National Suicide Prevention Month: Repeating the Basics and an Exhaustive Resource List

Industry Insights

Sep 10

By Deborah Keller, CEO Chordline Health

We are dying. By the thousands, we are dying by our own hands. Understanding depression and suicide and how to help others is more critical now than ever.

Few events are as painful, and personal, as a family member or friend making the choice to end their own lives. I have gotten that call twice in my life. It is something you never truly get over. Years later, an event or memory takes me right back. The well-worn, regret-filled thoughts begin: “Why didn’t he say something?” “I could have helped.” “Maybe I didn’t stay in touch enough.” “I am a nurse. How did I miss the signs?” Guilt settles in and waits for the sigh that always comes next. Then comes the pain. Finally, the reminder to breath.

September is National Suicide Prevention Month, it’s time to look closer at the “other” pandemic that is hiding plain sight as we battle the COVID pandemic.

According to the Centers for Disease Control and Prevention (CDC), the mortality rate for suicide in the U.S. in 2018 (the latest year for which figures are available) was 14.2 deaths per 100,000 people. That is higher than the mortality rate for COVID-19 in all but the top 14 nations in the world.

It also represents an increase of 35% since 1999, when the mortality rate was 10.5 per 100,000. Even more cause for concern is that the rate has been increasing by 2% each year since 2006.

The suicide rate per 100,000 is acute in the veteran community, where it is nearly double (27.7) that of the country at large even as the overall veteran population shrinks. It is sad to think of so many veterans surviving the risks of military service, particularly direct combat, only to later lose their lives by their own hands.

Clearly it is a significant issue in the U.S. What makes reversing or even managing this trend particularly difficult is that there can be so many underlying causes that lead to the decision to commit suicide.

Sometimes it is a general feeling of hopelessness due to big societal issues such as frustrations over income inequality, pervasive poverty, or gender or racial bias. Often, there is a much more personal crisis such as:

The breakup of a marriage or relationship
Loss of a family member (especially a child or parent)
An extended period of unemployment
Personal or business bankruptcy
Depression over a diagnosis of a condition (such as diabetes or cancer) viewed as a death sentence
The lingering effects of post-traumatic stress disorder (PTSD) from military service or a violent attack
Drug abuse
Mental health issues
A feeling of poor self-worth resulting from negative childhood messaging

And sometimes, no one ever knows the why – it is simply a decision someone makes because they feel they have no reason to keep on living. One patient suffering from severe depression once told me she was, “just too tired to keep living”. Another said, “It’s not so much that I want to die, I just don’t care if I live or not.”

It is important to recognize the signs of depression including:

Depressed mood, feeling sad, empty, hopeless
Loss of interest in favorite activities
Weight Loss
Decreased appetite
Difficulty sleeping
Restlessness or lethargy
Feeling worthless or guilty
Lack of concentration
Thoughts of death or suicide

Unlike most other conditions, what makes suicide particularly difficult to identify and manage is that sometimes the person who is having thoughts of suicide shows no outward signs. They may appear to be happy and well-adjusted, coping well with life, making future plans and otherwise appearing “normal”.

With the impact of COVID 19, it is more important now than it has ever been for all healthcare professionals, not just those who specialize in mental or behavioral health, to learn all they can about the typical behaviors and warning signs of those contemplating suicide and to use encounters to screen for suicidal thoughts. For example, when care managers are discussing medications with a person who has diabetes, they can also ask questions to help determine how they are coping mentally with their condition. There is a vast difference between seeking simple compliance with a plan of care and truly advocating for someone. A simple PHQ2 or PHQ9 can save a life. Sometimes people just need to be asked at the right time by the right person.

Not all practitioners are equipped to treat severe depression and they may not be the right person for the patient to confide in. It is important to be aware of available resources and to understand that intervention is not a one-size fits all endeavor. Providing a variety of options may be necessary to find the right long-term treatment. But first, save the life.

I have compiled an extensive list of resources here. I urge you to keep this close. Odds are that someone in your professional capacity and maybe even someone more near and dear to you needs this information right now.