Taking a second look at suicide during COVID-19: An interview with the AAS
Recent data from the Centers for Disease Control and Prevention (CDC) that one in four Americans aged 18 to 24 had thoughts of suicide in the prior 30 days has mental health stakeholders reeling: How could the numbers be that high, even during a pandemic?
That question led Beacon Health Options to interview additional experts on suicide prevention: Colleen Creighton, CEO of the American Association of Suicidology (AAS) and Dr. Jonathan Singer, president of the AAS Board of Directors. It turns out that a lot of assumptions about suicide are just exactly that — assumptions. At the root of the problem, these specialists say, is that we don’t have access to real-time national data. Data from 2018 — the most recent we have on suicide trends — can tell us little about anything today, such as a reaction to the pandemic, making it difficult to inform prevention efforts.
It turns out that a lot of assumptions about suicide are just that — assumptions. At the root of the problem, these specialists say, is that we don’t have access to real-time national data.
There has been a long-established connection between mental illness and suicide, but the COVID-19 pandemic has prompted us to take a deeper look. Indeed, several years ago, the CDC released a report indicating that many people who had attempted or died by suicide did not have a known pre-existing mental health condition at the time of death. “We’re seeing that play out now during the pandemic,” says Dr. Singer. “Youth are particularly stressed because of the pandemic’s ambiguity, and anxiety is a realistic reaction to a stressful time,” he continues.
“We make the assumption that there is a linear relationship between suicide ideation, attempts and deaths, but there’s not,” he notes, pointing out that while there has been a rise in suicide ideation for this age group, there hasn’t been a rise in deaths by suicide.
Another assumption we’re led to make is the particularly devastating effect COVID-19 is having on people of color, including suicide. Dr. Singer states there has been an increase in suicides among Black Chicago residents during the pandemic compared to the same time period in 2019. Only time will tell if the increased risk was associated with working in low-paying jobs with high risk and little protection, employment that is disproportionately comprised of Black and Brown residents. However, Chicago is just one isolated data point, Dr. Singer points out, so the connection is an assumption only as we don’t have national data to support a comparable trend nationwide.
“We need to see trends before they happen,” says Creighton. “That means we need a coordinated national strategy to get that real-time data,” an important goal of the AAS.
Everyone has a role to play in suicide prevention, ranging from clinician willingness to accept patients with a history of suicide to larger, systemic changes.
“The loss of a patient to suicide is tough on clinicians,” says Dr. Singer. “For example, there can be tension between loss survivors and clinicians. Clinicians can also feel personal loss, guilt and fear over a damaged reputation after the loss of a patient to suicide. It is for these kinds of reasons that clinicians can be reluctant to take on patients who have a history of suicidal attempts or thoughts. However, in spite of these legitimate difficulties, clinicians have a moral and professional obligation to accept these individuals as patients,” he continues.
Consequently, Drs. Nina Guten and Vanessa McGann, co-chairs of the Clinician Survivor Task Force, developed a resource for clinicians who are the survivors of a suicide loss and brought it to AAS to develop it even further. Available at cliniciansurvivor.org, it includes information on how to help family members, other patients and staff after a patient suicide, according to Creighton. Later this year, the group will also be launching a clinician loss training to connect clinicians navigating the same scenario.
Systemic fixes need to keep up with a changing world. For example, how services are reimbursed is a “patchwork quilt”, confusing for the customer and difficult for organizations to manage, says Dr. Singer. Reimbursement also has not kept up with many healthcare advancements, such as care delivered through some technological means.
Prevention trends: Where do we go from there?
As noted earlier, real-time data is critical to understanding people at suicide risk. Research is focusing on the role of technology to retrieve that real-time data, which is starting to challenge long-held assumptions about suicide, says Dr. Singer. For example, Ecological Momentary Assessment technology has helped us to learn that someone with a recent history of suicide attempt can fluctuate between no risk and high risk several times in a 24-hour period, important data that inform our efforts to understand the role of impulse and planning in suicidal behavior.
Research is focusing on the role of technology to retrieve that real-time data, which is starting to challenge long-held assumptions about suicide.
Data has traditionally been siloed, adds Creighton. We need information that supports the public good. What can we learn from the pandemic as it relates to mental health? How can such information help us better understand resilience, for example? Finally, all voices must be included to understand suicide, she adds. “We need to keep our ears to the ground to know where the gaps are,” she comments.
Real-time data can help make assumptions about suicide become facts, but it requires commitment and innovation that calls upon clinical, technology and systemic solutions. That way, we can address what is going on today, to solve today’s problems, such as a pandemic’s effect on suicide.