A Beacon of Hope in The Storm of Mental Illness: An Update On Suicide Risk and Prevention Awareness with Dr. Christine Moutier
With the recent COVID-19 pandemic, mental health concerns are on the rise. What do we know about the relationship between suicide risk and previous pandemics or natural disasters? What are some protective factors against suicide, and how can we capitalize on these, especially during this challenging time? We recently sat down with the Chief Medical Officer of the American Foundation for Suicide Prevention (AFSP), Dr. Christine Moutier to discuss these questions and more in a recent NEI Podcast episode.
NEI: What are some of the risk factors for suicide and how could these be different during this challenging time, in the midst of this global pandemic?
MOUTIER: Great question. The research is actually really pretty clear about several things around the topic of suicide, and specifically risk factors. It’s never going to be just one risk factor on its own. It’s a convergence of this sort of dynamic interplay between somebody who, in most cases, does have a mental health condition --often times not addressed or undertreated that-- then is intersecting with their genetics, their early childhood experiences of past trauma, their own psychological tendencies to catastrophize or to be overly self-punitive, and all of this is happening in the context of real-life stressors going on. And so, stressors such as bullying, relationship dysfunction, job-loss and financial strain, legal problems, shame and humiliation are hugely prominent in the suicide-risk perfect storm that I’m describing. And other things that we can also become more aware of, are that when it comes to our loved ones, and our colleagues, and our friends in this moment, we need to start thinking about our own health, and mental health and suicide risk and prevention from the standpoint of “what has happened in our past?” “What does that family history look like, in terms of the parent that the person grew up with who had untreated depression that affected their childhood growing up, or an uncle who died by suicide?”. All of those are known risk factors. And so, putting it into the frame of the moment we’re in related to COVID, all of those things are still 100% relevant, and now add some of the experiences people are having with anxiety, fear, losses of all different sorts during COVID. Grief, financial strain, and also just simply the routine aspects of our lives being turned upside down. There are some upsides to that for many people, but for many others it has not been a positive thing. And so, all of that can really press on a number of those risk factors that I mentioned, including for example somebody who has pre-existing depression, or an anxiety disorder, or PTSD, or history of trauma, or loss. And so now, they’re in this moment, where there are increases in reasons to feel anxious, to feel isolated, and to feel loss or those tremendous psychosocial strains like financial crisis and job loss. There are also the circumstances where people don’t live in homes that are even safe, so that there is a situation where there is intimate partner violence, child abuse, or elder abuse. Those are other specific circumstances that are especially worrisome right now without the usual safeguards. You know, we’re learning as a society how to create better safety nets and safeguards for all of those things. So those are some of the ways that I look at the risk factors for suicide, and how it lines up right now, in this moment.
NEI: As you were saying, we know that this is a really difficult time, and especially due to the economic and social consequences that have occurred in response to the COVID-19 pandemic, these definitely impact mental health in a negative way. How do we distinguish between behavior that seems like appropriate coping during this time, and behavior that should raise a red flag?
MOUTIER: That’s a really hard question in many instances because while it could look like pretty healthy adaptive coping, the person’s internal experience might be quite different. So I do think about adaptation, and if we put our current moment in a trauma model—not to say that we’re all experiencing the same thing, or that we’re all even experiencing trauma—but there has been a shift for almost everyone in the way that we’re doing life, and for some people there has been “Big T trauma” that has been part of the COVID experience. So in the trauma model, the key aspect to what comes next in terms of health outcomes, does relate to this complex interaction between multiple factors that are biological, psychological, and environmental, but add adapting and that ability to somehow retain a sense of strong optimism and hope for the future, while you creatively and spontaneously shift your strategy—whether that is creating a structure for your day and your weekly schedule, because the weekly routines are completely lifted, and the whole family is in the home now doing work and school remotely and things like that. Those are adaptations that would be really healthy for all the family members for them to create some structure and routine and communicate things more openly so everyone has a chance to connect and to get their needs met. But I would say the warning signs would look like sleep that is off-kilter and not coming back at least into a pre-COVID state. Not everyone has great sleep, but sleep is an early indicator of significant changes in health, including mental health. Another early warning sign that I see with regard to mood changes, for men and women, but certainly for men is an increase in irritability and a shortness in your fuse, so that you’re just not able to have the usual frustration tolerance that we have. Again, there’s a reservoir that we draw from and it’s being sapped by this moment. The other difficult thing is that everyone is being sort of strained in that way. Mental health professionals are accustomed to making that call about whether this is healthy adapting and maybe temporary response to stress or has it tipped over into a place of affecting functioning, perception, mood, thought processes, optimism. Again, the sort of Gestalt way of looking at it is, is the person fundamentally too far different from their usual self and their usual way of coping and functioning, and fulfilling roles? That’s another more concrete way to detect when it’s crossed the line.
For more on this topic, click on the link for the full podcast episode: A Beacon of Hope in the Storm of Mental Illness: An Update on Suicide Awareness and Prevention with Dr. Christine Moutier
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