Every 23 seconds of every day in the United States, someone attempts suicide. Every 11 minutes, an individual dies from suicide.
These most recent statistics from the Centers for Disease Control and Prevention (CDC) — an estimated 1.4 million suicide attempts and 48,344 deaths by suicide annually in 2018 — represented the latest in an ongoing trend of significant increases in the suicide rate in the United States, a public health crisis affecting all ages and demographics.
And then came the COVID-19 pandemic.
The pandemic’s negative impact on individuals’ mental and behavioral health has already been seen, and industry professionals expect a continued increase in a variety of mental and behavioral health issues, including risk for and incidence of suicide. At Rutgers Robert Wood Johnson Medical School, the Department of Psychiatry is looking at ways to proactively address the problem and avert a crisis.
A new web survey by the CDC revealed the incidence of people seriously considering suicide in the prior 30 days — approximately 11 percent of respondents — almost doubled over the previous year. For essential workers, that figure jumps to 21.7 percent.
Taking a Proactive Approach. Anticipating the more significant impact on clinicians’ mental health, the Department of Psychiatry led by Anthony Tobia, MD, professor and interim chair, is coordinating several initiatives designed to address mental and behavioral issues that could increase suicide risk.
Initiatives for health care professionals include “Quaranteams,” online communities, and semi-monthly film events, during which participants analyze films through a psychiatrist’s lens that provide medical staff the chance not only to socialize, but also offer a forum to review early warning signs and available resources to address wellness.
“Our goal is not only anticipating that next stage [of the disaster cycle], but also moving from tertiary care — watching it happen and then reacting — to primary prevention, doing it before anybody begins to have symptoms,” says Dr. Tobia.
Seeing the Community Impact. Rutgers University Behavioral Health Care also has developed mental health support services specifically for people who are struggling with the COVID-19 pandemic. Rehan Aziz, MD, associate professor of psychiatry and neurology, has seen that struggle among his own patients.
Individuals are reporting negative repercussions physically, socially, financially, and emotionally, he says. All of these losses are coming at a time of social unrest, a contentious election, and mixed messaging from authority figures.
“People have the idea that we’re under these restrictions and there’s no end in sight. There’s definitely increased depression, and it’s having an impact on people’s day-to-day activity and their normal sense of hopefulness,” says Dr. Aziz.
Ensuring individuals have access to the help they need could be a challenge, however.
“In the month before a suicide, 45 percent of patients see their primary care doctor, but only 20 percent of them actually see a mental health professional,” notes Dr. Aziz. “Part of the crisis is that people are either not able to access care or are not directed toward the appropriate care service. And in some cases, there is such a shortage of mental health professionals, those services are not available for them.”
As a result, it is critical to educate primary care physicians with respect to screening for depression, hopelessness, helplessness, and suicidal thoughts, Dr. Aziz says. The most important thing is early identification, Dr. Aziz stresses.
Dr. Aziz says he tries to address four issues during his conversations with patients: a safety assessment; encouragement of increased social engagement, such as more FaceTime or Zoom calls; psychotherapy, or talk therapy; and medications, if the symptoms are severe enough.
For his part, Dr. Tobia said he is hoping to help develop programming that will resonate with people long after the pandemic is over.
“I’m not looking for any real change in a week or two or a month or two, but maybe in a decade from now, people look back and say, ‘You know, it was a horrible situation, but there was this one thing we did that I remember…’ That’s the idea. That’s what I really hope.”
What to Look for/Warning Signs. People who are thinking of committing suicide often exhibit a number of symptoms — some subtle, some more overt — that they are at risk. Those signs include:
• Loss of interest in usual activities
• Social isolation — less interest in maintaining social connections, even virtually
• Change in appetite, whether lack of eating, or eating more, that often results in weight change
• Change in sleeping patterns, from disrupted sleep and insomnia, or napping more throughout the day
• Low energy — taking more time to do things than they normally would
• Extreme mood swings
• Acting anxious, agitated, or reckless
• Feeling hopeless or “trapped”
• Increased use of drugs and/or alcohol
• Making a plan or researching ways to die
• Expressing thoughts of suicide. This can be as simple as “I wish I could go to sleep and never wake up again,” or “If I died right now, it wouldn’t upset me a lot,” or more active, “I’m thinking of ending my life.”
“If someone close to you or someone at work points out something is wrong, the reflexive action is to reject that and become defensive. But you shouldn’t brush it off in general, especially during this extraordinary time,” Tobia advises.
National Suicide Prevention Lifeline, 24/7, English and Spanish, 1-800-273-TALK (8255)
New Jersey Hopeline, 24/7 Peer Support & Suicide Prevention Hotline, 1-855-NJ-HOPELINE (654-6735)
NJ Mental Health Cares, State-supported live help line for addressing COVID-19 stress, 1-866-202-HELP (4357)
SAMHSA Disaster Distress Helpline, 24/7 national hotline dedicated to providing immediate crisis counseling for people experiencing emotional distress, 1-800-985-5990
Crisis Text Line, Text HOME to 741741 to connect with a crisis counselor, 24/7
Rutgers4U, Confidential support line during COVID-19 pandemic for Rutgers staff, faculty, and families, Monday to Friday, 8 a.m. to 4 p.m., 1-855-654-6819
Care for Your Coronavirus Anxiety (virusanxiety.com), Website offering resources for anxiety and mental health during COVID-19 pandemic.