Suicide Prevention

Abstract

Suicide prevention begins with understanding depression and mental health protection.

The Corona Virus Disease 2019 caused by SARS-CoV-2 (COVID-19) is affecting physical and mental health in communities across the United States. Suicide was the 10th leading cause of death overall and second leading cause of death for persons aged 10 to 34 years in the United States in 2017 and 2018 (Centers for Disease Control and Prevention [CDC], 2020). Since COVID-19 emerged, symptoms of anxiety disorders, depression, trauma- and stressor-related disorder (TSRD), and thoughts of suicide have increased considerably (Czeisler et al., 2020). Pandemic-related changes in daily routines, job loss, financial worry, and child care concerns have placed enormous burdens on individuals and families, adding extra stress to workers with preexisting mental illness. In June 2020, a web-based sample from across the United States found increased complaints of depression and anxiety, as well as thoughts of suicide compared with the same time last year (Czeisler et al., 2020). Despite its limitations, this study found young males, especially Hispanics and Blacks, unpaid caregivers, and essential workers were most at risk for adverse mental health outcomes, increased substance use, and suicide ideation. Persons employed had greater mental health complaints than those not working.

Occupational health nurses must be vigilant in the detection of depression and intervene early. Common signs of depression include changes in appetite, energy levels, and sleep patterns; difficulty concentrating; and new or increased use of tobacco, alcohol, or other drugs. Five evidence-based steps help guide intervening when a depressed worker becomes suicidal (National Suicide Prevention Lifeline [NSPL], n.d.). First, ask the direct question, “Are you thinking about suicide?” Directly asking about suicide conveys nonjudgmental and supportive concern. Ask about emotional pain and reasons for staying alive; focus on why they want to live but avoid promising to keep their suicidal ideation secret. Give the worker positive feedback for discussing thoughts of suicide. Second, remain with them and ask who can be called to help them. Promote connectedness between the individual and their support system. Decreasing isolation is a protective factor against suicide because you want to keep them safe. Third, determine if the worker has a plan for suicide by asking how they would carry-out the suicide attempt. The occupational health nurse should inquire if the worker has access to the method, such as guns or drugs. Other questions include where the attempt would occur and when. The more detailed the plan, the more serious the person is about suicide. Fourth, connect the worker with resources for immediate help and ongoing support. Call national resources, such as the Substance Abuse and Mental Health Services Administration (SAMHSA) disaster distress hotline at 1-800-985-5990 or the NSPL at 1-800-273-8255. For more immediate help, contact local counseling services or call 911 for transport to a local emergency department. The last step involves follow-up. After the worker gets help, stay in touch by in-person visits, phone calls, or texts. Contacting the worker can promote connectedness and potentially decrease their suicide risk (NSPL, n.d.).

Educating employees about depression and mental health, suicide warning signs, and ways to protect those at risk is the first step toward suicide prevention; a good resource is this free webinar for community residents on suicide prevention during COVID-19: https://www.paloaltou.edu/news/suicide-prevention-during-covid-19-joyce-chu-phd. The American Psychological Association (APA) has information about COVID-19 and suicide prevention: https://www.apa.org/monitor/2020/06/covid-suicide. The CDC also addresses suicide prevention: https://www.cdc.gov/injury/features/be-there-prevent-suicide/index.html; information and prevention strategies for occupational health providers is available from NIOSH: https://www.cdc.gov/niosh/topics/stress/suicide.html and the NIOSH Science blog: https://blogs.cdc.gov/niosh-science-blog/2020/09/09/suicide-in-construction/. Maintaining relationships with friends and family, adopting a new hobby, staying physically active, getting adequate sleep, continuing good eating habits, and limiting COVID-related media exposure are effective ways to prevent depression and promote mental health.