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Edition 48 – COVID-19 and Suicide – Why Our Messaging Matters


Edition 48 – COVID-19

COVID-19 and Suicide – Why Our Messaging Matters

By Maureen Iselin, Kristen Quinlan PhD, Colleen Carr MPH

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Citation

Iselin M, Quinlan K, Carr C. COVID-19 and suicide – why our messaging matters. HPHR. 2021;48. DOI:10.54111/0001/VV15

COVID-19 and Suicide – Why Our Messaging Matters

Abstract

For many Americans, the COVID-19 pandemic and other political, social, economic, and environmental stressors of the past two years have resulted in serious declines in overall well-being and increases in suicide-related risk factors. Unfortunately, much of the messaging to the public during the pandemic has normalized suicide as a reaction to current stressors—which has the potential to increase risk of suicide contagion especially among those who are most vulnerable, including Black, Latino, American Indian/Alaska Native, and LGBTQ communities. The national narrative about suicide, and suicide prevention, needs to change—shifting to empower the public with concrete resources on how to talk about suicide and suicide prevention, and how to spread messages of hope, resilience, and help-seeking. As the nation continues to talk openly about the physical impacts of COVID-19, we must have the same open dialogue about the mental health impacts of the pandemic. This type of messaging is critical to the nation’s overall well-being moving forward.

The past two years have been volatile and traumatic for many people in the U.S. In addition to the COVID-19 pandemic, we have witnessed violence, racial injustice, a contested national election, devastating economic losses, employment uncertainty, and environmental disasters. Any of these events, by themselves or in combination with each other, could impact our nation’s mental health. And in the wake of these stressors, many Americans are experiencing risk factors for suicide—such as job loss, financial strain, food insecurity1, social isolation, hopelessness, or misuse and abuse of alcohol or other drugs2—and reporting increased mental health challenges—such as depression, anxiety, and suicide-related thoughts.3

 

As our nation has struggled to work through the events of the past two years, we have started talking more about the importance of mental health promotion and suicide prevention. While it is important to bring awareness to mental health in general, and suicide prevention specifically, the ways in which we talk and message about these issues to the public matters. Suicide contagion—the increased risk of suicide from exposure to suicide or suicidal behaviors—can be exacerbated by media reports of suicide with oversimplified explanations that are prolonged or repetitive, or that normalize suicide as a reaction to stressful events.4 Throughout the pandemic, both traditional and social media content have repeatedly lacked inclusion of effective solutions or help-seeking resources and, instead, included oversimplified reports tying youth suicides to school closures and normalizing suicide as a response to increased first responder work stress.5,6 These messages, while well-intentioned, could increase the risk of suicide contagion, especially among those who are already struggling, and also underestimate the impact of other risk factors that combine to contribute to suicide.   

The Power of Words & Coordination

Since its launch in 2010, the National Action Alliance for Suicide Prevention (Action Alliance)—the nation’s public-private partnership for suicide prevention housed at Education Development Center—has led efforts to align the field’s messaging about suicide and suicide prevention to both elevate awareness and spur action7, since coordinated messaging—distributed by various partners and channels—has a better chance of achieving impact and creating change. For example, a review on coordinated messaging found there is “greater success associated with repeated exposure to messages through multiple types of media and with…organized efforts that tailor messages to homogenous populations.”8 Furthermore, evidence suggests that informational messages promoting relatively straightforward actions can change behavior in broad populations.8

That’s why the Action Alliance—in its role convening leaders from government, business, and the non-profit sector—regularly activates its Messaging Work Group (MWG) to respond to data releases, new research, or other timely events or topics that would benefit from a coordinated and action-oriented response.9 The Action Alliance’s MWG is comprised of nearly 25 leading public and private sector partners at the forefront of national mental health and suicide prevention efforts who are committed to collective, aligned, and action-oriented prevention-focused messaging.

In the wake of COVID-19 and potentially harmful messaging appearing in both traditional and social media, the Action Alliance’s MWG led efforts to identify key messages about suicide prevention and mental health in the context of the pandemic.10 These key messages include:  

  • Acting now can help prevent negative mental health impacts of the pandemic.
    • We must respond to both our nation’s physical and mental health needs during, and in the aftermath of, this public health emergency. Just like we have taken steps to mitigate the physical impact of COVID-19, we must also take steps as a country to mitigate the potential mental health impacts.
  • The mental health impacts of the pandemic highlight the importance of a national, coordinated effort to promote mental health and prevent suicide.
    • We have an unprecedented opportunity to address the critical gaps in our nation’s mental health and suicide prevention systems. A national mental health and suicide prevention response must include both traditional and non-traditional sectors, including industries where employees have been significantly impacted by COVID-19 (e.g., airlines, hospitality, restaurants, food and beverage, healthcare).
  • Social connectedness is key and all Americans can play a role in supporting others.
    • Research indicates that a sense of belonging and social connectedness improves physical, mental, and emotional well-being. In fact, connectedness is a proven protective factor against suicide.
    • Having a caring and non-judgmental conversation with someone who is struggling or in crisis can help build connection and belonging. There are tools available to help anyone have these types of conversations with the people in their lives, including:
      • American Foundation for Suicide Prevention’s #RealConvo,11 National Suicide Prevention Lifeline’s #BeThe1To,12 and Mental Health America’s #TimetoTalk.13

    • While early data from 2020 shows overall suicide rates have actually decreased nationwide, we know that some racial/ethnic groups and age demographics have experienced an increase in suicide rates during this same time14. In addition, we know many Americans have experienced risk factors for suicide, including job loss, financial insecurity, and social isolation.15, 2

      • Some populations—including minority populations (particularly Black, Hispanic, and American Indian/Alaska Native), frontline workers, LGBTQ youth, or those experiencing job loss or financial strain—may be experiencing increased mental health challenges of the COVID-19 pandemic. Public messaging about available resources may help mitigate risk for these populations.
    • Help is available for those who may be experiencing a mental health or suicidal crisis.
      • Mental health services, evidence-based treatments, and supports—including telehealth—are available. In addition, if someone is experiencing an emotional crisis or thoughts of suicide, free 24/7, confidential supports are available, such as calling the National Suicide Prevention Lifeline at 800-273-8255 or texting ‘HOME’ to 741741 to reach the Crisis Text Line.
    • When discussing data related to suicide, be sure to include the appropriate context.
      • For example, increased outreach to crisis services does not necessarily mean more people are suicidal. Instead, it may mean more people are being made aware of a service or are connecting to care when they need it. The media should exercise caution when presenting data—helping the reader to understand the caveats and limitations, avoiding unwarranted causal inferences, and avoiding oversimplified explanations of complex phenomena.

In developing these messages and widely promoting the use of the Recommendations for Reporting on Suicide16 and other such best practices, the Action Alliance and its MWG equipped the media and others who message to the public about suicide and mental health with the tools needed to share messages that are accurate, consistent, safe, and action-oriented. The goal is to help change the conversation about mental health and suicide prevention and to spur action and help-seeking, especially among those who may be in crisis.  

Conclusion: The Power of Connection and Action

But it’s not just the news media or formal messengers who are looking for information about how best to promote connection and action in the context of mental health and suicide prevention. Recent polling conducted by the Action Alliance demonstrated that while 95 percent of Americans would do something if someone close to them was thinking of suicide, a majority of those surveyed (69 percent) identified barriers, such as not knowing what to say or not feeling comfortable with the topic.17 To that end, the Action Alliance’s MWG and other public and private sector partners used this data to develop messages that educate the public not only about the role they play in being there for others but also the actions they can take to stay safe and seek support by leveraging existing partner resources like: , the National Suicide Prevention Lifeline’s #BeThe1To campaign12, the U.S. Department of Veterans Affairs Reach Out campaign18, and the National Council for Suicide Prevention’s Take 5 to Save Lives campaign19, which provide actionable steps individuals can take to help support those who may be in crisis. These collective efforts empower everyone to have open and honest conversations about mental health and suicide prevention, and to take steps to care for their own mental health and well-being. By equipping all Americans with the tools and resources needed to provide support to those who may be struggling and to connect them with the help they need, we can  change the conversation about suicide and suicide prevention, while also changing the culture around the way we approach this important public health issue.

Our words have power and it’s everyone’s responsibility to ensure how we talk about suicide and suicide prevention decreases stigma, promotes help-seeking, and provides hope. If we want to strengthen the national dialogue, prevent the tragedy of suicide, and build greater mental resilience, it will take everyone doing their part. Together we can change the conversation, save lives, and build a more hopeful nation.      

 

For those experiencing a suicidal crisis or emotional distress, call the National Suicide Prevention Lifeline (800-273-8255) or text the Crisis Text Line (text HOME to 741741).

Acknowledgements

The authors would like to thank the National Action Alliance for Suicide Prevention, the nation’s public-private partnership for suicide prevention, for developing the resources identified in this commentary. The National Action Alliance for Suicide Prevention is supported by a grant from the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services, under Grant No. 1H79SM083028-01. The views, opinions, and content expressed are the views of the authors and do not necessarily reflect the official position of SAMHSA or HHS.

Disclosure Statement

The authors of this commentary have no personal, commercial, or financial interests that are relevant to the research and opinions represented in the work submitted to HPHR. This manuscript is not currently under consideration by any other publication and has not been previously published elsewhere.

References

  1. Center on Budget and Policy Priorities. Tracking the COVID-19 Economy’s Effects on Food, Housing, and Employment Hardships. https://www.cbpp.org/research/poverty-and-inequality/tracking-the-covid-19-economys-effects-on-food-housing-and Accessed October 22, 2021.

 

  1. Panchal, N, Kamal, R, Cox, C, Garfield, R. The Implications of COVID-19 for Mental Health and Substance use. Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/. Accessed October 22, 2021.

 

  1. Czeisler, ME, Lane, RI, Petrosky, E, Wiley, JF, Christensen, A, Njai, R, Weaver, MD, Robbins, R, Facer-Childs, ER, Barger, LK, Czeisler, CA, Howard, ME, Rajarantanm, SMW. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69(32):1049–1057.

 

 

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  1. Watkins, A, Rothfeld, M, Rashbaum, WK, Rosenthal, BM. Top E.R. Doctor Who Treated Virus Patients Dies by Suicide. The New York Times. https://www.nytimes.com/2020/04/27/nyregion/new-york-city-doctor-suicide-coronavirus.html. Accessed October 22, 2021.

 

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  1. Langford, L, Litts, D, Pearson, J. Using Science to Improve Communications About Suicide Among Military and Veteran Populations: Looking for a Few Good Messages. American Journal of Public Health. Vol. 103. No. 1. 2013.

 

  1. National Action Alliance for Suicide Prevention. Messaging Work Group. https://theactionalliance.org/task-force/messaging. Accessed October 22, 2021.

 

  1. National Action Alliance for Suicide Prevention. COVID-19 Mental Health and Suicide Prevention Key Messages. https://theactionalliance.org/covid-19/messaging/key_messages. Accessed October 22, 2021.

 

  1. American Foundation for Suicide Prevention. Have a #RealConvo. https://afsp.org/realconvo/. Accessed October 22, 2021.

 

  1. National Suicide Prevention Lifeline. #BeThe1To. https://www.bethe1to.com/. Accessed October 22, 2021.

 

  1. Mental Health America. Time to Talk: Uncomfortable, But Important. https://mhanational.org/time-talk-uncomfortable-important. Accessed October 22, 2021.

 

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  1. Ahmad FB, Cisewski JA, Miniño A, Anderson RN. Provisional Mortality Data — United States, 2020. MMWR Morb Mortal Wkly Rep 2021;70:519–522.

 

 

  1. Suicide Awareness Voices of Education. Recommendations for Reporting on Suicide. https://reportingonsuicide.org/. Accessed October 22, 2021.

 

  1. The Harris Poll. Public Perception of Mental Health and Suicide Prevention Survey Results: August 2020. https://theactionalliance.org/sites/default/files/suicide_and_mental_health_public_perception_survey_final_report_august_2020.pdf, Accessed October 22, 2021.

 

  1. U.S. Department of Veterans Affairs. Don’t Wait. Reach Out. https://www.va.gov/REACH/. Accessed October 22, 2021.

 

  1. National Council for Suicide Prevention. Take 5 to Save Lives. https://www.take5tosavelives.org/. Accessed October 22, 2021.

About the Authors

Maureen Iselin

Maureen Iselin is  Associate Director of Communications with the National Action Alliance for Suicide Prevention, housed at the Education Development Center. Her work involves working with public and private sector partners to help change the national conversation about suicide and suicide prevention to one of hope and help-seeking and to equip public messengers, news media, and entertainment media with the tools and resources they need to tell authentic, responsible, and prevention-focused stories related to suicide and mental well-being. Ms. Iselin received her BA in Communication Studies from Christopher Newport University in 2006.

Kristen Quinlan, Ph.D

Kristen Quinlan, Ph.D. is a Research Scientist with the Education Development Center. Her work involves identifying state, local, and agency data infrastructure needs to support data-driven decision making in suicide, substance misuse, and violence prevention and the use of data to identify risk centers and drivers in states and communities. Dr. Quinlan received her PhD from the University of Rhode Island in Behavioral Science in 2006.

Colleen Carr, MPH

Colleen Carr, MPH, is the Director of the National Action Alliance for Suicide Prevention – the nation’s public-private partnership for suicide prevention – housed at the Education Development Center. Ms. Carr is responsible for working with diverse public and private sector partners to advance the National Strategy for Suicide Prevention. She received her MPH from Boston University.