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April 30, 2020
Woman staring out of window

By Francine Broder, PsyD

Suicide continues to increase in the United States and around the world (Hedegaard et al., 2020), and it is within this context that COVID-19 showed up. Risk factors associated with an increase in suicide, such as social isolation and an economic downturn, are front and center as we all grapple with how to adjust to living with a pandemic.

Social distancing gives rise to closed businesses and cancellations across all industries. Many Americans are out of work, struggling with managing day-to-day life with little to no income and facing uncertain financial futures. Economic downturns have historically been associated with increased suicide rates (Oyesanya et al., 2015) and, sadly, the current situation may be no different.

While social distancing interventions have been implemented to curb the spread of the virus, an unintended consequence is the negative impact reduction in human contact has, especially for those who are emotionally vulnerable. Loneliness due to social isolation has long been understood as a risk factor for suicide. For example, rates of people dying by suicide spiked following the SARS outbreak in 2003 (Yip et al., 2010).

Even before COVID-19, approximately 25% of Americans aged 65 and older reported suffering from subjective feelings of isolation (National Academies of Sciences Engineering Medicine, 2020). A major component of the treatment program developed by Wenzel, Brown and Beck (2009) focuses on helping suicidal patients develop social support networks. Likewise, Miller et al. (2017) developed the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) for suicide screening, and provision of safety plans. They found that the follow-up phone calls built into the protocol yielded a significant decrease in harm.

How Can We Help?

Adam Grant, an organizational psychologist and self-described introvert, suggests that it is important to keep in mind that even people who feel best with a great deal of solitude require social interaction. In a recent New York Times article, he discussed how a caring, yet brief encounter can have a positive impact and can leave us feeling “seen.” He shared that as a graduate student working during winter break after his roommates went home for the holidays, he felt isolated and lonely. He made a list of the 100 people who mattered most in his life and spent a week writing each an email about what he appreciated about them. As the replies rolled in, he no longer felt lonely. In other words, it doesn’t necessarily take a major effort to go from feeling lonely to feeling connected.

As people at risk for suicide may think twice before heading to over-crowded emergency rooms, it is imperative that we reach vulnerable people in a suicidal crisis. There are suicide prevention interventions that were designed to be delivered remotely via telemedicine platforms. And results from the randomized clinical trials, Caring Letters Intervention (Luxton, et al., 2014), suggest that a simple intervention such as regularly communicating through personalized letters sent through the mail reduced suicide rates in people who had made attempts.

The current pandemic adds another layer of challenge to suicide prevention, but if we remember to differentiate physical distance from social and emotional distance, and that small acts of connection have demonstrated reduction in feelings of isolation and disconnection, we can mitigate the adverse effects of social isolation and loneliness.

References:

Oyesanya, M., Lopez-Morinigo, J., Dutta, R. (2015). Systematic review of suicide in economic recession. World Journal of Psychiatry, 5(2), 243-254.

Grant, A. www.nytimes.com/2020/04/16smarter-living/coronavirus-introverts-lonely.html

Hedegaard, H., Curtin, S., Warner, M. (2020). Increase in Suicide Mortality in the United States, 1999-2018. National Center for Health Statistics, CDC, NCHS Data Brief, No. 362.

Miller, I., Camargo, C., Arias, S., Sullivan, A., Allen, M., Goldstein, A. Manton, A. Espinola, J., Jones, R., Hasagawa, K., & Boudreaux, E. (2017). Suicide prevention in an emergency department population:  The ED_SAFE study. JAMA Psychiatry, 1;74(6), 563-570.

Motto, J., Bostrom, A. (2001). A randomized controlled trial of postcrisis suicide prevention. Psychiatric Services, 52(6), 828-833.

The National Academies of Sciences Engineering Medicine, (2020). Social isolation and loneliness in older adults. www.nap.edu/catalog/25663/social-isolation-and-loneliness-in-older-adults-opportunities-for-the

Wenzel, A., Brown, G., Beck, AT, (2009). Cognitive Therapy for Suicidal Patients. Washington, DC:  American Psychological Association: 

Yip, P., Cheung, Y., Cahua, P., Law, Y. (2010). The impact of epidemic outbreak:  the case of severe acute respiratory syndrome (SARS) and suicide among older adults in Hong Kong. Crisis, 31(2), 86-92.

Luxton, D. D., Thomas, E. K., Chipps, J., Relova, R. M., Brown, D., McLay, R., ... & Smolenski, D. J. (2014). Caring letters for suicide prevention: Implementation of a multi-site randomized clinical trial in the US military and veteran affairs healthcare systems. Contemporary Clinical Trials, 37(2), 252-260.

Resources:

National Suicide Prevention Lifeline (1-800-273-TALK)

Crisis Text Line (741741)