A Look Ahead to the Coming Year: An Interview with the American Foundation for Suicide Prevention’s Chief Medical Officer, Dr. Christine Yu Moutier

1. There have been reports that stress and anxiety have gone up over the last year or two. Is that true? What has been the impact of the pandemic on suicide risk?

It’s true – during the pandemic, our collective distress has increased. Feelings of uncertainty, a disrupted sense of safety, lack of predictability and disrupted routines, social isolation - could all be contributors to increased risk. Loss of loved ones to Covid, economic strain, job loss, increased substance use, increases in domestic violence, and racial trauma are all reasons that suicide risk is of concern now.

It’s also true that certain populations have suffered more than others: frontline and essential workers, caregivers, youth and young adults, and in particular, racial/ethnic groups – people who were already living with challenging health, mental health, social or economic strain prior to the pandemic. Parents are experiencing increased distress, and worry about the mental health of their children. And while help seeking is on the rise, only about half of Americans with mental health conditions are connecting to treatment. Rates of treatment are even lower for minoritized populations.

But these are on top of pre-pandemic risk factors for suicide, including unmanaged mental health conditions and other social determinants, such as lack of access to health care, education, and exposure to violence and trauma. So while it’s tempting to view suicide rates during these last two years through a purely pandemic lens, it’s important to remember that many risk factors for any given individual or population pre-date the onset of the pandemic.

1. So have suicide rates gone up? Are more people dying by suicide because of all the stress?

It may seem counterintuitive, but increases in distress, and even suicidal thoughts, do not mean that suicide rates will necessarily rise. In fact, a recently released CDC report analyzing 2020 U.S. mortality data – the numbers always take some time to get reported – actually showed an overall decline in the national suicide rate by 3% from 2019 to 2020. It may be that protective factors are strongly present for many – experiences like feeling connected to others, feeling a sense of communal support and being in this together, being willing to open up about distressing feelings or symptoms, and especially getting connected to mental health care – those are all positives that could be helping mitigate against risks during this past year.

This is an encouraging trend! It’s important to note, though, that it was not experienced across the board: while there were decreases in Americans over 35, there were stable or increased suicide rates in younger age groups, particularly 25-34-year-old millennials, as well as indications (upward trends that didn’t reach statistical significance) for 10-24-year-olds.

Additionally, in 2020, while White and Asian Americans had significant declines in rates, Black and American Indian/Alaska Native Americans experienced increases in suicide rates. So we must do more to understand these concerning trends for BIPOC populations and even more importantly, learn and implement effective strategies to address them.

1. Is there anything the average person can do to help prevent suicide?

We can all play a part in creating a culture where it’s safe and encouraged to address mental health! We can learn more about mental health and suicide, and we can try to incorporate those learnings into our daily lives. Harris polls conducted on behalf of AFSP show that attitudes have become much more positive toward mental health as a valid and key part of our lives – but we must close this gap between attitudes and actions. We can do this by modeling self-care, and attending to our mental and physical health in active and creative ways. We can be more honest and vulnerable in conversations, talk with people close to us about how we are coping with challenges, seek therapy or psychiatric treatment when needed, and encourage others to do the same.

Culture change needs to deepen into instinctual actions that reduce suicide risk. Just like most Americans know the basics for reducing risk of death from heart disease, we should all learn the risk factors and warning signs for suicide, how to have confident, real conversations involving mental health, and be familiar with the resources available for people who need help. These are things we can all do, and encourage with others.

1. Normally, the New Year is a good time to reboot one’s attitude, and try to think positively about the year ahead. But it’s tough, with life not having gone back to normal yet, and the fear that things may never go back to the way they were before. Are there any hopeful thoughts you can offer?

I think it’s important to take a moment to reflect on both the positives and negatives we’ve experienced over the past year. Part of living healthy is processing the hard stuff – and while people do that in different ways, it usually involves some form of communicating. By processing fears or trauma, we can regain more of a flexible and optimistic mindset that deepens our capacity for uncertainty in 2022. We don’t have all of the answers about what 2022 will bring in terms of the pandemic, but we can stay focused on the things that are more in our control – making choices to take care of our mental health; making sleep, nutrition and exercise priorities; and practicing steps to be present for others and for our own emotions.

1. We’ve seen an increase in the way workplaces are supporting their employees’ mental health. What does this look like in 2022?

Many companies are focusing on the wellbeing of their workforce like never before. Before the pandemic, a trend was already occurring, focusing on mental health and suicide prevention in the workplace. Organizations’ leadership were seeing the link between wellbeing and productivity, and employees expressing an interest in benefits and resources that promote mental health for themselves and their families. Concepts related to preventing burnout and addressing moral injury have been long discussed in many industries such as healthcare. Now, with the enormous challenges the pandemic has presented, it has become even more apparent that prioritizing employees’ mental health is not a luxury, but a necessary part of maintaining a company’s sustainability.

This priority on employee and family mental health takes many forms – from enhanced benefits to cover mental health services, to education and resources, to the formation of employee interest groups focused on various aspects of mental health or identity, e.g. parenting, caregivers of aging parents, depression, anxiety, eating disorders, LGBTQ, men’s or women’s mental health, to name a few.

1. As we look ahead, what would you say to someone who’s been struggling with their mental health as a result of the pandemic?

If you’ve been experiencing feelings of depression or new levels of worry or sleeplessness, lack of motivation, panic attacks, or issues with body image or unhealthy eating – or any change from your healthier baseline mental health – please know that you’re not alone. The majority of us have experienced significant changes in our health or wellbeing during the pandemic; it’s just a question of what aspect of health for any given person has changed, and how severe.

There is no shame in experiencing these shifts in health during a global pandemic that has turned most of our lives upside down! And there is every reason in the world to engage in strategies that can turn things around. For most of us, that looks like some combination of self-care strategies and/or mental health treatment. Nothing is an instant fix when it comes to most aspects of health, including mental health. But individualized strategies to address mental health changes DO work. You could start by picking two things to work into your upcoming week – you could do 15 minutes of stretching, exercise or meditation; cut down on alcohol; go to bed 30 minutes earlier; join a support group; or try therapy. Keep a log of your symptoms; while there won’t be a straight line to improvement, you will very likely notice significant changes over several weeks. The key is to then make note of the most effective strategies for yourself, and work those into your ongoing lifestyle so they become part of the norm.

Try to keep your mind focused on what you can do, rather than the hard circumstances in your life. Life is full of hard things: that’s something we can plan on. Accepting that might enable you to keep your mind focused on the present, and allow a place for humor and flexibility to thrive.

1. For those caring for others or worried about someone close to them the past few months: do you have any advice for the new year?

If there is someone in your life you’re worried about:

• Invite a private, open conversation in which you encourage them to share more about their experiences and perceptions. Listen actively and without judgment.
• If they aren’t ready to engage or get help, be patient with them, but don’t give up. Come back and revisit how they’re doing and encourage them again to consider talking with a professional.
• Take care of your own mental health. Do this not just for yourself – you need and deserve to be rested and as healthy as possible – but also for others: your own wellbeing can positively impact those around you, especially your loved ones. Your mood, good or bad, can be contagious in either direction.
• Practice setting healthy boundaries. Even though someone may be suffering, if this is a longer-term situation, you’ll do better if you set up some boundaries for yourself to ensure you can rest and rejuvenate, and be around positive influences for yourself.
• Consider what the person’s “love language” might be. In other words, how does that person tend to experience love or feel appreciated? The main love languages are: words of affirmation; acts of service; quality time in companionship; physical touch; and gifts. Some people have a top one or two of those that really resonate for them. You may have assumed that someone else’s love language is the same as your own, but we are all different people. If you can’t figure it out, you could even try asking them directly: “What makes you feel the most appreciated? Is it when you receive a gift, when someone’s words affirm you, when someone spends time with you, when having your car washed or an errand is taken care of, or is it physical contact?” Figuring out the other person’s love language might help hone your efforts to encourage the person, and allow them to be more effective.

While our experiences are diverse, our shared human experiences related to mental health are more evident now than any other moment in history. For those of us with lived experience, many feel more understood and therefore more seen and heard than ever before. I have a sense of hope for the future and the work ahead to make more significant progress with suicide prevention implementation. We have been resilient in many ways as individuals, families and communities. As we begin this New Year in 2022, I feel a sense of resolve to be present for one another and compassionate for the many ways we struggle, learn and progress. I invite you to join me in this sense of hope and connection.