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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.

Unusual times

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.

Suicide prevention

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.

9 Comments. Leave new

This is a very important story that needs to be covered. My daughter is in the television news business and I’ve particularly encouraged her to produce a segment on this critical issue.


Very interesting to read that although there is a rise in suicide ideation, deaths have not risen among adolescents during this time.


I would encourage all therapists to participate in Mental Health Academy international Suicide Summit. They just hosted event for this year; I’m assuming they’ll offer next year. It is PHENOMENAL! The event was FREE and CEUs offered.


A loved one, a family member, took his life today. No one truly understands why today became the last time he would breathe fresh air, or smile, would wave his hand or help a friend. There will be no more waves to ride, no more ice cream cones together, no more laughs and there was no time to say goodbye. What is left are questions which will never be answered, regret, sadness and tremendous loss. How do you celebrate a persons life knowing they struggled with depression every single day? How do you understand their death and in your heart you want them to be at peace and not suffering but you can’t quite wrap your head around ending ones life? How much suffering is too much suffering? I know I will not- cannot judge this suffering and his final decision. Yet, there are so many unanswered questions that will remain with us forever.

Anne L McCullough
September 11, 2020 4:08 pm

As a counselor for many years and former school teacher, I have never faced the impact of suicide until today. My precious 5th grade client of 5 yrs committed the final act last night. I must admit that I have been emotionally weakened recently losing my mother of 88 yrs in April and then a beloved 55 year old brother from glioblastoma (fast growing cancerous brain tumor) in June of this year.
Death of any form is so devastating for the loved ones left behind. We want to ask “why?” We have few answers…in the case of suicide. I am truly impacted by the loss of this child that gave NO indicators to me or family that she would take her own life. I feel myself going back through the recent stages I’ve just experienced and continuing to feel after losing my family loved ones.
So thankful for all the resources for help that are available. It’s a painful and slow process to maneuver through but one that is necessary to return to life with some resemblance to “normal.”


Excellent synopsis of some of the short falls and the goals for improving our awareness of and response to persons with suicide ideation. And my sincere condolences to those with losses who also reponded to this article.


We need a support system for us professionals so we can feel supported when we work with potentially suicidal patients


Suicide indeed continues to hunt society. COVID-19 and the unrest of discriminatory issues intensify the ideation for some as they feel hopeless and trapped. As a clinician, I do my best to offer hope to those around me including my clients. Many people embark on a slow path to suicide. Maybe we can be more alert to the signs in those individuals we’re in contact with. It’s just a difficult situation.


I found this article helpful and agree that we need more data given the stress of events like COVID-19 and the challenges in the way we communicate with technology. Connecting with others in a meaningful way is critical and I have never been too surprised when I learn of someone dying by suicide even when I know they were surrounded by loving people but I do ask the question, could we have done something different and I don’t think we have the answers to why we do have such a high suicide rate


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