Q&A for National Suicide Prevention Month: Pandemic’s effects, physician suicide

Each September marks National Suicide Prevention Month, an observance meant to raise awareness around suicide and ways in which to mitigate its risk.

In conjunction with this observance, Healio spoke with Doreen Marshall, PhD, vice president of mission engagement at the American Foundation for Suicide Prevention (AFSP), regarding the COVID-19 pandemic’s effects on suicide among various segments of the population, how to reduce the risk for physician suicide and more.

Healio: How has the COVID-19 pandemic affected suicide thus far among people generally, as well as among various sectors of the population (at-risk groups, health care providers, etc.)?

Marshall: According to provisional data from the CDC, the overall number of suicide deaths for the year 2020 declined from 47,511 to 44,834 (5.6%) between 2019 and 2020 (Ahmad et al.). While the most recent data from the CDC is encouraging from an overall population health level, the COVID-19 pandemic and its lasting effects on our nation’s mental health are far from over. It’s important for everyone to understand that COVID-19 alone doesn’t cause suicide. Also, even though the total number of suicide deaths may have decreased, there may be increases within some groups. Like other societal health disparities, the pandemic had a disproportionate impact on particular groups, including youth and young adults, as well as on minority groups, including LGBTQ, American Indian, Alaska Native, Black and Latino and other minoritized communities.

Healio: How may ongoing/lingering effects of the pandemic impact suicide rates and care related to suicide going forward?

Marshall: We may not understand the entire impact of COVID-19 on suicide deaths for another year or longer, as suicide mortality data takes time to collect and analyze in a meaningful way, and the pandemic is not over. Additionally, we know there can be a time lag in the manifestation of distress even months after the acuity of a traumatic or stressful period is over.

Still, we’re grateful that the pandemic has put the spotlight on the mental health dialogue and we’re hopeful that even after the pandemic, communities will continue to insist that mental and physical health are valued, discussed and treated equally.

Healio: What recent suicide-related research developments should clinicians be aware of?

Marshall: In addition to the data from the CDC regarding the decline in suicide deaths from 2019 to 2020, clinicians should also be aware of the following:

According to a nationwide CDC survey conducted during the COVID-19 pandemic, experiences of distress, such as depressive and anxiety symptoms, were three to four times greater than pre-pandemic periods. Additionally, more than 10% of respondents said they had seriously considered suicide in the past 30 days compared with just over 4% in 2018 (Czeisler et al.).

A CDC report also found that between February and March, when compared with the same time period in 2019, there was a 39% increase in ED visits for suspected suicide attempts among youth aged 12 to 17 years (Yard et al.). It’s important to note this data does not mean there was an increase in suicide deaths. The takeaway from this data is that we need to be paying attention to our youth across the board regardless of gender, race or ethnicity.

Healio: What significant unmet suicide research needs are most pressing, and how might they be addressed?

Marshall: The federal government must make an increased investment in medical research for suicide prevention, mental health, substance use disorders and related treatments. This will help the medical community better understand suicide, as well as to increase the number and availability of evidence-based treatments.

We also need an increased investment in research that will lead to a better understanding of how social determinants of health can be addressed to improve prevention efforts. This includes how to develop and expand culturally informed, evidence-based quality mental health care for diverse and minority populations and underserved communities

Healio: What can be done to mitigate the risk for physician suicide?

Marshall: Now more than ever, we need to appreciate the importance of physician mental health and help physicians more easily protect their mental health given the unprecedented changes to their work brought about by the pandemic and the daily risks they’re taking to keep everyone else safe. Leaders in the health care and policy industries have the responsibility to implement new suicide prevention strategies, offer accessible health care and make these resources available to all communities. Specifics include:

• making federal investments in and implementing policies that break down barriers to suicide prevention strategies;

• giving health care providers the training, tools, resources and institutional support necessary to identify signs of suicide risk, make accurate assessments and treatment decisions, and implement interventions that can have a dramatic life-saving impact; and

• improving mental health and suicide prevention for those within marginalized communities, including people with unmanaged mental health conditions, those at high risk for suicide, the socioeconomic disadvantaged and [Black, indigenous and people of color] and sexual minorities.

That said, while mental health professionals and health care leaders are a key resource, it’s important to note that everyone has a role to play in suicide prevention. Having an open, authentic conversation about mental health with someone can be the first important step in staying connected for yourself or someone else and helping get support or treatment, if needed.

Healio: Is there anything else you would like to add?

Marshall: In observance of National Suicide Prevention Month, there are a multitude of ways everyone, including psychiatrists and other mental health clinicians, can help put a stop to suicide, including:

• adding crisis resource numbers to your phone and encouraging loved ones to do the same;

• connecting with a friend, family member or person in your community who you think might be struggling with their mental health;

• advocating for mental health policies that ensure everyone in your community has access to mental health care, suicide prevention training and funding for local crisis resources; and

• getting involved with your local AFSP chapter and helping transform your community into one that’s smart about mental health, where everyone has support when they need it.

Additionally, AFSP provides opportunities for everyone to get involved with the organization and raise awareness for suicide prevention within their community, including joining a local chapter, participating in a community walk and creating a fundraising event.

References:

• Ahmad FB, et al. JAMA. 2021;doi:10.1001/jama.2021.546.
• Czeisler ME, et al. MMWR. 2021;doi:org/10.15585/mmwr.mm6932a1.
• Yard E, et al. MMWR. 2021;doi:org/10.15585/mmwr.mm7024e1.