June 22, 2020

Suicide prevention in the time of COVID-19

Maren Wright Voss, Tim Keady, Emma Campbell, and Ashley Yaugher

Ray of light

Talk to just about anyone and you will hear of their scars from the COVID-19 health scare of 2020. The impacts are wide-ranging and extend into the domain of suicide risk and prevention. Past epidemics of the last century have raised concern about increasing suicide rates (Wasserman, 1992) but there is hope to save a life, and we all have a part to play!

In Utah, Michael Staley the Research Prevention Coordinator with the Office of the Medical Examiner, reported that, prior to the beginning of the COVID-19 Pandemic, Utah had been experiencing a leveling off of suicides since 2015. And up until June 2020, increased rates of suicide were not found in real time data (Roe and Stauffer, 2020). However, there is a concern that numbers will rise as the Pandemic continues. It isn’t hard to understand as most feel the impact of social isolation, uncertainty and financial hardships, depression over loss, and anxiety about contagion. The impact of COVID-19 on mental health and suicide are just beginning to be measured. The effect of increased isolation, anxiety over job loss, deaths and illness of loved ones, depression, distress, and insomnia of the population at large has led to disproportionately worse mental health outcomes in adult caregivers (unpaid), essential workers, health care professionals ethnic/racial minorities, and younger adults (Sher, 2020). The outcomes include increased substance use and elevated suicidal ideation (Czeisler, et al., 2020). 

The current COVID-19 pandemic has been described by many mental health professionals as the most significant mental health crisis of their lifetime. The incidence of suicide increased significantly with a decrease in social contact, lack of integration, and fear during that pandemic (Sher, 2020 and Dunmore, 2020). Furthermore, the modern impact of traditional and other social media to immediately spread positive and negative reports of the virus may be producing negative stress related psychological impacts of fear and anxiety among those in vulnerable populations. Anxiety, fear, social isolation, insecurity, chronic stress, and economic uncertainty may lead to an exacerbation of stress-related disorders and suicidality in vulnerable populations. This includes individuals with pre-existing psychiatric illnesses, less resilient individuals, those in high COVID-19 prevalence areas, and people who have close relationships with someone who has died of COVID-19 (Sher, 2020).

The American Foundation of Suicide Prevention (AFSP) encourages everyone to protect their physical and mental health by focusing on what you can control, developing health habits, maintaining (or making new) connections, exploring relaxation techniques, and supporting youth. The website https://afsp.org/mental-health-and-covid-19/#resources---programs provides practical tools to positively impact communities’ understanding of mental health and suicide. From challenging misperceptions to providing resources for those who are struggling with isolation, anxiety, and depression related to COVID-19 we can all help (Clay, 2020).

Repeated exposure to news coverage and media reports about the COVID-19 crisis can intensify feelings of uncertainty, isolation, and financial concerns. Worries and fears related to this exposure may exacerbate various mental and physical symptoms and lead to the development of anxiety, depression, distress, social isolation, substance use, and sleep disorders in susceptible populations (Dunmore, 2020). Some suggest this exposure increases the possibility of suicidal ideation and other unhealthy behaviors (Barna, 2020 and Czeisler et al., 2020).

The following tips offer some practical actions that can be taken to reduce stress and anxiety during this challenging time.

5 Tips to Manage Stress and Anxiety during COVID

  1. Connect with others while safely practicing physical distancing. Social connections are incredibly important for our mental wellbeing and are still possible during COVID-19 with technology. Reach out to a friend or family member via video call, phone call, or even a text to relieve stress and anxiety by sharing your feelings with someone (Mental Health and Coping During COVID-19. (n.d.)). If a friend or family member is not available to talk, there are many resources online, such as the Utah Strong Recovery project https://hs.utah.gov/portfolio-item/state-offers-free-counseling-for-covid-related-stress, which offers free sessions with a crisis counselor.
  2. Meditation is a great way to look after your body and mental health (Mental Health and Coping During COVID-19. (n.d.)). Meditation comes in all shapes and sizes; stretching, breathing, mindfulness exercises, and more. The important thing with meditation is to do what works for you, which can be active like taking a walk or more calm like listening to your favorite mindfulness activity.
  3. Take breaks from the media to reduce the stress and anxiety constant exposure to COVID news can bring. Replace spending time on social media with other activities that bring you pleasure, such as reading, crafts, baking, and gardening (Mental Health and Coping During COVID-19. (n.d.)). 
  4. Exercise is essential in keeping you healthy, both physically and mentally (Mental Health and Coping During COVID-19. (n.d.)). Exercise does not have to mean going to the gym or be active for extended times; going for a walk around the neighborhood is a great way to get your body moving and get you out of the house. There are online exercise routines and videos that can help you make a regular exercise routine achievable. For example, The YMCA https://ymca360.org/on-demand has videos on multiple different kinds of exercise: yoga, weightlifting, dance fitness, kid activities, and more. 
  5. Create a daily routine that gives your day a feeling of purpose and is consistent with what is important to you (Mental Health and Coping During COVID-19. (n.d.)). Use this routine to practice the tips above daily. For example, schedule activities around work or other family schedules that you enjoy such as starting the day off with meditation, reaching out to a family member or friend, and ending the day with a walk. It is important to schedule in self-care along with your other responsibilities, so we do things to help us recharge each day. 

In this pandemic, the impact on suicide is still unknown according to the American Psychological Association (Clay, 2020), but the CDC recently reported that 11% have contemplated suicide and 13% were using drugs and alcohol more heavily in response to the pandemic (Czeisler, et al., 2020). The American Public Health Association has noted that calls to a federal disaster distress hotline were up by 900% in April (Barna, 2020). Utah’s crisis hotlines were busier, and suicides were up just slightly for the year according to Utah Public Radio reporting in June 2020 (Barnes, 2020). The fear is that deaths of despair will rise with these signs of distress, unless we take action to prevent it.

National Resources:

Local Resources:

References:

Barna, M. (2020). Experts fear suicide, deaths of despair will rise in wake of COVID-19: Mental health crisis. The Nation’s Health, July 2020, 50(5) 1-10.

Barnes, H. (2020). Suicide Prevention Program Provides Utahns with Resources During COVID-19 Pandemic. Utah Public Radio, August 6, 2020. Retrieved August 11, 2020: https://www.upr.org/post/suicide-prevention-program-provides-utahns-resources-during-covid-19-pandemic

Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1external icon.

Clay, R. (2020). COVID-19 and Suicide, COVID Special Report. American Psychological

Association, Vol 51, No. 4. Retrieved August 11, 2020 at: https://www.apa.org/monitor/2020/06/covid-suicide

Dunmore, R. (2020). Coronavirus-related suicides surface amid increased anxiety. Newsone. https://www.google.com/amp/s/newsone.com/3921332/coronavirus-related-suicides-amid-anxiety/amp/

Mental Health and Coping During COVID-19. (n.d.). Retrieved August 13, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

Roe, G., Stauffer, M. (2020). Report: Utah's suicide rates are 'leveling' after decades but are 'still high'. KUTV. Retrieved from https://kutv.com/news/local/report-utahs-suicide-rates-are-leveling-after-decades-but-are-still-high 

Sher, L. (2020). The impact of the COVID-19 pandemic on suicide rates. QJM: An International Journal of Medicine. https://doi.org/10.1093/qjmed/hcaa202

Wasserman, I. M. (1992). The impact of epidemic, war, prohibition and media on suicide: United States, 1910–1920. Suicide and Life‐Threatening Behavior, 22(2), 240-254.

Yip, P. S., Cheung, Y. T., Chau, P. H., & Law, Y. W. (2010). The impact of epidemic outbreak: the case of severe acute respiratory syndrome (SARS) and suicide among older adults in Hong Kong. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 31(2), 86.