a former Marine sergeant turned software pioneer, took his own life.

“He was a successful, visionary, ambitious, intelligent man,” Joiner said. “And he had an illness that ended up being fatal. That’s how I see him.”

Joiner, now a psychology professor and clinician at Florida State University, said his father’s death helped persuade him to make studying suicide his life’s work.

“I’d already inclined toward that decision, and this only made it starker. I already knew this was a problem,” he said. “It was a misery for the bereaved, and that’s not to mention the even more acute suffering suicidal people go through in the hours, days, months before their death – just a lot of suffering all around. And it wasn’t being studied then.”

It’s studied now, but given the size of the problem, we still know surprisingly little about it.

“I think that we’ve told the public that we know more about suicide than we know,” said April Foreman, a clinician on the American Association of Suicidology board of directors.

When someone dies by suicide, people and the media trot out a series of “maybes,” she said: Maybe it was mental illness. Maybe it was losing a job or getting divorced.

“Maybe it was not getting a phone call at just the right moment. Maybe. But maybe something was happening in their brains that in 20 years we’ll understand,” she said. “We tell stories about bullying or sadness like it’s a fairy tale. There’s probably real science there, and we just haven’t decided to treat it like that. … We’re telling stories about why people kill themselves that isn’t scientifically based, that are very inaccurate, and are just the easier stories to tell because it’s much harder to say we don’t know.”

Joiner compares suicide research today to “cancer research about 100 years ago.”

“People were so scared of the topic they wouldn’t even say the word,” but cancer research has since made great strides, he said. “I think the same thing will happen with suicide research, but that’s decades in the future. Right now we’re in our infancy.”

Suicide studies reflect the broad sweep of the current science. Some focus on genetic factors involved in maintaining brain circuits and neurotransmitters, biomarkers of at-risk populations, brain PET imaging and medications; others focus on psychotherapies, preventing substance abuse and school nurse interventions.

The effectiveness of prevention efforts has been difficult to determine as suicide rates increase, said Andrew Sperling, director of legislative affairs for the National Alliance on Mental Illness.

“The challenge is there are various suicide prevention programs, and we’re still learning a lot about what works and doesn’t work,” Sperling said. “There’s not a lot of evidence we’ve been very effective at it.”

Scientific knowledge is limited. Public knowledge is wrong.

Even key discoveries that enjoy broad support among researchers have yet to percolate into the public consciousness. 

Public health experts say: Suicide is preventable.

People think: Suicide is inevitable.

Consciously or unconsciously, many Americans write off those who seriously consider killing themselves as hopeless causes, unreachable. A study in 2017 showed that people are skeptical of a suicidal person’s ability to recover – the idea that even if we stop the person today, we won’t tomorrow.

“If you think once someone’s suicidal that they’re just going to die, then it doesn’t make sense to invest money in that,” Joiner said of a common point of “ignorance.”

Science tells us that isn’t true. So does common sense. Survivors of suicide attempts themselves are walking proof.

In 2016, nearly 45,000 died by suicide, but the number who attempted is almost 29 times that — meaning more than one and a quarter-million survived. Though a previous suicide attempt makes the risk of dying by suicide higher, it is just one of many risk factors. Nine out of 10 people who survive a suicide attempt will not go on to die by suicide later, according to studies that have tracked survivors over decades.

Cliff Bauman, a National Guardsman who struggles with post-traumatic stress disorder, attempted suicide once, but when he faced a crisis again he was able to get through it by using learned coping skills, including being aware of his triggers and having people he can trust.

“I made the conscious decision (after my attempt) to go back into counseling,” he said. “(I) was opening up about why I did what I did and how it got to that point, and I felt suddenly … the darkness doesn’t seem so dark.”

Another misconception is that suicidal ideation is rare. But one in 33 American adults seriously thought about suicide in 2016, the commonness of the thoughts belied by how rarely they’re discussed.

“Suicide is reflective of other issues that we don’t want to talk about,” said Adam Swanson, a senior prevention specialist at the Suicide Prevention Resource Center. “We don’t want to talk about the fact that people can’t afford to pay electric bills. … We don’t want to talk about the … pain people carry.”

Survivors are often the first to distinguish that it’s not a desire to die that drove their attempt but a desire to escape the pain. It’s something Shelby Rowe, a PTSD and suicide attempt survivor who works in suicide prevention knows firsthand.

“If I could go back to talk to myself that night when all I could hear in my head was ‘You can’t live like this anymore, you can’t live like this anymore’ … I would have said: ‘It’s OK, you’re right. It is really awful right now, and you can’t live like this anymore, but please live, because there is another way. There is another beautiful life waiting for you.'”

Mental and emotional pain is less acknowledged – both by doctors and the public – than physical pain, Foreman noted.

“It is OK for someone to suffer from wanting to kill themselves and to suffer from trying to kill themselves or even die that way, but it’s not OK to feel sick with the flu for a few days,” she said.

Stymied by stigma

The lack of compassion people feel for those who die by suicide is reflected in the lack of funding. Stigma goes beyond misconceptions.

“Stigma is about fear, and suicide is associated with our most primal fears – fear of death … fears of traumatic loss and our fears of mental illness,” Draper said.

Fear and discomfort also can be expressed as anger.

Retired California Highway Patrol officer Kevin Briggs said he has heard drivers shout “Go ahead and jump!” to people contemplating suicide on the Golden Gate Bridge.

The taunts reflect a disdain some people feel toward those who attempt suicide, whom they see as “weak” or “crazy,” a 2017 study found. Though mental illness is a risk factor for suicide, not everyone who is mentally ill has suicidal thoughts, and not everyone who attempts suicide is mentally ill.

But even statistics on the relationship between mental illness and suicide are incomplete “because we’re not funding it,” Harkavy-Friedman said.

“Every year we go to (Capitol) Hill and we advocate at the state level for fully funding the National Violent Death Reporting System,” she said.

The tracking system, now in place in just 40 states, helps health experts and law enforcement officials identify common circumstances associated with specific types of death, including suicide. Suicide can be especially hard to track without a strong system in place because family members may try to cover it up or pressure officials not to enter “suicide” into records.

In the past, even in clear cases of suicide, families were “not telling anybody for years because they thought they would be blamed or stigmatized,” Harkavy-Friedman said.

Stigma is not only an obstacle to accurate reporting, but it also has made politicians shy away. It’s part of why suicide wasn’t seriously studied or even discussed until the past few decades.

“Twenty years ago when I worked on (Capitol) Hill, you wouldn’t find suicide prevention on federal documents. It wasn’t talked about in the Department of Defense or in the general public. There were no researchers. There was no national strategy for suicide prevention,” said Jerry Reed, a doctor on the executive committee for the National Action Alliance for Suicide Prevention.

That changed in 1998 when Congress declared suicide a national problem, Reed said.

“Since then, the country has caught up to the significance of this issue, but it still has a long way to go.”

Congressional support is key because it affects the overall NIH budget. Congress also can pass special provisions regarding certain issues, as it has for Alzheimer’s and opioid abuse.

“Congress has made that a clear priority,” Lauer said.

Where’s the hope? A little bit in a lot of places

Despite challenges, experts agree our understanding of suicide is light-years ahead of where it was just a generation ago. And suicide prevention is at “unprecedented” levels, the Substance Abuse and Mental Health Services Administration reports.

Therapy

Through interventions, including medication and therapy, Joiner says he sees suicidal patients at his clinic go from “pretty desperate, pretty intent to die” to “turn(ing) a corner – and usually it’s shockingly quick.”

Joiner theorizes that suicide results from a combination of factors: feeling like a burden, isolation, and having lethal means and a lack of normal fear of death.

Short-circuit one of that – isolation, for instance – and you might stop someone from hurting himself.

“It stands to reason if you reconnect a little bit then risk should abate, so we just arrange within the context of people’s day-to-day lives small increased doses of social connection,” Joiner said. “It’s a very simple behavioral idea, but it seems to work if people do it.”

Asking a friend to lunch would be a great example, Joiner said, but some patients don’t have a friend. They might start simply with “show up to this community event and stay for 10 minutes.”

Of course, some people are chronically suicidal, but Joiner and others note that they can also feel relief through targeted therapy.

Shear Avory, a transgender person who sees a therapist (not associated with Joiner), has lived with daily suicidal ideation and continues to hold on to hope.

“For so long I’ve been stuck in just wanting everything to disappear, from wanting the trauma to go away,” said Avory, whose traumatic childhood included foster homes and conversion therapy. “I’m still alive. I’m still here. That feels like an accomplishment. … Healing is not a linear experience.”

Low-cost changes to health care

With unlimited funding, Joiner said he’d put resources toward practical things proven to work, such as “means safety” – which can include everything from putting pedestrian barriers on bridges to locking up guns and medicine cabinets – and training doctors to identify at-risk patients.

Training primary care doctors and other medical staff is the foundation of the Zero Suicide program.

Zero Suicide founder Mike Hogan said that though suicide is incredibly complex, determining who is at risk can actually be very simple: Once patients are in a health care setting, ask them. Studies have shown that asking people if they’re thinking about suicide does not plant the idea in their heads.

“If people are asked, they often really want to get it off their chest, and they want some help, and it opens the door to help,” Hogan said. “A little bit does a lot: asking, safety planning, reducing lethal means and reaching out … turns out to be quite powerful.”

A 2014 study found that 83% of those who die by suicide saw a health care provider in the year before their death. That’s particularly true for older white men, who account for most suicides.

“We can’t predict when they’ll die, just like we can’t predict when someone might die of a heart attack,” Hogan said. “But we can predict who needs a little help just like someone might need help because their lipid levels are high.”

Hogan said two nonprofit organizations that offer mental health treatments – Centerstone, which spans multiple states, and the Institute for Family Health in upstate New York – saw roughly 60 percent reductions in suicides after adopting Zero Suicide.

Becky Stoll, vice president for crisis and disaster management at Centerstone, said one of the biggest improvements has been the methodical approach to plugging holes in care. For instance, coordination between the suicide prevention committee and their IT department resulted in a program that changed the font color of high-risk patients if they missed appointments, which would then alert them to start calling the patient. If the patient didn’t answer, they’d start calling their friends and family. It was a simple change and it saved lives. In one case, a man’s wife called him after she had received calls from Centerstone. He had been standing on a bridge at the time.

“I’ve been in the field since the late ’80s, and I’ve not seen the enthusiasm the results that we’re seeing now,” Stoll said. “We don’t win every time, but we win a lot. When we know better, we have to do better. And embedding these frameworks into systems of care … it really does seem like we can have an impact. It seems like that’s catching wildfire across the U.S. … (We need to) make people feel they have lives worth living.”

Colorado has embraced Zero Suicide as one tool in its fight. But advocates are more closely watching the newly formed Colorado-National Collaborative, a partnership aimed at reducing suicides thereby 20percent by 2024.

Through a combination of funding from state and federal sources and the American Foundation for Suicide Prevention, Colorado’s Office of Suicide Prevention went from an annual budget of $536,000 about 18 months ago to $2.6 million as of Sept. 30. If the partnership between scientists and public health professionals proves effective in the state with the eighth-worst suicide rate in the country, it could be adopted nationwide.

Removing the means

Colorado and other states also have joined the Gun Shop Project, in which gun store owners and firing range instructors distribute suicide prevention materials as part of an effort to reach people who might be looking for a tool to commit suicide.

Guns were used in 23,000 of the 45,000 suicide deaths in 2016.

These interventions focus on the “means,” or how suicides are completed.

“We may not understand suicidality very well … (but) we know people don’t die of feeling suicidal – they die from a gunshot wound, they die from a medication overdose. Just like you don’t die by (a driver) having poor depth perception, you die from them striking the car and your head hitting the windshield,” Foreman said.

‘On the cusp’?

Many in the suicide research and prevention field describe it as being on a precipice – the science is not where it needs to be, but it shows promise; the funding is not where it needs to be, but it has increased. On the other side, they hope, are the results: a nation in which fewer lives are lost to suicide or tormented by suicidal thoughts.

“With suicide, I hope that we’re on a cusp of a movement,” Foreman said. “Where the people who have survived suicide attempts, the people who live with chronic suicidality, the families, the loved ones, the people who are left, that they get up and say: This suffering is the same as someone who has died by HIV … or cancer. It deserves the same quality science.”

Suicide, at a 50-year peak, pushes down US life expectancy

Mike Stobbe wrote that Suicides and drug overdoses pushed up U.S. deaths last year, and drove a continuing decline in how long Americans are expected to live.

Overall, there were more than 2.8 million U.S. deaths in 2017, or nearly 70,000 more than the previous year, the Centers for Disease Control and Prevention said Thursday. It was the most deaths in a single year since the government began counting more than a century ago.

The increase partly reflects the nation’s growing and aging population. But it’s deaths in younger age groups—particularly middle-aged people—that have had the largest impact on calculations of life expectancy, experts said.

“These sobering statistics are a wake-up call that we are losing too many Americans, too early and too often, to conditions that are preventable,” Dr. Robert Redfield, the CDC’s director, said in a statement.

The suicide death rate last year was the highest it’s been in at least 50 years, according to U.S. government records. There were more than 47,000 suicides, up from a little under 45,000 the year before.

A GENERAL DECLINE

For decades, U.S. life expectancy was on the upswing, rising a few months nearly every year. Now it’s trending the other way: It fell in 2015, stayed level in 2016, and declined again last year, the CDC said.

The nation is in the longest period of a generally declining life expectancy since the late 1910s, when World War I and the worst flu pandemic in modern history combined to kill nearly 1 million Americans. Life expectancy in 1918 was 39.

Aside from that, “we’ve never really seen anything like this,” said Robert Anderson, who oversees CDC death statistics.

In the nation’s 10 leading causes of death, only the cancer death rate fell in 2017. Meanwhile, there were increases in seven others—suicide, stroke, diabetes, Alzheimer’s, flu/pneumonia, chronic lower respiratory diseases, and unintentional injuries.

An underlying factor is that the death rate for heart disease—the nation’s No. 1 killer—has stopped falling. In years past, declines in heart disease deaths were enough to offset increases in some other kinds of death, but no longer, Anderson said.

(The CDC’s numbers do sometimes change. This week, CDC officials said they had revised their life expectancy estimate for 2016 after some additional data came in.)

WHAT’S DRIVING IT?

CDC officials did not speculate about what’s behind declining life expectancy, but Dr. William Dietz, a disease prevention expert at George Washington University, sees a sense of hopelessness.

Financial struggles, a widening income gap, and divisive politics are all casting a pall over many Americans, he suggested. “I really do believe that people are increasingly hopeless and that that leads to drug use, it leads potentially to suicide,” he said.

VoteCast, a wide-ranging survey of the electorate conducted by The Associated Press, found voters expressing pessimistic views about the future: About half of voters nationwide said they expect life in America for the next generation to be worse than it is today. Nearly a quarter said life would be better and about as many said it would be the same. VoteCast surveyed more than 115,000 voters nationwide as Americans cast ballots in this year’s midterm elections.

Drug overdose deaths also continued to climb, surpassing 70,000 last year, in the midst of the deadliest drug overdose epidemic in U.S. history. The death rate rose 10 percent from the previous year, smaller than the 21 percent jump seen between 2016 and 2017.

That’s not quite cause for celebration, said Dr. John Rowe, a professor of health policy and aging at Columbia University.

“Maybe it’s starting to slow down, but it hasn’t turned around yet,” Rowe said. “I think it will take several years.”

Accidental drug overdoses account for more than a third of the unintentional injury deaths, and intentional drug overdoses account for about a tenth of the suicides, said Dr. Holly Hedegaard, a CDC injury researcher.

OTHER FINDINGS

The CDC figures are based mainly on a review of 2017 death certificates. The life expectancy figure is based on current death trends and other factors.

The agency also said:

—A baby born last year in the U.S. is expected to live about 78 years and 7 months, on average. An American born in 2015 or 2016 was expected to live about a month longer, and one born in 2014 about two months longer than that.

—The suicide rate was 14 deaths per 100,000 people. That’s the highest since at least 1975.

—Montana had the highest suicide rate, and New York the lowest. Suicide rates were nearly twice as high in rural counties than in urban ones.

—The percentage of suicides due to drug overdose has been inching downward.

—Deaths from flu and pneumonia rose by about 6 percent. The 2017-2018 flu season was one of the worst in more than a decade, and some of the deaths from early in that season appeared in the new death dates.

—West Virginia was once again the state with the highest rate of drug overdose deaths. The CDC did not release state rates for suicides.

—Death rates for heroin, methadone, and prescription opioid painkillers were flat. But deaths from the powerful painkiller fentanyl and its close opioid cousins continued to soar in 2017.

—Gun deaths rose for the third year in a row, to nearly 40,000. That’s about 1,000 more than in 2016. They had been hovering around 33,500 deaths until a few years ago.

Like in other years, most gun deaths were suicides. Earlier CDC reports have noted increasing rates of suicide by gun. In 2017, it about 60 percent of them were by gun.

More next week as I discuss the discussion that we need to have and those who are left behind and suffer the most.

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.