Suicide Mortality and Coronavirus Disease 2019—A Perfect Storm?

Reger MA, Stanley IH, Joiner TE.
JAMA Psychiatry. 
Published online April 10, 2020.
doi:10.1001/jamapsychiatry.2020.1060

Suicide rates have been rising in the US over the last 2 decades. The latest data available (2018) show the highest age-adjusted suicide rate in the US since 1941.1 It is within this context that coronavirus disease 2019 (COVID-19) struck the US. Concerning disease models have led to historic and unprecedented public health actions to curb the spread of the virus. Remarkable social distancing interventions have been implemented to fundamentally reduce human contact. While these steps are expected to reduce the rate of new infections, the potential for adverse outcomes on suicide risk is high. Actions could be taken to mitigate potential unintended consequences on suicide prevention efforts, which also represent a national public health priority.

COVID-19 Public Health Interventions and Suicide Risk

Secondary consequences of social distancing may increase the risk of suicide. It is important to consider changes in a variety of economic, psychosocial, and health-associated risk factors.

Economic Stress

There are fears that the combination of canceled public events, closed businesses, and shelter-in-place strategies will lead to a recession. Economic downturns are usually associated with higher suicide rates compared with periods of relative prosperity.2 Since the COVID-19 crisis, businesses have faced adversity and laying off employees. Schools have been closed for indeterminable periods, forcing some parents and guardians to take time off work. The stock market has experienced historic drops, resulting in significant changes in retirement funds. Existing research suggests that sustained economic stress could be associated with higher US suicide rates in the future.

Social Isolation

Leading theories of suicide emphasize the key role that social connections play in suicide prevention. Individuals experiencing suicidal ideation may lack connections to other people and often disconnect from others as suicide risk rises.3 Suicidal thoughts and behaviors are associated with social isolation and loneliness.3 Therefore, from a suicide prevention perspective, it is concerning that the most critical public health strategy for the COVID-19 crisis is social distancing. Furthermore, family and friends remain isolated from individuals who are hospitalized, even when their deaths are imminent. To the extent that these strategies increase social isolation and loneliness, they may increase suicide risk.

The info is here.

Difficult Conversations: Navigating the Tension between Honesty and Benevolence

E. Levine, A. Roberts, & T. Cohen
PsyArXiv
Originally published 18 Jul 19

Abstract

Difficult conversations are a necessary part of everyday life. To help children, employees, and partners learn and improve, parents, managers, and significant others are frequently tasked with the unpleasant job of delivering negative news and critical feedback. Despite the long-term benefits of these conversations, communicators approach them with trepidation, in part, because they perceive them as involving intractable moral conflict between being honest and being kind. In this article, we review recent research on egocentrism, ethics, and communication to explain why communicators overestimate the degree to which honesty and benevolence conflict during difficult conversations, document the conversational missteps people make as a result of this erred perception, and propose more effective conversational strategies that honor the long-term compatibility of honesty and benevolence. This review sheds light on the psychology of moral tradeoffs in conversation, and provides practical advice on how to deliver unpleasant information in ways that improve recipients’ welfare.

From the Summary:

Difficult conversations that require the delivery of negative information from communicators to targets involve perceived moral conflict between honesty and benevolence. We suggest that communicators exaggerate this conflict. By focusing on the short-term harm and unpleasantness associated with difficult conversations, communicators fail to realize that honesty and benevolence are actually compatible in many cases. Providing honest feedback can help a target to learn and grow, thereby improving the target’s overall welfare. Rather than attempting to resolve the honesty-benevolence dilemma via communication strategies that focus narrowly on the short-term conflict between honesty and emotional harm, we recommend that communicators instead invoke communication strategies that integrate and maximize both honesty and benevolence to ensure that difficult conversations lead to long-term welfare improvements for targets. Future research should explore the traits, mindsets, and contexts that might facilitate this approach. For example, creative people may be more adept at integrative solutions to the perceived honesty-dilemma conflict, and people who are less myopic and more cognizant of the future consequences of their choices may be better at recognizing the long-term benefits of honesty.

The info is here.

This research has relevance to psychotherapy.

Physician at Epicenter of COVID-19 Crisis Lost to Suicide

Dr. Lorna Breem

Marcia Frellick
MedScape.com
Originally published 28 April 20

Grief-laden posts are coursing through social media following the suicide on Sunday of emergency department physician Lorna M. Breen, MD, who had been immersed in treating COVID-19 patients at the epicenter of the disease in New York City.

Breen, 49, was the medical director of the ED at NewYork-Presbyterian Allen Hospital in Manhattan.

According to a New York Times report, her father, Dr Philip C. Breen, of Charlottesville, Virginia, said his daughter did not have a history of mental illness but had described wrenching scenes, including that patients "were dying before they could even be taken out of ambulances."

The report said Lorna Breen had also contracted the virus but had returned to work after recovering for about 10 days.

Her father told the Times that when he last spoke with her, she seemed "detached" and he knew something was wrong.

"The hospital sent her home again, before her family intervened to bring her to Charlottesville," the elder Breen told the newspaper.

The article indicated that Charlottesville police officers on Sunday responded to a call and Breen was taken to University of Virginia Hospital, where she died from self-inflicted injuries.

The info is here.

Characteristics of Faculty Accused of Academic Sexual Misconduct in the Biomedical and Health Sciences

Espinoza M, Hsiehchen D.
JAMA. 2020;323(15):1503–1505.
doi:10.1001/jama.2020.1810

Abstract

Despite protections mandated in educational environments, unwanted sexual behaviors have been reported in medical training. Policies to combat such behaviors need to be based on better understanding of the perpetrators. We characterized faculty accused of sexual misconduct resulting in institutional or legal actions that proved or supported guilt at US higher education institutions in the biomedical and health sciences.

Discussion

Of biomedical and health sciences faculty accused of sexual misconduct resulting in institutional or legal action, a majority were full professors, chairs or directors, or deans. Sexual misconduct was rarely an isolated event. Accused faculty frequently resigned or remained in academics, and few were sanctioned by governing boards.

Limitations include that only data on accused faculty who received media attention or were involved in legal proceedings were captured. In addition, the duration of behaviors, the exact number of targets, and the outcome data could not be identified for all accused faculty. Thus, this study cannot determine the prevalence of faculty who commit sexual misconduct, and the characteristics may not be generalizable across institutions.

The lack of transparency in investigations suggests that misconduct behaviors may not have been wholly captured by the public documents. Efforts to eliminate nondisclosure agreements are needed to enhance transparency. Further work is needed on mechanisms to prevent sexual misconduct at teaching institutions.

The info is here.

Athletes often don’t know what they’re talking about (Apparently, neither do Presidents)

Cathal Kelly
The Globe and Mail
Originally posted 20 April 20

Here is an excerpt:

This is what happens when we depend on celebrities to amplify good advice. The ones who have bad advice will feel similarly empowered. You can see where this particular case slid off the rails.

Djokovic has spent years trying to curate an identity as a sports brand. Early on, he tried the Tiger Beat route, a la Rafael Nadal. When that didn’t work, he tried haughty and detached, a la Roger Federer. Same result.

Some time around 2010, Djokovic decided to go Full Weirdo. He gave up gluten, got into cosmology and decided to present himself as a sort of seeker of universal truths. He even let everyone know that he’d been visiting a Buddhist temple during Wimbledon because … well, who knows what enlightenment and winning at tennis have to do with each other?

Nobody really got his new act, but this switch happened to coincide with Djokovic’s rise to the top. So he stuck with it.

This went hand in hand with an irrepressibly chirpy public persona, one so calculatedly ingratiating that it often had the opposite effect.

It wasn’t a terrible strategy. Highly successful sporting oddbods usually become cult stars. If they hang on long enough, they find general acceptance.

But it didn’t turn out for Djokovic. Even now that he is arguably the greatest men’s player of all time, he still can’t manage the trick. There’s just something about the guy that seems a bit not-of-this-world.

The info is here.

What needs to happen before your boss can make you return to work

Mark Kaufman
www.mashable.com
Originally posted 24 April 20

Here is an excerpt:

But, there is a way for tens of millions of Americans to return to workplaces while significantly limiting how many people infect one another. It will require extraordinary efforts on the part of both employers and governments. This will feel weird, at first: Imagine regularly having your temperature taken at work, routinely getting tested for an infection or immunity, mandatory handwashing breaks, and perhaps even wearing a mask.

Yet, these are exceptional times. So restarting the economy and returning to workplace normalcy will require unparalleled efforts.

"This is truly unprecedented," said Christopher Hayes, a labor historian at the Rutgers School of Management and Labor Relations.

"This is like the 1918 flu and the Great Depression at the same time," Hayes said.

Yet unlike previous recessions and depressions over the last 100 years, most recently the Great Recession of 2008-2009, American workers must now ask themselves an unsettling question: "People now have to worry, ‘Is it safe to go to this job?’" said Hayes.

Right now, many employers aren't nearly prepared to tell workers in the U.S. to return to work and office spaces. To avoid infection, "the only tools you’ve got in your toolbox are the simple but hard-to-sustain public health tools like testing, contact tracing, and social distancing," explained Michael Gusmano, a health policy expert at the Rutgers School of Public Health.

"We’re not anywhere near a situation where you could claim that you can, with any credibility, send people back en masse now," Gusmano said.

The info is here.

Drivers are blamed more than their automated cars when both make mistakes

Awad, E., Levine, S., Kleiman-Weiner, M. et al.
Nat Hum Behav 4, 134–143 (2020).
https://doi.org/10.1038/s41562-019-0762-8

Abstract

When an automated car harms someone, who is blamed by those who hear about it? Here we asked human participants to consider hypothetical cases in which a pedestrian was killed by a car operated under shared control of a primary and a secondary driver and to indicate how blame should be allocated. We find that when only one driver makes an error, that driver is blamed more regardless of whether that driver is a machine or a human. However, when both drivers make errors in cases of human–machine shared-control vehicles, the blame attributed to the machine is reduced. This finding portends a public under-reaction to the malfunctioning artificial intelligence components of automated cars and therefore has a direct policy implication: allowing the de facto standards for shared-control vehicles to be established in courts by the jury system could fail to properly regulate the safety of those vehicles; instead, a top-down scheme (through federal laws) may be called for.

From the Discussion:

Our central finding (diminished blame apportioned to the machine in dual-error cases) leads us to believe that, while there may be many psychological barriers to self-driving car adoption19, public over-reaction to dual-error cases is not likely to be one of them. In fact, we should perhaps be concerned about public underreaction. Because the public are less likely to see the machine as being at fault in dual-error cases like the Tesla and Uber crashes, the sort of public pressure that drives regulation might be lacking. For instance, if we were to allow the standards for automated vehicles to be set through jury-based court-room decisions, we expect that juries will be biased to absolve the car manufacturer of blame in dual-error cases, thereby failing to put sufficient pressure on manufacturers to improve car designs.

The article is here.

Experiments on Trial

Hannah Fry
The New Yorker
Originally posted 24 Feb 20

Here are two excerpts:

There are also times when manipulation leaves people feeling cheated. For instance, in 2018 the Wall Street Journal reported that Amazon had been inserting sponsored products in its consumers’ baby registries. “The ads look identical to the rest of the listed products in the registry, except for a small gray ‘Sponsored’ tag,” the Journal revealed. “Unsuspecting friends and family clicked on the ads and purchased the items,” assuming they’d been chosen by the expectant parents. Amazon’s explanation when confronted? “We’re constantly experimenting,” a spokesperson said. (The company has since ended the practice.)

But there are times when the experiments go further still, leaving some to question whether they should be allowed at all. There was a notorious experiment run by Facebook in 2012, in which the number of positive and negative posts in six hundred and eighty-nine thousand users’ news feeds was tweaked. The aim was to see how the unwitting participants would react. As it turned out, those who saw less negative content in their feeds went on to post more positive stuff themselves, while those who had positive posts hidden from their feeds used more negative words.

A public backlash followed; people were upset to discover that their emotions had been manipulated. Luca and Bazerman argue that this response was largely misguided. They point out that the effect was small. A person exposed to the negative news feed “ended up writing about four additional negative words out of every 10,000,” they note. Besides, they say, “advertisers and other groups manipulate consumers’ emotions all the time to suit their purposes. If you’ve ever read a Hallmark card, attended a football game or seen a commercial for the ASPCA, you’ve been exposed to the myriad ways in which products and services influence consumers’ emotions.”

(cut)

Medicine has already been through this. In the early twentieth century, without a set of ground rules on how people should be studied, medical experimentation was like the Wild West. Alongside a great deal of good work, a number of deeply unethical studies took place—including the horrifying experiments conducted by the Nazis and the appalling Tuskegee syphilis trial, in which hundreds of African-American men were denied treatment by scientists who wanted to see how the lethal disease developed. As a result, there are now clear rules about seeking informed consent whenever medical experiments use human subjects, and institutional procedures for reviewing the design of such experiments in advance. We’ve learned that researchers aren’t always best placed to assess the potential harm of their work.

The info is here.

Donald Trump: a political determinant of covid-19

Gavin Yamey and Greg Gonsalves
BMJ 2020; 369  (Published 24 April 2020)
doi: https://doi.org/10.1136/bmj.m1643

He downplayed the risk and delayed action, costing countless avertable deaths

On 23 January 2020, the World Health Organization told all governments to get ready for the transmission of a novel coronavirus in their countries. “Be prepared,” it said, “for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread.” Some countries listened. South Korea, for example, acted swiftly to contain its covid-19 epidemic. But US President Donald Trump was unmoved by WHO’s warning, downplaying the threat and calling criticisms of his failure to act “a new hoax.”

Trump’s anaemic response led the US to become the current epicentre of the global covid-19 pandemic, with almost one third of the world’s cases and a still rising number of new daily cases.4 In our interconnected world, the uncontrolled US epidemic has become an obstacle to tackling the global pandemic. Yet the US crisis was an avertable catastrophe.

Dismissing prescient advice on pandemic preparedness from the outgoing administration of the former president, Barack Obama, the Trump administration went on to weaken the nation’s pandemic response capabilities in multiple ways. In May 2018, it eliminated the White House global health security office that Obama established after the 2014-16 Ebola epidemic to foster cross-agency pandemic preparedness. In late 2019, it ended a global early warning programme, PREDICT, that identified viruses with pandemic potential. There were also cuts to critical programmes at the Centers for Disease Control and Prevention (CDC), part and parcel of Trump’s repeated rejections of evidence based policy making for public health.

Denial
After the US confirmed its first case of covid-19 on 22 January 2020, Trump responded with false reassurances, delayed federal action, and the denigration of science. From January to mid-March, he denied that the US faced a serious epidemic risk, comparing the threat to seasonal influenza. He repeatedly reassured Americans that they had nothing to worry about, telling the public: “We think it's going to have a very good ending for us” (30 January), “We have it very much under control in this country” (23 February),
and “The virus will not have a chance against us. No nation is more prepared, or more resilient, than the United States” (11 March).

The info is here.