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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Suicide. Show all posts
Showing posts with label Suicide. Show all posts

Thursday, February 22, 2024

Rising Suicide Rate Among Hispanics Worries Community Leaders

A. Miller and M. C. Work
KFF Health News
Originally posted 22 Jan 24

Here is an excerpt:

The suicide rate for Hispanic people in the United States has increased significantly over the past decade. The trend has community leaders worried: Even elementary school-aged Hispanic children have tried to harm themselves or expressed suicidal thoughts.

Community leaders and mental health researchers say the pandemic hit young Hispanics especially hard. Immigrant children are often expected to take more responsibility when their parents don’t speak English ― even if they themselves aren’t fluent. Many live in poorer households with some or all family members without legal residency. And cultural barriers and language may prevent many from seeking care in a mental health system that already has spotty access to services.

“Being able to talk about painful things in a language that you are comfortable with is a really specific type of healing,” said Alejandra Vargas, a bilingual Spanish program coordinator for the Suicide Prevention Center at Didi Hirsch Mental Health Services in Los Angeles.

“When we answer the calls in Spanish, you can hear that relief on the other end,” she said. “That, ‘Yes, they’re going to understand me.’”

The Centers for Disease Control and Prevention’s provisional data for 2022 shows a record high of nearly 50,000 suicide deaths for all racial and ethnic groups.

Grim statistics from KFF show that the rise in the suicide death rate has been more pronounced among communities of color: From 2011 to 2021, the suicide rate among Hispanics jumped from 5.7 per 100,000 people to 7.9 per 100,000, according to the data.

For Hispanic children 12 and younger, the rate increased 92.3% from 2010 to 2019, according to a study published in the Journal of Community Health.

Friday, January 5, 2024

Mathematical and Computational Modeling of Suicide as a Complex Dynamical System

Wang, S. B., Robinaugh, D., et al.
(2023, September 24). 

Abstract

Background:

Despite decades of research, the current suicide rate is nearly identical to what it was 100 years ago. This slow progress is due, at least in part, to a lack of formal theories of suicide. Existing suicide theories are instantiated verbally, omitting details required for precise explanation and prediction, rendering them difficult to effectively evaluate and difficult to improve.  By contrast, formal theories are instantiated mathematically and computationally, allowing researchers to precisely deduce theory predictions, rigorously evaluate what the theory can and cannot explain, and thereby, inform how the theory can be improved.  This paper takes the first step toward addressing the need for formal theories in suicide research by formalizing an initial, general theory of suicide and evaluating its ability to explain suicide-related phenomena.

Methods:

First, we formalized a General Escape Theory of Suicide as a system of stochastic and ordinary differential equations. Second, we used these equations to simulate behavior of the system over time. Third, we evaluated if the formal theory produced robust suicide-related phenomena including rapid onset and brief duration of suicidal thoughts, and zero-inflation of suicidal thinking in time series data.

Results:

Simulations successfully produced the proposed suicidal phenomena (i.e.,rapid onset, short duration, and high zero-inflation of suicidal thoughts in time series data). Notably, these simulations also produced theorized phenomena following from the General Escape Theory of Suicide:that suicidal thoughts emerge when alternative escape behaviors failed to effectively regulate aversive internal states, and that effective use of long-term strategies may prevent the emergence of suicidal thoughts.

Conclusions:

To our knowledge, the model developed here is the first formal theory of suicide, which was able to produce –and, thus, explain –well-established phenomena documented in the suicide literature. We discuss the next steps in a research program dedicated to studying suicide as a complex dynamical system, and describe how the integration of formal theories and empirical research may advance our understanding, prediction, and prevention of suicide. 

My take:

In essence, the paper demonstrates the potential value of using computational modeling and formal theorizing to improve understanding and prediction of suicidal behaviors, breaking from a reliance on narrative theories that have failed to significantly reduce suicide rates over the past century. The formal modeling approach allows more rigorous evaluation and refinement of theories over time.

Sunday, October 1, 2023

US Surgeons Are Killing Themselves at an Alarming Rate

Christina Frangou
The Guardian
Originally published 26 Sept 23

Here is an excerpt:

Fifty years ago, in a landmark report called The Sick Physician, the American Medical Association declared physician impairment by psychiatric disorders, alcoholism and drug use a widespread problem. Even then, physicians had rates of narcotic addiction 30 to 100 times higher than the general population, and about 100 doctors a year in the US died by suicide.

The report called for better support for physicians who were struggling with mental health or addictions. Too many doctors hid their ailments because they worried about losing their licenses or the respect of their communities, according to the medical association.

Following the publication, state medical societies in the US, the organizations that give physicians license to practice, created confidential programs to help sick and impaired doctors. Physician health programs have a dual purpose: they connect doctors to treatment, and they assess the physician to ensure that patients are safe in their care. If a doctor’s condition is considered a threat to patient safety, the program may recommend that a doctor immediately cease practice, or they may recommend that a physician undergo drug and alcohol monitoring for three to five years in order to maintain their license. The client must sign an agreement not to participate in patient care until their personal health is addressed.

In rare and extreme cases, the physician health program will report the doctor to the state medical board to revoke their license.


Here is my summary:

The article sheds light on a distressing phenomenon in the United States: an alarming increase in suicide rates among surgeons. It underscores the severity of this issue by featuring a courageous surgeon who has taken the initiative to address it openly. The article suggests that the mental health and well-being of surgeons are under significant strain, potentially due to the demanding nature of their profession, and it calls for greater awareness and support to tackle this growing crisis. The featured surgeon's decision to speak out serves as a poignant reminder of the urgent need to address the mental health challenges faced by medical professionals.

The article underscores the critical issue of high suicide rates among U.S. surgeons, with a particular focus on the brave act of a surgeon who has chosen to raise awareness about this problem. It highlights the pressing need for comprehensive mental health support within the medical community to address the unique stressors that surgeons encounter in their line of work.

Monday, August 7, 2023

Shake-up at top psychiatric institute following suicide in clinical trial

Brendan Borrell
Spectrum News
Originally posted 31 July 23

Here are two excerpts:

The audit and turnover in leadership comes after the halting of a series of clinical trials conducted by Columbia psychiatrist Bret Rutherford, which tested whether the drug levodopa — typically used to treat Parkinson’s disease — could improve mood and mobility in adults with depression.

During a double-blind study that began in 2019, a participant in the placebo group died by suicide. That study was suspended prior to completion, according to an update posted on ClinicalTrials.gov in 2022.

Two published reports based on Rutherford’s pilot studies have since been retracted, as Spectrum has previously reported. The National Institute of Mental Health has terminated Rutherford’s trials and did not renew funding of his research grant or K24 Midcareer Award.

Former members of Rutherford’s laboratory describe it as a high-pressure environment that often put publications ahead of study participants. “Research is important, but not more so than the lives of those who participate in it,” says Kaleigh O’Boyle, who served as clinical research coordinator there from 2018 to 2020.

Although Rutherford’s faculty page is still active, he is no longer listed in the directory at Columbia University, where he was associate professor, and the voicemail at his former number says he is no longer checking it. He did not respond to voicemails and text messages sent to his personal phone or to emails sent to his Columbia email address, and Cantor would not comment on his employment status.

The circumstances around the suicide remain unclear, and the institute has previously declined to comment on Rutherford’s retractions. Veenstra-VanderWeele confirmed that he is the new director but did not respond to further questions about the situation.

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In January 2022, the study was temporarily suspended by the U.S. National Institute of Mental Health, following the suicide. It is unknown whether that participant had been taking any antidepressant medication prior to the study.

Four of Rutherford’s published studies were subsequently retracted or corrected for issues related to how participants taking antidepressants at enrollment were handled.

One retraction notice published in February indicates tapering could be challenging and that the researchers did not always stick to the protocol. One-third of the participants taking antidepressants were unable to successfully taper off of them.


Note: The article serves as a cautionary tale about the risks of clinical trials. While clinical trials can be a valuable way to test new drugs and treatments, they also carry risks. Participants in clinical trials may be exposed to experimental drugs that have not been fully tested, and they may experience side effects that are not well-understood.  Ethical researchers must follow guidelines and report accurate results.

Thursday, February 2, 2023

Yale Changes Mental Health Policies for Students in Crisis

William Wan
The Washington Post
Originally posted 18 JAN 23

Here are some excerpts:

In interviews with The Post, several students — who relied on Yale’s health insurance — described losing access to therapy and health care at the moment they needed it most.

The policy changes announced Wednesday reversed many of those practices.

By allowing students in mental crisis to take a leave of absence rather than withdraw, they will continue to have access to health insurance through Yale, university officials said. They can continue to work as a student employee, meet with career advisers, have access to campus and use library resources.

Finding a way to allow students to retain health insurance required overcoming significant logistical and financial hurdles, Lewis said, since New Haven and Connecticut are where most health providers in Yale’s system are located. But under the new policies, students on leave can switch to “affiliate coverage,” which would cover out-of-network care in other states.

In recent weeks, students and mental advocates questioned why Yale would not allow students struggling with mental health issues to take fewer classes. The new policies will now allow students to drop their course load to as low as two classes under special circumstances. But students can do so only if they require significant time for treatment and if their petition is approved.

In the past, withdrawn students had to submit an application for reinstatement, which included letters of recommendation, and proof they had remained “constructively occupied” during their time away. Under new policies, students returning from a medical leave of absence will submit a “simplified reinstatement request” that includes a letter from their clinician and a personal statement explaining why they left, the treatment they received and why they feel ready to return.

<cut>

In their updated online policies, the university made clear it still retained the right to impose an involuntary medical leave on students in cases of “a significant risk to the student’s health or safety, or to the health or safety of others.”

The changes were announced one day before Yale officials were scheduled to meet for settlement talks with the group of current and former students who filed a proposed class-action lawsuit against the university, demanding policy changes. 

<cut>

In a statement, one of the plaintiffs — a nonprofit group called Elis for Rachael, led by former Yale students — said they are still pushing for more to be done: “We remain in negotiations. We thank Yale for this first step. But if Yale were to receive a grade for its work on mental health, it would be an incomplete at best.”

But after decades of mental health advocacy with little change at the university, some students said they were surprised at the changes Yale has made already.

“I really didn’t think it would happen during my time here,” said Akweley Mazarae Lartey, a senior at Yale who has advocated for mental rights throughout his time at the school. 

“I started thinking of all the situations that I and people I care for have ended up in and how much we could have used these policies sooner.”

Sunday, December 4, 2022

Risk of Suicide After Dementia Diagnosis

Alothman D, Card T, et al.
JAMA Neurology
Published online October 03, 2022.

Abstract

Importance  Patients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services.

Objectives  To examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups.

Design, Setting, and Participants  This was a population-based case-control study in England conducted from January 1, 2001, through December 31, 2019. Data were obtained from multiple linked electronic records from primary care, secondary care, and the Office for National Statistics. Included participants were all patients 15 years or older and registered in the Office for National Statistics in England with a death coded as suicide or open verdict from 2001 to 2019. Up to 40 live control participants per suicide case were randomly matched on primary care practice and suicide date.

Exposures  Patients with codes referring to a dementia diagnosis were identified in primary care and secondary care databases.

Main Outcomes and Measures  Odds ratios (ORs) were estimated using conditional logistic regression and adjusted for sex and age at suicide/index date.

Conclusions and Relevance  Diagnostic and management services for dementia, in both primary and secondary care settings, should target suicide risk assessment to the identified high-risk groups.


Key Points

Question  Is there an association between dementia diagnosis and a higher risk of suicide?

Findings  In this nationally representative case-control study including 594, 674 persons in England from 2001 through 2019, dementia was found to be associated with increased risk of suicide in specific patient subgroups: those diagnosed before age 65 years (particularly in the 3-month postdiagnostic period), those in the first 3 months after diagnosis, and those with known psychiatric comorbidities.

Meaning  Given the current efforts to improve rates of dementia diagnosis, these findings emphasize the importance of concurrent implementation of suicide risk assessment for the identified high-risk groups.

Wednesday, November 16, 2022

‘What if Yale finds out?’

William Wan
The Washington Post
Originally posted November 11, 2022

Suicidal students are pressured to withdraw from Yale, then have to apply to get back into the university

Here are two excerpt:

‘Getting rid of me’

Five years before the pandemic derailed so many college students’ lives, a 20-year-old math major named Luchang Wang posted this message on Facebook:

“Dear Yale, I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted. Love, Luchang.”

Wang had withdrawn from Yale once before and feared that under Yale’s policies, a second readmission could be denied.
Instead, she flew to San Francisco, and, according to authorities, climbed over the railing at the Golden Gate Bridge and jumped to her death.

Her 2015 suicide sparked demands for change at Yale. Administrators convened a committee to evaluate readmission policies, but critics said the reforms they adopted were minor.

They renamed the process “reinstatement” instead of “readmission,” eliminated a $50 reapplication fee and gave students a few more days at the beginning of each semester to take a leave of absence without having to reapply.

Students who withdrew still needed to write an essay, secure letters of recommendation, interview with Yale officials and prove their academic worth by taking two courses at another four-year university. Those who left for mental health reasons also had to demonstrate to Yale that they’d addressed their problems.

In April — nearly 10 months after S. had been pressured to withdraw — Yale officials announced another round of changes to the reinstatement process. 

They eliminated the requirement that students pass two courses at another university and got rid of a mandatory interview with the reinstatement committee.

The reforms have not satisfied student activists at Yale, where the mental health problems playing out on many American campuses has been especially prominent.

(cut)

In recent years, Yale has also faced an “explosion” in demand for mental health counseling, university officials said. Last year, roughly 5,000 Yale students sought treatment — a 90 percent increase compared with 2015.

“It’s like nothing we’ve ever seen before,” said Hoffman, the director of Yale Mental Health and Counseling. Roughly 34 percent of the 14,500 students at 

Yale seek mental health help from college counselors, compared with a national average of 11 percent at other universities.

Meeting that need has been challenging, even at a school with a $41.4 billion endowment.

Bluebelle Carroll, 20, a Yale sophomore who sought help in September 2021, said she waited six months to be assigned a therapist. She secured her first appointment only after emailing the counseling staff repeatedly.

“The appointment was 20 minutes long,” she said, “and we spent the last five minutes figuring out when he could see me again.”

Because of staffing constraints, students are often asked to choose between weekly therapy that lasts 30 minutes or 45-minute sessions every two weeks.

Saturday, June 4, 2022

About one-fifth of lawyers and staffers considered suicide at some point in their careers, new survey says.

Debra Cassens Weiss
American Bar Association Journal
Originally posted 10 MAY 22

A new survey of lawyers and staff members hailing mostly from BigLaw has found that anxiety, depression and isolation remain at concerning levels, despite a slight decrease in the percentages since the survey last year.

The Mental Health Survey by Law.com and ALM Intelligence found that 67% of the respondents reported anxiety, 35% reported depression and 44% reported isolation, according to an article by Law.com.

The survey, conducted in March and April, asked respondents from around the world about their mental health and law firm environments in 2021.

The percentage of respondents who contemplated suicide at some point in their professional careers was 19%, the article reports.

In addition, 2.4% of the respondents said they had a drug problem, and 9.4% said they had an issue with alcoholic drinking.

About 74% of the respondents thought that their work environment contributed to their mental health issues. When asked about the factors that had a negative impact on mental health, top concerns were always being on call (72%), billable hour pressure (59%), client demands (57%), lack of sleep (55%) and lean staffing (49.5%).

The survey asked about the impact of remote work for the first time. About 59% said remote work increased their quality of life; about 62% said it increased the quality of home-based relationships; about 54% said it led to an increase in their billable hours; and 50% said it improved personal finances. But 76% said remote work hurt the quality of interpersonal relationships with colleagues.


Sunday, May 29, 2022

Unemployment, Behavioral Health, And Suicide

R. Ramchand, L. Ayer, & S. O'Connor
Health Affairs
Originally posted 7 APR 22

Key Points:
  • A large body of research, most of which is ecological, has investigated the relationship between job loss or unemployment rates and mental health, substance use, and suicide.
  • Groups historically experiencing health disparities (for example, Black and Hispanic populations and those without a high school or college degree) have been differently affected by unemployment during the COVID-19 pandemic. Similarly, preliminary evidence from three states suggests that suicide has disproportionately affected Americans who are members of racial and ethnic minority groups over the course of the pandemic.
  • COVID-19 has affected the workforce in unique ways that differentiate the pandemic from previous economic downturns. However, previous research indicates that increases in suicide rates associated with economic downturns were driven by regional variation in unemployment, availability of unemployment benefits, and duration and magnitude of changes in unemployment.
  • Policy mitigation strategies may have offset the potential impact of unemployment fluctuations on suicide rates during the pandemic. Policies include expanded unemployment benefits and food assistance, as well as tax credits and subsidies that reduced child care and health care costs.
  • Research is needed to disentangle which populations experienced the most benefit when these strategies were present and which had the greatest risk when they were discontinued.
  • Evidence-based strategies that expand the mental health workforce and integrate mental health supports into employment and training settings may be promising ways to help workers as they navigate persistent changes to workforce demands.

Suicide In The United States

A recent Health Affairs Health Policy Brief provides an overview of suicide in the United States. In 2019, 47,511 Americans intentionally ended their lives, making suicide the tenth leading cause of death. This is likely an underestimate—in 2019, 75,795 Americans died of poisonings, the majority of which were drug poisonings categorized as unintentional, although some were likely suicide overdoses that were misclassified.

Suicide is a growing national concern despite the fact that the national suicide rate decreased between 2018 and 2019 and again in 2020. This decrease comes after nearly twenty years of the national suicide rate increasing annually, and it was not observed in some minority racial and ethnic groups. In addition, although suicide rates decreased between 2018 and 2020, the drug overdose death rate increased.

Sunday, May 15, 2022

A False Sense of Security: Rapid Improvement as a Red Flag for Death by Suicide

Rufino, K., Beyene, H., et al.
Journal of Consulting and Clinical Psychology. 
Advance online publication.

Objective: 
Postdischarge from inpatient psychiatry is the highest risk period for suicide, thus better understanding the predictors of death by suicide during this time is critical for improving mortality rates after inpatient psychiatric treatment. As such, we sought to determine whether there were predictable patterns in suicide ideation in hospitalized psychiatric patients. 

Method: 
We examined a sample of 2,970 adult’s ages 18–87 admitted to an extended length of stay (LOS) inpatient psychiatric hospital. We used group-based trajectory modeling via the SAS macro PROC TRAJ to quantitatively determine four suicide ideation groups: nonresponders (i.e., high suicide ideation throughout treatment), responders (i.e., steady improvement in suicide ideation across treatment), resolvers (i.e., rapid improvement in suicide ideation across treatment), and no-suicide ideation (i.e., never significant suicide ideation in treatment). Next, we compared groups to clinical and suicide-specific outcomes, including death by suicide. 

Results: 
Resolvers were the most likely to die by suicide postdischarge relative to all other suicide ideation groups. Resolvers also demonstrated significant improvement in all clinical outcomes from admission to discharge. 

Conclusion: 
There are essential inpatient psychiatry clinical implications from this work, including that clinical providers should not be lulled into a false sense of security when hospitalized adults rapidly improve in terms of suicide ideation. Instead, inpatient psychiatric treatment teams should increase caution regarding the patient’s risk level and postdischarge treatment planning.

Impact Statement

As postdischarge from inpatient psychiatry is the highest risk period for suicide, better understanding the predictors of death by suicide during this time is critical for improving mortality rates after inpatient psychiatric treatment. Clinical providers should not be lulled into a false sense of security when hospitalized adults rapidly improve in terms of suicide ideation, instead, increasing vigilance regarding the patient’s risk level and postdischarge treatment planning. 

Saturday, May 14, 2022

Suicides of Psychologists and Other Health Professionals: National Violent Death Reporting System Data, 2003–2018

Li, T., Petrik, M. L., Freese, R. L., & Robiner, W. N.
(2022). American Psychologist. 
Advance online publication.

Abstract

Suicide is a prevalent problem among health professionals, with suicide rates often described as exceeding that of the general population. The literature addressing suicide of psychologists is limited, including its epidemiological estimates. This study explored suicide rates in psychologists by examining the National Violent Death Reporting System (NVDRS), the Centers for Disease Control and Prevention’s data set of U.S. violent deaths. Data were examined from participating states from 2003 to 2018. Trends in suicide deaths longitudinally were examined. Suicide decedents were characterized by examining demographics, region of residence, method of suicide, mental health, suicidal ideation, and suicidal behavior histories. Psychologists’ suicide rates are compared to those of other health professionals. Since its inception, the NVDRS identified 159 cases of psychologist suicide. Males comprised 64% of decedents. Average age was 56.3 years. Factors, circumstances, and trends related to psychologist suicides are presented. In 2018, psychologist suicide deaths were estimated to account for 4.9% of suicides among 10 selected health professions. As the NVDRS expands to include data from all 50 states, it will become increasingly valuable in delineating the epidemiology of suicide for psychologists and other health professionals and designing prevention strategies. 

From the Discussion

Between 2003 and 2018, 159 cases of psychologist death by suicide were identified in the NVDRS, providing a basis for examining the phenomenon rather than clarifying its true incidence. Suicide deaths spanned all U.S. regions, with the South accounting for the most (35.8%) cases, followed by the West (24.5%), Midwest (20.1%), and Northeast (19.5%). It is unclear whether this is due to the South and West actually having higher suicide rates among psychologists or if these regions have greater representation due to inclusion of more reporting states. It should also be noted that these regions make up different proportions of the population for the entire United States. According to the U.S. Census Bureau (n.d.), the proportion of each region’s population as compared to the entire U.S. population for the year 2019 was South (38.3%), West (23.9%), Midwest (20.8%), and Northeast (17.1%). This could have affected the number of cases seen within each region, as could other factors, such as the trend for gun ownership to be more than twice as common in the South than in the Northeast (Pew Research Center, 2017). The 2003–2018 psychologist suicide deaths were more than 13 times higher than NVDRS-identified psychologist homicide deaths (n = 12) for that same period (Robiner & Li, 2022).

The number of psychologist suicides identified in the NVDRS generally increased longitudinally. It is not clear whether this might signal an actual increasing incidence, and if so what factors may be contributing, or how much it is an artifact of the increasing number of NVDRS-reporting states. Starting in 2020, the data will more clearly reveal temporal patterns, with variation reflecting changes in suicide incidence rather than how many states reported. In the future, we anticipate longitudinal trends will not be confounded by variation in the number of reporting states.

Most psychologist suicide decedents were White (92.5%). Smaller percentages were Black, Indigenous, and People of Color (BIPOC): Black (2.5%), Asian or Pacific Islander (1.9%), and two or more races (3.1%). These proportions align largely with the racial/ethnic makeup of the psychologist workforce in APA’s Survey of Psychology Health Service Providers for White (87.8%), Black (2.6%), Asian (2.5%), and multiracial/multiethnic psychologists (1.7%; Hamp et al., 2016). The data are generally consistent with earlier findings of psychologist suicide (Phillips, 1999) that most psychologist suicide decedents are White and reveal slightly greater diversification within the field. CDC data from 2019 reveals rates in the general population of suicide per 100,000 are greatest in Whites (29.8 male, 8 female), followed by Blacks (12.4 male, 2.9 female), Asians (11.2 male, 4.0 female), and Hispanics (11.3 male, 3.0 female; NIMH, 2021). There were no cases of Hispanic psychologist suicide in this sample, which is generally consistent with the relatively lower numbers of suicides reported for Hispanics by the CDC. The relatively small numbers of suicides within subgroups limit the certainty of inferences that can be drawn about the association of ethnicity, and potentially other demographics, and suicide incidence. As the demographic composition of the field diversifies, the durability of the present findings for subgroups remains to be seen.

Thursday, May 5, 2022

USS George Washington sailors detail difficult working conditions after string of suicides

Melissa Chan
NBCNews.com
Originally posted 28 APR 22

Here are two excerpts:

Crisostomo and several other George Washington sailors said their struggles were directly related to a culture where seeking help is not met with the necessary resources, as well as nearly uninhabitable living conditions aboard the ship, including constant construction noise that made sleeping impossible and a lack of hot water and electricity. 

Since Crisostomo’s attempt, at least five of her shipmates on the George Washington have died by suicide, including three within a span of a week this April, military officials said. The latest cluster of suicides is under investigation by the Navy and has drawn concern from the Pentagon and Rep. Elaine Luria, D-Va., who served in the Navy for two decades.

On April 15, Master-at-Arms Seaman Recruit Xavier Hunter Sandor died by suicide onboard the George Washington, according to the Navy and the state chief medical examiner’s office. He had been working on the warship for about three months, his family said.

His death came five days after Natasha Huffman, an interior communications electrician, died by suicide off-base in Hampton, officials said.

The day before, Retail Services Specialist 3rd Class Mika’il Rayshawn Sharp also died by suicide off-base in Portsmouth, said his mother, Natalie Jefferson. 

“Three people don’t just decide to kill themselves in a span of days for nothing,” said Crisostomo, who left the Navy in October 2021, on an honorable discharge with a medical condition following her suicide attempt.

(cut)

When asked about mental-health resources, Smith told sailors that the Navy would put more chaplains on smaller ships for the first time, but that it’s not easy to hire more psychologists, psychiatrists, and other mental health care workers, because they’re not “out there in abundance.”

“You can’t just snap your fingers and grow a psychiatrist,” he said, adding that the sailors should be “each other’s counselors.”

Myers said a larger Navy team is being built to assess quality-of-life conditions on aircraft carriers undergoing overhauls. 

“Their recommendations will inform potential future action, identify areas for improvements, and propose mitigation strategies to optimize [quality of life],” he said.

In 2020, the most recent year for which full data is available, 580 military members died by suicide, a 16 percent increase from 2019, when 498 died by suicide, according to the Defense Department. Nineteen out of every 100,000 sailors died by suicide in 2020, compared to members of the Army, which had the highest rate, at about 36 per 100,000, Pentagon statistics show.

Tuesday, May 3, 2022

The Mystifying Rise of Child Suicide

Andrew Solomon
The New Yorker
Originally posted 4 APR 22

Here are two excerpts:

Every suicide creates a vacuum. Those left behind fill it with stories that aspire to rationalize their ultimately unfathomable plight. People may blame themselves or others, cling to small crumbs of comfort, or engage in pitiless self-laceration; many do all this and more. In a year of interviewing the people closest to Trevor, I saw all of these reactions and experienced some of them myself. I came to feel a love for Trevor, which I hadn’t felt when he was alive. The more I understood the depths of his vulnerability, the more I wished that I had encouraged my son, whose relationship with Trevor was often antagonistic, to befriend him. As I interviewed Trevor’s parents, my relationship with them changed. The need to write objectively without increasing their suffering made it more fraught—but it also became deeper and more loving. As the April 6th anniversary of Trevor’s death approached, I started to share their hope that this article would be a kind of memorial to him.

Angela was right that a larger issue is at stake. The average age of suicides has been falling for a long time while the rate of youth suicide has been rising. Between 1950 and 1988, the proportion of adolescents aged between fifteen and nineteen who killed themselves quadrupled. Between 2007 and 2017, the number of children aged ten to fourteen who did so more than doubled. It is extremely difficult to generalize about youth suicide, because the available data are so much sparser and more fragmentary than for adult mental illness, let alone in the broader field of developmental psychology. What studies there are have such varied parameters—of age range, sample size, and a host of demographic factors—as to make collating the information all but impossible. The blizzard of conflicting statistics points to our collective ignorance about an area in which more and better studies are urgently needed. Still, in 2020, according to the Centers for Disease Control and Prevention, in the United States suicide claimed the lives of more than five hundred children between the ages of ten and fourteen, and of six thousand young adults between fifteen and twenty-four. In the former group, it was the second leading cause of death (behind unintentional injury). This makes it as common a cause of death as car crashes.

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Perhaps the most unsettling aspect of child suicide is its unpredictability. A recent study published in the Journal of Affective Disorders found that about a third of child suicides occur seemingly without warning and without any predictive signs, such as a mental-health diagnosis, though sometimes a retrospective analysis points to signs that were simply missed. Jimmy Potash, the chair of the psychiatry department at Johns Hopkins, told me that a boy who survived a suicide attempt described the suddenness of the impulse: seeing a knife in the kitchen, he thought, I could stab myself with that, and had done so before he had time to think about it. When I spoke to Christine Yu Moutier, who is the chief medical officer at the American Foundation for Suicide Prevention, she told me that, in children, “the moment of acute suicidal urge is very short-lived. It’s almost like the brain can’t keep up that rigid state of narrowed cognition for long.” This may explain why access to means is so important; children living in homes with guns have suicide rates more than four times higher than those of other children.

Friday, April 8, 2022

What predicts suicidality among psychologists? An examination of risk and resilience

S. Zuckerman, O. R. Lightsey Jr. & J. White
Death Studies (2022)
DOI: 10.1080/07481187.2022.2042753

Abstract

Psychologists may have a uniquely high risk for suicide. We examined whether, among 172 psychologists, factors predicting suicide risk among the general population (e.g., gender and mental illness), occupational factors (e.g., burnout and secondary traumatic stress), and past trauma predicted suicidality. We also tested whether resilience and meaning in life were negatively related to suicidality and whether resilience buffered relationships between risk factors and suicidality. Family history of mental illness, number of traumas, and lifetime depression/anxiety predicted higher suicidality, whereas resilience predicted lower suicidality. At higher levels of resilience, the relationship between family history of suicide and suicidality was stronger.

From the Discussion section:

Contrary to hypotheses, however, resilience did not consistently buffer the relationship between vulnerability factors and suicidality. Indeed, resilience appeared to strengthen the relationships between having a family history of suicide and suicidality. It is plausible that psychologists may overestimate their resilience or believe that they “should” be resilient given their training or their helping role (paralleling burnout-related themes identified in the culture of medicine, “show no weakness” and “patients come first;” see Williams et al., 2020, p. 820). Similarly, persons who believe that they are generally resilient may be demoralized by their inability to prevent family history of suicide from negatively affecting them, and this demoralization may result in family history of suicide being a particularly strong predictor among these individuals. Alternatively, this result could stem from the BRS, which may not measure components of resilience that protect against suicidality, or it could be an artifact of small sample size and low power for detecting moderation (Frazier et al., 2004). Of course, interaction terms are symmetric, and the resilience x family history of suicide interaction can also be interpreted to mean that family history of suicide strengthens the relationship between resilience and suicidality: When there is a family history of suicide, resilience has a positive relationship with suicidality whereas, when there is no family history of suicide, resilience has a negative relationship with suicidality.

Tuesday, April 5, 2022

The Emerging Science of Suicide Prevention

Kim Armstong
PsychologicalScience.org
Originally published 28 FEB 22

The decisions leading up to a person’s death by suicide are made under conditions unlike almost any other. Although we may spend weeks or even months considering whether to purchase a home, change jobs, or get married, the decision to attempt suicide is often made in the spur of the moment amid a crush of emotions, according to Brian W. Bauer and Daniel W. Capron (University of Southern Mississippi). A person may live with suicidal thoughts for years, yet anywhere from 25% to 40% of suicide attempts may take place less than 5 minutes after the individual decides to take their life, Bauer and Capron wrote in a 2020 Perspectives on Psychological Science article. 

These circumstances make people experiencing suicidal ideation uniquely vulnerable to common cognitive biases that can result in irrational decision-making, causing them to act against their own self-interest. We are particularly bad at predicting how our emotional state may change in the future and tend to value short-term relief over long-term outcomes, Bauer and Capron noted. Both of these tendencies can contribute to the decision to end severe psychological pain through suicide despite the strong possibility that those feelings will change given time. 

Nudges could offer some hope to people in crisis. Based in behavioral economics, these microinterventions are designed to push people toward making choices that align with their own self-interest, such as conserving energy or getting vaccinated, by providing easily digestible information about the benefits of those choices (e.g., stickers on washing machines reading “Fuller laundry loads save water”) or even removing barriers to making those choices (e.g., offering walk-in vaccinations instead of requiring appointments). 

Nudges have been used in mental health contexts to help people cut back on their drinking and enroll in treatment programs. In the case of suicide prevention, pre-crisis interventions can occur at several levels, Bauer said in an interview with the Observer.  

Public safety campaigns, for example, might advise gun owners to store their firearms and ammunition separately, creating a barrier to impulsive self-harm, and encourage them to save the number for a local crisis hotline in their phone. In clinical care settings, reframing education on coping skills as a way to assist peers, rather than oneself, may increase patients’ willingness to complete safety plans and participate in suicide prevention workshops. And for individual patients, smartphones may offer an avenue for effective “just-in-time” interventions. 

Unfortunately, no nudge is a one-size-fits-all solution, Bauer said. 

Friday, April 1, 2022

Implementing The 988 Hotline: A Critical Window To Decriminalize Mental Health

P. Krass, E. Dalton, M. Candon, S. Doupnik
Health Affairs
Originally posted 25 FEB 22

Here is an excerpt:

Decriminalization Of Mental Health

The 988 hotline holds incredible promise toward decriminalizing the response to mental health emergencies. Currently, if an individual is experiencing a mental health crisis, they, their caregivers, and bystanders have few options beyond calling 911. As a result, roughly one in 10 individuals with mental health disorders have interacted with law enforcement prior to receiving psychiatric care, and 10 percent of police calls are for mental health emergencies. When police arrive, if they determine an acute safety risk, they transport the individual in crisis for further psychiatric assessment, most commonly at a medical emergency department. This almost always takes place in a police vehicle, many times in handcuffs, a scenario that contradicts central tenets of trauma-informed mental health care. In the worst-case scenario, confrontation with police results in injury or death. Adverse outcomes during response to mental health emergencies are more than 10-fold more likely for individuals with mental health conditions than for individuals without, and are disproportionately experienced by people of color. This consequence was tragically highlighted by the death of Walter Wallace, Jr., who was killed by police while experiencing a mental health emergency in October 2021.

Ideally, the new 988 number would activate an entirely different cascade of events. An individual in crisis, their family member, or even a bystander will be able to immediately reach a trained crisis counselor who can provide phone-based triage, support, and local resources. If needed, the counselor can activate a mobile mental health crisis team that will arrive on site to de-escalate; provide brief therapeutic interventions; either refer for close outpatient follow up or transport the individual for further psychiatric evaluation; and even offer food, drink, and hygiene supplies.
 
Rather than forcing families to call 911 for any type of help—regardless of criminal activity—the 988 line will allow individuals to access mental health crisis support without involving law enforcement. This approach can empower families to self-advocate for the right level of mental health care—including avoiding unnecessary medical emergency department visits, which are not typically designed to handle mental health crises and can further traumatize individuals and their families—and to initiate psychiatric assessment and treatment sooner. 911 dispatchers will also be able to re-route calls to 988 when appropriate, allowing law enforcement personnel to spend more time on their primary role of ensuring public safety. Finally, the 988 number will help offer a middle option for individuals who need rapid linkage to care, including rapid psychiatric evaluation and initiation of treatment, but do not yet meet criteria for crisis. This is a crucial service given current difficulties in accessing timely, in-network outpatient mental health care.

Wednesday, March 23, 2022

Moral Injury, Traumatic Stress, and Threats to Core Human Needs in Health-Care Workers: The COVID-19 Pandemic as a Dehumanizing Experience

Hagerty, S. L., & Williams, L. M. (2022)
Clinical Psychological Science. 
https://doi.org/10.1177/21677026211057554

Abstract

The pandemic has threatened core human needs. The pandemic provides a context to study psychological injury as it relates to unmet basic human needs and traumatic stressors, including moral incongruence. We surveyed 1,122 health-care workers from across the United States between May 2020 and August 2020. Using a mixed-methods design, we examined moral injury and unmet basic human needs in relation to traumatic stress and suicidality. Nearly one third of respondents reported elevated symptoms of psychological trauma, and the prevalence of suicidal ideation among health-care workers in our sample was roughly 3 times higher than in the general population. Moral injury and loneliness predict greater symptoms of traumatic stress and suicidality. We conclude that dehumanization is a driving force behind the psychological injury resulting from moral incongruence in the context of the pandemic. The pandemic most frequently threatened basic human motivations at the foundational level of safety and security relative to other higher order needs.

From the General Discussion

A subset of respondents added context to their experiences of moral injury in the form of narrative responses. These powerful accounts of the lived experiences of health-care workers provided us with a richer understanding of the construct of moral injury, especially as it relates to the novel context of the pandemic. Although betrayal is a known facet of moral injury from prior work (Bryan et al., 2016), our qualitative analysis suggests that dehumanization may also be a key phenomenon that underlies pandemic-related moral injury. Given our findings, we suggest that it may be important to attend to both betrayal and dehumanization when researching or intervening on the psychological sequelae of the pandemic. Our results support this because experiences of dehumanization in our sample were associated with greater symptoms of traumatic stress.

Another lens through which to view the experiences of health-care workers in the pandemic is through unsatisfied basic human motivations. Given the obvious barriers the pandemic presents to human connection (Hagerty & Williams, 2020), we had an a priori interest in studying loneliness. Our results indeed suggest that need of social connection appears relevant to the mental-health experiences of health-care workers during the pandemic such that loneliness was associated with greater traumatic stress, moral injury, and suicidal ideation. Echoing the importance of this social factor are findings from prior research suggesting that social connectedness buffers the association between moral injury and suicidality (Kelley et al., 2019) and buffers the impact of PTSD symptoms on suicidal behavior (Panagioti et al., 2014). Thus, our work further highlights lack of social connection as possible risk factor among individuals who face moral injury and traumatic stress and demonstrates its relevance to the mental health of health-care workers during the pandemic.

Friday, March 18, 2022

Parents think—incorrectly—that teaching their children that the world is a bad place is likely best for them

J. D. W. Clifton & Peter Meindl (2021)
The Journal of Positive Psychology
DOI: 10.1080/17439760.2021.2016907

Primal world beliefs (‘primals’) are beliefs about the world’s basic character, such as the world is dangerous. This article investigates probabilistic assumptions about the value of negative primals (e.g., seeing the world as dangerous keeps me safe). We first show such assumptions are common. For example, among 185 parents, 53% preferred dangerous world beliefs for their children. We then searched for evidence consistent with these intuitions in 3 national samples and 3 local samples of undergraduates, immigrants (African and Korean), and professionals (car salespeople, lawyers, and cops;), examining correlations between primals and eight life outcomes within 48 occupations (total N=4,535) . As predicted, regardless of occupation, more negative primals were almost never associated with better outcomes. Instead, they predicted less success, less job and life satisfaction, worse health, dramatically less flourishing, more negative emotion, more depression, and increased suicide attempts. We discuss why assumptions about the value of negative primals are nevertheless widespread and implications for future research.

From the General Discussion

When might very positive primals be damaging illusions (i.e., associated with negative outcomes)? Study 2 was a big-net search for these contexts. We examined eight outcomes, six samples, 4,535 unique subjects, and 48 occupations (n ≥ 30), including lawyers, doctors, police officers, professors, and so forth. This unearthed 1,860 significant correlations between primals and outcomes, and the overall pattern was clear. In 99.7% of these relationships, more negative primals were associated with worse outcomes, roughly categorized as slightly less job success, moderately less job satisfaction, much less life satisfaction, moderately worse health, much increased frequency of negative emotion and other depression symptoms, dramatically decreased psychological flourishing, and moderately increased likelihood of having attempted suicide. We also found no empirical justification for the popular moderation approach. In 297 of 297 significant differences in outcomes, those who saw the world as somewhat positive always experienced worse outcomes than those who saw the world as very positive. In sum, a robust correlational relationship exists between more negative primals and more negative outcomes, even when comparing positive beliefs to positive beliefs, even when comparing within occupation. The seemingly widespread meta-belief that associates negative primals with positive outcomes is unsupported.


Wednesday, March 9, 2022

As Suicide Attempts Rise in America, Mental Health Care Remains Stagnant

Kara Grant
MedPageToday.com
Originally posted 19 JAN 22

Despite the substantial increase in suicide attempts among U.S. adults over the last decade, use of mental health services by these individuals didn't match that growth, data from the National Surveys on Drug Use and Health (NSDUH) revealed.

From 2008 to 2019, suicide attempts among adults increased from 481.2 to 563.9 per 100,000 (adjusted odds ratio [aOR] 1.23, 95% CI 1.05-1.44, P=0.01), reported Greg Rhee, PhD, of the Yale School of Medicine in New Haven, Connecticut, and colleagues.

And according to their study in JAMA Psychiatry, there was a significant uptick in the number of individuals that attempted suicide within the past year who said they felt they needed mental health services but failed to receive it (34.8% in 2010-2011 vs 45.5% in 2018-2019).

Overall, the researchers found no significant changes in the likelihood of receiving past-year outpatient, inpatient, or medication services for mental health reasons, nor any change in substance use treatment services. An increase in the number of visits to mental health centers was detected, but even this change was no longer significant after correcting for different sources of mental health care.

"One would hope that as suicide attempts increase, the percentage of individuals who receive treatment in proximity to their attempt would also increase," Rhee and colleagues wrote. "Current suicide prevention interventions largely focus on individuals connected to treatment and high-risk individuals who have contact with the health care system."

"However, our finding that less than half of suicide attempters had clinical contact around the time of their attempt suggest[s] that it is not only important to expand initiatives for high-risk individuals with clinical contact, but also to implement public health-oriented strategies outside the formal treatment system," they suggested.

Thursday, November 4, 2021

The AMA needs to declare a national mental health emergency

Susan Hata and Thalia Krakower
STAT News
Originally published 6 OCT 21

As the pandemic continues to disrupt life across the U.S., a staggering number of Americans are reaching out to their primary care doctors for help with sometimes overwhelming mental health struggles. Yet primary care doctors like us have nowhere to turn when it comes to finding mental health providers for them, and our patients often suffer without the specialty care they need.

It’s time for the American Medical Association to take decisive action and declare a national mental health emergency.

More than 40% of Americans report symptoms of anxiety or depression, and emergency rooms are flooded with patients in psychiatric crises. Untreated, these issues can have devastating consequences. In 2020, an estimated 44,800 Americans lost their lives to suicide; among children ages 10 to 14, suicide is the second leading cause of death.

Finding mental health providers for patients is an uphill climb, in part because there is no centralized process for it. Timely mental health services are astonishingly difficult to obtain even in Massachusetts, where we live and work, which has the most psychologists per capita. Waitlists for therapists can be longer than six months for adults, and even longer for children.

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By declaring a mental health emergency, the AMA could galvanize health administrators and drive the innovation needed to improve the existing mental health system. When Covid-19 was named a pandemic, the U.S. health care infrastructure adapted quickly to manage the deluge of infections. Leaders nimbly and creatively mobilized resources. They redeployed staff, built field hospitals and overflow ICUs, and deferred surgeries and routine care to preserve resources and minimize hospital-based transmission of Covid-19. With proper framing and a sense of urgency, similar things can happen for the mental health care system.

To be clear, all of this is the AMA’s lane: In addition to the devastating toll of suicides and overdoses, untreated mental illness worsens cardiac outcomes, increases mortality from Covid-19, and shortens life spans. Adult mental illness also directly affects the health of children, leading to poor health outcomes across generations.