Updated: Sep 2, 2020
Published in Middlebury Neighbors - September 2020 Issue
Written by Dr. Christopher Young, MD | Medical Director for Wellmore Behavioral Health
I remember it like it was yesterday. A couple of minutes into my first overnight call as an intern in internal medicine, my first page came. At the time, AIDS was raging, there were no iPhones or Google and I was covering an HIV unit.
I was frozen, deer in headlights paralyzed. Mr. J had a low-grade fever. I started rifling through my on-call pocket manuals that I had jammed into my new white coat, looking for the answer as to what to do. The nurse who called me, aware it was my first night, was patient, calm, and caring.
After waiting on the phone, more than an appropriate amount of time for me to respond, she offered “would you like me to give him a little Tylenol?”. Startled out of my paralysis, I remember thinking, ‘that’s genius’ and said “thank you”.
I went on to learn over that difficult year that compassion, in combination with knowledge and experience would be the most effective way to navigate the medical complexities of the day.
These too are daunting times. The challenges our society faces today, like that intern years ago, are frankly overwhelming. This year, suicide prevention month comes on top of an escalating opioid epidemic and in the midst of an infectious pandemic, where hundreds of thousands have already lost their lives.
The toll on mental health has been enormous. During the pandemic, rates of depressive symptoms have soared along with alcohol sales, domestic violence, stress, anxiety and other conditions associated with depression and suicide.
One recent study, referenced by public health experts, found that people are nine times more likely to report mental health symptoms now compared to pre-COVID times. The Kaiser Family Foundation reported that nearly half of Americans have seen their mental health impacted by Coronavirus.
It is not just the fear of contracting the virus, or of a loved one getting sick with an illness that has limited established treatments, but all the collateral (direct and indirect) effects of the pandemic that are associated with worsening mental health and suicide.
Yes, it is true, COVID-19 has arrived at a time in our history when suicide, on the rise over the past two decades, is at its highest( age-adjusted) rate in the US since 1941. In JAMA Psychiatry, entitled “Suicide Mortality and Coronavirus Disease 2019- A Perfect Storm?”, authors Mark Reger and colleagues connect escalating public health issues, associated with the Pandemic, to suicide.
They point out that historically significant economic downturns have been linked with higher suicide rates. They also note the economic stresses of today- layoffs, school closures, homebound families, and impacted retirements- could contribute to additional increases in suicide.
Other factors, including an increase in gun sales, the most common method of suicide in the US, and reduced access to community or religious activities, seen as protective against suicide, are all going in the wrong direction.
Further, social isolation associated with home quarantine and physical distancing, intended to keep us safe from coronavirus, may be making depression worse. Prominent theories about the foundations of suicide postulate social connectedness as protective against depression. Increased isolation, loneliness, and feelings of disconnection from others may serve to elevate the risk of depression and suicide. Despite this ‘Perfect storm’ for suicide risk, there is hope.
Like coronavirus, depression can have a variable course and each and every case can look quite different. With an identified target, SARS- COV-2, medical researchers are rapidly chipping away at treatments for COVID-19, as they did for HIV. While Mental Health researchers also have a gargantuan task of understanding the multifaceted routes to suicide, they too are learning who is most vulnerable, how to prevent it, and how to treat it.
To start, as that nurse did years ago, we must be patient and assess what we are working with. In the realm of evidence-based models, mental health specialists who study disaster response have established five core components to employ in practice: Calming, Self-efficacy (the personal judgment of how well one can execute a course of action to deal with a situation), Connectedness, Hope and a sense of Safety. Additionally, small actions like creating routines and regiments can further structure one’s day and prevent some from slipping into a worsening mental state.
Interestingly, there may be a silver lining from the recent changes related to COVID-19. With the vast increase in mental health symptoms, associated with the pandemic, the stigma for mental health may reduce. More people identifying their symptoms and openly discussing them creates an opportunity to learn more about mental health, thus reducing the stigma related to it.
Equal insurance reimbursements for Telehealth, whether virtual or telephonic, compared to in-person, has improved access to mental health for all, including the homebound, transportation challenged, and those who live remotely. The move to Telehealth has also shed light on suicide prevention models created to be delivered remotely.
To dig down further into the science of Suicidology, like Coronavirus, there are efforts to better understand prevention, as well as the development of encouraging new treatments. University of Pittsburgh researchers, among others, are looking closely at familial pathways to identify early-onset suicide attempts and associated self-harming behaviors in order to find targets for prevention. Other researchers have focused on vulnerable populations such as those with substance use disorders- who may carry a 10-fold higher risk of suicide.
In Seattle, Dr. Richard Ries and his team have developed a promising new evidence-based model to address addiction-related suicide known as PARS (Preventing Addiction Related Suicide). In New Haven, Dr. Gerald Senacora and colleagues are studying ketamine and Eskatamine, medications that may specifically target and reduce suicidal ideation.
Unlike the politics of our day, which seems bent on pursuing an agenda by amassing power and control through the maneuvering of information, medical science pursues truths through research, data, and treatment trials.
While we may feel a bit like that intern years ago, overwhelmed in the face of a pandemic, we will get to a better day. Between the medical research and the deliverers of care, we should come through this with more experience, knowledge, and compassion.
Our Adult Outpatient Service provides substance use and co-occurring mental health treatment for individuals living and working in the community.
National Suicide Prevention Lifeline
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