Julie Dees, MA, LPC, director of Behavioral Health at PPMC, and Maria Oquendo, MD, PhD
If you or someone you know is in crisis, call the 24/7 toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Last month, many were shaken by the tragic news of Kate Spade’s and Anthony Bourdain’s suicides and found themselves asking how individuals who were so successful and seemingly happy could be in such difficult, dark places. In response to these losses and to reinforce the fact that suicide crosses all demographics and circumstances, PPMC invited Maria Oquendo, MD, PhD, chair of Psychiatry at the Perelman School of Medicine and immediate past president of the American Psychiatric Association and the International Academy of Suicide Research, to lead a seminar and Q&A focused on promoting awareness and prevention strategies.
The CDC reports that suicide is the tenth leading cause of death in the U.S. (60 percent via firearm), and the rate has continued to rise in nearly every state, making it not only a mental health issue, but a public health crisis. While women are more likely to report suicidal thoughts and attempts, men are more likely to complete a suicide attempt. The rates of suicide deaths tend to be higher among older Americans, but a distressing 11 percent of adolescent girls and 8 percent of adolescent boys have acknowledged a suicide attempt in the last year, underscoring the point that suicidal ideation does not discriminate.
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Oquendo explained that our culture typically views death by suicide as a “catastrophic reaction” to a negative stressor, but suicide is rarely caused by any single factor. Some individuals have “vulnerable brains” with specific abnormalities in their stress response and serotonin systems that predispose them to suicidal thoughts, and just like many other medical conditions, there are clear links between a family history of suicide and suicidal risk.
Approximately 90 percent of those who die by suicide also struggle with mental disorders such as depression, bipolar disorder, or schizophrenia, though many unfortunately aren’t diagnosed until after death. While further research is needed regarding the remaining 10 percent, Oquendo hypothesizes that “some individuals are so effective at hiding their symptoms and remaining completely emotionally reserved” that there often isn’t any way to know what’s happening in their heads until it’s too late.
Nevertheless, while the statistics are bleak, suicide is completely preventable.
“Suicide is one of the only situations where patients and doctors don’t want the same outcome. Acutely suicidal folks literally can’t imagine an alternate solution and are convinced those left behind will be better off without them,” Oquendo said. “Healthcare workers are uniquely positioned to help patients and loved ones deal with thoughts of suicide. Just starting the conversation, even if it seems overwhelming, is the first step and can save lives.”
Following Oquendo’s discussion, she invited questions from the audience. Dozens of hands flew up. Here are a few of those questions and answers.
Q: There’s been a lot of news coverage about teenagers and even elementary-age children committing suicide due to things like cyberbullying. How should we talk to kids about this?
A: There are a number of studies going on now that are looking into the relationship between bullying and cyberbullying and rates of suicide, but what we do know is that, statistically, bullies are actually more likely to die by suicide. We also know that there’s a clear link between childhood trauma and a heightened risk for suicidal behavior and thoughts. The suicide rates for adolescents, and especially for very young children between ages five and nine, are generally low, but distressed kids need help regardless of age. Research has shown that talking about suicide in a way appropriate for a child’s age and development does not actually increase their risk for suicide. For example, when my own kids were about 14 or 15, I emphasized that suicidal ideation is like a fever. It’s not a normal response, and it can become dangerous quickly. It’s a symptom alerting you to a larger problem that needs to be addressed with help from a professional.
Q: Let’s say we recognize that someone is in distress and may be suicidal. How do we initiate that conversation? What if we make it worse?
A: Again, talking about suicide does not make someone suicidal or make them more likely to attempt suicide, but rather it may help them open up about a topic that still seems taboo. I think even those of us who work in Behavioral Health and have worked with these patients for a long time can admit that talking about suicide can be very overwhelming, but research shows that individuals who are acutely suicidal don’t necessarily want to die; they just want their pain to stop. People who live through their attempts tend to express relief, so if you notice someone is having trouble sleeping, withdrawing at school or at work, struggling with substance abuse or another disorder, or is in any kind of distress, initiate the conversation. Talk to them openly, honestly, and with empathy. The American Foundation for Suicide Prevention’s motto is “Talk saves lives,” and it’s true.
Some individuals experience persistent suicidal ideation, while others are reactive and variable according to their environment, but either way, suicide is a crisis, and the best thing to do to get through a crisis is to have a safety plan in place. In addition to identifying their triggers, a person dealing with suicidal ideation should have an idea of some favorite activities to do or some trusted people to call or hang out with to distract them, as well as professionals they can reach out to in case of an emergency. In your conversation with them, first figure out if they’re in immediate danger, and if they’re not, ask them about their feelings. Listen and take them seriously, but don’t let the conversation dwell on suicide. Distraction is key because these episodes are typically short-lived.
Q: You mentioned that the suicide rate is going up every year in the United States. What is Penn Medicine doing to address this?
A: The CDC estimates that the rate of death by suicide in the United States is about 14 per 100,000 people, which is pretty high when compared to the world’s other major countries. By 2030, it’s believed that depression will become the number one disability in the world, and since many communities and individuals lack access to mental health resources (though I always promote free, anonymous groups!), that’s a concern. At Penn, we’re working hard to integrate psychiatric screenings and interventions into all realms of care. Penn’s Center for the Prevention of Suicide has also developed Cognitive Therapy for Suicide Prevention, a brief, targeted intervention for those who have previously attempted or thought of suicide. The center is also studying whether Safety Planning Intervention can reduce suicidal behaviors and prompt patients to seek mental health and substance abuse treatment programs.