Suicide-Focused Assessment and Treatment: An Update for Professionals

Free Webinar | October 20, 2021
McLean Hospital and Stanford University Department of Psychiatry

COVID - 19

The COVID-19 pandemic is emotionally stressful, and can be especially distressing for those already struggling with symptoms of depression and anxiety. According to recent data, Americans are reporting increased symptoms of depression, anxiety and fear (Czeisler et al., 2020; Holland, 2020; MHA, 2020).

Suicidal ideation is one of the most concerning symptoms of depression. The CDC recently reported that more than two times as many respondents had seriously considered suicide in the 30 days preceding their June 2020 survey than in the 12 months preceding a survey they had administered in 2018 (10.7% in 2020 vs. 4.3% in 2018). The rate of suicidal ideation conducted during the Covid-19 survey was particularly high among certain groups, notably young adults aged 18-24 years (25.5%), Hispanic individuals (18.6%), non-Hispanic Black individuals (15.1%), unpaid caregivers (30.7%), and essential workers (21.7%) (Czeisler et al., 2020).

Youth between the ages of 12 and 17 also made more visits to the Emergency Department for a suspected suicide attempts during the pandemic than they did before the pandemic. While suicide-related visits to Emergency Departments had decreased early in the pandemic likely due to the issuance of shelter-in place orders, they began to increase in May 2020 and soon significantly surpassed pre-pandemic levels. According to CDC data, suspected suicide attempts were 2.4 times higher in the spring of 2020, 1.7 times higher in the summer of 2020, and 2.1 times higher in the winter of 2021 than they were during the same periods in 2019. This elevation in suspected suicide attempts occurred especially among adolescent girls (Yard et al., 2021) and among those with no prior history of psychiatric problems (Ridout et al., 2021).

It is not known yet how COVID-19 will specifically impact suicide rates and it may take several years before data are available. However, there are some communities already seeing a spike in suicide rates in their counties (Vernachio, 2020).  While the overall number of suicides in the U.S. decreased by 5% between 2019 and 2020, this decline was accompanied by an increase in the number of suicides among people of color and an increase in the number of overdose deaths (Rabin, 2021). It is unclear if the decline in the number of suicide deaths in 2020 is a consequence of the pandemic or a continuation of a downward trend in suicides after suicides crested in 2018. The Department of Defense also reported an increase in the number of suicides in the military, but the DoD saw it as continuation of a current, distressing, upward trend and did not attribute it specifically to the pandemic (DoD, 2021).

However, there are steps we can take now to help mitigate suicide risk and protect ourselves and our communities. Dr. Christine Moutier, Chief Medical Officer at the American Foundation for Suicide Prevention, recently published an article in JAMA Psychiatry, which discusses how increased suicide rates are not an inevitable outcome of the pandemic. Rather, there are specific steps that can be taken now to reduce suicide risk both during the pandemic and in the future. These steps include not only increasing social connectedness and access to mental health care, but also addressing issues such as domestic violence, alcohol and drug use, financial strain, access to firearms, and irresponsible media reporting. As Dr. Moutier explained at the 2020 National Stop A Suicide Today Town Hall, the pandemic could serve as a potential positive catalyst for change, with some “silver linings,” such as normalizing the dialogue surrounding mental health experiences and increasing access to telehealth services.

WAYS TO COPE WITH STRESS

The CDC recommends some ways to take care of yourself, your friends, and your loved ones during the COVID-19 pandemic. These include:

  • Connect with others using virtual communication
  • Take breaks from watching, reading, or listening to news stories, including social media
  • Take care of your body
  • Take deep breaths, stretch, or meditate
  • Exercise regularly
  • Get plenty of sleep
  • Avoid alcohol and drugs
  • Try to do activities you enjoy

If you have a preexisting mental health condition, you should continue with your treatment and be aware of new or worsening symptoms. Call your healthcare provider if stress gets in the way of your daily activities for several days in a row. Moreover, if suicidal thoughts or impulses emerge, contact the National Suicide Prevention Lifeline at 1-800-273-8255Click here for additional action steps.

FOR CLINICIANS AND RESPONDERS

How Clinicians Can Help Mitigate Risk During the Pandemic (Clay, 2020)

  • Screen patients for depression and ask about suicide risk
  • Develop or update safety plans for patients with suicidal ideation
  • Help connect people with family and loved ones
  • Follow telehealth guidelines
  • Educate people about the warning signs for suicide
  • Push for increased mental health services, especially for underserved populations
  • Prioritize self-care for patients, families, and yourself

Support for Health Care Workers and First Responders
The current Covid-19 pandemic is presenting additional mental health challenges to health care workers, including suicide and secondary traumatic stress. Click here to read a recent piece on the topic, which contains suggestions for how you might be able to mitigate suicide risk among your medical colleagues.

On their website, the CDC recommends the following ways responders can reduce secondary traumatic stress reactions:

  • Acknowledge that secondary traumatic stress can impact anyone helping families after a traumatic event.
  • Learn the physical (e.g., fatigue, illness) and mental (e.g., fear, withdrawal, guilt) symptoms.
  • Allow time for you and your family to recover from responding to the pandemic.
  • Create a menu of personal self-care activities that you enjoy, such as spending time with friends and family, exercising, or reading a book.
  • Take a break from media coverage of COVID-19.
  • Ask for help is you feel overwhelmed or concerned that COVID-19 is affecting your ability to care for your family and patients as you did before the outbreak.

Resources for Health Care Workers and First Responders
The Zero Suicide Initiative has compiled a compendium of resources for health and mental health clinicians on providing suicide care during the Covid-19 pandemic. To access these resources, click here.

Additional Resources
Emergency Responders: Tips for Taking Care of Yourself

Disaster Technical Assistance Center

When Helpers Feel Helpless: Mitigating Suicide Risk of Health Care Workers in a Pandemic

‘I Couldn’t Do Anything’: The Virus and an E.R. Doctor’s Suicide