DAY 26 - We Need More Research. Now.

 

Few people know that there has been and continues to be promising research that could have a big impact on suicide prevention efforts. 

Serotonin is a chemical messenger that's believed to act as a mood stabilizer. It's said to help produce healthy sleeping patterns as well as boost your mood. *Numerous studies have shown that there is a precipitous dip in the serotonin levels in a person's brain, just prior to episodes of suicidal ideation and/or suicide attempts.  The reasons for this is not yet understood. However, if there were a reliable way to regularly check serotonin levels in the brains of those who have thoughts of suicide, the severity of their thoughts may be able to be predicted, allowing for effective intervention at critical times. 

**There has also been research that has connected the neurotransmitter GABA with suicide. The role of GABA is to inhibit or reduce the activity of the neurons or nerve cells. GABA plays an important role in behavior, cognition, and the body's response to stress. Research suggests that GABA helps to control fear and anxiety when neurons become overexcited. The GABA neurotransmitter and its receptors are involved in many different brain functions. Imbalances in GABA also are relevant to bipolar disorder, schizophrenia, and anxiety disorder. The GABA neurotransmitter and its receptors are critical to how humans think and act. The same as Serotonin, if we were to be able to monitor GABA imbalances in the brain, we'd be better able to predict when someone is suicidal.

Serotonin and GABA are just two examples of  brain chemistry related risk factors. There are many more. But both research and resources are needed. Because of the stigma around suicide, not enough is being done to put the current research to good use.

Many people know that trisomy 21 relates to Down's syndrome.

Many people know that BRCA is the gene that indicates a predisposition toward breast cancer.

We understand that insulin production is important for diabetics. 

We know how to split a gene.

We must do better when it comes to research about mental health and suicide.

[A partial list of sources, below.]

* https://www.jstage.jst.go.jp/article/jpa2/30/1/30_1_1/_article/-char/ja/

*https://www.sciencedirect.com/science/article/abs/pii/S0140673683925904

*https://www.karger.com/Article/Abstract/68691

** https://www.sciencedaily.com/releases/2010/03/100301102803.htm

** https://www.nature.com/articles/s41598-017-12776-8

** https://www.scientificamerican.com/article/the-origins-of-suicidal-brains/

DAY 23 - Substance Use and Suicide

 

For more posts and information about alcoholism and addiction and their relationship to suicide, click here.

DAY 21 - Geographic Risk Factors

Understanding where there are geographic suicide clusters helps us to determine risk factors, and provides data and information to researchers. 

DAY 20 - Hold Your Children Close.

 

Suicide is the second leading cause of death for young people aged 10 - 24 years old. As parents, educators, family, and friends, we must recognize that youth is a risk factor in and of itself.

Note that bullying, both in person and online, are significant contributors to youth suicide. Policies of no bullies or zero tolerance around bullying behavior are important first steps. 

Letting the kids in your life know that they are cared about and that they have people and places where they can safely discuss their feelings is a crucial part of prevention.

Hold your children close. Don't be afraid to ask. Take a moment today to make sure that the children you are close to know that they are loved.

DAY 19 - Eating Disorders and Suicide

 

A reminder to be kind to all people. And if you are aware or suspect that someone has an eating disorder, please make an extra effort. Most people aren't aware of the amount of self hatred that goes hand in hand with an eating disorder. Those who suffer from these disorders are always in need of compassion. 

U.S. adults with a lifetime history of an eating disorder—anorexia nervosa, bulimia nervosa, or binge eating disorder—are at increased risk of having a suicide attempt history.

Using data from a nationally representative sample of more than 36,000 respondents, researchers looked at the lifetime prevalence of suicide attempts in adults with an eating disorder history. They found that the prevalence of suicide attempts was 24.9% among those with a history of anorexia. Levels of suicide risk were different for each of the two anorexia subtypes. The prevalence of suicide attempts associated with the binge/purge subtype was much higher than the restricting subtype (44.1% and 15.7% respectively).

The researchers also found that 31.4% of those with a history of bulimia and 22.9% of those with a history of binge eating disorder had attempted suicide in their lifetime. After adjusting for sociodemographic variables, individuals with any type of eating disorder history were more likely to have a greater number of suicide attempts compared to those without an eating disorder history.

Source: https://www.sprc.org/news/suicide-attempts-eating-disorders

It Matters

 

Advocacy matters. Voting matters.

In his Military Times article (Will major veterans suicide prevention legislation pass this year, or get stalled by political fights?), Leo Shane II noted the continuing importance of advocacy when it comes to moving suicide prevention legislation forward.

"The future of major legislation on veterans suicide prevention policy in Congress remains unsettled for now despite claims of a breakthrough this week from Senate leaders and pleas from veterans advocates to pass something on the issue as soon as possible."

Even policies that are widely supported are stalled. In example, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act, passed out of the Senate in early August and has received praise from administration officials and veterans advocates alike.

The American Counseling Association also understands the importance of advocacy. In one of their most recent newsletters, they noted some of their successes;

"Due in part to your advocacy efforts, today the House has passed several mental health bills that are endorsed by ACA:

• H.R. 5469, the “Pursuing Equity in Mental Health Act,” introduced by Rep. Bonnie Watson Coleman (D-NJ), and eight other Members of Congress. The bill would authorize federal funding to address mental health inequities among underserved populations, including communities of color. The bill includes provisions that would: create a grant program targeted at high-poverty communities for culturally and linguistically appropriate mental health services; support research into disparities in mental health; reauthorize the Minority Fellowship Program to support more students of color entering the mental health workforce; and study the impact of smartphones and social media on adolescents.
• H.R. 1109, the “Mental Health Services for Students Act,” introduced by Reps. Grace Napolitano (D-CA) and John Katko (R-NY). The bill authorizes grants to fund school-based mental health services. The program would support screening for social, emotional, mental, and behavioral issues, including suicide or substance use disorders; treatment and referral for these issues; development of evidence-based programs for students experiencing these issues; and other strategies for schools to support students and the communities that surround them. The goal of the program is to create partnerships between schools and community-based mental health professionals across the country.
• H.R. 5572, the “Family Support Services for Addiction Act of 2020,” introduced by Reps. David Trone (D-MD) and Daniel Meuser (R-PA). The bill authorizes the Secretary of HHS to award grants to support family community organizations that develop, expand, and enhance evidence-informed family support services for families and family members living with substance use disorders or addiction. The grants may be used to build connections between family support networks, with behavioral health and primary care providers, and foster care services, among others. The grant may also be used to reduce stigma around addiction and addiction treatment, family support outreach activities, and connect families to peer support programs.

It remains to be seen whether the Senate, which will now be in session next week due to the pending Supreme Court nomination, will consider these measures before the November 3rd election. ACA will keep you updated on any developments."

Paying attention to public policy bills and updates is critical. Katie King of the San Jose Spotlight explains the need in her article, Anna Eshoo and Mental Health Advocates Push Suicide Prevention Legislation:

"[Quoting Victor Ojakian, suicide loss survivor] When someone dies from suicide, Ojakian explained, countless others are affected by the loss. Family, friends, neighbors, classmates, co-workers and church members all share in the sorrow; the pain ripples throughout the community and remains for years to come.

That grief casts a wide net in the United States. Recent data from the National Center for Health Statistics shows that suicide has ranked as the 10th leading cause of death for all ages each year since 2008. But some lawmakers in Congress are now taking steps that they hope will save lives.

The Energy and Commerce Committee passed three bills on July 15 related to suicide prevention, including The Campaign to Prevent Suicide Act, which would launch a national media campaign to raise awareness; the Suicide Prevention Lifeline Improvement Act of 2019, which would enhance the National Suicide Prevention Lifeline; and the Suicide Prevention Act, which would establish two grant programs to help hospitals or health centers identify and support at-risk patients.

If signed into law, each bill would provide a notable amount of funding. The lawmakers allotted $10 million each year from fiscal years 2020 through 2024 for the media campaign, and the National Suicide Prevention Lifeline — a nationwide network of more than 160 centers that run crisis hotlines — would see its funding increased to $50 million"

When you vote this November (or before) remember that it is critical that we familiarize ourselves with our elected officials and their stance on mental health and suicide prevention. Learn about the suicide prevention legislation that they have proposed or endorsed. It's important. It matters.

Finally, a note from the American Association of Suicide Prevention in regard to one our suicide prevention legislative successes this past year:

 

On Saturday, October 17, after passing unanimously out of Congress, the National Suicide Hotline Designation Act (S.2661) was signed into law. This historic legislation will support the full implementation of the three-digit "9-8-8" dialing code for the National Suicide Prevention Lifeline through funding guidance, federal reporting, and specialized services for at-risk communities like LGBTQ-youth and Veterans. A well-resourced, easy-to-remember 988 crisis hotline will increase access to necessary resources and support in times of crisis that will save lives.

 

This is a major victory for the suicide prevention movement. Of the nearly 20,000 bills introduced in a Congressional session, less than 1,000 are ever passed by Congress and signed into law.

 

AFSP Field Advocates have supported this effort over the past 3 years by emailing, calling, and meeting with their Members of Congress and writing media outlets across the country. It is through these efforts that we have seen real change to bring our country's mental health system into the 21st century with the full passage of the National Suicide Hotline Designation Act. We thank all of our advocates that have shared their stories and advocated for this landmark legislation.

 

THANK YOU and CONGRATULATIONS! 

 

There is still much more work to be done as we continue to advocate for a world without suicide. But through our joint efforts and your ceaseless passion we will save lives and bring hope to people effected by suicide. You can see AFSP's official press release here.

 

Please note that the 9-8-8 crisis hotline will not be nationally available until July 2022. Callers should continue to access the National Suicide Prevention Lifeline through 1-800-273-8255 until 9-8-8 is fully operational.

As always, we thank you for your support and your advocacy!  

**For additional resources and to learn more about advocacy, please see our Advocacy Page, here.

DA 11 - Never Forget

In addition to the endlessly heartbreaking tragedy of lives lost on September 11, 2001, we will never forget the incredible amount of bravery and sacrifice that was put forth by the fire fighters and police officers who rushed to the scene of the world trade center on that day, and lived on carrying such profound loss and often PTSD. 

When it comes to suicide prevention, we must not overlook those who serve as first responders to tragedies and life threatening situations. First responders have a suicide rate that is ten times that of the general population. In fact, in 2017, more police and fireman died by suicide than in the line of duty. EMT and Paramedic suicide rates are equally high.

If you are a first responder or if you know someone who is, please ensure that your station or place of business provides regular trainings and support services for compassion fatigue and PTSD.

Remember, you are appreciated and you are needed in this world.

Click below to learn more about a crisis call line specifically for those who work as first responders.

[Originally published 9/11/2018]

DAY 10 - World Suicide Prevention DAY

 

Since 2003, World Suicide Prevention Day is an awareness day observed on September 10th, every year. The day serves to provide a worldwide commitment and action to prevent suicides.

Worldwide, close to 800,000 people died from suicide in 2019. This is why worldwide efforts at suicide prevention are critical. We lose someone to suicide every 40 seconds.

Have the conversations. Fund the research. Make resources and treatment readily available. Fight stigma. Do it now.

DAY 4 - Drugs, Alcohol, and Death by Suicide

According to the U.S. Substance Abuse and Mental Health Services Administration, individuals with substance use disorders are particularly susceptible to suicide attempts and dying by suicide. 

Data shows that a diagnosis of alcohol or drug dependence is associated with a suicide risk that is 10 - 15 times greater than the suicide risk in the general population. Acute alcohol intoxication is present in about 30-40 percent of suicide attempts. In 2011, approximately 230,000 emergency department visits resulted from drug-related suicide attempts (and this number has risen since then).

The relationship between addiction and suicide cannot be understated. In order to effectively lower the number of lives lost to suicide, we must improve treatment for both mental illness and addiction.

Speak up and end the stigma around addiction and mental illness. It is time to dismantle the shame experienced by those who suffer from these diseases. Ending stigma is the first step toward paving the way to funding more research on effective treatment.

Begin now.

[Originally published 9/9/2018]

Her Father's Flag

Amon Gift, a US Army veteran, was twenty 23 years old 

when he died by suicide, in January of 2017. 

The photo abiove is of his daughter at his funeral.

I first published this photo as a Beauty of Grief feature in November of 2017. I try to share it again at lease once a year. Memorial Day seems a fitting day to share it again. Its heartbreaking message stands. We are losing too many veterans and active military members to suicide. And, as always - there are too many loss survivors left behind.

If you want to learn more about suicide and the military, I have written about it extensively here on this blog, including sharing statistics, research, and as always - the voices of those who have lost a loved one to suicide.

The reasons for the epidemic of military related suicide are varied and complex. However, the importance of showing our support to individuals is critical. While the overall rate of suicide related military deaths has decreased from 22 per day to 20 per day, suicide is still a leading cause of death for those who are veterans of the US military. And, of significant concern - records kept in 2018 suggest that the suicide rate of active duty members has reached the highest number during the entirety of record keeping. 

Today is Memorial Day. Reach out to someone who is serving or has served in the military. Let them know that they are loved and that you care.

Remember that supporting military related suicide prevention efforts should be happening every single day, as well.

If you are a veteran or actively serving member of the armed forces and you are feeling hopeless or suicidal - please reach out. You can start by calling the Veterans Crisis Line. Your service to the country is appreciated. Your life matters. You are needed in this world.

(Thank you to Kelsey Leann Tobin for permission to use the beautiful photo of her daughter, above.)

Day 28 - A Whole Body Tragedy

PTSD is a whole-body tragedy, an integral human event 

of enormous proportions with massive repercussions.
― Susan Pease Banitt

Let's talk about Post-Traumatic Stress Disorder (PTSD). Our internal response to trauma is often the platform for suicidal thinking, behaviors, and completions. If we do not understand and address the role trauma plays in the lives of individuals who die by suicide, we won't achieve comprehensive suicide prevention.

To better understand the connection between suicide and PTSD, let's start with a definition. Post-traumatic stress disorder (PTSD) is a psychiatric condition that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault. PTSD can also occur after sudden severe emotional trauma such as experiencing the unexpected loss or death of a loved one. Finally, PTSD can also occur after prolonged exposure to environments in which a person is being bullied, neglected, or suffering abuse (physically, sexually, mentally, emotionally, or otherwise).

To put this into perspective, let's look at some data:

• An estimated 70 percent of adults in the United States have experienced a traumatic event at least once in their lives and up to 20 percent of these people go on to develop PTSD.
• An estimated 5 percent of Americans—more than 13 million people—have PTSD at any given time.
• Approximately 8 percent of all adults (1 of 13 people in this country) will develop PTSD during their lifetime.
• An estimated 1 out of 10 women will get PTSD at some time in their lives. Women are about twice as likely as men to develop PTSD.

And again, putting the suicide/PTSD link into perspective, when we look at those who are the highest risk of suicide, a diagnosis or probable diagnosis of PTSD is pervasive:

Those serving in the military.
First responders.
Those having been bullied.
Individuals who identify as part of the LGBTQ community.
Those having suffered sexual abuse.
Those having suffered a head injury.
Survivors of suicide loss.

Given the close connection between trauma and death by suicide, we have to look at what is happening to the brain, during severe or prolonged traumatic events.

Many people incorrectly assume that PTSD is related to purely mental/emotional reactions to these events. This misconception is not only highly stigmatizing - it is also inaccurate. Unfortunately this stigma impairs our ability to prioritize the research needed to improve treatment of PTSD. Stigma suggests that PTSD only happens to those who are not emotionally strong enough to manage their feelings during and after trauma. This belief is very damaging because it further shames those who are suffering, and profoundly denigrates the deceased.

Here is a graphic that shows what is actually happening at the inception of PTSD:

What the graphic shows is that during trauma, your emotions and reactions are dictated by physiological responses and not by rational thinking. Survival mode is not conducive to well thought out rational behavior. By matter of necessity, we react based on sights, sounds and emotional stimuli. We are not reacting based on thoughts or access to cognitive information. Our behavior becomes singularly oriented toward avoidance of further pain and trauma. Our actions are guided by physiological changes in the brain, not thought processes. Here are the most important words in the graphic above, as they apply to our traumatic events:

This is NOT a cognitive choice.

The physical and mental response to trauma has nothing to do with thought, cognition, decision making, personality, weakness, or strength. It has everything to do with a brain's physiological response to the trauma.

Following trauma, some brains are unable, without effective treatment, to maintain consistent physiological stability. Some reasons are known, many more are not. More research is desperately needed.

For those with PTSD, they may have periods of significant stability, where they are able to manage many of life's normal ups and downs with appropriate levels of pain and frustration. When their PTSD is activated however, their reactions to normal stressors may seem heightened to a level that appears unreasonable. Some of the symptoms of PTSD include ongoing emotional distress, personality disturbances and/or changes, severe anxiety/aggression/depression and poor impulse control. All of these symptoms, while seemingly based in 'thought processes', are actually dictated by the same brain changes that occurred at the inception of the PTSD.

Some of the most successful treatments for PTSD involve behavioral therapies, not necessarily cognitive therapies. In other words, we are seeing success in treating those with PTSD when we work to provide them with skills for recognizing and managing symptoms when they occur. Traditional 'talk therapy' that encourages a person to remember and discuss events in their life, has shown a propensity for re-traumatizing those with PTSD. We must make long term and easily accessible behavioral (skills based) therapies available to all individuals who are suffering from PTSD.

There are other significant developments in PTSD research. Researchers have found that the condition can be detected via brain scans.

"Brain imaging studies have shown alterations in a circuit including medial prefrontal cortex (including anterior cingulate), hippocampus, and amygdala in PTSD. Many of these studies have used different methods to trigger PTSD symptoms (eg, using traumatic cues) and then look at brain function. Stimulation of the noradrenergic system with yohimbine resulted in a failure of activation in dorsolateral prefrontal, temporal, parietal, and orbitofrontal cortex, and decreased function in the hippocampus.173 Exposure to traumatic reminders in the form of traumatic slides and/or sounds or traumatic scripts was associated with an increase in PTSD symptoms, decreased blood flow, and/or failure of activation in the medial prefrontal cortex/anterior cingulate, including Brodmann's area 25, or subcallosal gyrus, area 32 and 24, as measured with positron emission tomography (PET) or functional MRI (fMRI)"

What do all those words above amount to? Again:

PTSD induced behaviors and 'decisions' or 'choices' actually reflect the physical impact of traumatic events on the brain's ability to respond, and do not reflect decisions or choices.

PTSD is a formidable enemy when it comes to suicide, but there is hope. With more research, we will be able to further streamline finding the best behavioral therapies to support those with PTSD symptoms, and we may be able to identify other treatments that could have a restorative effect on the damaged brain functioning that occurs when PTSD is present.

If you suffer from PTSD, know that your symptoms are not your fault and not a product of your being weak, or selfish, or 'unable' to handle your problems. Know that there is hope and there is help, and that many people are fighting to ensure that better treatments are on their way.

If you love someone with PTSD, please keep all of the above in mind, educate yourself further, advocate for your loved one so that they have access to support services and treatment of their own, and reach out for support for yourself. And always have the suicide prevention lifeline phone number (1-800-273-8255) on hand. (There is a special number for those in the military, as well.)

And if you have lost someone to PTSD, let me say this: For my generation and all of those prior, we have spent our entire lives conditioned to believe that when someone dies by suicide, they made a 'choice' of some kind. We take that belief and compare and contrast the 'choice' to die with a choice we think they could have made to stay alive and be a part of our lives.

The questions we are asking are agonizing. They are also inaccurate. With PTSD, the accurate question, is this:

What impacted my loved one's thought processes so that they were unable to make the choice to live?

That is the question that we must answer. Those answers will lead us to the solutions that will begin to appreciatively save lives.

We must end the stigma. Have the conversations. Make resources available. Fund the research.

BEGIN NOW.

Day 27 - Brain Injury and Suicide Risk

Tiaina Baul "Junior" Seau Jr.
January 19, 1969 - May 2, 2012

NFL linebacker.
10-time All-Pro. 
12-time Pro Bowl selection.
Named to the NFL 1990s All-Decade Team. 
Elected to the Pro Football Hall of Fame.
In 2012 Seau died by suicide. 
He was diagnosed with CTE posthumously.  
Junior Seau was 43 years old when he died.

The link between brain injuries and suicide is undeniable. Studies have shown that both major and minor traumatic brain injuries (TBI) increase suicide risk. Chronic Traumatic Encephalopathy (CTE), a degenerative brain disease often associated with athletes, is the result of having suffered multiple head traumas.

The list of those with CTE who had no prior history of mental illness, and then began exhibiting symptoms and/or died by suicide, is extensive. Here is a partial list of Former NFL players with confirmed CTE:

• Jovan Belcher^[4]
• Forrest Blue^[5]
• Bill Bryant^[6]
• Lew Carpenter^[7]
• Dwight Clark^[8]
• Daniel Colchico^[6]
• Lou Creekmur^[9]
• Art DeCarlo^[6]
• Shane Dronett^[10]
• Dave Duerson^[11][12]
• Pete Duranko^[6]
• Ray Easterling^[12][13][14]
• Frank Gifford^[12][15]
• Cookie Gilchrist^[12][16]
• John Grimsley^[17]
• Chris Henry^[12][18]
• Aaron Hernandez^[19]
• Jim Hudson^[6]
• Gerry Huth^[6]
• Tom Keating^[6]
• Terry Long^[1]
• Rob Lytle^[20]
• John Mackey^[12][21]
• Ollie Matson^[12][22]
• Tom McHale^[12][23]
• Earl Morrall^[24]
• Paul Oliver^[6]
• Joe O'Malley^[6]
• Mike Pyle^[6]
• Adrian Robinson^[25]
• Scott Ross ^[26]
• Tyler Sash^[12][27]
• Junior Seau^[12][28]
• Bubba Smith^[12][29]
• Robert Sowell^[6]
• Ken Stabler^[12][30]

The list above is woefully incomplete. At present, CTE can only be diagnosed post mortem. Some families are not comfortable donating the brains of their loved ones for autopsies related to CTE research. Also, understanding how to identify CTE is relatively new. Recognizing and diagnosing the condition has only been possible since 2002. Prior to that, the degenerative brain disease was not yet understood.

CTE was initially identified by the pathologist Bennet Omalu, MD, who performed the autopsy on former NFL player Michael Webster.Webster was 50 years old when he died. Webster had slowly developed increasingly significant symptoms of mental illness during his career in the NFL and following his retirement. After extensive research, Dr. Omalu was the first to discover abnormal proteins in his brain, referred to as neurofibrillary tangles. Today, brain imaging scans show the  permanent impact that concussion related CTE has on a brain:

For those living with the disease, the symptoms are devastating.

(Image above from the Patrick Risha Stop CTE Awareness Foundation)

Given this, understanding and addressing the risk of dying by suicide when a person has suffered a head injury is critical to overall suicide prevention. We must do more research on how to identify brain injury, as often a person who has incurred an injury initially has no (or very minor) outward symptoms.

It is absolutely imperative that people understand that the physiological response to (even minor) head injuries can have a profound impact on long term behavioral symptoms. The two are inextricably linked. Recent studies have shown that having suffered just one concussion leaves a person with a suicide risk that is three times that of those who have not had a head injury at any time during their life.

The urgency of needing more research speaks for itself. Postmortem is not an acceptable time to diagnose a fatal disease.

As a survivor of suicide loss, I also need to say this. The discovery of CTE makes a very important statement about the impact of stigma on suicide. Consider that until CTE was diagnosable, the public perception of of those who suffered from the related symptoms of mental illness and/or died by suicide, was accusatory and ugly. Like all who have struggled with these issues or lost their life in this way - those with CTE were often considered weak of character. Many athletes who died by suicide were deemed selfish and unappreciative of their success.

The pervasive belief that individuals suffering from symptoms of mental illness and who die by suicide are at 'fault' for their death is often wholly inaccurate.

The vast majority of the public still believe that a person who dies by suicide was making a 'choice' that they had entire control over. This is a belief that leads to agonizing questions asked by those left behind. This stigma is believed by the majority of the public, including those who have lost someone to suicide and those who are directly suffering from mental illness. Considering the fact that even one concussion raises suicide risk, why aren't we making diagnosis, awareness, and treatment of CTE and related conditions more of a priority?

Why aren't we comforting those who have lost someone to suicide by telling them that there are often definitive physiological reasons behind years of erratic behavior and suicidality?

Survivors of suicide loss torment themselves with guilt and rage related to questions around why the person they lost did not love them enough to stay alive, or why their own love wasn't enough to keep someone alive.

Again, it is critical that we do more research and that we develop better tools for diagnosis, treatment, and management of all factors that contribute to suicide risk, CTE and head injuries included.