tag:theconversation.com,2011:/fr/topics/suicide-prevention-6969/articlesSuicide prevention – The Conversation2023-12-18T04:17:23Ztag:theconversation.com,2011:article/2180222023-12-18T04:17:23Z2023-12-18T04:17:23ZHave we been trying to prevent suicides wrongly all this time?<figure><img src="https://images.theconversation.com/files/564114/original/file-20231207-24-kcxs7w.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stressed-man-treated-by-psychologist-psychiatrist-2188371701">witsarut sakorn/Shutterstock</a></span></figcaption></figure><p>Traditional approaches to preventing suicide have focused on “who is at risk?” The aim is to identify an individual and to help them get support.</p>
<p>But that approach doesn’t seem to be working. Australia’s suicide rates have remained stubbornly high. There was an increase in the rate of suicides from <a href="https://www.aihw.gov.au/suicide-self-harm-monitoring/data/deaths-by-suicide-in-australia/suicide-deaths-over-time">2012 to 2022</a>.</p>
<p>We often do not know who is most vulnerable to suicide, and if we do, we struggle to efficiently target resources to them when they need it most. So we need a fresh approach.</p>
<p>Maybe we’ve been asking the wrong question all this time. Rather than asking “who is at risk?” we should also ask “<em>when</em> is a person at risk?” </p>
<p>We know depression <a href="https://theconversation.com/suicide-prevention-takes-more-than-treating-depression-13781">increases</a> suicide risk, but on a given day most depressed people will not consider suicide. We need to know <em>when</em> a person’s risk has risen to help them access support immediately.</p>
<p>Our preliminary research conducted in a Perth psychiatric hospital, and <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fabn0000880">published recently</a>, suggests this might be worth pursuing.</p>
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Read more:
<a href="https://theconversation.com/focusing-on-people-at-high-risk-of-suicide-has-failed-as-a-suicide-prevention-strategy-104002">Focusing on people at 'high risk' of suicide has failed as a suicide prevention strategy</a>
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<h2>What we did</h2>
<p>We conducted a “proof of concept” study involving inpatients at the psychiatric hospital Perth Clinic. Patients were invited to complete questionnaires on iPads in each room. Over more than a decade, more than 20,000 patients participated in the study, resulting in about 350,000 completed questionnaires.</p>
<p>We then examined questionnaire data from 110 inpatients who attempted suicide in the hospital over an average 25-day period. These patients were typically female (78%) and had a diagnosis of major depression or an anxiety disorder. They were 14 to 77 years old.</p>
<p>Of note, nurses had rated roughly half as having “no” to “low risk” of suicide, based on interviews with patients.</p>
<p>We then looked for patterns in the data to see if we could see who and <em>when</em> someone was at increased short-term risk of attempting suicide.</p>
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Read more:
<a href="https://theconversation.com/how-do-i-do-suicide-watch-at-home-202845">How do I do 'suicide watch' at home?</a>
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<h2>What we found</h2>
<p>We found that on the day of a suicide attempt, a person’s perception they were a <a href="https://psycnet.apa.org/record/2017-47896-001">burden</a> to friends and family increased greatly.</p>
<p>The day before a suicide attempt, patients reported an increased loss of hope in their lives. They perceived they could not change things that mattered to them.</p>
<p>We used this data to develop an algorithm to monitor spikes in these and other key risk factors that may signal increased short-term risk of suicide attempts.</p>
<p>This algorithm, now live in the hospital, alerts staff to at-risk patients to facilitate targeted and immediate interventions when the risk of attempted suicide is at its highest.</p>
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Read more:
<a href="https://theconversation.com/how-to-ask-someone-youre-worried-about-if-theyre-thinking-of-suicide-100237">How to ask someone you're worried about if they're thinking of suicide</a>
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<h2>How can we apply these findings?</h2>
<p>Key signals we identified as indicators of short-term risk of suicide – perceptions of burden or hopelessness – are often <a href="https://psycnet.apa.org/record/2009-01414-000">not matched by reality</a>. </p>
<p>While people may think they are a burden, their friends and family members disagree. Far from being burdened, those friends and family are the ones who struggle to know how and when to give the assistance they desperately want to provide. Likewise, a <a href="https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2850.2003.00573.x">perception of hopelessness</a> is often transient and doesn’t always reflect reality.</p>
<p>So clinical staff can work with patients to help them re-evaluate these misguided beliefs, and to collaboratively develop coping strategies.</p>
<p>For instance, a core belief of “I am a burden” is replaced by “I wouldn’t think a loved one was a burden if they were suffering.”</p>
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<a href="https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Nurse comforting patient, one hand on shoulder, one on hand on knee" src="https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Clinical staff work with patients to help them re-evaluate their perceptions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-nurse-comforting-senior-man-on-738116425">Monkey Business Images/Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/what-makes-a-good-psychologist-or-psychiatrist-and-how-do-you-find-one-you-like-120981">What makes a good psychologist or psychiatrist and how do you find one you like?</a>
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<h2>Where to now?</h2>
<p>The aim now is to trial our approach in a larger number of psychiatric patients, across multiple sites across Australia, to see if this gives staff enough time to intervene and prevent imminent suicides.</p>
<p>We’re also hoping to test our methods in the community. This includes predicting the risk of suicide among school students, and remotely monitoring people at risk of suicide who present to primary care, such as their GP. </p>
<p>For instance, we are working with GPs to extend Perth Clinic’s daily monitoring system to track the symptoms of GP patients between appointments. Through this approach the GPs can monitor the effectiveness of medications or identify periods of heightened risk that can be addressed at future appointments.</p>
<p>Our approach is just one aspect of suicide prevention. We also need to address the complex web of societal, socioeconomic and other factors that contribute to the type of distress we see in people contemplating suicide.</p>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.</em></p><img src="https://counter.theconversation.com/content/218022/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Page is a research consultant to Perth Clinic where the research was conducted. The research has been supported by the Australian Research Council's Linkage Scheme where Perth Clinic was the industry partner.</span></em></p><p class="fine-print"><em><span>Michael Kyron does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Rather than asking ‘who is at risk?’ of suicide we should also ask ‘when is a person at risk?’ Our preliminary research shows this has promise.Michael Kyron, Research Fellow, School of Psychological Science, The University of Western AustraliaAndrew Page, Pro Vice-Chancellor (Research), The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2103562023-07-28T12:19:42Z2023-07-28T12:19:42ZAs suicides rise in the US, the 988 hotline offers hope – but most Americans aren’t aware of it<figure><img src="https://images.theconversation.com/files/539383/original/file-20230725-21-y5cy7z.jpg?ixlib=rb-1.1.0&rect=21%2C0%2C4814%2C3639&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You can call 988 for yourself, or for a friend or family member.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-using-phone-royalty-free-image/160077976?phrase=sad+young+person+on+phone&adppopup=true">Flashpop/Stone via Getty Images</a></span></figcaption></figure><p><em>July 2023 marks the one-year anniversary of the national launch of the <a href="https://988lifeline.org/">988 Suicide & Crisis Lifeline</a>. Currently, more than 200 call centers throughout the U.S. are responding to 988 calls. But few people know it exists. SciLine interviewed <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/12708">Dr. Emmy Betz</a>, a professor of emergency medicine at the University of Colorado, who discussed the critical need to raise awareness about 988, the increasing numbers of suicide deaths in the U.S. and the signs that someone is thinking about suicide.</em> </p>
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<iframe src="https://player.vimeo.com/video/846727921" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Emmy Betz discusses 988 and suicide prevention.</span></figcaption>
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<p><em>Below are some highlights from the discussion. Answers have been edited for brevity and clarity.</em></p>
<p><strong>Can you share some statistics about suicide in the U.S.?</strong></p>
<p><strong>Emmy Betz:</strong> Suicide continues to be a <a href="https://www.cdc.gov/suicide/facts/index.html">leading cause of death</a> in the United States. In fact, it’s the 12th-leading cause of death among all ages. We had been seeing suicide rates rise from about 2000, up until around the COVID era. There was <a href="https://www.cdc.gov/nchs/pressroom/podcasts/2021/20211105/20211105.htm">a small dip in rates</a> during those COVID years, which was great, but unfortunately we’ve now seen rates increase again. In 2021, there were 48,000 suicide deaths in the U.S., which is about one every 11 minutes.</p>
<p><strong>What about youth suicide?</strong></p>
<p><strong>Emmy Betz:</strong> Suicide rates among youth in particular <a href="https://www.usnews.com/news/health-news/articles/2023-06-15/cdc-study-shows-rise-in-violent-death-rates-among-u-s-youth">have increased</a>. Between 2011 and 2021, suicide rates for youth rose 60%. Particularly concerning are increases in suicide rates among young individuals of color, where there have traditionally been lower suicide rates. </p>
<p><strong>Who should call 988, and when?</strong></p>
<p><strong>Emmy Betz:</strong> 988 is the suicide and crisis lifeline. I want to really emphasize, <a href="https://www.webmd.com/mental-health/features/988-suicide-prevention-overview">it’s not just for suicide</a>. It’s for anyone who’s experiencing substance abuse, mental health crisis, emotional distress or suicidal thoughts. You can call for yourself. You can call for someone in your family or a friend. It’s available 24/7, and it’s free and confidential.</p>
<p><strong>How has the first year of the 988 hotline gone?</strong></p>
<p><strong>Emmy Betz:</strong> In the first year, 988 answered <a href="https://www.samhsa.gov/sites/default/files/988-one-year-anniversary-issue-brief.pdf">nearly 5 million calls, chats or texts</a>. That’s great news. But one thing that I think is concerning: There was a Pew Charitable Trusts <a href="https://www.pewtrusts.org/en/research-and-analysis/articles/2023/05/23/most-us-adults-remain-unaware-of-988-suicide-and-crisis-lifeline">survey published in April 2023</a>. Only 13% of respondents said they knew both about 988 and what it was for. So I think we still have a ways to go in terms of raising awareness among people about what the hotline is, when you should call and then <a href="https://988helpline.org/what-to-expect/">what happens when you do call</a>.</p>
<p><strong>What are warning signs that a person is thinking about suicide?</strong></p>
<p><strong>Emmy Betz:</strong> It can vary. Sometimes, it can look like what we think of classically as depression – somebody who might seem sad, seems withdrawn and not doing the things that they previously have been wanting to do. </p>
<p>Certainly anything like talking a lot about death, mentioning suicide, mentioning not wanting to be around anymore – those are all very concerning. Some people, though, can seem angry or sort of ramped up or different. </p>
<p>The main thing to look out for is if someone says that they’ve lost hope or that they <a href="https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide">aren’t looking towards the future anymore</a>. </p>
<p>And perhaps the most important thing to know – it’s OK to ask. If you’re ever worried that someone might be having thoughts of suicide, <a href="https://suicideprevention.nv.gov/Youth/Myths/">it’s fine to ask them directly</a>. You’re not going to prompt suicidal thoughts by asking that question. </p>
<p><strong>What are some prevention strategies for firearm suicides?</strong></p>
<p><strong>Emmy Betz:</strong> Here at the University of Colorado, I lead the <a href="https://medschool.cuanschutz.edu/emergency-medicine/major-programs/firearm-injury-prevention-initiative">firearm injury prevention initiative</a>, which is a new program funded through the medical school that hopes to reduce all sorts of firearm injuries and deaths, including suicide. </p>
<p>Where I live in Colorado, 73% of our gun deaths are by suicide. It’s a <a href="https://coloradosun.com/2023/04/06/colorado-gun-violence-explained-charts/">critical problem in our state</a>. And these deaths are preventable.</p>
<p>Suicide typically occurs in the context of some kind of crisis, whether it’s related to a job, or a recent breakup with a romantic partner, or something else. Prevention is all about getting people through that high-risk period, to get the treatment or resources they need. </p>
<p>We know that if a person uses a firearm in a suicide attempt, about 90% of the time they die. So my work and the work of our initiative really focuses on how can we reduce firearm access when someone is in that high-risk period. </p>
<p>And importantly, it’s not about confiscation. It’s not about legislation. It’s about engaging with communities, educating communities and educating health care providers about what we can do to reduce firearm access – specifically, encouraging people to take steps to lock up guns differently, such as changing the locks or changing the password so the at-risk person can’t access the gun. </p>
<p>When someone has suicide risk, it can be a good idea to <a href="https://doi.org/10.1186/s40621-022-00389-3">move firearms out of the home temporarily</a>. We’ve been working with gun ranges, retailers and other locations that offer voluntary and temporary firearm storage as a solution for people – to make the home safer while someone’s getting better.</p>
<p>There are things we can do that don’t conflict with views on Second Amendment rights. I’m thrilled to see <a href="https://www.nssf.org/safety/suicide-prevention/nssf-afsp-partnership/">firearm rights organizations working with large organizations</a> like the Veterans Administration, the Department of Defense and medical organizations.</p>
<p><strong>What is suicide contagion, and what should journalists know about covering suicide without contributing to it?</strong></p>
<p><strong>Emmy Betz:</strong> Suicide contagion is the phenomenon whereby hearing about one suicide – in particular, the methods – leads to additional individuals <a href="https://time.com/5572394/suicide-contagion-study/">attempting or dying by suicide</a> using the same methods. </p>
<p>It’s really important that journalists talk about suicide, and that we raise awareness, and we get these messages out. But there are guidelines about how to reduce contagion. There are guidelines from the American Foundation for Suicide Prevention and other large organizations that <a href="https://afsp.org/safereporting/#:%7E:">really spell out best practices for journalists</a>. </p>
<p><em>Watch the <a href="https://www.sciline.org/mental-health/suicide-prevention/">full interview</a> to hear more about the 988 hotline and suicide prevention.</em> </p>
<p><em><a href="https://www.sciline.org/">SciLine</a> is a free service based at the nonprofit American Association for the Advancement of Science that helps journalists include scientific evidence and experts in their news stories.</em></p>
<p><em>This article was corrected to fix the attribution for the April 2023 survey.</em></p><img src="https://counter.theconversation.com/content/210356/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emmy Betz receives research grant funding from the National Institutes of Health and the Department of Defense. </span></em></p>The 988 Suicide & Crisis Lifeline is for anyone experiencing suicidal thoughts, emotional distress, substance abuse issues or mental health problems.Emmy Betz, Professor of Emergency Medicine, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2073932023-06-25T13:34:56Z2023-06-25T13:34:56ZWhat to do if your child is struggling: Steps caregivers can take to help kids and teens with their mental health<figure><img src="https://images.theconversation.com/files/533781/original/file-20230623-21-poqbou.jpg?ixlib=rb-1.1.0&rect=119%2C175%2C5345%2C3723&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caregivers are encouraged to have conversations about mental health early and often, whether their child or teen is struggling or not.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Emerging research suggests that child and adolescent mental health problems are on the rise. For example, <a href="https://doi.org/10.1001/jamapediatrics.2021.2482">one in four children</a> report that they have experienced clinically elevated rates of depression, and rates of emergency department visits for attempted suicide have <a href="https://doi.org/10.1016/S2215-0366(23)00036-6">increased by 22 per cent</a> in the past few years.</p>
<p>As clinicians and researchers, we have interacted with thousands of caregivers, many of whom have asked us how they can better understand and support their children’s mental health. </p>
<p>Below we offer a step-by-step guide for recognizing the signs of mental distress and responding with support and resources to help foster recovery and resilience in children and adolescents.</p>
<h2>Recognize signs of distress</h2>
<p>Children and adolescents have varying reactions to experiences and events, and signs of mental distress can look different across young people (and can look different compared to adults too).</p>
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<img alt="A woman with her arm around a teen, sitting on the edge of a bed, seen from behind" src="https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Talking about mental health helps to normalize the conversation and supports children and adolescents in knowing they can go to you when they are struggling.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Changes are normal in children and adolescents, but <a href="https://ontario.cmha.ca/documents/child-and-youth-mental-health-signs-and-symptoms/">dramatic and sustained changes are not</a>. Typically, caregivers should be on the lookout for a combination of: </p>
<ol>
<li><p>Increased distress, such as more <a href="https://ontario.cmha.ca/documents/children-youth-and-depression/">sadness</a>, irritability, <a href="https://www.anxietycanada.com/articles/abcs-of-anxiety/">worry</a>, or <a href="https://www.camh.ca/-/media/files/guides-and-publications/what-parents-teen-risk-taking-en.pdf">risk-taking</a>.</p></li>
<li><p>Changes in daily functioning, such as changes in sleep, eating, physical activity, energy levels and/or interests, which may be subsequently impacting their peer or family relationships, extracurriculars or academic performance.</p></li>
</ol>
<h2>Talk to your children about mental health</h2>
<p>We encourage caregivers to have conversations about mental health early and often, whether their child or teen is struggling or not. This helps to normalize the conversation and supports children and adolescents in knowing they can go to you when they are struggling.</p>
<p>Conversations are especially important when children or adolescents <a href="https://health.sunnybrook.ca/mental-health/talk-about-mental-illness-conversation-parents/">appear to be struggling</a>. You can start by letting them know you care, and then pointing out what you have observed in terms of changes in their distress and daily functioning, such as “I’ve noticed that you’ve been sleeping a lot more than usual. Have you noticed these changes too?” Then ask if you can talk about this further together to deepen the conversation.</p>
<p>If you feel that strategy won’t work for your child, or if you often get answers of “fine” to “how are you feeling?”, try the third person strategy, which can <a href="https://doi.org/10.3389%2Ffpsyg.2016.01715">reduce distress</a> during tense conversations. </p>
<p>In this scenario, make a statement about children’s mental health generally, such as “I hear there’s a lot of kids and teens struggling with their mental health right now” and then ask open-ended questions, such as: “what do you think about that?” or “what have you noticed about your own mental health lately”? </p>
<figure class="align-center ">
<img alt="A man and a teen outside, having a conversation." src="https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If your child finds it hard to have face-to-face conversations about their mental health, ask them to go for a walk and start the conversation then.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>When you have conversations about mental health with your child or adolescent, try to minimize any potential discomfort. It’s best to find a time that works well for your child. For example, when they are rested, fed, and relaxed. </p>
<p>Also, some children find it hard to have face-to-face conversations about their mental health. If this is the case with your child or adolescent, you could ask them to go for a walk and start the conversation then or when you are doing something else, like loading the dishwasher or driving to an extracurricular activity. This can take the pressure off what might be perceived as stressful face-to-face conversations.</p>
<p>When children and adolescents do open up, express empathy for what they are going through, using phrases such as “that sounds really difficult” and/or “I understand how painful that can be.” Often as caregivers, we want to jump into problem-solving mode, but the most effective approach to supporting children and adolescents is often to listen and validate their feelings and/or distress. </p>
<p>Communicating and connecting with children and adolescents, and confirming they have our support, can foster resilience in times of adversity. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KZBTYViDPlQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Express empathy for what children and adolescents are going through. This video discusses empathy and sympathy.</span></figcaption>
</figure>
<h2>Talk with their teacher</h2>
<p>If you remain concerned about your child, and want to gather additional information, you could speak with their teacher or guidance counsellor. Up to <a href="https://doi.org/10.1542/peds.2020-1440">80 per cent of children</a> get their knowledge about mental health from schools. Guidance counsellors are specifically trained to <a href="https://doi.org/10.1080/03069885.2010.531384">address mental health concerns</a> and other school staff are used to having conversations about mental health with students. They typically welcome these conversations with caregivers.</p>
<p>Teachers can also provide a valuable perspective on how a child’s mental health may have changed, and what might be precipitating these changes. For example, children may be experiencing learning struggles or bullying, which they haven’t yet disclosed to you, but is causing them some distress. Guidance counsellors and teachers can also help brainstorm ideas for building up children’s coping strategies and supporting their success at school.</p>
<p>If possible, have your child join these conversations, so they feel involved in discussions about their own mental health and develop agency in addressing it.</p>
<h2>Talk with your health-care provider</h2>
<p>Health-care providers are trained in evaluating mental and physical health problems alike. They can formally <a href="https://cps.ca/en/mental-health-screening-tools">screen and assess for mental health problems</a> by asking the caregiver and child questions about changes in mood, behaviour and functioning and matching symptoms of distress and impairment with “diagnostic criteria” for various mental health disorders. </p>
<figure class="align-center ">
<img alt="A woman with a child on her lap talking to a doctor" src="https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Health-care providers can offer strategies and resources to support children and caregivers.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>With this knowledge, health-care providers can offer strategies and resources to support children and caregivers. They will work with caregivers and children directly to decide on the best approaches to addressing the child’s mental health struggles.</p>
<p>It is also important to let children and adolescents know of other services they can access for support, such as <a href="https://kidshelpphone.ca/">Kids Help Phone</a>, which is available via text or phone 24/7.</p>
<h2>Immediately address urgent mental health problems</h2>
<p>The strategies above can occur when children and adolescents are not in immediate danger. But when your child shows warning signs of suicide, or is engaging in self-harm behaviour, <a href="https://www.camh.ca/en/professionals/treating-conditions-and-disorders/suicide-risk/suicide---detecting-and-assessing-suicidality">get them help as soon as possible</a>, including:</p>
<ul>
<li><p>Taking them to the nearest acute care hospital.</p></li>
<li><p>If your child will not go to the hospital or you’re unsure if this is the right thing to do, get help from a health-care provider as quickly as possible. You can call the health-care team or a crisis line.</p></li>
<li><p>If your child is attempting or about to attempt suicide, do not leave them alone, and call 911 immediately.</p></li>
</ul>
<p>Although supportive in nature, taking care of our children’s mental health can also be taxing and/or triggering for many caregivers. To best support children and adolescents, we also need to take care of ourselves. We encourage caregivers to prioritize their own mental health, so that they can feel energized and empowered to attend to their children’s mental health.</p>
<p>If caregivers have concerns about their own mental health, we recommend the following resources:</p>
<ul>
<li><a href="https://www.wellnesstogether.ca/en-CA">Wellness Together Canada</a> is a free and confidential service available to Canadian residents. They can give you information on mental health, offer free confidential sessions with health professionals, and provide peer support services.</li>
<li>Speak to your health-care provider.</li>
<li>If you are in crisis, contact <a href="https://talksuicide.ca/">Talk Suicide Canada</a>.</li>
</ul><img src="https://counter.theconversation.com/content/207393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sheri Madigan receives funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation, an anonymous donor, and the Canada Research Chairs program.</span></em></p><p class="fine-print"><em><span>Tracy Vaillancourt receives funding from the Canadian Institutes of Health Research, Social Sciences and Humanities Research Council and Canada First Research Excellence Fund. </span></em></p>With child and adolescent mental health problems on the rise, here is a step-by-step guide for caregivers for recognizing signs of mental distress and responding with support and resources.Sheri Madigan, Professor, Canada Research Chair in Determinants of Child Development, Owerko Centre at the Alberta Children’s Hospital Research Institute, University of CalgaryTracy Vaillancourt, Tier 1 Canada Research Chair in School-Based Mental Health and Violence Prevention, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2028452023-04-24T02:33:23Z2023-04-24T02:33:23ZHow do I do ‘suicide watch’ at home?<figure><img src="https://images.theconversation.com/files/518308/original/file-20230329-1118-ptejyr.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhappy-woman-lying-bed-stressed-when-558220300">Shutterstock</a></span></figcaption></figure><p>Some people still at imminent risk of suicide leave hospital to be cared for at home by their partner.</p>
<p>So their partner becomes their carer. That person is then on alert for extended periods of time for future suicide attempts. This is all while helping with their loved one’s medication, liaising with health professionals, working or looking after other family members.</p>
<p>But there’s hardly any advice for carers on how to do “suicide watch” at home. Partners can be left to improvise, leading to high levels of distress. In a <a href="https://www.abc.net.au/news/2023-03-21/timor-leste-veteran-suicide-attempts-shocks-q-a/102122274">recent disclosure</a>, one woman described how she tied herself to her suicidal partner for nine days before finding help for him.</p>
<p>We’re social workers with a special interest in grief, and preventing suicide and related distress. Here’s what can help while doing “suicide watch” at home and how to get support. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/suicide-risk-is-high-for-military-and-emergency-workers-but-support-for-their-families-and-peers-is-missing-193451">Suicide risk is high for military and emergency workers – but support for their families and peers is missing</a>
</strong>
</em>
</p>
<hr>
<h2>Left to cope</h2>
<p>We’ve conducted our own research into available supports for family carers with a loved one at home who’s at risk of suicide.</p>
<p>What we’ve found so far is that mental health services often provide surveillance for people in their facilities who are at risk of taking their lives. But there’s not always enough beds in crisis wards, space in emergency departments or culturally safe care available. </p>
<p>This means partners, family and friends are left to provide practical surveillance at home.</p>
<p><a href="https://www.researchgate.net/publication/351296701_Suicide_can't_always_be_prevented_but_it_can_be_postponed_Lived_experiences_of_providing_care_and_support_to_people_who_suicide_attempt_and_those_who_have_gone_on_to_die_by_suicide_A_report_prepared_f">A 2020 report</a> we prepared for the Prime Minister’s National Suicide Prevention Adviser described carers’ experiences.</p>
<p>Carers told us they felt ill-equipped when asked, or felt they had to do “suicide watch”, given the gravity of the situation. </p>
<p>Often carers were told by health professionals, while waiting for crisis care, or when discharged after the immediate suicide crisis had subsided, to keep an eye on the person at all times. They were also told to check for access to means of suicide to keep the house “safe”.</p>
<p>The effect of the intense monitoring meant carers, who did have to leave the house to go to work or to seek their own support, had to ask friends and extended family to take on, or help with, surveillance duties.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/518125/original/file-20230329-14-56c55m.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C664&q=45&auto=format&w=1000&fit=clip"><img alt="Male couple, one sitting in bed, the other sitting on edge of bed, looking worried" src="https://images.theconversation.com/files/518125/original/file-20230329-14-56c55m.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C664&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518125/original/file-20230329-14-56c55m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518125/original/file-20230329-14-56c55m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518125/original/file-20230329-14-56c55m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518125/original/file-20230329-14-56c55m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518125/original/file-20230329-14-56c55m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518125/original/file-20230329-14-56c55m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Carers felt ill-equipped when left to cope at home.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/caucasian-gay-couple-having-argument-each-1231948474">UfaBizPhoto/Shutterstock</a></span>
</figcaption>
</figure>
<p>Carers in this situation are a <a href="https://www.researchgate.net/publication/351296701_Suicide_can't_always_be_prevented_but_it_can_be_postponed_Lived_experiences_of_providing_care_and_support_to_people_who_suicide_attempt_and_those_who_have_gone_on_to_die_by_suicide_A_report_prepared_f">distinct group of people</a> who need support and resources. That’s because their role complements the work of crisis and community mental health services.</p>
<p>But when we looked at what was available for them online – clear and logical information about how to keep an eye on a person – we couldn’t find any single Australian resource that identified the practical aspects of doing “suicide watch” at home.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-we-losing-so-many-indigenous-children-to-suicide-114284">Why are we losing so many Indigenous children to suicide?</a>
</strong>
</em>
</p>
<hr>
<h2>What practical things might help?</h2>
<p>Here are some practical tips, mainly based on what carers say works:</p>
<ul>
<li><p>talk to the person you are caring for, using some of these <a href="https://www.sane.org/images/you-are-not-alone/pdfs/You-are-not-alone-download-05.pdf">conversation starters</a>. These conversations will help shape how you might keep an eye on them, with their consent</p></li>
<li><p>ensure you have consent from the person you are <a href="https://www.carergateway.gov.au/">caring for</a> to speak to their GP, or treating team and know the phone numbers for crisis mental health when your concern levels rise</p></li>
<li><p>start a conversation with the person about developing a <a href="https://www.beyondblue.org.au/get-support/beyondnow-suicide-safety-planning?gclid=Cj0KCQjww4-hBhCtARIsAC9gR3asMb1atASp_Phf_cQVIj31J1jTovfBPXQwEMdz4fLImsoohOK_W1waAobGEALw_wcB">safety plan</a>, which may change over time. This will help you understand what the possible risks might be in the home. You can then support that person to enact their safety plan, empowering them and yourself</p></li>
<li><p><a href="https://pubmed.ncbi.nlm.nih.gov/33355984/">lock medication</a> cupboards, remove access to toxic substances, or any other means that might place a person at risk. This can increase safety in the short term</p></li>
<li><p><a href="https://journals.sagepub.com/doi/abs/10.1177/10547738221119344">sleep close to the person’s room</a>. Go to them if they call out or if you are concerned about how they are coping</p></li>
<li><p>reach out to <a href="https://www.researchgate.net/publication/357130318_Predictors_of_caregiver_burden_among_carers_of_suicide_attempt_survivors">other people</a> in your family or friend network to say you are keeping an eye on a loved one. This may help share the tasks and give you some time out. Carers have a right to look after their own needs, alongside caring for a family member or friend. </p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-ask-someone-youre-worried-about-if-theyre-thinking-of-suicide-100237">How to ask someone you're worried about if they're thinking of suicide</a>
</strong>
</em>
</p>
<hr>
<h2>What needs to happen next?</h2>
<p>Vague directives to carers to “just keep an eye on them” until care arrives, or services become available, can make people feel ill-equipped and unsupported when providing care at home.</p>
<p>No-one should have to tie themselves to their loved one <a href="https://www.abc.net.au/news/2023-03-21/timor-leste-veteran-suicide-attempts-shocks-q-a/102122274">for nine days</a> to remain vigilant about the risk of suicide until accessing help.</p>
<p>We also need longer-term practical and emotional supports for carers, beyond immediate advice on how to do “suicide watch” at home. We need adequate health funding to do this.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. If you are a carer and would like support, contact <a href="https://www.carersaustralia.com.au">Carers Australia</a> on 1800 422 737.</em></p><img src="https://counter.theconversation.com/content/202845/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Wayland receives funding from SANE Australia and the National Mental Health Commission</span></em></p><p class="fine-print"><em><span>Myfanwy Maple receives funding from SANE Australia and the National Mental Health Commission. </span></em></p>Carers can be left to figure it out for themselves, without support. Here’s what can help.Sarah Wayland, Associate Professor, University of New EnglandMyfanwy Maple, Professor of Social Work, University of New EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1984742023-03-28T19:29:00Z2023-03-28T19:29:00ZSuicide prevention: Protective factors can build hope and mitigate risks<figure><img src="https://images.theconversation.com/files/517342/original/file-20230324-24-cfiq1p.jpg?ixlib=rb-1.1.0&rect=233%2C17%2C1523%2C1053&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Protective factors like supportive relationships can counteract suicide risk factors.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/suicide-prevention--protective-factors-can-build-hope-and-mitigate-risks" width="100%" height="400"></iframe>
<p>Globally, an estimated <a href="https://www.who.int/news-room/fact-sheets/detail/suicide">700,000 people take their own life every year</a> — a statistic that underscores the importance of suicide prevention. </p>
<p>Suicidal thoughts (ideation), plans and attempts are suprisingly common: <a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/healthy-living/suicide-canada-key-statistics-infographic/ENG.pdf">12 per cent of Canadians have thought about suicide during their lifetime, 4.3 per cent made a plan and 3.1 per cent attempted it</a>.</p>
<p>Past suicide prevention efforts have emphasized the <a href="https://doi.org/10.1111/acps.13059">identification and mitigation of risk factors</a>. Most guidelines comprise <a href="https://pubmed.ncbi.nlm.nih.gov/27841450/">lists of non-specific factors such as mental illness, physical illness, life stress, special population status or access to lethal means</a>. This leaves room for improvement.</p>
<p>The focus is increasingly shifting toward protective factors that make it less likely that individuals will consider, attempt or die by suicide. Protective factors can help counterbalance the effects of risk factors on mental health. For example, <a href="https://doi.org/10.1016/j.genhosppsych.2013.10.006">optimism and gratitude may reduce suicidal ideation even if someone is experiencing depression</a>.</p>
<p>This emerging field offers evidence-based strategies to protect against suicidal thoughts and behaviours and reduce their frequency.</p>
<h2>Social support and connectedness</h2>
<p>The interpersonal theory of suicide describes the social nature of suicide and emphasizes <a href="https://doi.org/10.1016/j.jrp.2013.04.007">two key elements explaining why people consider suicide</a>: feelings of not belonging, and the sense of being a burden to others.</p>
<figure class="align-center ">
<img alt="Illustration of a stick figure preventing a line of dominoes from falling over" src="https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517346/original/file-20230324-22-65cut6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Anyone — especially those with whom a trusting relationship has been established — can be a source of support by both offering and asking for help.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1016/j.jad.2013.01.033">Research on social support</a> suggests that the perception that one is cared for, loved, esteemed, and a member of a network of mutual obligations, contributes to a sense of belonging, making it a protective factor against suicide. Different <a href="https://doi.org/10.1192/bjp.bp.115.169094">social networks can provide emotional support, practical help or information</a>. </p>
<p>Individuals who perceived they had strong <a href="https://doi.org/10.1001/jamanetworkopen.2020.27491">social support had an approximately 40 per cent reduced risk of suicidal ideation and attempts</a>. Connection with others may also be protective for people experiencing interpersonal adversity in one sphere of their life. For instance, <a href="https://doi.org/10.1001/jamapediatrics.2014.1223">strong family connections may protect against suicidal ideation for a youth experiencing bullying in school</a>. </p>
<p>Social support is a key protective factor for suicide, and anyone — especially those with whom a trusting relationship has been established — can be a source of support by both offering and asking for help. </p>
<h2>Beliefs and sense of meaning</h2>
<p>Several therapeutic approaches promote searching for meaning in life. Meaning has been described by Michael Steger, director of the Center for Meaning and Purpose at Colorado State University, as having two key components: <a href="https://doi.org/10.1080/17439760.2015.1137623">a sense of comprehensibility, and the pursuit and attainment of goals</a>. </p>
<p>Both the <a href="https://doi.org/10.1186/s12888-020-02485-4">presence and search for meaning can protect against suicidal behaviours by decreasing hopelessness</a>, a negative attitude about future life events. Furthermore, <a href="https://doi.org/10.1016/j.jrp.2013.04.007">gratitude indirectly buffers against suicidal ideation by contributing meaning in life</a>. Gratitude exercises, such as daily journaling, are easily implementable interventions. </p>
<figure class="align-center ">
<img alt="Illustration of three silhouettes of a human head with different emotional expressions" src="https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517347/original/file-20230324-20-mdnoy8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Several therapeutic approaches promote searching for meaning in life.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Cultural, religious and personal beliefs are also recognized sources of guidance to perceive life as meaningful. For instance, <a href="https://doi.org/10.1080/07481187.2014.970299">a study of Asian-American students found that for some, a desire to not let loved ones down was protective against suicide attempts</a>. </p>
<p>Other studies suggest <a href="https://doi.org/10.1080/19349637.2012.744620">spiritual faith provides the ability to find personal meaning amidst stressful life circumstances</a>. The relationship between religion and suicide is complex. Several studies have found religion to play a protective role <a href="https://doi.org/10.1093/med/9780198834441.003.0002">against suicidal ideation and attempt</a>. This arises from social factors (mutual care of members of supportive community), ethical considerations (condemnation of suicide) and fear (God’s wrath), as well as by <a href="https://doi.org/10.1080/13811118.2015.1004494">interpreting suffering in a tolerable way</a>. </p>
<p>A <a href="https://doi.org/10.1001/jamapsychiatry.2016.1243">study of U.S. women showed that those who frequently attended religious service</a> had approximately five-fold lower rate of suicide mortality compared to those who never attended. </p>
<h2>Mindfulness and self-compassion</h2>
<p><a href="https://doi.org/10.1007/s12671-021-01815-1">Self-compassion and mindfulness</a> have received increasing attention for their potential to buffer against suicidal thoughts and behaviours. </p>
<p>Educational psychologist <a href="https://self-compassion.org/the-three-elements-of-self-compassion-2/">Kristin Neff</a> defines <a href="https://doi.org/10.3389/fpsyg.2021.633482">self-compassion as kindness towards oneself in a time of pain</a>. </p>
<p>Self-compassion decreases negative self-judgments, which helps counteract negative emotional states such as self-loathing and self-isolation. Adopting a compassionate stance may help individuals accept difficult thoughts and emotions as a way out of suffering, and is critical for <a href="https://doi.org/10.1007/s10879-022-09550-x">moving individuals toward a life that is not structured around avoidance or escape from painful thoughts, emotions and physiological sensations</a>.</p>
<p>A related concept is mindfulness, defined as the practice of purposely bringing one’s attention to the present moment without judgement. Mindfulness-based interventions may be a promising practice to help navigate suicidal thoughts and behaviours. </p>
<p>Most interventions are a form of mental training to develop skills such as mindful awareness, focused attention and well-being. These skills allow one to <a href="https://doi.org/10.1080/13811118.2020.1833796">respond rather than react to stimuli, enhancing cognitive and emotional regulation</a>. </p>
<p><a href="https://doi.org/10.1001/jamapsychiatry.2018.1109">Dialectical behaviour therapy, the gold-standard treatment for chronic suicidality, also promotes acceptance while advocating for change by focusing on emotion regulation</a>. Dialectic thinking allows an individual to hold two seemingly opposite ideas as part of the same truth. Accepting that opposites can co-exist by engaging in more flexible thinking is a valuable strategy to regulate intense emotions.</p>
<p>Recent research in the field of mindfulness has begun to describe the role played by the mind-body connection in mechanisms related to suicide. In the presence of suicidal ideation, individuals with reported <a href="https://doi.org/10.1016/j.psychres.2019.112661">low levels of dissociation, defined as detachment from reality, were less likely to attempt suicide</a>. </p>
<p>Subsequent studies have shown the benefit of interventions aimed at improving interoception — the ability to sense and accept internal sensations and emotions — in reducing suicidal ideation. Engaging in <a href="https://doi.org/10.1016/j.beth.2021.02.001">self-guided progressive body relaxation exercise led to improved body trust and reduced identification with suicide</a>.</p>
<h2>Healthy lifestyle and habits</h2>
<p>Sleep hygiene and physical activity promote overall well-being in both physiological and psychological ways, given the strong mind-body connection.</p>
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<span class="caption">Protective factors such as optimism and gratitude may reduce suicidal ideation even if someone is experiencing depression.</span>
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<p>Sleep serves critical roles in <a href="https://doi.org/10.5665/sleep.4886">cognitive functions</a>, <a href="https://doi.org/10.3389/fpsyt.2022.920789">mood regulation and impulse control, among other things</a>. Research has shown an association between sleep duration and suicide risk. One study observed the lowest risk for suicidal ideation and attempts for <a href="https://doi.org/10.1016/j.smrv.2018.07.003">people sleeping eight to nine hours per day</a>. The same study suggested an 11 per cent reduction in risk of suicide plans for every one-hour increase in sleep.</p>
<p>Evidence also shows the benefits of physical activity. A recent systematic review has shown that physically <a href="https://doi.org/10.1016/j.jad.2017.08.070">active individuals reported almost 50 per cent lower suicidal ideation</a>. </p>
<p>Physical activity <a href="https://doi.org/10.1080/00223980.2021.1992334">can also be perceived as a form of self-compassion and an exercise in gratitude by recognizing the importance of treating the body with care</a>. Emerging evidence also suggests that the documented benefits of physical activity, such as walking, are larger when it takes place in nature. A study found that <a href="https://doi.org/10.1016/j.jad.2022.08.121">people with treatment-resistant major depressive disorder who walked in nature experienced fewer negative internal feelings than those who walked in urban streets</a>. </p>
<h2>Protective factors and resilience</h2>
<p>Suicide is complex. <a href="https://doi.org/10.3389/fpsyt.2016.00108">People considering or who have attempted suicide are suffering from tremendous emotional pain</a>. There is no one-size-fits-all recipe for prevention, but sharing knowledge about things that can help guard against suicide is critical. It raises hope and is part of the solution. </p>
<p>These protective factors for suicide can be regarded as <a href="https://doi.org/10.1111/acps.13059">pillars of resilience</a>. As a society, it is imperative to continue bringing more awareness to the discussion of suicide and to help people build resilience individually and collectively. </p>
<p><em>If you or someone you know is thinking about suicide, call 911 for emergency services. For support, call Canada Suicide Prevention Service at 1-866-277-3553 (from Québec) or 1-833-456-4566 (other provinces), or send a text to 45645. Visit <a href="https://talksuicide.ca/crisis-services-canada">Crisis Services Canada</a> for more resources.</em></p><img src="https://counter.theconversation.com/content/198474/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie-Claude Geoffroy holds a Canada Research Chair (II) on Youth Suicide Prevention and receives fundings from numerous public and private funding organisations including a FRQ-SC research team.</span></em></p><p class="fine-print"><em><span>Massimiliano Orri receives funding from the Canadian Institutes of Health Research, the Fonds de Recherche du Québec, the American Foundation for Suicide Prevention, the Helsefonden, the Brain and Behavior Research Foundation, and the MQ Foundation. </span></em></p><p class="fine-print"><em><span>Bassam Khoury and Naomie Gendron do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The focus of suicide prevention is shifting toward protective factors: characteristics that make it less likely that individuals will consider, attempt or die by suicide.Naomie Gendron, Medical Student, McGill UniversityBassam Khoury, Associate Professor, Department of Educational and Counselling Psychology, McGill UniversityMarie-Claude Geoffroy, Assistant Professor, Department of Educational and Counselling Psychology and Canada Research Chair in Youth Suicide Prevention, McGill UniversityMassimiliano Orri, Assistant Professor, McGill Group for Suicide Studies, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2007932023-03-16T12:33:43Z2023-03-16T12:33:43Z54% of firearm deaths in the US are from suicide – and easy access to a gun is a key risk factor<figure><img src="https://images.theconversation.com/files/514028/original/file-20230307-18-j1qfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Suicide deaths involving firearms have increased over last decade.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/old-semi-automatic-hand-gun-royalty-free-image/1249406015">Josiah S/iStock/Getty Images Plus</a></span></figcaption></figure><figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/514546/original/file-20230309-20-2qyuqj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/514546/original/file-20230309-20-2qyuqj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=255&fit=crop&dpr=1 600w, https://images.theconversation.com/files/514546/original/file-20230309-20-2qyuqj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=255&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/514546/original/file-20230309-20-2qyuqj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=255&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/514546/original/file-20230309-20-2qyuqj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=321&fit=crop&dpr=1 754w, https://images.theconversation.com/files/514546/original/file-20230309-20-2qyuqj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=321&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/514546/original/file-20230309-20-2qyuqj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=321&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>More than half – 54% – of all firearm deaths in the United States in 2021 were attributable to suicide, according to <a href="http://wonder.cdc.gov/mcd-icd10-expanded.html">February 2023 data</a> from the Centers for Disease Control and Prevention. </p>
<p>Suicide deaths involving firearms – the <a href="http://wonder.cdc.gov/mcd-icd10-expanded.html">most common means of suicide</a> in the U.S. – have increased 28% since 2012. Groups particularly at risk <a href="https://www.statista.com/statistics/258916/number-of-firearm-suicide-deaths-in-the-united-states-by-gender/">include men</a> <a href="https://www.mentalhealth.va.gov/suicide_prevention/data.asp">and veterans</a>, who are more likely to have access to and experience with firearms. Research also suggests that alcohol use is a significant risk factor for gun-related suicides, as opposed to suicides involving less lethal means. This is particularly true for <a href="https://www.doi.org/10.1136/injuryprev-2012-04031710.1136/injuryprev-2012-040317">young adults and middle-aged people</a>.</p>
<p>Access to firearms is a <a href="http://www.doi.org/10.7326/M13-1301">key risk factor for suicide</a> due to their high lethality. Suicide attempts that involve firearms end in death <a href="http://www.doi.org/10.7326/M19-1324">90% of the time</a>. Suicide is often an impulsive act, and when a person has access to swift and lethal means such as a firearm, there is limited opportunity to intervene or allow for a suicidal impulse to pass. </p>
<p>It is a common myth that once a person has made up their mind to die by suicide it is not possible to prevent them from doing so. In fact, most individuals who survive an attempt <a href="http://www.doi.org/10.1192/bjp.181.3.193">do not attempt suicide again</a>, and those who survive an initial attempt using one method are <a href="http://www.doi.org/10.1056/NEJM199112053252305">unlikely to switch</a> <a href="http://www.doi.org/10.1176/appi.ajp.2013.12091256">to a different method</a>.</p>
<p>These findings underscore the importance of <a href="http://www.doi.org/10.1146/annurev-publhealth-031811-124636">restriction of access to firearms</a> as a <a href="https://afsp.org/extreme-risk-protection-orders#what-the-research-shows">critical suicide prevention strategy</a>. </p>
<p>Research indicates that storing a firearm safely <a href="http://www.doi.org/10.1136/jech.2003.017343">reduces the risk</a> of the owner – as well as others, including any <a href="http://www.doi.org/10.1001/jamapediatrics.2019.1078">children living in the home</a> – dying by suicide. </p>
<p><a href="https://project2025.afsp.org/wp-content/uploads/2020/03/Toolkit_Safe_Firearm_Storage_CLEARED_508_2-24-20.pdf">Firearm safety measures</a> include gun safes, lockboxes, storing firearms separate from ammunition, and either <a href="http://www.doi.org/10.2105/AJPH.2019.305545">voluntarily</a> or involuntarily removing firearms from the home when a person has a mental health condition or other warning signs for suicide risk.</p>
<p><a href="https://theconversation.com/red-flag-laws-saved-7-300-americans-from-gun-deaths-in-2020-alone-and-could-have-saved-11-400-more-185009">Nineteen states</a> – <a href="https://casetext.com/statute/california-codes/penal-code-pen/part-6-control-of-deadly-weapons-16000-34370/title-2-weapons-generally-17500-19405/division-32-gun-violence-restraining-orders-18100-18205">California</a>, <a href="https://law.justia.com/codes/connecticut/2018/title-29/chapter-529/section-29-38c/">Connecticut</a>, <a href="https://www.flsenate.gov/laws/statutes/2018/790.401">Florida</a> and <a href="https://mdcourts.gov/district/ERPO">Maryland</a> among them – as well as the <a href="https://oag.dc.gov/public-safety/dcs-red-flag-law-removing-guns-potentially">District of Columbia</a> have enacted so-called <a href="https://theconversation.com/red-flag-laws-saved-7-300-americans-from-gun-deaths-in-2020-alone-and-could-have-saved-11-400-more-185009">red flag laws</a>. These allow law enforcement, family members and sometimes school administrators or health care professionals to petition the court to remove a firearm from the home of a person at risk of harming themselves or others.</p>
<p>In addition to these measures, policymakers and care providers can address other risk factors for suicide as part of a comprehensive suicide prevention strategy. This includes <a href="https://pubmed.ncbi.nlm.nih.gov/30285348/">screening and identifying</a> people who are at high risk, treating underlying mental health conditions, improving <a href="https://www.rand.org/research/gun-policy/analysis/essays/mental-health-access-and-suicide.html">access to mental health care</a> and encouraging <a href="https://www.cdc.gov/suicide/factors/index.html">stronger family and community connections</a>. Prevention priorities also include reducing <a href="https://www.cdc.gov/suicide/factors/index.html">risk factors</a> such as exposure to violence, financial strain and chronic illness.</p>
<p>Another strategy is training friends, teachers, clergy, coaches and other community members in assessing suicide risk and referring individuals to resources. This <a href="https://doi.org/10.1080/13811118.2018.1509749">has been shown</a> to increase both the likelihood that a trained helper offers needed assistance, as well as the likelihood that the person who is suffering seeks help.</p>
<p><em>If you or someone you know is in crisis, call 988 to speak with a trained listener. Veterans can press 1 after dialing 988 to connect directly to the Veterans Crisis Lifeline. Or, text HELLO to 741741. Both services are free, available 24/7, and confidential.</em></p><img src="https://counter.theconversation.com/content/200793/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heidi Zinzow receives funding from the National Science Foundation and Agency for Healthcare Research and Quality. She has previously received funding from the Substance Abuse and Mental Health Services Administration and National Institutes for Health.</span></em></p>Keeping weapons locked away and unloaded reduces the risk of death by suicide for gun owners and their children.Heidi Zinzow, Professor of Psychology, Clemson UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2002312023-03-01T13:27:05Z2023-03-01T13:27:05ZWhen does clinical depression become an emergency? 4 questions answered<figure><img src="https://images.theconversation.com/files/511817/original/file-20230222-20-evglvk.jpg?ixlib=rb-1.1.0&rect=38%2C0%2C4239%2C2773&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sen. John Fetterman has been widely praised for going public about his need for treatment for depression.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sen-john-fetterman-walks-through-the-statuary-hall-of-the-u-news-photo/1463984574?phrase=John%20Fetterman&adppopup=true">Alex Wong via Getty Images News</a></span></figcaption></figure><p><em>The news that Sen. John Fetterman, a Pennsylvania Democrat, checked himself into Walter Reed National Military Medical Center on Feb. 15, 2023, to be treated for clinical depression <a href="https://www.theguardian.com/society/commentisfree/2023/feb/21/john-fetterman-depression-mental-illness-stigma">sparked a national discussion</a> around the need for <a href="https://www.nytimes.com/2023/02/17/us/politics/fetterman-mental-illness-stigma.html">openness about mental health struggles</a>. This comes after Fetterman <a href="https://theconversation.com/fettermans-struggles-with-language-highlight-the-challenges-after-a-stroke-a-vascular-neurologist-explains-aphasia-and-the-path-to-recovery-192482">suffered a near-fatal stroke</a> in May 2022, <a href="https://www.cnn.com/2023/02/20/health/john-fetterman-depression-hospitalization/index.html">prompting questions about possible links</a> between post-stroke recovery and mental health.</em></p>
<p><em>The Conversation asked John B. Williamson, an <a href="https://chp.phhp.ufl.edu/about-2/people/core-faculty/john-b-williamson-ph-d/">associate professor of psychiatry and neuroscience</a> at the University of Florida, to explain when depression becomes a crisis and what inpatient treatment entails.</em></p>
<h2>What is clinical depression?</h2>
<p>Clinical depression, or major depressive disorder, occurs in <a href="https://doi.org/10.1001/jamapsychiatry.2017.4602">20% of the population over the lifetime</a>. It can surface and differ from person to person in a variety of ways.</p>
<p>Clinical depression symptoms include feelings of sadness and loss of interest and motivation to engage in once pleasurable activities such as hobbies. Other symptoms include changes in appetite – either increased or decreased – changes in sleep patterns, be it too much or too little, loss of energy, restlessness and difficulty thinking and concentrating. To qualify as clinical depression, these symptoms must persist for at least two weeks. </p>
<p><a href="https://doi.org/10.1001/jamapsychiatry.2017.4602">One form of the condition</a> can also occur in the context of stressful situations, such as the death of a loved one, divorce or loss of a job. Depressive symptoms can also occur <a href="https://doi.org/10.1016/j.jad.2017.06.009">alongside and because of other disorders </a> and medical conditions like stroke and thyroid disease, and <a href="https://doi.org/10.1176/appi.ajp.2015.15030363">these conditions may complicate recovery</a>. </p>
<p>Severe depression can <a href="https://doi.org/10.1186/s12991-020-00302-6">mimic other conditions, including dementia</a>, in which an impairment in thinking is significant enough to interfere with a person’s ability to live independently. It can also worsen the quality of life in older age. Depression has also been linked with <a href="https://doi.org/10.1001%2Fjamanetworkopen.2019.21043">higher rates of death from any cause</a>, such as cardiovascular disease. </p>
<p>Untreated depression can negatively affect overall health and quality of life. </p>
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<h2>When does depression become an emergency?</h2>
<p>An acute change in mood that persists for weeks or is associated with thoughts of self-harm <a href="https://theactionalliance.org/">should not be ignored</a>. In some cases, it may constitute an emergency.</p>
<p>Depressed mood, whether from a major depressive episode, or in the context of another problem, can become an emergency when there are thoughts of suicide. Suicidal thoughts may be passive, such as preferring not to be alive, or active, meaning an explicit desire to harm oneself. Broadly, this means having ideas about ending one’s life. </p>
<p>It is important to understand the signs and risks for suicide to help prevent it, both for yourself and others. Feelings of hopelessness, agitation and lack of reasons to live are <a href="https://www.cdc.gov/suicide/factors/index.html">vulnerabilities for suicide</a>. This vulnerability increases with poor sleep and higher risk-taking behavior, including substance abuse. Additional noticeable signs may be withdrawing from friends and family and increased preoccupation with death. </p>
<p>If a person expresses suicidal thoughts or a desire to harm or kill themselves, immediate attention is needed. Help is available through the <a href="https://988lifeline.org/">988 Suicide and Crisis Lifeline</a> and any emergency room.</p>
<h2>What is inpatient care for depression?</h2>
<p>Inpatient mental health care is useful when a more controlled environment is needed. This environment is important for patients at increased risk for suicide and can also be a useful tool for treating substance abuse, hallucinations and paranoia or mania in the <a href="https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955">context of bipolar disorder</a>. </p>
<p>An inpatient care unit is meant to be a calm environment with 24/7 monitored care. Services include evaluation by professionals and may involve medication management when necessary. Inpatient care settings will usually offer individual and group psychotherapy options, <a href="https://www.arts.gov/initiatives/creative-forces">as well as art therapy</a> and other expressive therapies such as writing. And they may include education on the management of mental health. </p>
<p>The primary goal is stabilizing the patient, helping them to develop coping skills and connecting the patient with services to prevent future need for inpatient care. </p>
<p>The average stay in an inpatient unit <a href="https://doi.org/10.1176/appi.ps.201100412">is about 10 days</a>. It is possible to enter inpatient care voluntarily. Others are admitted by a physician or other authorized individual, which in most cases would be a parent, spouse or adult child. Admission sometimes occurs by way of an emergency room visit or through communication with a health care professional. For instance, sometimes a therapist or physician may facilitate inpatient admission. </p>
<h2>Is treatment for depression effective?</h2>
<p>The good news is that depression responds well to treatment. In cases in which thoughts of suicide with imminent risk of harm are not present, depression can be managed with psychotherapy, medication or a combination of both. There is a <a href="https://doi.org/10.1001/jamapsychiatry.2020.0164">great deal of evidence</a> for the <a href="https://doi.org/10.1016/S0140-6736(17)32802-7">effectiveness of these approaches</a>.</p>
<p>Clinical depression may go into remission with psychotherapy or the use of medication. Unfortunately, about half of people who experience clinical depression experience chronic or recurring symptoms. <a href="https://doi.org/10.1177%2F0706743716659416">Longer-term treatment and self-care</a> including psychotherapy and medication may be necessary. </p>
<p>There are additional treatment considerations when active thoughts of suicide are involved. It is important to discuss these feelings with a medical professional. Primary care physicians commonly <a href="https://www.npr.org/sections/health-shots/2011/08/06/138987152/antidepressant-use-climbs-as-primary-care-doctors-do-the-prescribing">treat depression via medication</a>; <a href="https://www.cdc.gov/nchs/products/databriefs/db377.htm#">slightly more than 13% of Americans take them</a>.
However, it may be beneficial to seek out treatment from mental health care specialists such as psychiatrists, psychologists, psychiatric nurses and other licensed mental health care professionals. </p>
<p>A conversation with either a primary care or a mental health care professional is a viable route to getting started with assessment and treatment. People who get treatment for suicidal thoughts are <a href="https://theactionalliance.org/">much less likely to kill themselves</a>. </p>
<p>The <a href="https://www.usa.gov/federal-agencies/substance-abuse-and-mental-health-services-administration">Substance Abuse and Mental Health Services Administration</a> operates a national helpline to assist in facilitating appropriate <a href="https://www.samhsa.gov/find-help/national-helpline">treatment referrals for patients (1-800-662-HELP)</a>.</p><img src="https://counter.theconversation.com/content/200231/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John B. Williamson receives funding from the Department of Veterans Affairs, Department of Defense, National Endowment of the Arts, the International Obsessive Compulsive Disorder Foundation, McKnight Brain Research Foundation, and the National Institutes of Health</span></em></p>Sen. John Fetterman’s admission to a hospital for mental health treatment has set off an important national discussion about the need to reduce stigmas around mental illness.John B. Williamson, Associate Professor of Psychiatry and Neuroscience, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1983822023-02-05T12:54:21Z2023-02-05T12:54:21ZDrinking and suicide: How alcohol use increases risks, and what can be done about it<figure><img src="https://images.theconversation.com/files/507957/original/file-20230202-14498-760nn0.JPG?ixlib=rb-1.1.0&rect=517%2C239%2C4191%2C3155&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As Canadians weigh the pros and cons of alcohol use, they should be thinking not just about the risks to their physical health, but also to their mental health.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span></figcaption></figure><p><a href="https://doi.org/10.1177/003335491613100116">Nearly half of us</a> know someone who ended their life by suicide. Worldwide, <a href="https://www.who.int/publications/i/item/9789240026643">700,000</a> people die by suicide each year. In Canada, <a href="https://www.canada.ca/en/public-health/services/suicide-prevention/suicide-canada.html">12 people die by suicide each day — and another 200 attempt suicide</a>. While the prevalence and destructiveness of suicide is clear, much less is known about why people die by suicide.</p>
<p>Alcohol is believed to be a major contributor to death by suicide. Among people who die by suicide, alcoholism is the <a href="https://doi.org/10.1111/j.1530-0277.1998.tb04388.x">second-most common</a> mental disorder, and is involved in roughly one in four deaths by suicide. However, there is still much to learn. As a psychologist and scientist, my research aims to understand whether alcohol actually increases the risk of dying by suicide.</p>
<p>Alcohol recently became a hot topic when the Canadian Centre on Substance Use and Addiction updated Canada’s low-risk alcohol drinking guidelines. The difference in what they considered low-risk consumption in 2018 and 2022 was drastic: from the previous <a href="https://www.camh.ca/-/media/files/canadas-low-risk-guidelines-pdf.pdf">two to three drinks per day</a>, they now suggest <a href="https://ccsa.ca/sites/default/files/2023-01/CCSA_Canadas_Guidance_on_Alcohol_and_Health_Final_Report_en.pdf">two to three drinks per week</a>. Moreover, the entire emphasis of the guidelines changed from how to drink safely, to the message that drinking is never completely safe. </p>
<p>There is so much concern about Canadians’ drinking that some <a href="https://ccsa.ca/sites/default/files/2022-08/CCSA-LRDG-Update-of-Canada%27s-LRDG-Final-report-for-public-consultation-en.pdf">policymakers are advocating for warning labels on alcohol bottles</a> like those on cigarette packages. Clinicians and scientists are concerned. The public is concerned. In fact, we are so concerned about excessive drinking that we implement initiatives like Dry January where we challenge ourselves not to drink alcohol for a month.</p>
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Read more:
<a href="https://theconversation.com/im-an-addiction-researcher-and-therapist-heres-why-promoting-sober-dry-months-bothers-me-176657">I'm an addiction researcher and therapist. Here's why promoting sober 'dry months' bothers me.</a>
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<h2>Alcohol and suicide</h2>
<figure class="align-center ">
<img alt="A messy side table with a beer bottle, a wine glass, several other glasses and a plate with a slice of pizza on it" src="https://images.theconversation.com/files/507114/original/file-20230130-189-mzyaog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507114/original/file-20230130-189-mzyaog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507114/original/file-20230130-189-mzyaog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507114/original/file-20230130-189-mzyaog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507114/original/file-20230130-189-mzyaog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507114/original/file-20230130-189-mzyaog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507114/original/file-20230130-189-mzyaog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">There are several neurobiological and psychological theories proposed to explain the relationship between alcohol use and suicide.</span>
<span class="attribution"><span class="source">(Pexels/Cottonbro Studios)</span></span>
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<p>There are well-established links between alcohol and cancer, heart disease and violence. Alcohol also undermines mental health, with links to depression and anxiety. However, more investigation is required before making any statements on the link between alcohol and suicide. This is where my and my colleague’s research comes in.</p>
<p>We conducted the most comprehensive meta-analysis on the link between alcohol (ab)use and death by suicide to date. By analyzing the data from 33 longitudinal studies — and 10,253,101 participants — we determined that alcohol use is a substantial risk factor for death by suicide. In fact, we found that <a href="https://doi.org/10.1111/sltb.12846">alcohol use increased the risk of death by suicide by a frightening 94 per cent</a>. </p>
<p>So, how can we understand this link and use the results of our study to help prevent suicide?</p>
<p>There are several neurobiological and psychological theories proposed to explain the relationship between alcohol use and suicide. <a href="https://doi.org/10.1093/alcalc/agn100">Alcohol affects neurotransmitters</a>, which are the chemical messengers such as GABA and serotonin that help regulate mood. Upsetting these systems could increase suicidal thoughts. </p>
<p>Chronic and heavy alcohol use is related to depressed mood. It can increase aggressive behaviour and suicide motivation, and inhibit decision-making and pain responses. Social psychologist <a href="https://doi.org/10.1037/0033-295X.97.1.90">Roy Baumeister’s theory of suicide</a> asserts problematic alcohol use and suicide share an underlying root cause: a desire to escape painful self-awareness and the associated negative mood and emotions. </p>
<p>Another <a href="https://doi.org/10.1037/a0018697">theory of suicide</a> suggests the severity of depressive symptoms, such as a hopeless sense of not belonging, is directly proportional to the likelihood of a lethal suicide attempt. The effects of problematic alcohol use can have similar effects.</p>
<h2>Recognizing risk</h2>
<p>Beyond current theories regarding the link between suicide and alcohol use, effective prevention requires knowing who is most at risk. Our study found those who drink heavily and more frequently have increased risk of death by suicide, particularly over longer periods of time. Especially vulnerable populations include women, military personnel and youth. </p>
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<img alt="Close-up of hands holding a glass" src="https://images.theconversation.com/files/507951/original/file-20230202-14454-85lvkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507951/original/file-20230202-14454-85lvkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507951/original/file-20230202-14454-85lvkb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507951/original/file-20230202-14454-85lvkb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507951/original/file-20230202-14454-85lvkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507951/original/file-20230202-14454-85lvkb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507951/original/file-20230202-14454-85lvkb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Beyond current theories regarding the link between suicide and alcohol use, effective prevention requires knowing who is most at risk.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Women could be at greater risk because heavy drinking generally has <a href="https://doi.org/10.1016/j.cpr.2004.08.003">more negative physical and cognitive consequences for women than men</a>. For youth, perhaps the higher risk is due to the <a href="https://doi.org/10.1111/acer.13164">elevated rates of heavy and problematic drinking in young adults</a> or that <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039401&pickMembers%5B0%5D=2.22&pickMembers%5B1%5D=3.1&cubeTimeFrame.startYear=2016&cubeTimeFrame.endYear=2020&referencePeriods=20160101%2C20200101">suicide is the second leading cause of death among 15 to 29-year-olds</a>. </p>
<p>Military personnel have higher rates of both <a href="https://doi.org/10.1080/13811118.2012.667321">suicide</a> and <a href="https://doi.org/10.3109/09540261.2010.550868">alcohol</a> use. Our study indicates these combine to produce a 282 per cent increased risk of death by suicide. </p>
<p>These are the people we should be working to help. </p>
<p>Public policies should be looking to increase awareness of the link between alcohol and suicide and to assess and treat problematic alcohol use as a way to prevent suicide. The results of our research highlight just how needed these measures are in our society, but prevention requires change at both the individual and systemic level.</p>
<p><a href="https://www.canada.ca/en/health-canada/services/canadian-alcohol-drugs-survey/2019-summary.html">Over three-quarters of Canadians drink alcohol</a>, so either you drink or know someone who does. As Canadians weigh the pros and cons of adopting the new drinking guidelines, they should be thinking not just about the risks to their physical health, but also to their mental health. </p>
<p>Suicide, heart disease and cancer are consistently among the <a href="https://doi.org/10.25318/1310039401-eng">top 10 causes of death</a> of Canadians, and alcohol increases the risk of all of these killers. </p>
<p>People with problematic alcohol use are also a vulnerable population and we owe them a special duty of care; that should also inform public policies. If it means saving a loved one, warning labels on beer cans seem like a pretty low price to pay.</p>
<p><em>If you or someone you know is thinking about suicide, please contact Canada Suicide Prevention Service at 1-866-277-3553 (from Québec) or 1-833-456-4566 (other provinces), or send a text to 45645. Visit <a href="https://talksuicide.ca/">Crisis Services Canada</a> for more resources.</em></p><img src="https://counter.theconversation.com/content/198382/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Sherry receives funding from the Social Sciences and Humanities Research Council. </span></em></p>Public policies should be looking to increase awareness of the link between alcohol and suicide and to assess and treat problematic alcohol use as a way to prevent suicide.Simon Sherry, Clinical Psychologist and Professor in the Department of Psychology and Neuroscience, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1922902023-01-31T13:48:00Z2023-01-31T13:48:00ZBlack college students who turn to their faith think less about suicide<figure><img src="https://images.theconversation.com/files/506846/original/file-20230127-22-4ri2s1.jpg?ixlib=rb-1.1.0&rect=58%2C48%2C6464%2C4293&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Suicide attempts have risen dramatically among Black youths in recent years.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/depressed-teen-boy-listens-to-music-on-wireless-royalty-free-image/1383921318?adppopup=true">SDI Productions via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Black college students who resorted to self-blame when faced with stress were also more likely to experience suicidal thoughts within the past year. This is in comparison to those who were less likely to resort to self-blame.</p>
<p>But those who turned to their faith to cope with stress were less likely to think about taking their own lives.</p>
<p>These are just two of the key findings from a <a href="https://doi.org/10.1016/j.childyouth.2022.106448">study</a> on Black students’ mental health that I published in 2022. I initially conducted this work for my dissertation, analyzing previously collected surveys of 400 Black college students in the U.S. All participants were 18 to 35 years old. The overarching goal of this study was to examine the relationship between depression and suicidal ideation – or thoughts of suicide – to better understand how to disrupt the relationship between the two. </p>
<h2>Why it matters</h2>
<p>While the suicide rates for white children between ages 5 and 11 decreased slightly – going from 1.14 to 0.77 per 1 million from 1993 to 2012 – suicide rates for Black children of the same age <a href="https://doi.org/10.1001/jamapediatrics.2015.0465">nearly doubled</a>. Specifically, they went from 1.36 to 2.54 per 1 million during the same time frame.</p>
<p>Further, an analysis of data from the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey showed that suicide attempts <a href="https://theactionalliance.org/sites/default/files/ring_the_alarm-_the_crisis_of_black_youth_suicide_in_america_copy.pdf">rose 73%</a> for Black high school students between 1991 and 2017. </p>
<p>A more recent report indicates that deaths by suicide among 15-to-17-year-old Black youths <a href="https://doi.org/10.1016/j.jaac.2021.08.021">increased 4.9% between 2003 and 2017</a>, with suicides increasing 6.6% in Black girls and 2.8% in Black boys.</p>
<p>My colleague and I published a related study in 2020 in which we found that in a survey of more than 150,000 college students, the odds of attempting suicide within the past 12 months were <a href="https://doi.org/10.1016/j.jad.2019.10.019">1.48 times greater for Black students</a> than for white students.</p>
<p>Therefore, it seems that if Black students are experiencing increased risk for suicide both before and during their time in college, additional safeguards may be needed to help Black students cope with the various stressors they encounter not just during their time on campus, but throughout all stages of development.</p>
<p>For these reasons, I believe it is important for educators and those who support Black students to understand that experiencing persistent feelings of self-blame is potentially harmful to students’ mental health. </p>
<h2>What’s next</h2>
<p>Examples of self-blame as measured in this study include asking participants to respond to statements like “I have been blaming myself for things that happened” and “I have been criticizing myself.” Other statements, like “I have been trying to find comfort in my religion or spiritual beliefs” and “I’ve been praying or meditating,” were used to measure Black students’ personal engagement with faith, religion and spirituality. While the questions included in this survey offer some insight into connections among self-blame, faith and mental health, I still see a need to explore other aspects of religion that highlight the role that faith plays for young people and their overall well-being. </p>
<p>Therefore, I am working to assess how various practices – such as attending religious services, reading sacred texts, joining faith communities and developing a personal, intimate relationship with God – influence mental health outcomes over time. I believe this will ultimately help identify which specific parts of being religious are most helpful or harmful for Black students as they transition from adolescence to adulthood.</p><img src="https://counter.theconversation.com/content/192290/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janelle R. Goodwill is an advisory board member for Soul Survivors of Chicago. She also received a grant from the National Institute of Mental Health. The views expressed in this article do not reflect those of NIMH or other related governmental agencies. </span></em></p>Self-blame was found to be associated with experiencing suicidal thoughts.Janelle R. Goodwill, Assistant Professor of Social Work, Policy, and Practice, University of ChicagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1962642022-12-15T15:50:34Z2022-12-15T15:50:34ZCanada delays expanding medical assistance in dying to include mental illness, but it’s still a policy built on quicksand<figure><img src="https://images.theconversation.com/files/500879/original/file-20221213-14-4j61be.jpeg?ixlib=rb-1.1.0&rect=506%2C191%2C5867%2C4242&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The planned expansion of Canada's medical assistance in dying (MAID) law to include people with mental illnesses whose death is not imminent has been delayed, but not cancelled.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The federal government admitted Thursday it needs more time before expanding Canada’s controversial medical assistance in dying (MAID) policy to enable MAID solely for mental illness.</p>
<p>Although the government had recently announced its intention to proceed with expanding MAID for those with mental health disorders by next March, <a href="https://www.ctvnews.ca/politics/feds-seeking-to-delay-expansion-of-medical-assistance-in-dying-laws-1.6196668">Justice Minister David Lametti said he had heard from medical experts that the health-care system wasn’t prepared to deal with patients who want to end their lives for mental health reasons</a>. He did not commit to a new deadline. </p>
<p>But the justice minister said Ottawa was only seeking to delay implementation of the MAID changes — it’s still clear the government remains intent on <a href="https://www.theglobeandmail.com/canada/article-maid-canada-mental-health-law/">further expanding its legislation to include mentally ill people who are suicidal and could get better</a>.</p>
<p>It’s one of many controversial elements of the proposed changes to the MAID legislation, and remains cause for concern.</p>
<p>Canada’s federal minister of disability inclusion recently expressed feeling devastated about Canadians being driven to <a href="https://www.cbc.ca/news/politics/assisted-dying-carla-qualtrough-1.6625412">seek assisted death through MAID — medical assistance in dying — due to lack of social supports</a>.</p>
<p>Some are pushing for <a href="https://nationalpost.com/news/quebec-college-of-physicians-slammed-for-suggesting-maid-for-severely-ill-newborns">MAID for infants</a>, while others think <a href="https://www.theglobeandmail.com/canada/article-maid-canada-mental-health-law/">non-dying disabled people on wait lists</a> should receive MAID. When <a href="https://www.thestar.com/politics/provincial/2022/11/29/justice-minister-david-lametti-under-fire-for-unbelievable-comparisons-between-euthanasia-and-suicide.html?rf">the minister of justice suggests we should make it easier for those ambivalent about suicide to die</a>, that is bone chilling.</p>
<p>When Canada embarked on this journey years ago, I cautioned about the importance of ensuring we <a href="https://www.theglobeandmail.com/opinion/how-mental-illness-complicates-assisted-dying/article30193498/">“do the least harm” with our expanding laws</a>. As physician chair of my hospital MAID team, I have seen the myths and realities that have fuelled our MAID expansion. </p>
<h2>False autonomy and false compassion</h2>
<p>As a society, we take comfort that MAID is provided for compassionate relief from suffering. Individually, MAID has been sold to Canadians as an autonomous choice, and framed as a right. When MAID was introduced in 2016, for those whose deaths were reasonably foreseeable, these principles may have been true. In contrast, our MAID expansion to non-dying disabled people has been misled by the fallacies of false autonomy and false compassion.</p>
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Read more:
<a href="https://theconversation.com/why-is-access-to-medically-assisted-death-a-legislated-right-but-access-to-palliative-care-isnt-161994">Why is access to medically assisted death a legislated right, but access to palliative care isn’t?</a>
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<p>True autonomy requires true choice. For those of us fortunate enough to live lives with privilege, choosing “death with dignity” can be sold as an autonomous choice. Yet we have now had marginalized Canadians living in poverty be given state-supported suicide who have openly said they chose MAID not to avoid suffering from illness, but because <a href="https://www.cbc.ca/news/canada/manitoba/sathya-dharma-kovac-als-medical-assistance-in-death-1.6605754">society had failed to provide them a chance to live with dignity</a>. </p>
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<img alt="A woman in a navy jacket" src="https://images.theconversation.com/files/500681/original/file-20221213-14387-fa7efg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/500681/original/file-20221213-14387-fa7efg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=458&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500681/original/file-20221213-14387-fa7efg.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=458&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500681/original/file-20221213-14387-fa7efg.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=458&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500681/original/file-20221213-14387-fa7efg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=575&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500681/original/file-20221213-14387-fa7efg.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=575&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500681/original/file-20221213-14387-fa7efg.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=575&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Minister of Employment, Workforce Development and Disability Inclusion Carla Qualtrough, pictured in the House of Commons on Dec. 8, recently described MAID requests driven by lack of social supports as devastating.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
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<p>Most would be hard-pressed to argue it reflects true autonomy with a range of choices when the marginalized poor are enticed toward “painless” death to escape a painful life of poverty.</p>
<p>Canadians have rationalized that non-dying disabled people are being provided MAID in the name of compassion. However, it is not compassionate to provide death for one reason while pretending it is for another. We have reassured ourselves that MAID is for medical conditions that will not improve, or are irremediable. In the court cases that originally established MAID — which involved conditions like <a href="https://bccla.org/2012/10/in-memory-of-gloria/">ALS</a> and <a href="https://www.cbc.ca/news/canada/montreal/medically-assisted-dying-law-overturned-quebec-1.5280702">spinal stenosis</a> — or for medical conditions like cancers, that can be true.</p>
<p>However, evidence shows it is <a href="https://www.eagmaid.org/report">impossible to predict that a mental illness will not improve in any individual</a>. Yet expansion activists mistakenly believe they can make such predictions. Science tells us their chance of being right amounts to chance or less, with <a href="https://doi.org/10.1017/s0033291722002951">precision modelling showing only 47 per cent of “irremediability” predictions end up being correct</a> — which is worse than flipping a coin.</p>
<h2>False safety</h2>
<p>Perhaps most tragically, the twin pillars of false autonomy and false compassion fuelling the expansion agenda have been propped up by the third myth of false safety.</p>
<p>Until now, expansion activists have reassured that “<a href="https://www.suicideinfo.ca/local_resource/suicide-physician-assisted-death/">MAID is not suicide</a>.” When provided to help avoid a painful death for those who are dying, we can distinguish MAID from suicide. Yet when expanded to those seeking death for mental illness, evidence shows MAID becomes indistinguishable from suicide. <a href="https://cca-reports.ca/reports/medical-assistance-in-dying/">We cannot differentiate those seeking psychiatric euthanasia from suicidal individuals</a> who resume fulfilling lives after being provided suicide prevention, rather than facilitated death. </p>
<figure class="align-center ">
<img alt="A woman sitting a table looking pensive" src="https://images.theconversation.com/files/500851/original/file-20221213-26864-o5h4ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500851/original/file-20221213-26864-o5h4ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500851/original/file-20221213-26864-o5h4ft.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500851/original/file-20221213-26864-o5h4ft.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500851/original/file-20221213-26864-o5h4ft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500851/original/file-20221213-26864-o5h4ft.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500851/original/file-20221213-26864-o5h4ft.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Until now, expansion activists have reassured that ‘MAID is not suicide.’</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>All this sobering evidence is sadly borne out by our <a href="https://globalnews.ca/news/9176485/poverty-canadians-disabilities-medically-assisted-death/">now common headlines</a> of assisted suicide <a href="https://www.ctvnews.ca/health/woman-with-chemical-sensitivities-chose-medically-assisted-death-after-failed-bid-to-get-better-housing-1.5860579">being provided</a> to <a href="https://www.ctvnews.ca/health/woman-with-disabilities-nears-medically-assisted-death-after-futile-bid-for-affordable-housing-1.5882202">marginalized Canadians</a> seeking <a href="https://www.chatelaine.com/health/maid-assisted-death-poverty/">escape from life suffering</a> and <a href="https://toronto.citynews.ca/2022/10/13/medical-assistance-death-maid-canada/">poverty</a>. </p>
<p>The government-appointed federal panel, <a href="https://policyoptions.irpp.org/magazines/missing-the-mark-on-a-profound-social-change-with-maid-for-mental-illness/">chaired by an expansionist in favour of MAID for mental illness</a>, was responsible for providing safeguards, standards and guidelines for how to implement MAID for mental illness. Instead, the panel recommended that <a href="https://www.canada.ca/en/health-canada/news/2022/05/final-report-of-the-expert-panel-on-maid-and-mental-illness.html">no further legislative safeguards be required before providing death for mental illness, and did not provide any specific standards</a> for the length, type or number of treatments that should be tried before providing MAID. Its report even suggested society had made an “ethical choice” that MAID should be provided even if suicide and MAID were the same.</p>
<p>Two members of the initial 12-member panel resigned, including the <a href="https://www.hilltimes.com/story/2022/06/16/maid-expert-panel-recommendations-are-inadequate-contends-panel-member-who-resigned/270807/">health-care ethicist</a> and <a href="https://www.theglobeandmail.com/opinion/article-expert-panel-maid-mental-illness/">a mental health advocate panelist with lived experience</a>. </p>
<h2>Suicide prevention</h2>
<p>The whole issue of suicide prevention has been shockingly absent from many of these discussions, including those with key medical associations. In all of its consultations on <a href="https://www.justice.gc.ca/eng/csj-sjc/pl/charter-charte/c7.html">Bill C-7</a> leading up to the <a href="https://www.ctvnews.ca/politics/senators-amend-maid-bill-to-put-18-month-time-limit-on-mental-illness-exclusion-1.5302151">sunset clause</a>, the Canadian Psychiatric Association (of which I am a former past president) inexplicably <a href="https://www.cpa-apc.org/wp-content/uploads/Brief-JUST-12-Nov-2020-FIN.pdf">never once presented known evidence about suicide risks associated with mental illness</a>. </p>
<p>While some organizations such as the <a href="https://suicideprevention.ca/media/statement-on-the-expansion-of-medical-assistance-in-dying-to-those-without-a-reasonably-foreseeable-death/#:%7E:text=The%20Canadian%20Association%20for%20Suicide,process%20that%20is%20already%20happening">Canadian Association for Suicide Prevention</a> discussed the importance of preventing suicide, <a href="https://www.cpa-apc.org/wp-content/uploads/Brief-LCJC-23-Nov-2020-FIN.pdf">CPA never raised this crucial topic</a> — indeed they <a href="https://sencanada.ca/en/Content/Sen/Committee/432/LCJC/02ev-55071-e">avoided using any variant of the word “suicide.”</a></p>
<figure class="align-right ">
<img alt="A man in a dark suit and tie gestures with his hand." src="https://images.theconversation.com/files/500677/original/file-20221213-14838-oz0t5e.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/500677/original/file-20221213-14838-oz0t5e.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500677/original/file-20221213-14838-oz0t5e.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500677/original/file-20221213-14838-oz0t5e.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500677/original/file-20221213-14838-oz0t5e.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500677/original/file-20221213-14838-oz0t5e.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500677/original/file-20221213-14838-oz0t5e.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Minister of Justice David Lametti in the House of Commons on Nov. 22, 2022. Lametti recently made controversial statements about MAID.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span>
</figcaption>
</figure>
<p>With this vacuum of national leadership and evidence-based guidance, perhaps it is not surprising that our <a href="https://www.thestar.com/politics/provincial/2022/11/29/justice-minister-david-lametti-under-fire-for-unbelievable-comparisons-between-euthanasia-and-suicide.html?rf">minister of justice recently suggested that MAID “provides a more humane way for [people with mental illness] to make a decision” when “for physical reasons and possibly mental reasons, [they] can’t make that choice themselves to do it themselves.”</a></p>
<p>This remarkable statement, coming from the person entrusted with responsibly implementing Canada’s assisted dying laws, will keep me and many of my colleagues up at night.</p>
<h2>The need to pause</h2>
<p>I am not a conscientious objector. However it is clear to me that Canada’s planned expansion of MAID to mental illness is based on ignorance — if not outright disregard — of fundamental <a href="https://www.cdc.gov/suicide/prevention/index.html">suicide prevention principles</a>. It appears to ignore what drives the most marginalized people to consider death as an alternative to life suffering. Perhaps, though, it does not ignore the <a href="https://globalnews.ca/news/7407627/health-care-costs-canada-assisted-dying/">cost savings of providing MAID</a> rather than treatment and community support for dignified living.</p>
<p>The <em><a href="https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do">Carter v. Canada</a></em> and <a href="https://www.canlii.org/en/qc/qccs/doc/2019/2019qccs3792/2019qccs3792.html?searchUrlHash=AAAAAQANdHJ1Y2hvbiBnbGFkdQAAAAAB&resultIndex=1"><em>Truchon v. Canada</em></a> court cases shaping MAID laws did not review or rule on MAID for mental illness. Expanding MAID within three months would have meant providing facilitated suicide for the mentally ill without any standards, or any consideration of the role of suicide prevention.</p>
<p>Postponing the March 2023 expansion of euthanasia for mental illness is the only responsible course. Canadians and mental health organizations recognized this and called for it, with the Canadian Association for Suicide Prevention and over 200 individual psychiatrists so far signing <a href="https://www.socpsych.org/calltoaction">a petition to this effect</a>, and the academic chairs of the departments of psychiatry across Canada <a href="https://www.theglobeandmail.com/canada/article-maid-delay-mental-illness-medical-experts/">joining this call for delay</a>. </p>
<p>To proceed with the planned changes would have been morally, medically and politically irresponsible. Moving forward, it will be important to ensure our future policies are evidence-based. Fortunately, the situation is not yet irremediable.</p>
<p><em>If you are experiencing suicidal thoughts, you need to know you’re not alone. If your life or someone else’s is in danger, call 911 for emergency services. For support, call Canada Suicide Prevention Service (CSPS) at 1-833-456-4566. Visit <a href="https://talksuicide.ca">Crisis Services Canada</a> for more resources.</em></p><img src="https://counter.theconversation.com/content/196264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karandeep Sonu Gaind is Chief of Psychiatry and physician chair of the Humber River Hospital MAiD team, a former president of the Canadian Psychiatric Association and a founding director of the nascent Society of Canadian Psychiatry, and was retained as an expert by the former Attorney General of Canada in the Truchon and Lamb cases.</span></em></p>Canada’s planned expansion of MAID to mental illness is based on ignorance — if not outright disregard — of fundamental suicide prevention principles.Karandeep Sonu Gaind, Professor of Psychiatry, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1902242022-09-27T20:29:01Z2022-09-27T20:29:01ZWhy suicide prevention support is crucial for people with fetal alcohol spectrum disorder<figure><img src="https://images.theconversation.com/files/486689/original/file-20220927-25-he77l6.jpg?ixlib=rb-1.1.0&rect=17%2C224%2C5425%2C3763&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People with FASD experience a range of vulnerabilities both from the impacts of prenatal alcohol exposure on the brain and body, and from the adverse life experiences commonly associated with this disability.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Fetal alcohol spectrum disorder (FASD) <a href="https://canfasd.ca/wp-content/uploads/2019/08/Toward-a-Standard-Definition-of-FASD-Final.pdf">is a lifelong disability</a> that affects the brain and body of people prenatally exposed to alcohol. <a href="https://doi.org/10.1080/19315864.2022.2082604">New research</a> is backing concerns raised by the FASD community about the high rates of suicidality among people with FASD. </p>
<p>As a team of FASD researchers and professionals who work with people with FASD, we are growing increasingly concerned with these statistics and stories we are hearing from caregivers. </p>
<h2>FASD and suicidality</h2>
<p>Suicidality is a <a href="https://doi.org/10.1521/suli.2007.37.3.264">spectrum of thoughts and behaviours</a> surrounding suicide. It encompasses suicidal ideation, suicide-related communication, suicide attempts and death by suicide. </p>
<p>Using data from Canada’s <a href="https://canfasd.ca/topics/diagnosis/#nationaldatabase">National FASD Database</a>, our team demonstrated that <a href="https://doi.org/10.1177/07067437211053288">suicidality among people with FASD was alarmingly high</a>. At some point during their lifetime, 25.9 per cent of our sample (206 of 796 individuals) experienced suicidal ideation or suicide attempt(s). Comparatively, rates in the general population range from <a href="https://doi.org/10.1177/0706743719878987">three per cent</a> to <a href="https://www.canada.ca/en/public-health/services/publications/healthy-living/suicide-canada-key-statistics-infographic.html">12 per cent</a>. </p>
<p>These findings are consistent with the current (albeit limited) research on FASD and suicide. Individuals with FASD often experience suicidality at <a href="https://doi.org/10.1177/1455072517707887">significantly younger ages</a> than those without FASD. </p>
<p>In a <a href="https://doi.org/10.1002/bdr2.1465">recent American study</a>, youth aged 13-18 years with FASD required medical assistance due to suicide attempts at rates 5.5 times higher than the general population. <a href="https://jptcp.com/index.php/jptcp/article/view/240">Other Canadian researchers</a> have reported suicide as a leading cause of death among a group of individuals with FASD. </p>
<figure class="align-right ">
<img alt="Graphic reading 'September is FASD awareness month' with an illustration of red sneakers" src="https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Initiatives like strengthening social supports, enhancing coping skills, hopefulness and positive future outlooks, as well as identifying reasons for living, are critical for suicide prevention.</span>
<span class="attribution"><span class="source">(CanFASD)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Because FASD is a multifaceted disorder, we must understand the <a href="https://doi.org/10.3389/fpsyg.2021.778471">complex reasons</a> this population may be at a higher risk for suicidality. </p>
<p>People with FASD experience a range of vulnerabilities both from the impacts of prenatal alcohol exposure on the brain and body, and from the adverse life experiences commonly associated with this disability. Research points to several individual, relational and environmental reasons for the high risk of suicidality among people with FASD. </p>
<h2>Individual factors</h2>
<p>Demographic factors like <a href="https://doi.org/10.1177/07067437211053288">age, region</a> and <a href="https://doi.org/10.1002/bdr2.1465">living situation</a> all play a role in the risk of suicidality among people with FASD, as do <a href="https://doi.org/10.1093/alcalc/agz049">neurodevelopmental challenges</a>, sleep problems and <a href="https://doi.org/10.3109/09638237.2011.577113">co-occurring mental health and substance use challenges</a>. </p>
<p>In our study, the odds of suicidality among people with FASD were 6.7 times higher for those with substance use challenges and 1.9 times higher for those with difficulties with affect regulation, which is the ability to control emotional responses. We found that experiences of depression, anxiety and post-traumatic stress disorder were high among people with FASD who experienced suicidality, which is worrisome considering these co-occurring diagnoses are common in this population. </p>
<h2>Relational factors</h2>
<p>Strong and stable relationships are an <a href="https://canfasd.ca/wp-content/uploads/publications/Final-Towards-Healthy-Outcomes-Document-with-links.pdf">important factor influencing healthy outcomes</a> for people with FASD. <a href="https://doi.org/10.3389/fpsyt.2022.931528">Conflict with others, social isolation and social disconnection</a> are common challenges for those who have FASD and suicidality. Being <a href="https://doi.org/10.1111/j.1530-0277.2011.01661.x">bullied</a> and <a href="https://jptcp.com/index.php/jptcp/article/view/446">feeling a lack of belonging</a> also contribute to a higher risk of suicidality. </p>
<p>The risk is also higher for individuals with a family history of substance use, suicidality or mental health concerns, or a personal history of trauma. We found that people with FASD who experienced trauma or abuse in their past were 2.8 times more likely to exhibit suicidality during their lifespan. </p>
<h2>Environmental factors</h2>
<figure class="align-center ">
<img alt="Illustration of a person talking to a counsellor" src="https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=340&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=340&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=340&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=428&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=428&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=428&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Outcomes can be significantly improved with access to effective supports and services for physical and mental health. However, the lack of FASD-informed services is a big barrier.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In our <a href="https://doi.org/10.1177/07067437211053288">recent study</a> we also found higher rates of suicidality among people with prenatal alcohol exposure who lived in group homes and institutional settings such as custody or in-patient treatment. Interactions with institutional systems like <a href="https://doi.org/10.1016/j.chiabu.2020.104888">child welfare</a> and <a href="https://doi.org/10.1177/0706743718816064">justice</a> and negative experiences within health-care systems also play a role, as can the <a href="https://doi.org/10.1007/s10699-020-09676-y">multiple layers of stigma</a> that this population experiences. </p>
<p>Outcomes <a href="https://doi.org/10.3389/fpsyt.2022.931528">can be significantly improved</a> with access to effective supports and services for physical and mental health. However, the lack of FASD-informed services is a big barrier.</p>
<h2>Support for individuals, families and communities</h2>
<p>For those with FASD, having a stable and nurturing home environment is <a href="https://doi.org/10.1097/00004703-200408000-00002">an important protective factor</a> against mental health issues in general, so it stands to reason that <a href="https://canfasd.ca/wp-content/uploads/2019/10/FASD-X-Housing-Pei-2018_Amended-March-04-2019-dl.pdf">safe and secure housing</a> is important to reduce the likelihood of suicide. </p>
<p>Addressing factors like co-occurring mental health issues, social isolation, substance use, trauma, abuse and involvement with the justice system may also help to reduce risk. Initiatives like strengthening social supports, enhancing coping skills, hopefulness and positive future outlooks, as well as identifying reasons for living, are critical for suicide prevention. </p>
<p>The impact of suicidality in FASD is not confined only to individuals who have the disorder. The experiences of caregivers, families, friends and communities need to be included as well. </p>
<p>Even though our work identified that <a href="https://doi.org/10.1177/07067437211053288">one in three individuals with FASD experienced suicidality</a> at some point during their lives, this also means that two thirds of individuals <em>did not</em>. This raises a crucial question for September’s <a href="https://canfasd.ca/fasd-awareness-month/">Fetal Alcohol Spectrum Disorder Awareness Month</a>: What factors may bolster resilience and positive outcomes to protect individuals with FASD and their families from harmful outcomes? It’s essential that future research focuses on this area.</p>
<p><em>If you or someone you know is feeling suicidal, please contact <a href="https://talksuicide.ca">Talk Suicide Canada</a> (1-833-456-4566).</em></p><img src="https://counter.theconversation.com/content/190224/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kelly D. Harding works as a Research Associate and as the Director of Research Administration for The Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD). The original research reported in this article was supported by funding from PolicyWise for Children and Families. Publication of the research discussed in this article was supported by CanFASD. </span></em></p><p class="fine-print"><em><span>Carly McMorris: This work was supported by Policy Wise for Children and Families and CanFASD.</span></em></p><p class="fine-print"><em><span>Dorothy Badry does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fetal alcohol spectrum disorder (FASD) is a multifaceted disorder. There are complex reasons why this population may be at higher risk for suicide, suicide attempts and suicidal ideation.Kelly D. Harding, Adjunct Professor, Psychology, Laurentian UniversityCarly McMorris, Associate Professor of Education, University of CalgaryDorothy Badry, Professor, Social Work, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1900642022-09-07T20:08:05Z2022-09-07T20:08:05ZIt’s RUOK Day – but ‘how can I help?’ might be a better question to ask<figure><img src="https://images.theconversation.com/files/483135/original/file-20220907-13-i2yi7j.jpg?ixlib=rb-1.1.0&rect=50%2C42%2C5557%2C3690&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/two-people-holding-hand-together-600w-736740664.jpg">Shutterstock</a></span></figcaption></figure><p>Mental health and suicide prevention have become <a href="https://www.health.gov.au/health-topics/mental-health-and-suicide-prevention/what-were-doing-about-mental-health">critical topics</a> of public discussion in the last few decades. Awareness of mental illness has been advanced by <a href="https://mhaustralia.org/media-releases/400-plus-organisations-and-counting-doing-their-bit-reduce-stigma-world-mental-health">public campaigns</a> and <a href="https://www.beyondblue.org.au/get-involved/ambassadors">personal stories</a>. </p>
<p>There has been tireless advocacy from <a href="https://nmhccf.org.au/">consumer and carer</a> organisations and <a href="https://www.blackdoginstitute.org.au/bush-fire-support-service/resource/other-support-options/">mental health institutes</a>. <a href="https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/mental-health-workforce">Health care workers</a>, <a href="https://mhfa.com.au/schools">teachers</a> and <a href="https://mhfa.com.au/">community members</a> have increased their capacity and expertise in mental health work. </p>
<p>Despite this, mental illness rates <a href="https://www.abs.gov.au/articles/first-insights-national-study-mental-health-and-wellbeing-2020-21">continue to rise</a>. <a href="https://www.aihw.gov.au/suicide-self-harm-monitoring/data/deaths-by-suicide-in-australia/suicide-deaths-over-time">Suicide has increased over the last decade</a>, particularly in <a href="https://www.aihw.gov.au/suicide-self-harm-monitoring/data/populations-age-groups/suicide-among-young-people">adolescents</a> and <a href="https://headspace.org.au/assets/download-cards/02-HSP254-Suicide-in-Primary-Schools-Summary-FA-low-res2.pdf">even in children</a>.</p>
<p>So on another <a href="https://www.ruok.org.au/">RUOK Day</a>, it is understandable we feel unsure a simple question can make a difference. What good is simply asking a family member, friend, or colleague if they are OK? Are we just <a href="https://www.theguardian.com/science/head-quarters/2017/feb/07/empathy-is-crucial-to-being-a-good-person-right-think-again">performing empathy</a> without purpose, making a token query that is ultimately futile? And what do we do if they say “no”?</p>
<p>Poor mental health and mental illness are <a href="https://www.mindaustralia.org.au/resources/understanding-mental-health-conditions">not the same thing</a>. Just like physical wellbeing, we can be unhealthy without being sick. So how can we best offer support to people who need help across a range of mental health needs? </p>
<h2>Recognising stress</h2>
<p>Sometimes, people are mentally unwell because of situational stress. <a href="https://www.beyondblue.org.au/the-facts/grief-and-loss/">Grief</a>, <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/Managing-a-relationship-breakdown">relationship breakdown</a>, <a href="https://humanrights.gov.au/our-work/1-mental-health-workplace">job stress</a>, <a href="https://www.beyondblue.org.au/the-facts/natural-disasters-and-your-mental-health">natural disasters</a> and other difficult life circumstances can affect our health, and mean we need additional support. </p>
<p>For other people, stress is long term and severe. People who live with <a href="https://theconversation.com/mental-distress-is-rising-especially-for-low-income-middle-aged-women-medicare-needs-a-major-shakeup-to-match-need-184635">poverty</a>, <a href="https://theconversation.com/domestic-abuse-and-mental-ill-health-twin-shadow-pandemics-stalk-the-second-wave-148412">violence</a>, <a href="https://www1.racgp.org.au/ajgp/2019/april/high-psychological-distress-in-primary-carers-of-p">carer stress</a>, <a href="https://humanrights.gov.au/about/news/speeches/multiculturalism-mental-health-and-psychology-racism">discrimination</a> and <a href="https://www.aihw.gov.au/reports/australias-welfare/social-isolation-and-loneliness-covid-pandemic">loneliness</a> often experience a life of poor health. </p>
<p>People with <a href="https://www.lowitja.org.au/page/research/research-categories/cultural-and-social-determinants/mental-health/completed-projects/stress-and-chronic-disease">chronic severe stress</a> often develop physical and mental illnesses, and need additional support. </p>
<p>Increasingly, we are also seeing people struggling with <a href="https://www.theguardian.com/world/2021/jan/30/covid-is-an-existential-crisis-that-comes-from-an-awareness-of-your-own-freedoms">deeper existential issues</a>, particularly in adolescence. Issues like <a href="https://www.orygen.org.au/About/News-And-Events/2021/Climate-change-and-youth-mental-health-personal-re">climate change</a> can be <a href="https://theconversation.com/climate-change-mental-health-services-a-better-education-system-what-marginalised-young-people-told-us-needs-to-be-fixed-180492">so overwhelming</a> young people can feel life has <a href="https://theconversation.com/yes-young-people-are-concerned-about-climate-change-but-it-can-drive-them-to-take-action-171300">no purpose or meaning</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483131/original/file-20220907-26-losp6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/483131/original/file-20220907-26-losp6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483131/original/file-20220907-26-losp6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483131/original/file-20220907-26-losp6t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483131/original/file-20220907-26-losp6t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483131/original/file-20220907-26-losp6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483131/original/file-20220907-26-losp6t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483131/original/file-20220907-26-losp6t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Deeper existential issues can feel overwhelming.</span>
<span class="attribution"><a class="source" href="https://images.pexels.com/photos/5699746/pexels-photo-5699746.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels/Alex Green</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/brain-fingerprinting-of-adolescents-might-be-able-to-predict-mental-health-problems-down-the-line-187765">'Brain fingerprinting' of adolescents might be able to predict mental health problems down the line</a>
</strong>
</em>
</p>
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<h2>Knowing how to help</h2>
<p>When people disclose the pain of grief, the feeling of overwhelm, or the hopelessness of poverty, it can be difficult to know how to help. Practical strategies like dropping off a meal, or offering to pick up the children from school can be enormously helpful. But so can listening without judgement or offering remedies. A person living with a difficult situation has likely already done their best to solve problems. They may need support more than solutions. </p>
<p>We can help on an individual level, but we can also contribute as a community to <a href="https://www.neaminational.org.au/">local initiatives</a> like <a href="https://www.ozharvest.org/volunteer/">food banks</a>, <a href="https://www.health.gov.au/initiatives-and-programs/community-visitors-scheme-cvs-0">visiting services for the elderly</a>, <a href="https://headspace.org.au/careers/volunteering-and-youth-participation/">youth health initiatives</a>. </p>
<p>We can also advocate for <a href="https://theconversation.com/psychological-tips-arent-enough-policies-need-to-address-structural-inequities-so-everyone-can-flourish-180224">fairer and more equitable policies</a> at a state and federal level. No mental health initiative will protect vulnerable Australians if they don’t have a roof over their head, food on the table and safe refuge from violence. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/psychological-tips-arent-enough-policies-need-to-address-structural-inequities-so-everyone-can-flourish-180224">Psychological tips aren’t enough – policies need to address structural inequities so everyone can flourish</a>
</strong>
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<h2>Understanding trauma</h2>
<p>People who live with the legacy of <a href="https://www.phoenixaustralia.org/your-recovery/">trauma</a> can have memories, experiences and emotions that affect them daily, often without warning. <a href="https://www.openminds.org.au/news/understanding-trauma-and-ptsd">Survivors of trauma</a> often have <a href="https://www.aihw.gov.au/reports/mental-health-services/stress-and-trauma">poor physical and mental health</a>. We are only beginning to understand the impact trauma has <a href="https://www.theguardian.com/society/2021/sep/20/trauma-trust-and-triumph-psychiatrist-bessel-van-der-kolk-on-how-to-recover-from-our-deepest-pain">on the body as well as the mind</a>. </p>
<p>If people disclose trauma, the most important response is to <a href="https://www.southpacificprivate.com.au/how-to-respond-when-someone-discloses-trauma/">listen</a>. We shouldn’t try to take over managing the situation. People who live with trauma often have little control over their situation, and it is important to <a href="https://www.health.nsw.gov.au/mentalhealth/psychosocial/principles/Pages/trauma-informed.aspx">support their own decisions and choices</a>. </p>
<p>A simple question like “how can I help?” can allow people to seek support while still maintaining a sense of control. </p>
<h2>Treating mental illness</h2>
<p>There is a <a href="https://headspace.org.au/explore-topics/for-young-people/mental-health-difficulties/">spectrum of mental ill-health</a>, and people who are very unwell may be experiencing <a href="https://www.betterhealth.vic.gov.au/health/servicesandsupport/types-of-mental-health-issues-and-illnesses">mental illness</a>. Mental illnesses can be short term or lifelong, mild to severe, and cover a range of symptoms including <a href="https://www.healthdirect.gov.au/signs-mental-health-issue">distressing thoughts, feelings, physical sensations and behaviours</a>. </p>
<p>People with long term mental illnesses can have periods of stability, and times of crisis, and often need to rely on <a href="https://mhfa.com.au/sites/default/files/guide_for_caregivers_of_people_with_mental_illness_-_may_2020.pdf%20when%20they%20are%20unwell">carers for support</a>. </p>
<p>The diagnosis of a mental illness is <a href="https://www1.racgp.org.au/ajgp/2020/december/making-a-good-mental-health-diagnosis">often quite difficult</a>, particularly for people who live with other complex needs. Cultural diversity, intellectual disability, physical illness, neurodiversity and other issues can complicate diagnosis. So it’s essential to consult a health professional who is able to make a diagnosis safely. </p>
<p>Although it is tempting to make a diagnosis of depression, anxiety or other mental health conditions using <a href="https://www.headtohealth.gov.au/">online programs and checklists</a>, mental health symptoms can overlap with a number of physical diseases, including thyroid disease, anaemia and even diabetes or heart disease. For this reason, a physical <a href="https://theconversation.com/your-first-point-of-contact-and-your-partner-in-recovery-the-gps-role-in-mental-health-care-124083">check-up with a GP</a> can help. </p>
<p>On RUOK Day, checking in with people with a known history of mental illness is important. Although there is often support in the early stages of illness, people with chronic disease of any type often describe feeling <a href="https://www.nami.org/Blogs/NAMI-Blog/January-2019/Combatting-the-Loneliness-of-Mental-Illness">lonely and isolated</a> in the longer term. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1566990804505460737"}"></div></p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/mental-distress-is-much-worse-for-people-with-disabilities-and-many-health-professionals-dont-know-how-to-help-187078">Mental distress is much worse for people with disabilities, and many health professionals don't know how to help</a>
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</em>
</p>
<hr>
<h2>Living with suffering</h2>
<p>We do not have a cure for everything. It is uncomfortable to recognise <a href="https://theconversation.com/in-australia-land-of-the-fair-go-not-everyone-gets-an-equal-slice-of-the-pie-70480">life is not fair</a> and <a href="https://thedecisionlab.com/biases/just-world-hypothesis">bad things can and do happen to good people</a>. </p>
<p>It is tempting to offer a raft of <a href="https://creakyjoints.org/support/how-to-support-someone-with-chronic-illness/">potential remedies</a> to avoid having to <a href="https://www.psychologytoday.com/au/blog/isnt-what-i-expected/201706/sitting-suffering">sit with the profound pain</a> of another human being. It makes us realise we are also vulnerable, and this is uncomfortable. </p>
<p>For this reason, many people with long term suffering often experience <a href="https://www.psychologytoday.com/au/blog/chronically-me/202202/the-link-between-chronic-illness-and-loneliness">loneliness</a>. On RUOK Day, it is worth considering how we as a community can better support the people who need comfort and care all year round. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/there-is-an-urgent-need-to-prevent-the-lifelong-damage-caused-by-adverse-childhood-experiences-188415">There is an urgent need to prevent the lifelong damage caused by adverse childhood experiences</a>
</strong>
</em>
</p>
<hr>
<h2>Are we OK?</h2>
<p>We may feel comfortable discussing mental health for others but find it difficult to seek mental health support for ourselves. </p>
<p><a href="https://www.betterhealth.vic.gov.au/health/servicesandsupport/stigma-discrimination-and-mental-illness">Self-stigma</a> is real, and prevents us from seeking appropriate care. Guilt and shame can also be symptoms of depression and anxiety. </p>
<p>Perhaps RUOK Day is a good opportunity to book a physical and mental health <a href="https://theconversation.com/your-first-point-of-contact-and-your-partner-in-recovery-the-gps-role-in-mental-health-care-124083">check-up with your GP</a>. </p>
<p>Finally, we all need to honestly discuss and address the ways we contribute to poor mental health in the community. Workplaces that normalise financial abuse, bullying and harassment <a href="https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/mental-health-in-the-workplace">cause harm</a>. Domestic violence <a href="https://www.facs.nsw.gov.au/domestic-violence/about/effects-of-dv">causes harm</a>. Poverty and discrimination <a href="https://www.aihw.gov.au/getmedia/746ded57-183a-40e9-8bdb-828e21203175/aihw-aus-221-chapter-4-2.pdf.aspx">cause harm</a>. </p>
<p>Checking in and connecting with those around us has merit in some circumstances – but we can all reduce mental harm by addressing our own behaviour at an individual, local and national level. </p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/190064/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Louise Stone receives funding from ACT health to research mental health services for young people in the ACT. </span></em></p>What good is asking someone if they are OK if we are just performing empathy? And what do we do if they are really not OK?Louise Stone, General practitioner; Associate Professor, ANU Medical School, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1879252022-08-23T20:04:31Z2022-08-23T20:04:31ZSuicide rates reveal the silent suffering of Australia’s ageing men<figure><img src="https://images.theconversation.com/files/477292/original/file-20220803-14-yx5kuh.jpg?ixlib=rb-1.1.0&rect=15%2C7%2C5188%2C3456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1595843471708-94f8f23d5be6?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=3270&q=80">Unsplash/Mark Timberlake</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Men aged 85 and older have the highest suicide rates in Australia, but the tragedy has gone relatively unnoticed. This group is growing older, feeling alone and flying under the radar.</p>
<p>The tragedy of suicide is recognised as a major public health issue. Yet what may come as a surprise to many is data <a href="https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/latest-release#intentional-self-harm-deaths-suicide-in-australia">published</a> by the Australian Bureau of Statistics showing men over 85 have suicide rates more than three times the average rate.</p>
<p>Public perception is that men – in particular, young men – have the highest suicide risk. While this is true for the net number of suicides, if we don’t consider age-standardised rates (which account for differences in age distribution across the population) we miss a crucial finding.</p>
<h2>Adjusting for age</h2>
<p>Men aged over 85 accounted for a relatively small proportion of all male suicides (3.1%) in 2020 (the latest data available). But the age-specific suicide rate was 36.2 deaths per 100,000 (up from 32.3 per 100,000 in 2019). For women aged over 85, this rate was much lower (6.2 per 100,000). The next highest rate was for men in both the 40-44 and 50-54 age bands (27.1 per 100,000).</p>
<p>In 2020, the overall suicide rate was 12.1 per 100,000 people.</p>
<p>But this issue is rarely addressed in public discourse or policy directives. The <a href="https://www.abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/2020-21#psychological-distress">National Study of Mental Health and Wellbeing</a> released last month did not include data on people older than 85.</p>
<p>This risk is <a href="https://theconversation.com/elderly-men-have-the-highest-suicide-rate-and-ageism-stops-us-from-doing-something-about-it-46923">not new</a>, but little has changed to address it over the past decade. In light of COVID and what it has <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2021.679711/full">revealed about ageism</a> and the value of older people in our society, it is crucial to explore these issues again. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/477294/original/file-20220803-1926-uuu06d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="older man with head in hands" src="https://images.theconversation.com/files/477294/original/file-20220803-1926-uuu06d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477294/original/file-20220803-1926-uuu06d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477294/original/file-20220803-1926-uuu06d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477294/original/file-20220803-1926-uuu06d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477294/original/file-20220803-1926-uuu06d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477294/original/file-20220803-1926-uuu06d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477294/original/file-20220803-1926-uuu06d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">All the key risk factors for suicide have become even more relevant due to COVID.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-man-covering-his-face-hands-701935606">Shutterstock</a></span>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drought-increases-rural-suicide-and-climate-change-will-make-drought-worse-185392">Drought increases rural suicide, and climate change will make drought worse</a>
</strong>
</em>
</p>
<hr>
<h2>Preventable deaths</h2>
<p>It is startling that men who have shown resilience to survive to late life are at such risk of preventable death. Many factors contribute, including physical and material circumstances like <a href="https://pubmed.ncbi.nlm.nih.gov/28511737/">frailty, chronic pain, bereavement</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/23209090/">financial troubles</a>. However, we cannot assume only external issues cause distress and lead to suicide.</p>
<p>In fact, for older people, successful ageing is rarely defined purely by physical circumstances. Ageing well often implies flourishing despite hardship.</p>
<p>The silent challenge among men aged over 85 who take their own lives is psychological and existential distress, which can <a href="https://pubmed.ncbi.nlm.nih.gov/20438238/">reinforce feelings of loneliness and worthlessness</a>. Older men at risk of suicide may feel they are “no longer needed” or perceive themselves as “burdensome” to family and community.</p>
<p>These beliefs can overlap with major life transitions, such as retirement, <a href="https://pubmed.ncbi.nlm.nih.gov/31431103/">stopping driving</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/21500012/">moving to residential care, where they are a minority</a>. Such stressful events can increase feelings of marginalisation, loss of independence and worthlessness, and also lead to social isolation.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-challenging-masculine-stereotypes-is-good-for-men-114300">How challenging masculine stereotypes is good for men</a>
</strong>
</em>
</p>
<hr>
<h2>Talking about it</h2>
<p>A reluctance to express their feelings or be vulnerable has long been discussed as an important factor for men’s wellbeing, especially when they’re feeling low. </p>
<p>Research suggests gender stereotypes and social norms linked to masculinity <a href="https://pubmed.ncbi.nlm.nih.gov/27664823/">reduce help-seeking behaviours</a> and <a href="https://journals.sagepub.com/doi/abs/10.1177/2156869317725890">can increase suicide risk</a>. Many ageing men hold restrictive and stoic beliefs about what it means to be a man. This may make them <a href="https://pubmed.ncbi.nlm.nih.gov/29019282/">less inclined to share</a> when they aren’t coping. </p>
<p>Yet emerging research <a href="https://pubmed.ncbi.nlm.nih.gov/27473200/">challenges the assumption</a> men don’t talk because they can’t. One reason men are not talking about their mental health struggles is because there’s <a href="https://opus.lib.uts.edu.au/handle/10453/153516">nowhere for them</a> to open up in a way they see as culturally and socially acceptable.</p>
<p>Instead, older men are speaking through their actions.</p>
<p>Suicide prevention and early intervention responses that are not tailored to the needs of older men are unlikely to be effective. We need to meet men where they are and listen to their quiet and absent voices by designing programs in partnership with them.</p>
<p>This means better understanding men’s <a href="https://pubmed.ncbi.nlm.nih.gov/28871841/">barriers</a> to suicide interventions. These include a lack of trust in traditional services and an aversion to “formal” supports that frame emotional distress and suicidal behaviours as mental illness. </p>
<p>It also means exploring, developing and funding new options that are acceptable, relevant and accessible, such as gendered support, peer-led programs, community-based informal support and programs combining exercise with mental health promotion. </p>
<p>The objective is not only to develop more suitable suicide prevention for this specific group, but also to examine broader interactions between ageing, isolation and loneliness; <a href="https://www.cambridge.org/core/journals/international-psychogeriatrics/article/covid19-the-implications-for-suicide-in-older-adults/9890D02E0DA3021FCFE66B9A29F2684E">all key risk factors</a> for suicide that have become even more relevant due to COVID.</p>
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Read more:
<a href="https://theconversation.com/friday-essay-grey-haired-and-radiant-reimagining-ageing-for-women-182336">Friday essay: grey-haired and radiant – reimagining ageing for women</a>
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<h2>More calls for help</h2>
<p>Increased feelings of distress and loneliness produced by the pandemic can be measured by <a href="https://www.abc.net.au/news/2021-08-04/lifeline-records-highest-daily-calls-on-record/100350522">increased calls to services such as Lifeline</a>. And more persistent mental health problems are likely to present more slowly, <a href="https://psycnet.apa.org/fulltext/2020-41461-001.html">over longer horizons</a>, and peak after the most acute phases of the pandemic.</p>
<p>Older people have handled much of the burden of COVID, including unprecedented <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295320/">restrictions and ageist sentiments</a>. We must recognise these factors – growing old, being alone and feeling unheard - underpin increasing distress felt by men aged over 85, not only during the pandemic, but more generally.</p>
<p>This group must be seen as a priority population for suicide prevention. We must start listening and work together to find solutions so older men can access the help they need in a way that suits them.</p>
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<p><em>UNSW Ageing Futures Institute would like to acknowledge the research contribution of <a href="https://www.lifeline.org.au/about/our-research/">Lifeline Research Foundation</a>’s Dr Anna Brooks (National Manager) and Dr Tara Hunt (Research and Engagement Manager).</em></p>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, you can call these support services, 24 hours, 7 days:</em></p>
<ul>
<li><p><em>Lifeline: 13 11 14</em></p></li>
<li><p><em>Suicide Call Back Service: 1300 659 467</em> </p></li>
<li><p><em>Kids Helpline: 1800 551 800 (for people aged 5 to 25)</em></p></li>
<li><p><em>MensLine Australia: 1300 789 978</em></p></li>
<li><p><em>StandBy - Support After Suicide: 1300 727 24</em></p></li>
</ul><img src="https://counter.theconversation.com/content/187925/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rhys Mantell receives PhD scholarship funding from The National Health and Medical Research Council’s (NHMRC).</span></em></p><p class="fine-print"><em><span>Adrienne Withall receives funding from the NHMRC and MRFF. She is affiliated with the Ageing Futures Institute and the Australian Human Rights Institute. </span></em></p>If we consider suicide rates within age groups, men over 85 are at three times the average risk. We should make sure older men have ways to express when they’re not coping and seek help.Rhys Mantell, PhD Candidate, School of Population Health, UNSW SydneyAdrienne Withall, Senior Research Fellow, School of Population Health, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1888062022-08-19T14:48:09Z2022-08-19T14:48:09ZHow drama can help open up conversations on suicide for young people in post-pandemic times<p>Suicide is the <a href="https://www.kff.org/news-summary/suicide-represents-2nd-leading-cause-of-death-among-young-people-ages-15-29-who-notes-on-world-mental-health-day/">second highest cause of death</a> in 15-to-29-year-olds around the world, according to UK charity <a href="https://www.youngminds.org">Young Minds</a>, an organisation set up to help children and young people with mental health issues. </p>
<p>Many young people have experienced problems with their mental health during and since the COVID-19 pandemic, which is <a href="https://www.bmj.com/content/372/bmj.n614">predicted</a> to lead to a mental health epidemic. Factors such as the move to home schooling, physical isolation from friends and uncertainty over easing of restrictions have all contributed to poor mental health. But my <a href="https://www.ingentaconnect.com/contentone/intellect/jaah/2019/00000010/00000003/art00002">research</a> has shown that using drama to explore these sensitive issues could be one way to tackle the emerging crisis.</p>
<p>Against the pandemic backdrop, it is likely that there will be a rise in young people <a href="https://cls.ucl.ac.uk/wp-content/uploads/2020/11/Mental-ill-health-at-age-17-%E2%80%93-CLS-briefing-paper-%E2%80%93-website.pdf">attempting suicide</a> and, in some cases, taking their own lives. Recent research has found that 7% of British children have <a href="https://www.theguardian.com/society/2021/feb/21/uk-17-year-olds-mental-health-crisis">attempted suicide by the age of 17</a>. </p>
<p>So there is an urgent need for early intervention and prevention strategies to be devised and implemented in schools to reverse the potential increase in suicide amongst young people.</p>
<p>In 2019, as a lecturer in performance, I carried out a drama research <a href="https://www.ingentaconnect.com/contentone/intellect/jaah/2019/00000010/00000003/art00002">project</a> in South Ayrshire schools which aimed to change attitudes towards talking about suicide. Contrary to popular belief, if there are serious concerns about someone’s safety, asking them directly if they’re contemplating suicide is recommended by mental health charity <a href="https://www.mind.org.uk/information-support/helping-someone-else/supporting-someone-who-feels-suicidal/talking-about-suicidal-feelings/">Mind</a>.</p>
<p>This project, part of a <a href="https://publichealthscotland.scot/">Public Health Scotland</a> strategy, was called <a href="http://www.healthscotland.com/documents/6021.aspx">Read Between The Lines</a> and aimed to spread this message to young people in the hope of opening up conversations about suicide. My current research aims to develop the work done in Read Between The Lines and, after the restrictions of COVID-19, learn lessons from digital innovations in teaching and learning in addressing mental health issues around suicide.</p>
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<h2>The play’s the thing</h2>
<p>In Read Between The Lines, a short play was presented to an audience of 11-to-18-year-olds which showed the difference talking can make in keeping young people safe. In the play, a teenage girl shows signs of contemplating suicide. </p>
<p>By talking to a friend, she is supported through her difficulties and ultimately turns away from the idea. Using drama to represent such difficult and sensitive conversations allowed the audience to <a href="https://www.ingentaconnect.com/contentone/intellect/jaah/2019/00000010/00000003/art00002">explore these issues in a safe and supportive space</a>.</p>
<p>Without such opportunities to talk freely about subjects like suicide, <a href="https://www.ingentaconnect.com/contentone/intellect/jaah/2019/00000010/00000003/art00002">young people might otherwise be drawn</a> to other fictional and sometimes sensationalised depictions of suicide. Following <a href="https://www.theguardian.com/media/2018/may/11/netflix-criticised-over-return-of-suicide-drama-13-reasons-why">criticism</a> from mental health organisations, in 2019 Netflix <a href="https://www.theguardian.com/tv-and-radio/2019/jul/16/netflix-cuts-controversial-suicide-scene-from-13-reasons-why">removed a controversial scene</a> from its show <a href="https://www.netflix.com/search?q=13%20%20reasons%20why&suggestionId=81233040_collection&jbv=80117470">13 Reasons Why</a> which showed a character taking her own life. </p>
<p>Acknowledging the potential vulnerability of some young people, Netflix then developed a <a href="https://www.wannatalkaboutit.com/gb/">website</a> which offers support for a range of mental and physical wellbeing issues. Despite such resources, there is a need for more direct local responses to suicide prevention education using both digital and in-person approaches. </p>
<p>Building on the Read Between The Lines project, I am currently exploring ways of using digital resources, such as those developed by <a href="http://realtalk.film/">Grassroots Suicide Prevention</a>. This resource, largely aimed at men, is a good example of how conversations on suicide can be generated safely. </p>
<p>But using such digital resources is only part of an effective approach; role playing with young people can be also a powerful tool to <a href="https://www.ingentaconnect.com/contentone/intellect/jaah/2019/00000010/00000003/art00002">bring about change</a>. This is why I believe that drama is one of the best ways to reach young people and help them talk comfortably about issues such as suicide.</p>
<figure class="align-center ">
<img alt="Two teenage girls sit on floor and talk to each other." src="https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479356/original/file-20220816-5564-ywqf10.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A scene from the Read Between The Lines project.</span>
<span class="attribution"><span class="source">James Layton</span>, <span class="license">Author provided</span></span>
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<h2>Drama: inhabiting different worlds</h2>
<p>Brazilian theatre director and activist <a href="https://www.theguardian.com/world/2009/may/06/augusto-boal-obituary">Augusto Boal</a> argued that drama can allow two worlds to be simultaneously inhabited, which he describes as “<a href="https://uwe-repository.worktribe.com/output/957720/metaxis-the-transition-between-worlds-and-the-consequences-for-education">metaxis</a>”, meaning that someone can play a role without getting lost in a character or situation. In this way, individuals can explore difficult and challenging scenarios.</p>
<p>For Boal, being an active participant is a powerful tool in bringing about change. In a similar way, <a href="https://www.mantleoftheexpert.com/what-is-moe/dorothy-heathcote/">Dorothy Heathcote’s</a> pioneering drama education work of the 1970s placed children in the role of expert in exploring a range of topics.</p>
<p>In a <a href="https://youtu.be/owKiUO99qrw?t=1561">BBC documentary</a> from 1971, a child reflecting on one of Heathcote’s sessions commented that she’d rather explore a drama of her own making rather than a play because “a play is not our own words”. Allowing the children to play out their own (real) world through their own (imagined) drama world is an essential ingredient in Heathcote’s approach and one that helps bring about dialogue. </p>
<p>Drama can produce meaningful and productive dialogue about suicide and the mental health issues around it, as both my own and Heathcote’s work demonstrate. Heathcote’s use of dramatic spaces allows roles to be assumed intuitively, where the relationship between “expert” and “learner” is equally balanced.</p>
<p>In doing so, the boundaries between the expert and the learner become blurred which helps to develop spaces and communities where proper, ongoing dialogue actually happens.</p>
<p>A delicate balance is necessary when dealing with sensitive topics like suicide if it is to help nurture a society where young people can talk and listen to each other. The exploratory nature of drama offers a way to build such an environment and a promising way to tackle a mental health crisis in which lives are needlessly lost.</p>
<p><em>If you’re struggling with suicidal thoughts, the following services can provide you with support:</em></p>
<p><em>In the UK and Ireland – call Samaritans UK at 116 123.</em></p>
<p><em>In the US – call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or IMAlive at 1-800-784-2433.</em></p>
<p><em>In Australia – call Lifeline Australia at 13 11 14.</em></p>
<p><em>In other countries – visit IASP or Suicide.org to find a helpline in your country.</em></p><img src="https://counter.theconversation.com/content/188806/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Layton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Role play and drama offer young people struggling with mental health issues an opportunity to explore the feelings that can lead to suicide.James Layton, Lecturer in Performance, University of the West of ScotlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1877442022-08-17T12:38:26Z2022-08-17T12:38:26ZHow easy access to guns at home contributes to America’s youth suicide problem<figure><img src="https://images.theconversation.com/files/479472/original/file-20220816-8518-8ptg2w.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3860%2C2590&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Easy access to firearms increases the risk of teen suicide.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.no/detail/photo/kids-and-guns-royalty-free-image/157647475?adppopup=true">CowlickCreative/Getty Images</a></span></figcaption></figure><p>School shootings in the U.S. <a href="https://theconversation.com/what-we-know-about-mass-school-shootings-in-the-us-and-the-gunmen-who-carry-them-out-183812">are national tragedies</a>, and the toll they take in <a href="https://www.npr.org/2022/05/28/1101307932/texas-shooting-uvalde-gun-violence-children-teenagers?t=1660229579095">lives cut short</a> <a href="https://theconversation.com/the-lasting-consequences-of-school-shootings-on-the-students-who-survive-them-183906">and traumatized</a> distinguishes the U.S. from other high-income countries. But there is another way that guns are killing American children, and in far greater numbers: suicide.</p>
<p>Between 2011 and 2020, the most recent decade for which data is available, <a href="https://www.cdc.gov/injury/wisqars/">14,763 children ages 5-17 died by suicide</a> in the U.S. – a rate of approximately four deaths every day. Over <a href="https://www.cdc.gov/injury/wisqars/">40% of these suicides</a> involved a firearm. The <a href="https://doi.org/10.1001/archpedi.153.8.875">great majority</a> <a href="https://doi.org/10.1521/suli.2010.40.6.609">of guns involved</a> in youth suicides come <a href="https://doi.org/10.1016/j.ypmed.2022.107066">from the victim’s home or the home of a relative</a>.</p>
<p>As scholars who have <a href="https://bouve.northeastern.edu/bchs/directory/matthew-miller/">studied firearm violence</a> and <a href="https://www.hsph.harvard.edu/hicrc/faculty-and-staff/azrael-deborah/">suicide prevention</a>, we know the exceptionally high rate of gun suicides by U.S. youths is directly linked to the easy access many young people have to guns in and around the home.</p>
<p>Suicide rates among children have <a href="https://www.cdc.gov/injury/wisqars/">trended up over the past decade</a>, as they have for adults. For children ages 5-17, suicides have climbed by around 50%, from 1,129 children in 2011 to 1,679 in 2020. </p>
<p>That equates to a jump in the suicide rate from 2.1 deaths per 100,000 children in America to 3.1 per 100,000. Half of this increase – 0.5 deaths per 100,000 children – was due to suicide by guns.</p>
<p>Although suicides affect all racial and ethnic groups in America, the suicide rate is <a href="https://www.cdc.gov/injury/wisqars">highest among Native communities</a>, while recent increases have disproportionately hit Asian/Pacific Islanders and Black communities.</p>
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<p>Studies show that the risk of death by suicide is <a href="https://doi.org/10.1001/archpedi.1993.02160340052013">over four times higher</a> in households with firearms. Consistent with this elevated risk in gun-owning households, <a href="https://www.doi.org/10.1097/00005373-200202000-00011">studies that compare rates of suicide in different cities</a> and across the 50 states show that in places where there are more guns there are more overall suicide deaths due to there being <a href="https://www.doi.org/10.1097/00005373-200202000-00011">more firearm suicides</a>.</p>
<h2>Reducing the risk</h2>
<p>The suicide risk associated with the presence of firearms in homes with children can be reduced, though not eliminated, by storing firearms locked, unloaded and separate from ammunition.</p>
<p>Today, approximately <a href="https://doi.org/10.1001/jamanetworkopen.2021.48823">40% of U.S. households with children contain firearms</a>. This means that around 30 million children under the age of 18 currently live in a home with at least one firearm, of whom roughly 5 million live in homes where at least one firearm is both loaded and unlocked.</p>
<p>A <a href="https://doi.org/10.1001/jamapediatrics.2019.1078">recent simulation study</a> estimated that approximately 100 suicides a year among youths ages 5 to 19 could be prevented if the proportion of unlocked firearms in households with children decreased from 50%, as is approximately the case today, to 40%. </p>
<p>Research also suggests that when clinicians provide counseling to parents that emphasizes the importance of making guns inaccessible to their children, a <a href="https://doi.org/10.1093/epirev/mxv006">substantial minority of parents improve storage</a> by locking previously unloaded guns, <a href="https://doi.org/10.1016/j.annemergmed.2020.02.007">especially when the counseling is supplemented</a> with free firearm storage devices.</p>
<p>For youths at particularly high risk of suicide who are seen in the emergency department for a mental or behavioral health crisis, training clinicians to counsel parents to reduce access to firearms – often referred to as “lethal means counseling” – can result in a substantial <a href="https://pubmed.ncbi.nlm.nih.gov/32307124/">increase in the proportion of parents spoken to</a> about firearm risk in the emergency department and, critically, in the proportion of parents who lock previously unloaded guns after returning home. </p>
<p>Storing guns unloaded and locked up does not necessarily, or in itself, prevent children’s access to firearms.</p>
<p>The evidence that a firearm in a child’s home substantially increases that child’s risk of death by suicide is overwhelming. Locking and unloading all household firearms and storing firearms separately from ammunition substantially mitigates, but does not eliminate, this risk.</p>
<p>In a recent nationally representative study of parents and their adolescent children, all of whom lived in a home with firearms, more than one-third of adolescents reported being able to independently <a href="https://doi.org/10.1001/jamanetworkopen.2021.0989">access a loaded household firearm in less than 5 minutes</a> – and 50% within an hour. Although this proportion was lower in homes where parents locked away all their guns, even here one-quarter of children said they were able to access and fire a loaded gun within 5 minutes. </p>
<p>Meanwhile, 3 in 10 parents acknowledged that their child could independently access a household firearm, suggesting that many either do not fully appreciate the risk access to firearms confers or do not believe that the risk pertains to their children. Moreover, nearly 1 in 4 children whose parents indicated that their child could not independently access a household gun reported being able to access and fire a gun in their home within 5 minutes. </p>
<p>We believe that rigorously evaluating how to effectively communicate the importance of making household firearms inaccessible to children is an urgently needed next step if we are to prevent the loss of so many young lives year after year to suicide.</p><img src="https://counter.theconversation.com/content/187744/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Miller receives funding from the Joyce Foundation, the National Collaborative of Gun Violence Research, The National Institutes of Health, and the American Foundation for Suicide Prevention.</span></em></p><p class="fine-print"><em><span>Deborah Azrael receives funding from the Joyce Foundation, the National Collaborative of Gun Violence Research, and the American Foundation for Suicide Prevention.</span></em></p>Youth suicides in the US have increased by around 50% over the past decade – gun availability is a big part of that trend.Matthew Miller, Professor of Health Sciences and Epidemiology, Northeastern UniversityDeborah Azrael, Director of Research, Harvard T.H. Chan School of Public HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772432022-04-24T14:02:52Z2022-04-24T14:02:52ZBuilding healthy relationship skills supports men’s mental health<figure><img src="https://images.theconversation.com/files/458918/original/file-20220420-17-6shyho.jpg?ixlib=rb-1.1.0&rect=278%2C24%2C4734%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are few courses or programs that teach men relationship skills from the perspective of healthy masculinity.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Healthy relationships positively influence men’s well-being. <a href="https://doi.org/10.1016/j.jad.2017.06.007">Men who are partnered or married live longer lives than single men,</a> and they have better mental health than women and unpartnered men. Marriage appears to offer a protective influence on men’s health, reducing loneliness, depression and suicidality, and is associated with <a href="https://doi.org/10.1017/S0033291719002964">less substance and alcohol use</a>. </p>
<p>Despite these benefits, male suicide continues to be a global crisis. As men’s health researchers, our focus has been on men’s suicidality. Much of this work is motivated by the fact that <a href="https://www150.statcan.gc.ca/n1/pub/82-624-x/2012001/article/desc/11696-04-desc-eng.htm">men complete suicide at three to four times the rate of women,</a> and are known to use more lethal methods (guns, asphyxiation) to end their life. </p>
<p>While major depression is a contributing factor to suicidality, <a href="https://doi.org/10.1016/j.socscimed.2021.113831">a recent review</a> concluded that being unmarried, single, divorced or widowed are also strong predictors of suicidality among men.</p>
<p>Men who adhere to traditional aspects of masculinity — emotional stoicism, needing to be in control, fear of being seen as weak for seeking help — are <a href="https://doi.org/10.1177%2F1049732317718148">more likely to self-isolate, resort to anger or aggression, or self-harm when they experience distress</a>. The links between men’s mental illness, suicidality and intimate relationships are particularly concerning when considering the high rates of divorce and separation in countries including <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/220309/dq220309a-eng.htm">Canada</a>, <a href="https://www.abs.gov.au/statistics/people/people-and-communities/marriages-and-divorces-australia/latest-release">Australia</a> and <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/divorce">Britain</a>.</p>
<p>To investigate the intersection of men’s health and intimate relationships, we conducted in-depth, <a href="https://doi.org/10.1177%2F16094069211053522">semi-structured interviews over Zoom</a> with 49 men and 30 service providers who work with male clients. We collected men’s first-person experiences of an intimate partner break-up, as well as providers’ perspectives of relationship challenges and how masculinity influences men’s coping in strained relationships. </p>
<h2>The impact of relationship loss</h2>
<p>Interestingly, men enjoyed interviewing from home in familiar surroundings and openly shared detailed stories about their relationship break-ups. They also reported anxiety, depression and suicidality in the aftermath of a relationship ending. We found that <a href="https://doi.org/10.1016/j.ssmqr.2022.100039">relationship loss exacerbated pre-existing mental health issues for some men, and for others, it catalyzed the onset of mental health challenges</a>. </p>
<figure class="align-center ">
<img alt="A man with a beard sitting alone looking away from the camera toward a window" src="https://images.theconversation.com/files/458923/original/file-20220420-24727-etvhry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458923/original/file-20220420-24727-etvhry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458923/original/file-20220420-24727-etvhry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458923/original/file-20220420-24727-etvhry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458923/original/file-20220420-24727-etvhry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458923/original/file-20220420-24727-etvhry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458923/original/file-20220420-24727-etvhry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Men described their distressed states, fragile mental health and potential for breaking down in the wake of breaking up.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Men in long- and short-term partnerships talked about the challenges they faced during the course of their relationships: domestic conflict, parenting stressors, infidelity, illness or job loss. The also discussed how these issues made it difficult for them to effectively negotiate with a partner to maintain and grow their relationship, or amicably separate. </p>
<p>Gendered aspects of traditional masculinity, such as autonomous problem solving, maintaining control over life events and being seen as a confident family man, were tested and undone by distressed relationships.</p>
<p>The men described their distressed states, fragile mental health and potential for breaking down in the wake of breaking up. Many participants commented on how they struggled with the emotional work involved in sustaining a long-term relationship. </p>
<p>Intense emotions, including sadness, anger, guilt and regret, were triggered by the loss of partners, and manifested in varying degrees of anxiety, depression, and for some men, suicidality. Several men detailed the experience of panic attacks that lead to hospitalization in the wake of a break-up. </p>
<p>To cope with emotional distress, many men relied on alcohol, “Herculean” amounts of cannabis, excessive exercising, frenzied dating, marathon gaming and other emotion-blunting strategies. However, we also learned that with time, most men sought out friends and family for support and searched for books, podcasts and online resources to alleviate distress and better understand relationship dynamics. </p>
<p>Some men reached out beyond their own networks and joined parenting or divorce groups, and found activities with male peers helped improve their mental health. Many attended professional therapy to address longstanding mental health issues or experience the benefits of professional therapeutic rapport for the first time.</p>
<h2>Relationship skills</h2>
<figure class="align-center ">
<img alt="A man and a woman relaxing on a sofa talking" src="https://images.theconversation.com/files/458927/original/file-20220420-23-238lzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458927/original/file-20220420-23-238lzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458927/original/file-20220420-23-238lzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458927/original/file-20220420-23-238lzr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458927/original/file-20220420-23-238lzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458927/original/file-20220420-23-238lzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458927/original/file-20220420-23-238lzr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Healthy relationships positively influence men’s well-being.</span>
<span class="attribution"><span class="source">(Pexels/Ekaterina Bolovtsova)</span></span>
</figcaption>
</figure>
<p>Because the influence of intimate partner relationships on men’s health — and on others in their life — is so pivotal, the question of relationship skills arises. We performed a <a href="http://doi.org/10.1002/hpja.463">scoping review</a> — an assessment of the scope of available research — of relationship skills training for men. It concluded that existing programs tend to be corrective in nature, designed to change men’s behaviour in the context of family or intimate partner violence. </p>
<p>There are few settings, courses or programs upstream of domestic violence that teach men relationship skills from the perspective of healthy masculinity. It may be timely to develop relationship skills training and interventions to support men in coping with the stressors inherent in intimate relationships to benefit their health, and those around them.</p>
<p>Given the positive influence of healthy relationships on men’s mental health, making strength-based relationship skills resources a priority, beyond programs that address abuse, could have clear benefits for men’s well-being.</p><img src="https://counter.theconversation.com/content/177243/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John L. Oliffe receives funding from Movember and is supported by a Tier 1 Canada Research Chair in Men’s Health Promotion.</span></em></p><p class="fine-print"><em><span>Gabriela Gonzalez Montaner and Mary Theresa Kelly do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Healthy relationships have a positive influence on men’s health and mental health. Prioritizing relationship skills for men is one way to approach the global crisis in male suicide.John L. Oliffe, Professor and Canada Research Chair in Men's Health Promotion, University of British ColumbiaGabriela Gonzalez Montaner, Project Coordinator, Men's Health Research Program, University of British ColumbiaMary Theresa Kelly, Research Contractor, Men's Health Research, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1710082022-02-15T13:22:33Z2022-02-15T13:22:33ZAfter the FDA issued warnings about antidepressants, youth suicides rose and mental health care dropped<figure><img src="https://images.theconversation.com/files/445533/original/file-20220209-19735-a32t0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The link between antidepressant use and increases in suicidal thoughts or behaviors among treated youth is unproven.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/having-a-bad-day-royalty-free-image/640139784?adppopup=true">FatCamera/E+ via Getty Images</a></span></figcaption></figure><p>Depression in young people is vastly undertreated. About two-thirds of depressed youth don’t receive <a href="https://doi.org/10.1542/peds.2016-1878">any mental health care at all</a>. Of those who do, a significant proportion rely on antidepressant medications.</p>
<p>Since 2003, however, <a href="https://doi.org/10.1176/ajp.2007.164.6.884">the U.S. Food and Drug Administration has warned</a> that young people might experience suicidal thinking and behavior during the first months of treatment with antidepressants. </p>
<p>The FDA <a href="https://doi.org/10.1176/appi.ajp.2007.07050775">issued this warning to urge</a> clinicians to monitor suicidal thoughts at the start of treatment. These warnings appear everywhere: on TV and the internet, in print ads and news stories. The most strongly worded warnings appear in black boxes on medication containers themselves. </p>
<p>We are professors and researchers at <a href="https://www.populationmedicine.org/SSoumerai">Harvard Medical School</a>, the <a href="https://ldi.upenn.edu/fellows/fellows-directory/ross-koppel-phd/">University of Pennsylvania Perelman School of Medicine</a> and University at Buffalo. For over 30 years, we have been studying the intended and unintended effects of health policies on patient safety.</p>
<p>We have found that FDA drug warnings can sometimes prevent life-threatening adverse effects, but that <a href="https://doi.org/10.2307/3350088">unintended consequences of these warnings</a> are also common. In 2013, working for the FDA itself, we published a systematic review of the <a href="https://doi.org/10.1002/pds.3480">effects of previous FDA warnings</a> on a variety of medications. We found that about a third backfired, resulting in underuse of needed care and other adverse effects. </p>
<p><a href="https://doi.org/10.1176/appi.prcp.20200012">In our more recent study</a> from 2020, we found that the FDA antidepressant warnings have led to reduced mental health care and increased suicides among youth – even though researchers <a href="https://doi.org/10.1038/sj.npp.1300996">have yet to find a clear link</a> between antidepressants and increased suicidality in young people. </p>
<p>Further, despite the warnings, monitoring by clinicians of suicidal thoughts at the start of treatment has not increased <a href="https://doi.org/10.1176/appi.ajp.2007.07010205">from its tiny rate of less than 5%</a>.</p>
<h2>Youth suicides rose following FDA warnings</h2>
<p>For <a href="https://doi.org/10.1176/appi.prcp.20200012">our 2020 study</a>, we obtained 28 years of data, between 1990 and 2017, on actual suicide deaths in the U.S. among adolescents and young adults. We used data from <a href="https://wonder.cdc.gov/">the WONDER Database</a>, maintained by the U.S. Centers for Disease Control and Prevention, which contains mortality counts based on death certificates for U.S. residents and population counts for all U.S. counties.</p>
<p>We found that during the pre-warning period, there was a 13-year stable downward trend in youth suicides, following availability of new and safer antidepressants. </p>
<p><a href="https://doi.org/10.1176/appi.prcp.20200012">That trend reversed</a>, we found, soon after the FDA began antidepressant warnings in late 2003. Youth suicide deaths increased significantly.</p>
<p>Then we applied our findings to the whole U.S. population of adolescents and young adults. The results of that analysis suggest that there were almost 6,000 additional suicide deaths in just the first six years after the FDA issued the boxed warnings, from 2005 through 2010. The rates also continued to rise thereafter.</p>
<p>Over this same time period, older adults – whose depression is not targeted by the warnings – experienced much lower increases in suicide.</p>
<p><iframe id="5TtZt" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/5TtZt/10/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Fewer depressed youths got treatment</h2>
<p>Our findings align with a growing body of research that confirms these warnings have had serious unintended effects: <a href="https://doi.org/10.1056/NEJMp1408480">scaring many patients</a>, as well as their parents and doctors, away from both <a href="https://doi.org/10.1136/bmj.g3596">antidepressant medications</a> and <a href="https://doi.org/10.1001/archgenpsychiatry.2009.46">psychotherapy</a> that can reduce major symptoms of depression. </p>
<p>These studies include a rigorous 2017 study that <a href="https://doi.org/10.1002/da.22681">analyzed mental health care trends</a> among 11 million youths who rely on Medicaid for insurance coverage. This research documented that immediately after the FDA warnings began in 2003, there was a sudden and sustained 30%-40% drop in youth visits to doctors for all depression care, including antidepressant prescriptions. </p>
<p>Seven years after the first FDA warning, doctor visits for depression by young people had dropped by around 50%, compared with the pre-warning trend, thus <a href="https://www.nimh.nih.gov/health/statistics/major-depression">severely reducing treatment and suicide prevention</a>. </p>
<p><iframe id="2yH6P" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/2yH6P/11/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>That trend included Black and Latino youths, who have already <a href="https://www.dovepress.com/racial-and-ethnic-differences-in-depression-current-perspectives-peer-reviewed-fulltext-article-ND">long suffered from undertreatment</a>. </p>
<p>Almost simultaneously, youth poisonings via prescription drugs, such as sleeping pills, went up. <a href="https://doi.org/10.1136/bmj.g3596">Research has shown</a> that prescribed medications are a widespread method by which young people attempt suicide. This finding adds to the evidence that the antidepressant warnings increased suicidal behavior. </p>
<figure class="align-center ">
<img alt="A tattooed teenage girl speaks to a therapist during a group psychotherapy meeting. Three other young people, sitting in the background, are listening." src="https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">About two-thirds of depressed young people in the U.S. receive no mental health treatment at all.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/tattooed-rebel-teenage-girl-sitting-in-front-of-a-royalty-free-image/1006550718?adppopup=true">Katarzyna Bialasiewicz/iStock via Getty Images</a></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.3389/fpsyt.2019.00294">In 2018, researchers reported on two patients in their 20s</a> whose experiences illustrate the potential real-life impacts of the black-box warnings. Both young adults had been prescribed antidepressants for major depression and severe panic attacks, but they refused to take them because of the FDA’s message. </p>
<p>Their conditions worsened, and eventually both attempted suicide. Fortunately, family members were able to intervene in time, and each young adult was then hospitalized.</p>
<p>After they accepted the reassurances of hospital psychiatrists that the benefits of the medications would likely exceed any risks, both patients began to take their prescribed antidepressants. These medications, combined with talk therapy, alleviated their symptoms without intensifying suicidal thoughts. </p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p>
<h2>Reevaluating the warnings</h2>
<p>As scientists, we are trained to always seek potential alternative explanations – some additional factor not included in the research – that could explain the reduction in care or increase in suicides that we and others have recorded in our studies. </p>
<p>However, the sudden, simultaneous and large effects – all of which directly reduced treatment and increased suicidal behavior – strongly suggest this is not a coincidence. It is unlikely that any outside factor can account for the multiple parallel effects on depression care, suicidal behavior and suicide deaths.</p>
<p>A large and growing body of evidence shows that the FDA’s black-box warnings on antidepressants need to be reevaluated.</p>
<p>More generally, there’s a need for independent researchers to monitor the effects of FDA warnings on public health – both intended and unintended.</p><img src="https://counter.theconversation.com/content/171008/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Soumerai receives funding from the NIH.. </span></em></p><p class="fine-print"><em><span>Ross Koppel does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A well-intentioned public health message has had serious negative impacts on the treatment of young people for depression.Stephen Soumerai, Professor of Population Medicine, Harvard Medical School, Harvard UniversityRoss Koppel, Professor of Medical Informatics and Adjunct Professor of Sociology, University of Pennsylvania; Professor of Biomedical Informatics, University at BuffaloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1698282021-11-11T18:57:27Z2021-11-11T18:57:27ZWe studied suicide notes to learn about the language of despair – and we’re training AI chatbots to do the same<figure><img src="https://images.theconversation.com/files/431426/original/file-20211111-21-cbuohc.jpeg?ixlib=rb-1.1.0&rect=54%2C54%2C5952%2C3953&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>While the art of conversation in machines is limited, there are improvements with every iteration. As machines are developed to navigate complex conversations, there will be technical and ethical challenges in how they detect and respond to sensitive human issues. </p>
<p>Our work involves building chatbots for a range of uses in health care. Our system, which incorporates multiple algorithms used in artificial intelligence (AI) and natural language processing, has been in development at the <a href="https://aehrc.csiro.au/">Australian e-Health Research Centre</a> since 2014. </p>
<p>The system has generated several chatbot apps which are being trialled among selected individuals, usually with an underlying medical condition or who require reliable health-related information. </p>
<p>They include <a href="https://theconversation.com/new-app-helps-people-with-neurological-conditions-practise-speech-51665">HARLIE</a> for Parkinson’s disease and <a href="https://theconversation.com/the-future-of-chatbots-is-more-than-just-small-talk-53293">Autism Spectrum Disorder</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/33234441/">Edna</a> for people undergoing genetic counselling, Dolores for people living with chronic pain, and Quin for people who want to quit smoking. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1394776246525960195"}"></div></p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%28suicide%29+AND+%28%28autism%29+OR+%28smoking%29+OR+%28chronic+pain%29+OR+%28parkinson%27s+disease%29%29&sort=">Research</a> has shown those people with certain underlying medical conditions are more likely to think about suicide than the general public. We have to make sure our chatbots take this into account.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Siri often doesn’t understand the sentiment behind and context of phrases.</span>
<span class="attribution"><span class="source">Screenshot/Author provided</span></span>
</figcaption>
</figure>
<p>We believe the safest approach to understanding the language patterns of people with suicidal thoughts is to study their messages. The choice and arrangement of their words, the sentiment and the rationale all offer insight into the author’s thoughts. </p>
<p>For our <a href="https://ebooks.iospress.nl/volumearticle/56629">recent work</a> we examined more than 100 suicide notes from various <a href="https://www.amazon.com/Suicide-Notes-Predictive-Clues-Patterns/dp/0898853990">texts</a> and identified four relevant language patterns: negative sentiment, constrictive thinking, idioms and logical fallacies.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/introducing-edna-the-chatbot-trained-to-help-patients-make-a-difficult-medical-decision-150847">Introducing Edna: the chatbot trained to help patients make a difficult medical decision</a>
</strong>
</em>
</p>
<hr>
<h2>Negative sentiment and constrictive thinking</h2>
<p>As one would expect, many phrases in the notes we analysed expressed negative sentiment such as:</p>
<blockquote>
<p>…just this heavy, overwhelming despair…</p>
</blockquote>
<p>There was also language that pointed to constrictive thinking. For example:</p>
<blockquote>
<p>I will <em>never</em> escape the darkness or misery…</p>
</blockquote>
<p>The phenomenon of constrictive thoughts and language is <a href="http://www.suicidology-online.com/pdf/SOL-2010-1-5-18.pdf">well documented</a>. Constrictive thinking considers the absolute when dealing with a prolonged source of distress. </p>
<p>For the author in question, there is no compromise. The language that manifests as a result often contains terms such as <em>either/or, always, never, forever, nothing, totally, all</em> and <em>only</em>.</p>
<h2>Language idioms</h2>
<p>Idioms such as “the grass is greener on the other side” were also common — although not directly linked to suicidal ideation. Idioms are often colloquial and culturally derived, with the real meaning being vastly different from the literal interpretation. </p>
<p>Such idioms are problematic for chatbots to understand. Unless a bot has been programmed with the intended meaning, it will operate under the assumption of a literal meaning. </p>
<p>Chatbots can make some disastrous mistakes if they’re not encoded with knowledge of the real meaning behind certain idioms. In the example below, a more suitable response from Siri would have been to redirect the user to a crisis hotline.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An example of Apple’s Siri giving an inappropriate response to the search query: ‘How do I tie a hangman’s noose it’s time to bite the dust’?</span>
<span class="attribution"><span class="source">Author provided</span></span>
</figcaption>
</figure>
<h2>The fallacies in reasoning</h2>
<p>Words such as <em>therefore, ought</em> and their various synonyms require special attention from chatbots. That’s because these are often bridge words between a thought and action. Behind them is some logic consisting of a premise that reaches a conclusion, <a href="https://www.goodreads.com/book/show/22920682-the-burning-brand">such as</a>:</p>
<blockquote>
<p>If I were dead, she would go on living, laughing, trying her luck. But she has thrown me over and still does all those things. <em>Therefore</em>, I am as dead.</p>
</blockquote>
<p>This closely resemblances a common fallacy (an example of faulty reasoning) called <a href="https://en.wikipedia.org/wiki/Affirming_the_consequent">affirming the consequent</a>. Below is a more pathological example of this, which has been called <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1943-278X.1981.tb01006.x">catastrophic logic</a>:</p>
<blockquote>
<p>I have failed at everything. If I do this, I will succeed.</p>
</blockquote>
<p>This is an example of a semantic <a href="https://plato.stanford.edu/entries/fallacies/">fallacy</a> (and constrictive thinking) concerning the meaning of <em>I</em>, which changes between the two clauses that make up the second sentence.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/6757205/">This fallacy</a> occurs when the author expresses they will experience feelings such as happiness or success after completing suicide — which is what <em>this</em> refers to in the note above. This kind of <a href="https://www.amazon.com/Voices-Death-Edwin-S-Shneidman/dp/0060140232">“autopilot” mode</a> was often described by people who gave psychological recounts in interviews after attempting suicide.</p>
<h2>Preparing future chatbots</h2>
<p>The good news is detecting negative sentiment and constrictive language can be achieved with off-the-shelf algorithms and publicly available data. Chatbot developers can (and should) implement these algorithms.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=545&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=545&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=545&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=684&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=684&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=684&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Our smoking cessation chatbot Quin can detect general negative statements with constrictive thinking.</span>
<span class="attribution"><span class="source">Author provided</span></span>
</figcaption>
</figure>
<p>Generally speaking, the bot’s performance and detection accuracy will depend on the quality and size of the training data. As such, there should never be just one algorithm involved in detecting language related to poor mental health. </p>
<p>Detecting logic reasoning styles is a <a href="https://ebooks.iospress.nl/volumearticle/56629">new and promising area of research</a>. Formal logic is well established in mathematics and computer science, but to establish a machine logic for commonsense reasoning that would detect these fallacies is no small feat. </p>
<p>Here’s an example of our system thinking about a brief conversation that included a semantic fallacy mentioned earlier. Notice it first hypothesises what <em>this</em> could refer to, based on its interactions with the user.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=580&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=580&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=580&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Our chatbots use a logic system in which a stream of ‘thoughts’ can be used to form hypothesises, predictions and presuppositions. But just like a human, the reasoning is fallible.</span>
<span class="attribution"><span class="source">Author provided</span></span>
</figcaption>
</figure>
<p>Although this technology still requires further research and development, it provides machines a necessary — albeit primitive — understanding of how words can relate to complex real-world scenarios (which is basically what semantics is about). </p>
<p>And machines will need this capability if they are to ultimately address sensitive human affairs — first by detecting warning signs, and then delivering the appropriate response. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-future-of-chatbots-is-more-than-just-small-talk-53293">The future of chatbots is more than just small-talk</a>
</strong>
</em>
</p>
<hr>
<p><strong><em>If you or someone you know needs support, you can call Lifeline at any time on 13 11 14. If someone’s life is in danger, call 000 immediately.</em></strong></p><img src="https://counter.theconversation.com/content/169828/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Individuals who experience suicidal thoughts can show signs of this in the language they use. We analysed more than 100 suicide notes to find these language patterns.David Ireland, Senior Research Scientist at the Australian E-Health Research Centre., CSIRODana Kai Bradford, Principal Research Scientist, Australian eHealth Research Centre, CSIROLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1711102021-11-04T00:51:21Z2021-11-04T00:51:21ZRecruiting more mental health workers won’t stop suicides. Preventing child abuse and neglect will<figure><img src="https://images.theconversation.com/files/429896/original/file-20211103-21-1gb152a.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/teddy-bear-sitting-raining-vintage-filter-765892621">Shutterstock</a></span></figcaption></figure><p>Two major reports on mental health and suicide released this week suggest two very different solutions to preventing suicides. </p>
<p>One, from the <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House/Mental_Health_and_Suicide_Prevention/MHSP/Report">House of Representatives Select Committee on Mental Health and Suicide Prevention</a>, recommends putting more resources into the mental health workforce. This includes recruiting and training more health professionals.</p>
<p>This might sound commendable, but <a href="https://journals.sagepub.com/doi/full/10.1177/0004867420924104">I argue</a> the evidence shows this is unlikely to work.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1455670823734243332"}"></div></p>
<p>The other report, from the <a href="https://www.aihw.gov.au/reports/burden-of-disease/health-impact-suicide-self-inflicted-injuries-2019/contents/about">Australian Institute of Health and Welfare</a> (AIHW) released today, provides the latest data on suicide and self-harm. This report makes no recommendations about preventing suicide. However, it identifies child abuse and neglect as a major modifiable risk factor for suicide right across the lifespan.</p>
<p>This approach to preventing suicide, involving removing the underlying causes, has <a href="https://www.childhoodadversity.org.au/media/3dnlakks/summary_evidence_interventions_report_v1.pdf">more evidence to back it</a>. Yet this was barely mentioned in the select committee report.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-asked-9-000-australians-about-their-mental-health-needs-post-covid-this-is-what-they-want-165885">We asked 9,000 Australians about their mental health needs post-COVID — this is what they want</a>
</strong>
</em>
</p>
<hr>
<h2>More health workers unlikely to reduce suicide</h2>
<p>In my own <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House/Mental_Health_and_Suicide_Prevention/MHSP/Submissions">submission</a> to the select committee report, I argued increasing treatment resources is unlikely to reduce rates of suicide. </p>
<p>Over the past 15 years or so, Australia has <a href="https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/summary">substantially increased spending on mental health services</a> and expanded the mental health workforce considerably. </p>
<p>However, the suicide rate has been trending upward over this period. The AIHW report noted that between 2003 and 2019, the loss of life due to suicide increased by 13%. </p>
<p>It could be argued suicide would have risen even more over this period without the increase in services or the increase in services has not been sufficient to meet demand. </p>
<p>However, an examination of <a href="https://journals.sagepub.com/doi/10.1177/0004867419838053">long-term suicide trends in Australia over three decades</a> show no evidence various implemented service innovations and mental health policies have had any impact.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429895/original/file-20211103-23-15g4u9s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Doctor or nurse putting hand on patient's shoulder" src="https://images.theconversation.com/files/429895/original/file-20211103-23-15g4u9s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429895/original/file-20211103-23-15g4u9s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429895/original/file-20211103-23-15g4u9s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429895/original/file-20211103-23-15g4u9s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429895/original/file-20211103-23-15g4u9s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429895/original/file-20211103-23-15g4u9s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429895/original/file-20211103-23-15g4u9s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">More mental health doctors and nurses won’t necessarily fix the problem.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nurse-treating-teenage-girl-suffering-depression-361337108">Shutterstock</a></span>
</figcaption>
</figure>
<p>While it might be expected treating mental health problems with talk therapy or medication would reduce suicide deaths, there is <a href="https://pubmed.ncbi.nlm.nih.gov/28428338/">very little evidence from randomised trials</a> to support a reduction in suicide as a result of treatment.</p>
<p>A major limitation of any attempt to reduce suicide is that suicidal feelings often arise relatively quickly in response to overwhelming events. These include relationship breakdown, loss of a job, financial crisis or trouble with the law. </p>
<p>Suicidal actions can also be impulsive. This may be particularly the case for males and is more likely when the person has been using alcohol. In such circumstances, if a mental health professional was present, they may be able to support the person and prevent a suicide. </p>
<p>However, in practice, it is unlikely a professional will be present when a crisis occurs. This is why it is important everyone in the community has <a href="https://theconversation.com/how-to-ask-someone-youre-worried-about-if-theyre-thinking-of-suicide-100237">basic suicide prevention skills</a>, as they may be in the best position to provide support on the spot.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-ask-someone-youre-worried-about-if-theyre-thinking-of-suicide-100237">How to ask someone you're worried about if they're thinking of suicide</a>
</strong>
</em>
</p>
<hr>
<h2>Could preventing child abuse and neglect work?</h2>
<p>The AIHW estimates child abuse and neglect account for around a third of the burden of suicide and self-harm in females and around a quarter in males. “Burden” refers to the combined effects of suicide and self-harm on years of life lost and disability.</p>
<p>However, this is only a theoretical calculation based on what would occur if child abuse and neglect could be eliminated. The AIHW report does not suggest how Australia could go about reducing, let alone eliminating, this risk factor.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/complex-trauma-how-abuse-and-neglect-can-have-life-long-effects-32329">Complex trauma: how abuse and neglect can have life-long effects</a>
</strong>
</em>
</p>
<hr>
<p>Reducing child abuse and neglect sounds like a difficult task and any benefits for suicide prevention would take decades to see. </p>
<p>However, there is evidence it is possible to reduce this and other childhood adversities that increase risk for suicide. </p>
<p>The <a href="https://www.childhoodadversity.org.au/">Centre for Research Excellence in Childhood Adversity and Mental Health</a>, with which I am affiliated, has <a href="https://www.childhoodadversity.org.au/media/3dnlakks/summary_evidence_interventions_report_v1.pdf">reviewed the international evidence</a>.</p>
<p>We found high-quality evidence for a number of interventions to reduce these adversities or lessen their impact on children.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429899/original/file-20211103-25-dkz3qb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Therapist holding up emojis to toddler" src="https://images.theconversation.com/files/429899/original/file-20211103-25-dkz3qb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429899/original/file-20211103-25-dkz3qb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429899/original/file-20211103-25-dkz3qb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429899/original/file-20211103-25-dkz3qb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429899/original/file-20211103-25-dkz3qb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429899/original/file-20211103-25-dkz3qb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429899/original/file-20211103-25-dkz3qb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We should be aiming for more early intervention in at-risk children.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-psicologist-toddler-doing-therapy-1531855292">Shutterstock</a></span>
</figcaption>
</figure>
<p>To find out which interventions would best suit Australia’s needs, we convened a panel of experts and sought their consensus on national priorities. </p>
<p><a href="https://journals.sagepub.com/doi/abs/10.1177/00048674211025717">The experts’ recommendations</a> included:</p>
<ul>
<li><p>training programs to improve the quality of parenting</p></li>
<li><p>home visiting programs where a nurse visits at-risk families with young children</p></li>
<li><p>school programs to prevent bullying</p></li>
<li><p>psychological therapies for children exposed to trauma.</p></li>
</ul>
<p>These programs <a href="https://www.childhoodadversity.org.au/media/3dnlakks/summary_evidence_interventions_report_v1.pdf">can work in various ways to protect children</a>. These include improving the capacity of parents to care for themselves and their children, reducing adverse events such as bullying, and reducing the impact of adversities once they have occurred. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/treating-a-childs-mental-illness-sometimes-means-getting-the-whole-family-involved-169729">Treating a child's mental illness sometimes means getting the whole family involved</a>
</strong>
</em>
</p>
<hr>
<h2>Where to next for suicide prevention?</h2>
<p>On the surface, training more mental health professionals and providing more services seems a plausible approach to preventing suicide that is relatively easy to implement. However, the evidence does not support this actually works.</p>
<p>There is no one approach of achieving a lasting reduction in suicide in Australia. The <a href="https://www.suicidepreventionaust.org/news/statsandfacts">causes of suicide are complex</a> and require a multi-pronged solution.</p>
<p>However, reducing childhood adversities is part of the solution that has been neglected. Australia needs to give it greater priority.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/171110/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Jorm holds a National Health and Medical Research Council Investigator Grant. He is a Chief Investigator on the Centre for Research Excellence on Childhood Adversity and Mental Health which receives funding from the National Health and Medical Research Council and Beyond Blue. He is also an unpaid Director of Mental Health First Aid International, Editor-in-Chief of Mental Health & Prevention, Chair of the Research Committee of Prevention United and a member of the Alliance for the Prevention of Mental Disorders.</span></em></p>Despite more spending on mental health services, suicide rates continue to climb. So in light of two major new reports released this week, we need to rethink our strategy to save lives.Anthony Jorm, Professor emeritus, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1638632021-10-06T16:30:18Z2021-10-06T16:30:18ZUnderstanding the early-life origins of suicide: Vulnerability may begin even before birth<figure><img src="https://images.theconversation.com/files/424824/original/file-20211005-19-1cjc5q8.jpg?ixlib=rb-1.1.0&rect=219%2C323%2C4365%2C3120&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vulnerability to suicide may build up throughout the course of life, and may start with events occurring in the perinatal period and infancy.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Suicide is a tragic event. Unfortunately, <a href="https://www.who.int/news/item/09-09-2019-suicide-one-person-dies-every-40-seconds">every 40 seconds, a person dies by suicide</a>. Beyond the premature loss of an individual’s life, <a href="https://doi.org/10.1111/sltb.12450">more that 100 people may be affected</a> by each suicide, including family, friends and community members. </p>
<p>People considering their own death have often gone through long periods of intense suffering and internal struggles. They may have endured mental illness and experienced a range of adverse life events. Helping people suffering from a mental disorder and/or going through a difficult time is therefore of the utmost importance to preventing suicide. </p>
<p>However, evidence from research conducted in the past two decades has highlighted that suicide is not only the result of such contributing factors around the time of death. Instead, vulnerability to suicide may build up throughout the course of life. It may start with events occurring very early in life, in the perinatal period and infancy, that have long-lasting influences on suicide in adulthood.</p>
<h2>The developmental origins of health and diseases</h2>
<p>In the 1990s, British epidemiologist David Barker noticed that children born with low birth weight (less than 2.5 kilograms) or preterm (before 37 weeks) were more likely to develop chronic conditions such as <a href="https://doi.org/10.1056/NEJMra0708473">cardiovascular or metabolic diseases</a> as adults. These observations served as the foundation of the <a href="https://doi.org/10.1093/inthealth/ihy006">developmental origins of health and diseases</a> (or DOHaD) hypothesis. </p>
<p>The DOHaD hypothesis suggests that exposure to environmental influences during the critical period of fetal development could have significant consequences on an individual’s short- and long-term health. This knowledge promoted <a href="http://www.project-earlynutrition.eu/eneu/">early-life interventions</a> such as prenatal and infant nutrition to improve long-term outcomes. It also supported <a href="https://www.who.int/news-room/fact-sheets/detail/preterm-birth">guidelines to promote quality care</a> before, between and during pregnancies.</p>
<p>As such, the DOHaD hypothesis has increased scientific interest in understanding how early-life events influence the risk of other health problems, including suicide.</p>
<h2>Early-life origins of suicide</h2>
<figure class="align-right ">
<img alt="Illustration of a fetus and a network of interconnected dots." src="https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424649/original/file-20211005-19-rez0dc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">When the fetus is exposed to adversity, it may adapt to survive a harsh environment in utero.</span>
<span class="attribution"><span class="source">(Pixabay/Canva)</span></span>
</figcaption>
</figure>
<p>As researchers with the <a href="http://www.lifespanproject.net/">LIFESPAN research project</a>, our goal is to better understand whether early-life factors influence the risk of suicide later in life, and how. If early life factors are associated with suicide, suicide prevention strategies need to be implemented early in life.</p>
<p>Within the LIFESPAN project, we recently conducted a <a href="https://doi.org/10.1016/S2215-0366(19)30077-X">meta-analysis</a> looking at 42 articles from 21 longitudinal cohort studies from Europe, North America, South America and Asia. It examined associations of 14 early-life factors in the prenatal and perinatal periods — including low birth weight, obstetric complications, impoverished socio-economic conditions of the family at childbirth and young parental age — with later suicide. </p>
<p>Out of the 14 factors investigated, seven were associated with suicide in adulthood, providing support for the DOHaD hypothesis. The strongest early-life influences on later suicide were parental characteristics such as low parental education, low family socio-economic conditions and young maternal age, as well as restricted fetal growth, including <a href="https://doi.org/10.1192/bjp.2021.15">low birth weight</a>.</p>
<p>For example, researchers found that children born with a lower birth weight or <a href="https://doi.org/10.1093/ije/dyab038">who were premature</a> were more likely to die by suicide than children born with normal birth weight. They also found that children of <a href="https://doi.org/10.1016/S0140-6736(04)17099-2">teenage parents</a> were more likely to die by suicide than children of older parents, and that children born to parents with <a href="https://doi.org/10.1093/aje/kwt014">lower levels of education</a> were more likely to die by suicide than children born to parents with higher levels of education. </p>
<p>It is important to note that these are epidemiological findings that should not be directly applied to the single individual, but rather they should be applied to the population. We cannot consider a prematurely born baby as being at risk of suicide, but in a given population, babies born prematurely are, on average, at higher risk of dying by suicide than children born at term.</p>
<h2>How early-life risk factors increase suicide risk</h2>
<figure class="align-center ">
<img alt="Illustration of a person's silhouette in a sad posture" src="https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424672/original/file-20211005-23-1wm6y6k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If early life factors are associated with suicide, suicide prevention strategies need to be implemented early in life.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>An important followup question is to understand <a href="https://doi.org/10.1017/S0033291720002974">why factors occurring very early in life may influence behaviour happening decades later</a>. A first theory implicates social mechanisms. Socio-economic factors (such as poverty or lower education levels) are key determinants of health and tend to be <a href="https://doi.org/10.1007/s13524-012-0120-1">transmitted from one generation to another</a>. </p>
<p>Children born to a family with low financial resources may have restricted access to quality education, health care and life opportunities. This may increase their chances of being confronted with financial and social problems in adulthood, which may in turn increase suicide risk. In other words, social and economic problems that increase suicide risk in adulthood may be, in part, the continuation of the socioeconomic conditions of the family into which a child was born. </p>
<p>This is also true for non-monetary indicators of socio-economic position, such as <a href="https://doi.org/10.1177/0002716217729471">parental education</a>. Parents who are young and less educated may not have the material and emotional resources to provide their children with the best start in life. Providing resources to young parents from low socio-economic conditions may therefore be an opportunity to improve their child’s health in adulthood, and consequently decreasing suicide risk.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of a blue human silhouette with clouds and rain in its head" src="https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=799&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=799&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=799&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1004&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1004&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424825/original/file-20211005-17-1ojeeii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1004&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The capacity to cope with life stress, also known as resilience, is a key protective factor for suicide and mental health problems in general.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>A second theory implicates <a href="https://doi.org/10.1073/pnas.2023598118">brain development</a>. The DOHaD hypothesis states that when the fetus is exposed to adversity, it reacts with adaptations to survive a harsh environment in utero. These adaptations may result in impairments in brain development, which are in turn associated with decreased cognitive skills that may further reduce a person’s capacity to deal with stressful events later in life. The capacity to cope with life stress, also known as resilience, is a key protective factor for suicide and mental health problems in general. </p>
<p>Reducing risk factors that may determine <a href="https://doi.org/10.1056/NEJMra0708473">low birth weight or fetal suffering</a>, such as poor nutrition, infections, exposure to chemicals or hormonal perturbations, is important for the health of the offspring. However, interventions to boost resilience among children who have experienced adversity during the fetal period may also be a promising avenue for preventing later problems, including suicide.</p>
<h2>Suicide prevention from an early-life perspective</h2>
<p>Early prevention is universally recognized as a leading way to <a href="https://doi.org/10.1542/peds.2017-3174">reduce health problems</a> while <a href="https://heckmanequation.org/resource/invest-in-early-childhood-development-reduce-deficits-strengthen-the-economy/">minimizing societal costs</a>. Early prevention often means removing or reducing risk factors in a population before a health problem manifests. </p>
<p>In this perspective, research on the early-life origins of suicide invites us to integrate interventions at the individual level with prevention at the population level. It supports the need to think about suicide prevention as a long-term, rather than uniquely a short-term, endeavour with the goal of reducing vulnerability to suicide during the life course. </p>
<p>Public health policy providing the best environment for children to grow up may have the potential to build resilience and reduce the long-term vulnerability to suicide.</p>
<p><em>If you or someone you know is thinking about suicide, call 911 for emergency services. For support, call Canada Suicide Prevention Service at 1-866-277-3553 (from Québec) or 1-833-456-4566 (other provinces), or send a text to 45645. Visit <a href="https://www.crisisservicescanada.ca/en/">Crisis Services Canada</a> for more resources.</em></p><img src="https://counter.theconversation.com/content/163863/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement no. 793396 (awarded to Massimiliano Orri).
Massimiliano Orri is affiliated with the Bordeaux Population Health Research Centre, INSERM U1219, University of Bordeaux</span></em></p><p class="fine-print"><em><span>Marie-Claude Geoffroy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Early life influences have been linked to higher risk of suicide later in life. Reducing those risks, and boosting resilience in children exposed to them, may help reduce suicide rates.Massimiliano Orri, Assistant Professor, McGill Group for Suicide Studies, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill UniversityMarie-Claude Geoffroy, Assistant Professor, Department of Educational and Counselling Psychology and Canada Research Chair in Youth Suicide Prevention, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1670342021-09-10T12:28:08Z2021-09-10T12:28:08ZAmerican Muslims are at high risk of suicide – 20 years post-9/11, the links between Islamophobia and suicide remain unexplored<figure><img src="https://images.theconversation.com/files/419891/original/file-20210907-14-y57odp.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">American Muslims are two times as likely to attempt suicide compared to other major faith groups.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/indian-woman-royalty-free-image/854681654">MmeEmil/E+ via Getty Images</a></span></figcaption></figure><p>This year, 9/11 holds a dual significance for Americans across the country. It not only marked the 20th anniversary of the tragic events and lives lost since Sept. 11, 2001, but also <a href="https://afsp.org/national-suicide-prevention-week">National Suicide Prevention Awareness Week</a>. For American Muslims who are both victims of <a href="https://news.gallup.com/poll/157082/islamophobia-understanding-anti-muslim-sentiment-west.aspx">increased rates of Islamophobic violence</a> and survivors of suicide attempts, this juxtaposition is especially stark. </p>
<p>In the field of <a href="https://dx.doi.org/10.2105%2FAJPH.2016.303374">public health</a>, Islamophobia is recognized as akin to racism in how it leads to <a href="https://dx.doi.org/10.2105%2FAJPH.2018.304402">negative physical and psychological health outcomes</a>. But this definition misses the crucial elements of <a href="https://doi.org/10.1002/9781119240716.ch7">structural violence</a> and social stigma that underlie the <a href="https://www.cair.com/press_releases/cair-releases-2021-mid-year-snapshot-report-on-anti-muslim-bias-incidents/">hate crimes and microaggressions</a> American Muslims face. These elements are not only the key ingredients in such acts of social violence, but also the same risk factors for individual <a href="https://www.mirecc.va.gov/visn19/docs/SDVCS.pdf">self-directed violence, which is the definition of suicide</a>.</p>
<p>I am the first self-identifying Muslim American to <a href="https://reporter.nih.gov/search/aPO5qRI4RUO2eEzUQ0BbWA/project-details/10156678">receive federal funding</a> from the National Institutes of Health to conduct grassroots mental health research within the American Muslim community. I identify as a victim of Islamophobic violence and a <a href="https://www.amelianooroshiro.com">survivor of a suicide attempt</a>. The hypothesis of my research is that the past two decades of anti-Muslim stigma in the sociopolitical climate of post-9/11 America have created the <a href="https://doi.org/10.2105/AJPH.2018.304419">necessary conditions</a> for young Muslims in America to internalize self-hatred and ultimately attempt suicide.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/419887/original/file-20210907-14-qjwnoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people wearing headscarves looking at another person out of frame standing on a blurred out street." src="https://images.theconversation.com/files/419887/original/file-20210907-14-qjwnoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419887/original/file-20210907-14-qjwnoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419887/original/file-20210907-14-qjwnoc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419887/original/file-20210907-14-qjwnoc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419887/original/file-20210907-14-qjwnoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419887/original/file-20210907-14-qjwnoc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419887/original/file-20210907-14-qjwnoc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">American Muslims constitute a diverse group of racial minorities and immigrants with unique life experiences.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/muslim-women-in-discussion-after-run-after-work-royalty-free-image/1204464585">Thomas Barwick/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<h2>Suicide disparities and risk factors in American Muslims</h2>
<p>Suicide is a <a href="https://www.nimh.nih.gov/health/statistics/suicide">major public health concern</a> worldwide. It is a top 10 leading cause of death in this country and the No. 1 leading cause of death in <a href="https://theconversation.com/asian-american-young-adults-are-the-only-racial-group-with-suicide-as-their-leading-cause-of-death-so-why-is-no-one-talking-about-this-158030">certain populations</a>. A July 2021 study revealed that American Muslims report <a href="https://doi.org/10.1001/jamapsychiatry.2021.1813">two times the odds of a suicide attempt</a> in their life compared to other faith groups. These findings suggest a disparity and indicate that there is a unique set of factors that increases American Muslims’ risk of suicide. </p>
<p>In general, there are many elements that contribute to <a href="https://www.cdc.gov/suicide/factors/index.html">suicide risk</a>. Some of these include a past history of mental illness, knowing someone who previously attempted suicide and having access to lethal means like guns. Research studies on suicide risk in American Muslims, however, must specifically account for our distinct experience of being <a href="https://libguides.uwinnipeg.ca/c.php?g=370387&p=2502732">racialized</a>, stigmatized and <a href="https://www.theguardian.com/inequality/2017/nov/08/us-vs-them-the-sinister-techniques-of-othering-and-how-to-avoid-them">“othered”</a> in post-9/11 America. Given the unique <a href="https://www.ispu.org/thought-leadership/muslim-american-experience-bibliography/">experience of Islamophobia</a> that Muslims in America face, a scientific focus on these social factors is essential for studies on American Muslims. </p>
<p>A <a href="https://www.pewforum.org/2019/07/23/feelings-toward-religious-groups/">2019 Pew Research Center survey</a> measuring the level of warmth or coldness that U.S. adults felt toward certain religious groups found that Muslims were placed toward the extremes of the cold end of the scale. A 2017 survey from Pew found that <a href="https://www.pewforum.org/2017/07/26/how-the-u-s-general-public-views-muslims-and-islam/">half of U.S. adults</a> said Islam is not a part of mainstream society and perceived at least some Muslims as anti-American. </p>
<p>These attitudes point to how being a Muslim has been stigmatized in America. There is abundant evidence that <a href="https://doi.org/10.2105/AJPH.2012.301069">stigma is a fundamental cause of health disparities</a>, especially as it relates to <a href="https://www.apa.org/career-development/structural-stigma.pdf">suicide among people with minority identities</a>. I argue that the stigma of being Muslim in America results in exposure to Islamophobic violence that can lead to increased suicide risk and disparity. </p>
<h2>The intersectionality of Muslim American identity</h2>
<p>But being Muslim is not the only form of stigma and structural violence that American Muslims face. American Muslims are a <a href="https://www.pewresearch.org/fact-tank/2017/01/31/worlds-muslim-population-more-widespread-than-you-might-think/">very heterogenous group</a> with <a href="https://theconversation.com/muslims-arrived-in-america-400-years-ago-as-part-of-the-slave-trade-and-today-are-vastly-diverse-113168">diverse</a> backgrounds as <a href="https://www.pewresearch.org/fact-tank/2019/01/17/black-muslims-account-for-a-fifth-of-all-u-s-muslims-and-about-half-are-converts-to-islam/">racial minorities</a> and <a href="https://www.thoughtco.com/voluntary-migration-definition-1435455">forced and voluntary migrants</a>. Coming from over 77 countries, <a href="https://www.pewresearch.org/politics/2011/08/30/section-1-a-demographic-portrait-of-muslim-americans/">nearly 80%</a> of us are first- or second-generation immigrants, and the majority are racial and ethnic minorities. It is the combined identities of being a Muslim, a racial or ethnic minority and of immigrant-origin that results in <a href="https://doi.org/10.1186/s12916-018-1246-9">intersectional stigma</a>– these identities converge and interact with each other in ways that can negatively affect health. </p>
<p>Therefore, a more scientifically accurate understanding of Islamophobia endorses the intersectionality of our stigma as a key variable contributing to suicide risk. Research on American Muslims addresses the dearth of scientific knowledge on culturally specific social factors of suicide. Yet for American Muslims, what factors contribute to our risk for suicide and what protective factors build our resilience are still to be uncovered.</p>
<h2>Challenges in American Muslim mental health research</h2>
<p>Prior to 2006, the <a href="https://pubmed.ncbi.nlm.nih.gov/?term=(muslim)%20AND%20(%22mental%20health%22)&sort=">PubMed</a> research database returned fewer than 70 search results on “Muslim” and “mental health.” Major grants for funding research on this topic were nonexistent. The launch of the <a href="https://www.doi.org/10.1080/15564900600980517">Journal of Muslim Mental Health</a> that year attempted to fill this crucial research gap. Today, the over 700 search results with the terms “Muslim” and “mental health” still represent less than one-thousandth of a percent of over 320,000 results on <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22mental+health%22+">mental health overall</a>. Evidently, the study of suicide in American Muslims itself faces disparities.</p>
<p>A major barrier to expanding research on American Muslim mental health is access to federal funding. The <a href="https://www.nimhd.nih.gov/about/overview/">National Institute on Minority Health and Health Disparities</a> designates certain groups as disparity populations, which does not include faith groups. While Muslims <a href="https://www.pewresearch.org/fact-tank/2016/01/06/a-new-estimate-of-the-u-s-muslim-population/">constitute only 1%</a> of the U.S. population, we are projected to become the <a href="https://www.pewresearch.org/fact-tank/2017/04/06/why-muslims-are-the-worlds-fastest-growing-religious-group/">world’s largest faith group</a> by the second half of this century. Even so, <a href="https://doi.org/10.2105/ajph.2019.305285">data on American Muslim health is missing</a> due to a lack of research resources and scientific interest. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/419888/original/file-20210907-19-ied5r6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up profile of person with beard on a dark background." src="https://images.theconversation.com/files/419888/original/file-20210907-19-ied5r6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419888/original/file-20210907-19-ied5r6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=621&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419888/original/file-20210907-19-ied5r6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=621&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419888/original/file-20210907-19-ied5r6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=621&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419888/original/file-20210907-19-ied5r6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=781&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419888/original/file-20210907-19-ied5r6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=781&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419888/original/file-20210907-19-ied5r6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=781&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Because of how American Muslims are demographically defined in research, health data about this community is lacking.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/portrait-of-a-man-in-dark-background-royalty-free-image/1221419415">Jasmin Merdan/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>Research on American Muslims relies on select elements of our identities as racial minorities and immigrants to qualify for research funding. But these qualities alone do not fully capture American Muslim lived experiences with Islamophobia and faith-based stigma, prejudice and discrimination. Without data and research on our community, American Muslims may not be considered a disparity group under current classifications and therefore miss critical funding opportunities.</p>
<h2>Suicide research on American Muslims may advance insights across diverse communities</h2>
<p>What will America look like by the time we mark the 50th anniversary of 9/11? </p>
<p>By 2051, the <a href="https://www.washingtonpost.com/dc-md-va/2021/08/12/census-data-race-ethnicity-neighborhoods/">diversification of the American population</a> will reveal a <a href="https://www.nytimes.com/2021/08/24/opinion/us-census-majority-minority.html">majority minority</a> racial and ethnic demographic. Already, the majority of youth under 18 are people of color. Forty years from now, first- and second-generation immigrants will encompass <a href="https://www.pewresearch.org/social-trends/2013/02/07/second-generation-americans/">over a third of the population</a>. </p>
<p>Alarmingly, <a href="https://dx.doi.org/10.3390%2Fijerph15071438">second-generation immigrants</a> worldwide are considered an at-risk group for suicide. The diverse new generations in America are born into adverse conditions that expose them to <a href="https://www.ptsd.va.gov/publications/rq_docs/V32N1.pdf">race-based trauma</a> and <a href="https://www.apa.org/pi/aids/resources/exchange/2012/04/minority-stress">minority stress</a>, or the cumulative negative health effects caused by racism and by being a part of a stigmatized minority group, respectively.</p>
<p>The intersectional discrimination that American Muslims already experience today makes a strong case that we are a crucial reference group when it comes to future mental health research on diverse and marginalized communities. The immense value of culturally relevant research on suicide among American Muslims is evident from its substantial potential to apply across different racial, ethnic and immigrant groups. </p>
<p>Insights from the American Muslim lived experience may provide science with the tools to make sure suicide in minority communities becomes a thing of the past.</p>
<p><em>If you are struggling with suicidal thoughts, please call the suicide helpline now at 1-800-273-8255 (TALK) or visit the <a href="https://suicidepreventionlifeline.org/">National Suicide Prevention Lifeline</a> website. You are not alone and there is hope.</em></p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/167034/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amelia Noor-Oshiro receives funding from the National Institute on Minority Health and Health Disparities.</span></em></p>Islamophobia increased post-9/11. Twenty years later, American Muslims are still dealing with the mental health effects – and research barriers limit what is known about what puts them at risk.Amelia Noor-Oshiro, PhD Candidate in Public Health, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1524852021-01-28T18:33:30Z2021-01-28T18:33:30ZTeen suicide prevention during COVID-19: How parents and kids can have honest and safe conversations<figure><img src="https://images.theconversation.com/files/380720/original/file-20210126-21-1so5zfp.jpg?ixlib=rb-1.1.0&rect=0%2C67%2C2995%2C1989&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Don’t wait for teens to come to you. Engage them in conversation.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>“School or no school, it won’t matter.”</p>
<p>“Young people’s issues are minor compared to those of adults.”</p>
<p>As researchers concerned with suicide prevention in youth, we sometimes hear people express sentiments like these about young people in the pandemic. But socialization is an important part of growing up. As much as COVID-19 has affected adults, it may affect children and teens even more.</p>
<p>How to explain to a young child why he cannot play with other children? How can children learn to read <a href="https://theconversation.com/covid-19s-teaching-challenges-5-tips-from-pediatric-care-for-teachers-wearing-masks-144446">facial expressions when people wear masks</a>? How to see friends, how to date and form new relationships with social distancing and schools mostly online? Such experiences are so vital to teenage and young adult development.</p>
<p>This new angst is now added to the plethora of <a href="https://doi.org/10.1111/jcpp.12831">mental health issues already affecting young people</a>. Though experts <a href="https://doi.org/10.1136/bmj.m4352">suspect there has been an uptick in suicide in the pandemic</a>, 2020 statistics are not in yet.</p>
<p>How common is teenage suicide?</p>
<p>Suicide is the second leading cause of death in adolescents. Each year in Canada, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896524/">there are more than 200 young lives lost due to suicide</a>.</p>
<p>Many parents wonder what they should know about teen suicide and what they can do to prevent it. With a better understanding of suicide, and with teenagers spending more time at home, we believe that parents can engage in an honest and safe conversation about suicide with their kids.</p>
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<figcaption><span class="caption">‘The Suicide Crisis Line: An Education in Listening’ with crisis line volunteer Dylan Gunaratne | TEDxCalStateLA.</span></figcaption>
</figure>
<h2>What parents should know about teen suicide</h2>
<p>Every life lost to suicide is one too many. When someone dies by suicide, people closest to the deceased are <a href="https://doi.org/10.1111/sltb.12450">severely aggrieved, and members of the community, such as students and teachers at school are afflicted as well</a>.</p>
<p>For each suicide, many more teens think about suicide or attempt suicide. Our research shows that before age 21, <a href="https://doi.org/10.1542/peds.2019-3823">about 22 per cent of adolescents claim to have thought about it, 10 per cent have had serious thoughts and seven per cent have attempted suicide</a>. While the probability of death remains low, the likelihood of ideation (considering or wanting to end one’s own life) or attempts is common.</p>
<p>There is an important sex and gender gap in deaths by suicide: about two or three boys to one girl. However, girls are more prone to attempt suicide.</p>
<p>Why are suicide rates higher in boys? First, boys often use more violent means, making medical intervention difficult. Second, traditional gender roles (“boys are strong”) may encourage the hiding of innermost thoughts and discourage help-seeking. But the gap is closing. Suicide rates are on <a href="https://doi.org/10.1177/0706743720940565">the rise in girls and young women in Canada</a>.</p>
<p>Why do adolescents attempt to take their own lives? This haunting question has no clear answers.</p>
<p>Suicide is a <a href="https://doi.org/10.1016/S0140-6736(15)00234-2">complex phenomenon, with biological, psychological and social interactions</a>. </p>
<figure class="align-left ">
<img alt="Life gets better together graphic." src="https://images.theconversation.com/files/380733/original/file-20210126-17-sbezbo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/380733/original/file-20210126-17-sbezbo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380733/original/file-20210126-17-sbezbo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380733/original/file-20210126-17-sbezbo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380733/original/file-20210126-17-sbezbo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380733/original/file-20210126-17-sbezbo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380733/original/file-20210126-17-sbezbo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The ‘It Gets Better’ project inspires people globally to share stories to remind the next generation of LGBTQ+ youth that hope is out there.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Suicidal thoughts and behaviours are closely <a href="http://doi.org/10.1001/2013.jamapsychiatry.55">tied to mental disorders ranging from major depression, anxious disorder, conduct disorders, attention deficit hyperactivity disorder (ADHD) and alcohol or substance abuse</a>. </p>
<p>Certain personality traits, such as <a href="https://doi.org/10.1542/peds.2013-3677">borderline personality</a>, can also increase suicide risk. </p>
<p>We also know that suicide rates are higher in <a href="http://doi.org/10.1111/jcpp.12831">Indigenous youth and in youth identifying as lesbian, gay, bisexual, transgender</a>, <a href="https://www.suicideinfo.ca/resource/sexual-minorities-suicide-prevention/">queer or questioning (LGBTQ+)</a>.</p>
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<figcaption><span class="caption">‘Tomorrow’s Hope,’ A First Nations youth suicide prevention motion comic from the Government of Alberta.</span></figcaption>
</figure>
<p>Many experts point to increased use of social media and to cyberbullying as factors fuelling the mental health crisis. About 15 per cent of adolescents report having been cyberbullied at least once in any given year. </p>
<p>With the COVID-19 crisis and more time spent online, the risks of excessive screen time, loneliness and cyberbullying could have increased, <a href="https://doi.org/10.1111/jcpp.13158">with associated adverse social and mental health effects</a>.</p>
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<figcaption><span class="caption">‘It Gets Better’ project video.</span></figcaption>
</figure>
<h2>What parents can do to prevent suicide</h2>
<p>Suicidal ideation often signals psychological distress. Thus, suicidal ideation should always be taken seriously.</p>
<p>A recent study in the United States showed that <a href="https://doi.org/10.1542/peds.2018-1771">50 per cent of parents were not aware that their adolescents, especially younger adolescents, were thinking about suicide</a>. </p>
<p>For this reason, it’s important to be there, and be aware. Be especially attentive to warning signs. Don’t wait for teens to come to you. Engage them in conversation.</p>
<p>Be alert for any signs of psychological suffering, non-suicidal self-injury, social isolation, increased drug/alcohol use or researching the internet for potential means. Any step toward exploring suicide or signs of considering a suicide attempt should be considered a red flag.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1263863485932412929"}"></div></p>
<h2>How to respond</h2>
<p><a href="https://afsp.org/teens-and-suicide-what-parents-should-know">The American Foundation for Suicide Prevention</a> recommends that concerned parents ask the question directly. </p>
<p>For instance, a parent might ask: “I am concerned because I’ve noticed that you have been acting differently lately. Some teens undergoing a difficult time can have dark thoughts or even suicidal thoughts: Is it happening with you?”</p>
<p>Asking the question about suicide will show you care. It will not increase suicidal thoughts or put ideas into your child’s head.</p>
<p>The most powerful parental response is to validate your teen’s feelings. To validate does not mean to agree, but to genuinely recognize and accept feelings, thoughts and behaviours.</p>
<p>However, a teen may not feel like sharing or expressing loneliness. When communication is difficult, tell your teen you’re available. Ensure they have someone to confide in.</p>
<p>Validation can be challenging. Parents are encouraged to seek professional help for themselves and to consult <a href="https://www.newharbinger.com/power-validation">self-help books on validation</a>.</p>
<h2>Seek help early</h2>
<p>Most adolescents who transition from ideation to attempt will do it within the first year. Seek help early.</p>
<p>Among teens who attempted suicide, <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/abs/trajectories-of-suicide-attempts-from-early-adolescence-to-emerging-adulthood-prospective-11year-followup-of-a-canadian-cohort/7E82D4882A1FA71D50A40EC7EA04ECF9">about half will make another attempt during the course of adolescence</a>. </p>
<p>For some, the risk continues into adulthood. The risk of dying by suicide is highest for those who attempt more than once. Restricted access to means, such as locking down medication, is an important prevention strategy. </p>
<p>It’s important to know that providing adequate social support and professional mental health care can change outlooks on life. While suicide might appear as a solution to a suffering teenager, it never is. Recovery is always possible. Teenagers with <a href="https://www.penguinrandomhouse.com/books/225252/building-a-life-worth-living-by-marsha-m-linehan/">suicidal ideation need to be reminded it’s never too late to build a life worth living</a>. </p>
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Read more:
<a href="https://theconversation.com/some-students-in-the-class-of-2020-may-face-traumatic-loss-due-to-coronavirus-heres-how-to-help-134937">Some students in the class of 2020 may face traumatic loss due to coronavirus. Here's how to help.</a>
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</em>
</p>
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<p>While initial interventions should focus on safety, long-term treatment seeks to build protective factors, such as self-acceptance, supportive relationships and commitment to positive life goals. In this <a href="https://www.mherc.mb.ca/page.php?id=8">time of recovery</a> stories of advocates who have survived suicide ideation or attempts and moved beyond surviving to thriving can be an important source of hope.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/h2au58zB_kk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">‘From suicidal to hopeful, how I learnt to fight,’ TEDxAuckland talk with Jazz Thornton.</span></figcaption>
</figure>
<h2>Available resources for parents and teens</h2>
<p>Determining suicidal risk is complex, even for the most experienced mental health professional. There is no blood test or brain scan to predict with precision who will make an attempt or who will die by suicide.</p>
<p>We recommend that, according to level of need, parents who are worried call helplines, contact their adolescent’s therapist or take their teen to the hospital emergency department (ER). A visit to the ER may be appropriate when the risk is acute or imminent.</p>
<p>Mental health services are available privately or through public institutions like schools and health clinics. Treatments such as <a href="https://www.newharbinger.com/parenting-teen-who-has-intense-emotions">dialectical behavioural therapy</a>, or cognitive behavioural therapy when parents are involved, have been effective in reducing suicide risk in vulnerable teens.</p>
<p>While you are not expected to know exactly what to do or say if your teen has suicidal thoughts, you can certainly be a valuable source of support.</p>
<p><em>Parents and teens are not alone. If your life or someone else’s is in danger, call 911 for emergency services. For support, <a href="https://kidshelpphone.ca/need-help-now-text-us/">reach Kids Help Phone</a> at 1-800-668-6868, or text CONNECT to 686868. Or, call Canada Suicide Prevention Service (CSPS) at 1-833-456-4566. Visit <a href="https://www.crisisservicescanada.ca/en/">Crisis Services Canada</a> for more resources.</em></p><img src="https://counter.theconversation.com/content/152485/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie-Claude Geoffroy a reçu des financements de American Foundation for Suicide Prevention and The Canadian Institutes of Health Research</span></em></p><p class="fine-print"><em><span>Anthony Gifuni receives funding from the Fonds de Recherche du Québec - Santé (FRQS/MSSS training Program for specialty medicine residents with an interest in pursuing a research career). </span></em></p>Suicide prevention experts believe parents can engage in an honest and safe conversation about suicide with kids.Marie-Claude Geoffroy, Assistant Professor, Department of Educational and Counselling Psychology and Canada Research Chair in Youth Suicide Prevention, McGill UniversityAnthony Gifuni, Visiting Scholar, Department of Psychology, Stanford UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1485972020-11-10T14:18:31Z2020-11-10T14:18:31ZHow you can help veterans every day<figure><img src="https://images.theconversation.com/files/368014/original/file-20201106-13-s06b4t.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C1823%2C1260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">U.S. Army veteran Derek Martin gives his son a big hug at a veteran support group cookout on Nov. 7, 2015. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/army-veteran-derek-martin-takes-a-break-from-manning-the-news-photo/1089851856?adppopup=true"> Jon Hatch/Digital First Media/Boulder Daily Camera via Getty Images</a></span></figcaption></figure><p>As the nation celebrates our <a href="https://data.census.gov/cedsci/table?q=S2101&tid=ACSST1Y2019.S2101">17 million living veterans</a>, it is also important to know that the chance these heroes will end their own lives prematurely is <a href="https://www.mentalhealth.va.gov/docs/data-sheets/2022/2022-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf">still higher than among civilians</a>.</p>
<p><a href="https://doi.org/10.1016/j.amepre.2019.03.014">Among veterans with PTSD</a>, suicide is the fourth most common cause of death. Among veterans younger than 35, it’s second. </p>
<p>Over the past decade, suicide rates have also <a href="https://www.dspo.mil/Portals/113/Documents/2021%20ASR/FY21%20ASR.pdf?ver=1F9QARTc2gfXMGIoqum0Mw%3d%3d">risen among members of the military</a>. For most years since 2017, rates for active-duty service members have been above those of civilians. The same is true for National Guard service members since 2015 and for veterans <a href="https://www.mentalhealth.va.gov/docs/data-sheets/2022/2022-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf">for the past decade</a>.</p>
<p><a href="https://hhs.purdue.edu/directory/shelley-macdermid-wadsworth/">I’m a researcher</a> who studies risk and resilience in military and veteran families. I can tell you that <a href="https://www.dspo.mil/Portals/113/Documents/CY2019%20Suicide%20Report/DoD%20Calendar%20Year%20CY%202019%20Annual%20Suicide%20Report.pdf?ver=YOA4IZVcVA9mzwtsfdO5Ew%3d%3d">the single most common stressor</a> for those who attempt or complete suicide is a serious relationship difficulty with an intimate partner or someone else within the past year. And more than 40% of service members who attempted or completed suicide had been seen within that year by a medical, mental health or social service professional. About one-third communicated a <a href="https://www.pdhealth.mil/sites/default/files/images/docs/TAB_B_2018_DoDSER_Annual_Report-508%20final-9MAR2020.pdf">potential for self-harm</a>. </p>
<figure class="align-center ">
<img alt="A man driving with a big dog sitting in the back seat." src="https://images.theconversation.com/files/368018/original/file-20201106-23-l502ld.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/368018/original/file-20201106-23-l502ld.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/368018/original/file-20201106-23-l502ld.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/368018/original/file-20201106-23-l502ld.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/368018/original/file-20201106-23-l502ld.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/368018/original/file-20201106-23-l502ld.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/368018/original/file-20201106-23-l502ld.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Veteran Chad Brown drives with his service dog, Axe, in Boynton Beach, Fla. on June 19, 2017 to a meeting of Soul River, a group he founded to bring together veterans dealing with PTSD.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/war-veteran-chad-brown-drives-with-his-service-dog-axe-at-news-photo/805920474?adppopup=true">Javier Galeano/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>A ‘good catch’</h2>
<p>It’s not only medical professionals who can help a veteran who is dealing with despair and contemplating death by suicide. You can also help.</p>
<p>Some recent studies have suggested that a <a href="https://theconversation.com/why-predicting-suicide-is-a-difficult-and-complex-challenge-98052">complex array of factors</a> combine to lead a person to contemplate death by suicide. And many things contribute to the feelings of despair that veterans experience. </p>
<p>In addition to post-traumatic stress disorder, other mental health problems and medical challenges, veterans also face unemployment, bereavement and parenting issues. It is easy to understand how veterans might feel overwhelmed and desperate. </p>
<p>Through my work, I’ve heard firsthand the stories of service members and veterans who had decided to take their own lives but did not. Often I’ve observed that it was a “good catch” that did it: a friend or family member answered a call at an odd hour; noticed the person seemed “off” and asked careful questions; stayed with them while summoning professional help; or checked in with them so they wouldn’t feel isolated. Families, friends, neighbors and colleagues all may have opportunities to make these catches. </p>
<p>Peer support programs may also help. Alcoholics Anonymous and Narcotics Anonymous are effective alone or in combination with clinical treatment for substance use disorders. Results regarding mental health problems such as depression are more mixed, but a consistent finding is that peer support <a href="https://doi.org/10.1037/ser0000178">can help promote compliance</a> with treatment, communication with clinicians, improved coping and self-care, and increased feelings of hope and self-efficacy. Studies suggest that <a href="https://doi.org/10.1037/ser0000178">peer support can also help people</a> during transition times, particularly when they are leaving military service to return to civilian life.</p>
<p>Veterans themselves are taking action. In the Department of Veterans Affairs, peer facilitators are key to a new “<a href="https://www.va.gov/WHOLEHEALTH/veteran-resources/Peer-Facilitator-Materials.asp">whole health” approach</a>. American Legion members also offer support aimed at preventing suicide through their <a href="https://www.legion.org/betheone">Be the One campaign</a>.
Across the country, <a href="https://justiceforvets.org/what-is-a-veterans-treatment-court/">veterans treatment courts</a> routinely include mentors to boost the success of clients. </p>
<figure class="align-center ">
<img alt="Those with depression and PTSD can find solace in support groups." src="https://images.theconversation.com/files/365577/original/file-20201026-15-ok3bwc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/365577/original/file-20201026-15-ok3bwc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/365577/original/file-20201026-15-ok3bwc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/365577/original/file-20201026-15-ok3bwc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/365577/original/file-20201026-15-ok3bwc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/365577/original/file-20201026-15-ok3bwc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/365577/original/file-20201026-15-ok3bwc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Support groups can help those with depression and PTSD.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/man-talking-during-a-support-group-meeting-royalty-free-image/1182151564?adppopup=true">Courtney Hale via Getty Images</a></span>
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<h2>Peer support is out there</h2>
<p>Not all peers have to be veterans. Sometimes the strongest connections are with those who have had different challenges and who also can therefore relate – like a family member’s addiction, or one’s own disability or mental health problem.</p>
<p>Many peer networks can help, including the <a href="https://www.nami.org/Support-Education/Mental-Health-Education/NAMI-Family-to-Family">National Alliance on Mental Illness</a>, the <a href="https://www.cancer.org/support-programs-and-services/online-communities.html">American Cancer Society</a> and the <a href="https://www.alz.org/help-support/community/support-groups">Alzheimers Association</a>. Even though they may not focus specifically on suicide, they help reduce isolation, increase social connections, and support coping and self-care.</p>
<p>We can all help to prevent death by suicide. And joining a peer support program or training to make ourselves ready aren’t the only ways. Simply being more attentive as a friend, family member, neighbor or colleague can help. </p>
<p>It is normal for a person to feel awkward when talking to someone contemplating death by suicide. Learning is a great way to prepare. For example, “<a href="https://qprinstitute.com/about-qpr">Question, Persuade, Refer (QPR)</a>” is evidence-based training that can help anyone recognize early warning signs of suicide, learn ways to offer hope and encouragement, and connect with help.</p>
<p>On this Veterans Day, by all means, let’s thank veterans for their service. But perhaps we could challenge ourselves to go further and do service on behalf of others. Who knows what opportunities might arise to make a good catch? </p>
<p>If you or any of your loved ones are in need of help, call, text or chat the <a href="https://suicidepreventionlifeline.org/">National Suicide and Crisis Lifeline</a> at 988. Veterans and military members can dial 988 and then press 1 for special operators. </p>
<p><em>This article was updated on November 10, 2022 with more recent hyperlinks.</em></p><img src="https://counter.theconversation.com/content/148597/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shelley MacDermid Wadsworth receives or has received funding from the Department of Defense, the Department of Veterans Affairs, and the National Institutes of Health. She provides scientific guidance for the Military Child Education Coalition and Combined Arms. </span></em></p>The rate of death by suicide is rising among veterans. The most common stressor is a serious relationship difficulty.Shelley MacDermid Wadsworth, Distinguished Professor of Human Development and Family Studies, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1298212020-09-08T15:02:17Z2020-09-08T15:02:17ZSouth African universities need to know why students’ suicide risk is so high<figure><img src="https://images.theconversation.com/files/310280/original/file-20200115-134784-fz84i3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>An estimated 800,000 people die by <a href="http://www.who.int/mental_health/prevention/suicide/">suicide</a> globally each year. It’s the second most common cause of death in people aged 15 to 29. University students around the globe are more at <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/prevalence-of-suicidal-thoughts-and-behaviours-among-college-students-a-metaanalysis/F31360A7411B35C4AC3B1A8DA67FA016">risk</a> of suicidal behaviour than the general population. It’s important to understand the reasons so that effective interventions can be planned to prevent suffering and death.</p>
<p>An international group of experts, working as part of the World Health Organisation’s <a href="https://www.hcp.med.harvard.edu/wmh/college_student_survey.php">World Mental Health International College Student Initiative</a>, has been established to investigate the high <a href="https://doi.org/10.1017/S0033291716001665">rates</a> of psychological distress among students across the globe, and to address the need for a coordinated response to promote mental health. Researchers from Stellenbosch University and the University of Cape Town in South Africa are part of this network.</p>
<p>Our recent <a href="https://doi.org/10.1080/07481187.2019.1701143">study</a> of first-year students at two large South African universities was part of this initiative. The group we studied had unusually high rates of psychological distress and suicidal behaviour, highlighting the need for campus-based suicide prevention programmes in South Africa.</p>
<p>International <a href="https://doi.org/10.1037/abn0000362">studies</a> show that as many as 31% of students report a common mental disorder in the past 12 months – most frequently depression, anxiety and attention difficulties.<br>
The South African data also <a href="https://doi.org/10.1037/abn0000362">show</a> that in the previous 12 months, 20.8% of first year students had experienced anxiety and 13.6% had experienced depression. With approximately <a href="https://doi.org/10.1186/s12889-019-7218-y">one third of students</a> reporting symptoms of psychological distress in the previous year. This is concerning because our study found that students’ thoughts about suicide tended to start if they had a mental health problem such as depression or anxiety.</p>
<h2>Mental health and suicidal thoughts</h2>
<p>We found that 30.6% of students had thoughts of suicide in the past 12 months, 16.6% had made a suicide plan and 2.4% had attempted suicide. These <a href="https://doi.org/10.1192/bjp.bp.107.037697">rates</a> are markedly higher than those found in the country’s general population. These are also marginally higher than <a href="https://doi.org/10.1017/S0033291717002215">rates</a> typically found among students in other parts of the world. There are no accurate data about the number of students in South Africa who complete suicide. But anecdotal <a href="https://www.wits.ac.za/news/latest-news/in-their-own-words/2018/2018-10/campus-suicide.html">evidence</a> suggests that deaths as a result of suicide among students in South Africa are also a cause for concern.</p>
<p>Most students in our study were between 18 and 21 years old. But those with suicidal thoughts and behaviours reported that these problems started when they were around 15 or 16 years of age. The onset of suicidality prior to age 11 was very low but increased sharply up to age 18. After that there was a marked decline in onset. Less than 15% of students reported that their suicidality started after they were 18 years old. </p>
<p>More than half (57.2%) of students who’d had thoughts of suicide in the past 12 months went on to make a suicide plan. And 19.1% of those who made a plan went on to attempt suicide.</p>
<p>The most common risk factors for suicide include untreated mental health problems, social isolation, financial difficulties, hazardous substance use and <a href="https://doi.apa.org/doiLanding?doi=10.1037%2Fbul0000084">interpersonal conflict</a>. Feeling hopeless, ashamed, powerless and trapped also increase the <a href="https://doi.apa.org/doiLanding?doi=10.1037%2Fbul0000123">risk of suicide</a>, particularly if these painful feelings are unbearable and appear to have no end. </p>
<p>Suicidal behaviour is also sometimes <a href="https://link.springer.com/article/10.1007/s11469-017-9755-x">associated</a> with impulsivity and impaired problem solving skills. </p>
<h2>Way forward</h2>
<p>Because of the link between mental health problems like depression and anxiety and thoughts of suicide, it’s important to promote student mental health as part of campus-based suicide prevention programmes. This is particularly important given the poor access to mental health services in South Africa, and the fact that <a href="https://ijmhs.biomedcentral.com/articles/10.1186/s13033-020-0339-y">less than a third</a> of students who need psychological support receive the care they need. </p>
<p>More research in South Africa is needed to ensure that suicide prevention strategies are correctly tailored and focused to reach students most at risk. This is important given that mental health resources in South Africa are scarce and universities in the country face considerable resource constraints. </p>
<p><a href="https://www.usaf.ac.za">Universities South Africa</a>, an organisation representing South Africa’s universities, recognised the need for action in this area and initiated a national student mental health survey. This research is being funded by the South African Medical Research Council and will be completed this year. The evidence it provides could form the basis of a more scientific approach to promoting student mental health in South Africa and reducing rates of suicide. </p>
<p>Suicide is preventable and effective treatments do exist. It is not always easy to identify someone who is as risk of suicide just from the way they speak or act. But common <a href="https://afsp.org/risk-factors-and-warning-signs">warning signs</a> include talking about death and expressing hopelessness or unbearable pain. Withdrawing and isolating oneself may also signal danger, especially if the person has a history of previous suicide attempts or substance use. </p>
<p>Help is available. If you are feeling suicidal talk to someone about it, stay connected to others and reach out for help. In a suicidal crisis you should contact your doctor or consult a mental health professional. <a href="http://lifelinesa.co.za/">Life Line</a> and the <a href="http://www.sadag.org/index.php?option=com_content&view=article&id=11&Itemid=114">South African Depression and Anxiety Group</a> also offer support.</p><img src="https://counter.theconversation.com/content/129821/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jason Bantjes receives funding from South African Medical Research Council as part of their Mid-Career Scientist Programme. The views presented here do not reflect those of the SAMRC,</span></em></p>Rates of suicidal behaviour are higher among South African students than among the general population or students in other countries. Understanding why will help shape prevention efforts.Jason Bantjes, Associate Professor in the Psychology Department, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1282122020-01-20T19:03:06Z2020-01-20T19:03:06ZPreventing suicide in nursing homes is possible. Here are 3 things we can do to make a start<figure><img src="https://images.theconversation.com/files/310767/original/file-20200119-118343-fq44er.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7348%2C4902&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More than 50% of nursing home residents experience symptoms of depression.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Suicide among nursing home residents is a major concern. Between 2000 and 2013, <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/gps.4862">around 140</a> Australian nursing home residents took their own lives.</p>
<p>This issue has been hidden for too long, and met with minimal efforts targeted at prevention.</p>
<p>We consulted with experts and stakeholders in aged care, geriatric medicine, old age psychiatry, suicide prevention and public policy to develop 11 recommendations for the prevention of suicide among nursing home residents. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/too-many-australians-living-in-nursing-homes-take-their-own-lives-92112">Too many Australians living in nursing homes take their own lives</a>
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<p>In our <a href="https://www.ncbi.nlm.nih.gov/pubmed/31414623">recently published study</a>, we put forward three of these as the highest priorities for implementation: expanding suicide prevention frameworks to include aged care residents, aligning nursing home life with community living, and improving residents’ access to mental heath services.</p>
<h2>The scope of the problem</h2>
<p>Risk factors for suicide among <a href="https://www.ncbi.nlm.nih.gov/pubmed/26010874">nursing home residents</a> include having diagnosed depression, declining physical health, and being within the first 12 months of residency. This suggests adjustment – to the onset of health problems or to life in a nursing home – can be problematic.</p>
<p>More than half of nursing home residents suffer <a href="https://www.aihw.gov.au/getmedia/7ad35fb2-bc14-4692-96b1-c15d73072319/16256.pdf.aspx?inline=true">symptoms of depression</a>. This is compared to 10-15% of adults of the same age living in the community. </p>
<p>Notably, young people in nursing homes (64 years and younger) are <a href="https://doi.org/10.1080/09638288.2019.1696417">three times more likely</a> to take their own life than their counterparts aged 65 and over.</p>
<p>Although the reported number of suicides each year in nursing homes (around ten) is relatively small, deaths from suicide represent only the “tip of the iceberg” of self-harm and suicidal behaviour in nursing homes. Research has shown <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1532-5415.2002.50070.x">one in every seven residents</a> exhibits self harming behaviours on a weekly basis, such as cutting, hitting, or eating foreign objects.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/reducing-depression-in-nursing-homes-requires-more-than-just-antidepressants-38970">Reducing depression in nursing homes requires more than just antidepressants</a>
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</p>
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<h2>Expanding suicide prevention frameworks</h2>
<p>The first key recommendation is expanding existing <a href="https://www2.health.vic.gov.au/about/publications/policiesandguidelines/victorian-suicide-prevention-framework-2016-2025">state</a> and <a href="https://www.lifeinmindaustralia.com.au/splash-page/docs/LIFE-framework-web.pdf">national</a> suicide prevention frameworks to include older adults and those living in institutional settings with targeted prevention strategies.</p>
<p>In practical terms, this would offer care providers clearer guidelines to recognise and address suicidal ideation and behaviour in nursing home residents, taking into account this group’s unique set of risk factors.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/310809/original/file-20200120-118323-d7y0k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/310809/original/file-20200120-118323-d7y0k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/310809/original/file-20200120-118323-d7y0k8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/310809/original/file-20200120-118323-d7y0k8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/310809/original/file-20200120-118323-d7y0k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/310809/original/file-20200120-118323-d7y0k8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/310809/original/file-20200120-118323-d7y0k8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Older people living in nursing homes have a unique set of risk factors for mental health problems.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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</figure>
<h2>Making nursing homes less like institutions</h2>
<p>The second recommendation is aligning nursing home life with community living to make nursing homes a place where most people would be happy to live.</p>
<p>This requires addressing the physical presence of the nursing home within our community. As one research participant commented: </p>
<blockquote>
<p>[…] many care residences isolate residents from the community. Most residences are fortress-like, closed, inward-looking buildings with few public views to the outside.</p>
</blockquote>
<p>Evidence points to <a href="https://www.mja.com.au/journal/2018/208/10/clustered-domestic-residential-aged-care-australia-fewer-hospitalisations-and">better quality of life</a> among residents of smaller cottage style or cluster communal residences, compared to standard Australian models of residential aged care. </p>
<p>We can also look to <a href="https://architizer.com/blog/inspiration/collections/nursing-home-collection/">examples</a> of innovative nursing home design outside of Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-our-residential-aged-care-system-doesnt-care-about-older-peoples-emotional-needs-103336">How our residential aged-care system doesn't care about older people's emotional needs</a>
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<p>Another aspect of this recommendation is addressing the atmosphere and organisational culture within the nursing home. </p>
<p>Organisational culture differs between facilities, but a common thread is staff being more task-oriented, or focused on <a href="https://theconversation.com/red-tape-in-aged-care-shouldnt-force-staff-to-prioritise-ticking-boxes-over-residents-outcomes-121561">ticking boxes</a>, than person-centred in their care approach. This is due to time pressures and is notoriously difficult to change.</p>
<p>Improving the mood in nursing homes would involve emphasising person-centred care, and encouraging residents to be social and involved in the wider community.</p>
<p>Ultimately, we need to address <a href="https://theconversation.com/gods-waiting-room-life-needs-to-be-valued-in-nursing-homes-59980">negative community attitudes</a> towards transitioning into a nursing home and challenge the prevailing societal view <a href="https://theconversation.com/what-is-quality-in-aged-care-heres-what-studies-and-our-readers-say-104852">death is preferable</a> to living in residential aged care.</p>
<h2>Better access to mental health services</h2>
<p>The third recommendation is improving residents’ access to mental health services, including allied health and medical specialists.</p>
<p>This will be essential to manage the high prevalence of depression, anxiety and other mental health issues, as well as to support residents with their progressive decline in health and independence.</p>
<p>We’ve already seen steps to change the Medicare system to ensure residents have access to medical and psychological treatments for mental health disorders, with <a href="https://www.australianageingagenda.com.au/2018/05/11/at-long-last-mental-health-support-for-residents/#.WvUTF80_TSs">additional funding</a> announced in the 2018-19 federal budget.</p>
<p>Further steps might include routine mental health assessments alongside physical health check ups for all residents. This would see mental health issues identified early and treatment plans put in place.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/310811/original/file-20200120-118347-1ik8y22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/310811/original/file-20200120-118347-1ik8y22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/310811/original/file-20200120-118347-1ik8y22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/310811/original/file-20200120-118347-1ik8y22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/310811/original/file-20200120-118347-1ik8y22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/310811/original/file-20200120-118347-1ik8y22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/310811/original/file-20200120-118347-1ik8y22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Encouraging social activities among residents can be part of aligning nursing home life with community living.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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</figure>
<p>We also need to better recognise the traumatic impact of the nursing home environment, where <a href="https://www.gen-agedcaredata.gov.au/Topics/People-leaving-aged-care">more than one-quarter of residents die each year</a>. One participant in our research noted: </p>
<blockquote>
<p>The effect of a dying friend down the corridor is often put in the too hard basket. </p>
</blockquote>
<p>Being more open about death and dying should prompt better support for residents, families and staff.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aged-care-failures-show-how-little-we-value-older-people-and-those-who-care-for-them-103356">Aged care failures show how little we value older people – and those who care for them</a>
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</p>
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<h2>Next steps</h2>
<p>These recommendations provide the first substantive foundation for suicide prevention strategies in nursing homes in Australia. If no action is taken, older people, their families, staff and the community will continue to suffer.</p>
<p>The next step requires action from government, regulators, professional organisations and the aged care sector to support implementation and evaluation of these recommendations.</p>
<p>We don’t need to wait for the <a href="https://agedcare.royalcommission.gov.au/Pages/default.aspx">Royal Commission into Aged Care Quality and Safety</a> to conclude before beginning this important work.</p>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/128212/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Briony Murphy (now Jain) is an Adjunct Senior Research Fellow with the Department of Forensic Medicine, Monash University, and conducted the research highlighted in this article whilst completing a PhD with the same organisation, which was funded by the Australian Government Research Training Program. </span></em></p><p class="fine-print"><em><span>Joseph Ibrahim has received funding from Commonwealth and State Health Departments for research, education and consultancies. He was an expert witness for the Coroner's Court in South Australia, Victoria and New South Wales and provided evidence to the multiple inquiries into aged care including but not limited to the Royal Commission and those lead by Carnell-Paterson, Senate and, House of Representatives. Joseph recently featured in The Good Weekend – People Who Mattered 2019 as a leading health contributor.</span></em></p>Expanding suicide prevention frameworks to include aged care residents, aligning nursing home life with community living, and improving residents’ access to mental heath services will be key.Briony Murphy, Research fellow, Monash UniversityJoseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.