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Suicide is defined as death caused by injuring oneself with the intention of dying. Over the years suicide has become a more common trend among younger people especially. According to the Centers for Disease Control and Prevention, Suicide is the 2nd leading cause of death among people ages 10-24 years old. Research shows that this particular population is more vulnerable to mental health problems. Young people often experience various challenges navigating changes in life which could bring up emotions like fear, confusion, doubt, and shame.
Since the Covid-19 pandemic, people have experienced more disruption to their, life, work, and relationships putting more strain on their mental well-being. Suicide Prevention in Youth (2022) mentioned in their article that about 18% of youth in the US particularly seriously considered attempting suicide and 8.6% made suicide attempts within the past year in 2020. Suicide also among this population seems to be more prevalent in girls and among minority groups with limited access to mental health resources. Effects of suicide do not just have a physical impact on an individual, but they leave lasting effects in many areas of their lives like relationship, jobs, and their mental or emotional well-being. There are many factors that contribute to suicide or self-harming behaviors, some of them include; Mental health conditions: people who suffer from disorders like depression, anxiety, and other mood disorders may be more susceptible to suicide. People with depressive symptoms especially youths may have an increased sense of isolation and social alienation which increases the chances of self-harming behaviors (Freitage et al., 2022) Family History: Family systems and their environment can affect how a person is raised and how they identify in society. Family factors that contribute risk of suicide may include the history of suicide in the family, relationship conflict, presence of trauma or violence, neglect, parental divorce, and so on Alcohol and substance use- According to the American Addition Center’s article on substance abuse and suicide, suicide is the leading cause of death among people who misuse alcohol and drugs (2022). It’s common for people who experience suicidal thoughts to abuse alcohol and drugs in the hope of escaping the emotional pain. Unfortunately, alcohol/ drug use further intensifies depressive symptoms and increases the likelihood of impulsive behaviors. Previous Suicide Attempts- Not only does a prior suicide attempt increase the risk of suicide, but it also leaves both short and long-term effects on the individual. O’Brien et al (2022) suggested that with adolescents there are usually more reports of significant emotional distress and the overwhelming presence of negative emotions. Adding that adolescents who have previously attempted suicide are 60 times more likely to die from suicide than those who never attempted. Environmental Factors: other factors that may contribute to suicide may include socio-economic status, unemployment, discrimination, loss, access to means, criminal/legal problems, impulsivity or aggression tendencies, relationship problems, bullying, harassment, and identity crisis Warning Signs for Suicide There is a myth that talking about suicide increases the likelihood of suicide which is not true. Although, depression and suicide often coincide, it’s important to watch out for other signs of suicide. Awareness of the emotional and behavioral signs of suicide can be especially helpful for parents, teachers, and friends when assessing the risk of suicide. Talking about suicide creates a space for open communications and de-stigmatization of suicide; some warning signs include; · Recent fascination with death · Feelings of hopelessness and worthlessness · Feeling like a burden to others · Feelings of guilt, shame and anger · Saying goodbye to friends and family · Giving away prized possessions · Change in eating and sleeping patterns · Recklessness · Losing interest in personal hygiene or appearance · Withdrawn from friends, families and communities · Recent suicide attempt · Increase alcohol or substance use Treatment With collaborative efforts from family, teachers, and the engaging community suicide is always preventable. Losing someone to suicide is difficult and it comes with a lot of complicated emotions. Suicide does not only affect an individual, but it also affects the lives of the people around them. Assessing risk for suicide and treatment is possible with the help of everyone. The use comprehensive approach that assesses the level of risk and underlying problem causing suicidal thoughts or behaviors helps to enhance suicide care and rehabilitation. Ways to improve suicide care include; Psychotherapy- Seeking professional help like counseling can help with early interventions and effective assessment for suicide. Mental health and peer support especially in schools can help with providing strategies that can help individuals cope with issues regarding impulsivity, interpersonal conflict, sexual identity, trauma care, suicidal behaviors, self-esteem, social connectedness and so on which not only promotes mental wellness but improves access to appropriate mental health care. Medications- As discussed earlier one of the risk factors for suicides is the presence of other mental health disorders. Along with psychotherapy interventions, the use of antidepressants, anti-anxiety, antipsychotics, and other medications for mental illness can help better manage suicidal behaviors and thoughts Addiction treatment: Treatment for alcohol and substance dependency can help with addiction treatment and promote participation in social support groups that can help with rehabilitation Family support and Education: Involving family and friends in the treatment process can help provide a supportive environment for change. Family support and community engagement can foster better-coping skills, improve communication and more connectedness for the individual. Psychoeducation for individuals and families that center on de-stigmatization of mental health problems could promote positive treatment outcomes. Connecting with people you can trust can go a long way in seeking help and preventing suicide! Suicide Care Resource: Call a suicide hotline number
Amanda.Lautieri. (2022, September 15). The link between substance abuse & suicide in teens. American Addiction Centers. https://americanaddictioncenters.org/blog/link-between-substance-abuse-suicide-in-teens Centers for Disease Control and Prevention. (2023, May 9). Disparities in suicide. Centers for Disease Control and Prevention. https://www.cdc.gov/suicide/facts/disparities-in-suicide.html https://www.cdc.gov/suicide/facts/disparities-in-suicide.html Editorial: Suicide prevention in youth. (2022). Child & Adolescent Mental Health, 27(4), 325–327. https://doi.org/10.1111/camh.12604 Freitag, S., Bolstad, C. J., Nadorff, M. R., & Lamis, D. A. (2022). Social Functioning Mediates the Relation Between Symptoms of Depression, Anxiety, and Suicidal Ideation Among Youth. Journal of Child & Family Studies, 31(5), 1318–1327. https://doi.org/10.1007/s10826-021-02088-x O’Brien, K. H. M., Nicolopoulos, A., Almeida, J., Aguinaldo, L. D., & Rosen, R. K. (2021). Why adolescents attempt suicide: A qualitative study of the transition from ideation to action. Archives of Suicide Research, 25(2), 269–286. https://doi.org/10.1080/13811118.2019.1675561
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An important aspect of veterans' mental health is moral injury (MI) and its impact. A moral injury can occur in response to acting or witnessing behaviors that go against an individual's values and moral beliefs. In traumatic situations, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations (Norman & Maguen, 2021). Of veterans, over half have experienced moral injuries (Koenig et al., 2019). It’s often associated with a comorbidity of mental health issues such as suicide ideation and post-traumatic stress disorder (PTSD).
Research has shown that moral injury is common among veterans with PTSD (Currier et al., 2019). Moral injury can accompany feelings of guilt, shame, self-condemnation, loss of trust, loss of meaning, and spiritual struggles. Veterans who experience PTSD symptoms might struggle with co-occurring cognitive, emotional, and behavioral conflicts that may have been caused by moral injuries. For some individuals, transgressing cherished moral values or experiencing betrayal by trusted others in high-stakes situations may be severely traumatic (Koenig et al., 2019). The identification and treatment of MI among those with PTSD may help in the management of symptoms. Recent research suggests that exposure to potentially morally injurious experiences may be associated with an increased risk for suicidal behavior among US combat veterans. Data from survey results were analyzed and showed that depression and PTSD were strong correlators of suicide ideation and attempts among those who experienced moral injury (Nichter et al., 2021). The events in combat and other missions may violate one’s deeply held belief systems and, for some service members, may result in inner conflict. Exposure to wartime atrocities and combat-related guilt has been shown to predict increased suicidal ideation (Bravo et al., 2020). To better inform prevention and treatment efforts among veterans, it’s important to identify risk factors that may moderate associations between moral injury and suicidal behavior. Moral injury can be self-directed or other-directed. The two categories are defined by the attribution of responsibility for the event: personal responsibility (veteran's reported distress is related to his own behavior) versus responsibility of others (veteran's distress is related to actions taken by others) (Schorr et al., 2018). In one study, self-compassion was found to combat feelings of overidentification, or a tendency to overidentify with one’s failings and shortcomings that resulted after self-directed moral injury. Mindfulness and social connectedness also were found to weaken the impact of other-directed moral injury (Kelley et al., 2019). Prayer and meditation teach individuals to bring awareness to the present moment, with a sense of nonjudgment and acceptance of current thoughts, emotions, and sensations. These may be variables that mental health professionals should consider when working with veterans who have experienced moral injuries. Some resources on moral injury include:
References
Bipolar disorder is a chronic mood disorder that affects about 2.8% of the US adult population annually (National Alliance on Mental Health, 2022). It’s characterized by manic or hypomanic states alternating or intermixed with cycles of depression. It consists of three types (Bipolar 1, Bipolar 2, and Cyclothymia) which involve clear changes in mood, energy, and activity levels. (National Institute of Mental Health, 2020).
The median age of onset for bipolar disorder is 25 years, and it can develop equally in men and women of all races, ethnic groups, and social classes (National Alliance on Mental Health, 2022). The way they may differ, however, is how rapid each mood cycle is and how often they occur. In addition, more than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression, indicating that the disease has a heritable component (National Institute of Mental Health, 2020). Some bipolar disorder symptoms are similar to those of other illnesses, which can make it challenging for a healthcare provider to make a diagnosis. Also, many individuals with bipolar disorder may have another mental condition or disorder such as anxiety disorder, substance use disorder, ADHD, or an eating disorder (National Institute of Mental Health, 2020). Sometimes, a person with severe episodes of mania or depression may experience psychotic symptoms, such as hallucinations or delusions that tend to match the person’s extreme mood. As a result, people with bipolar disorder who also have psychotic symptoms are often incorrectly diagnosed with schizophrenia. When those who have symptoms of bipolar disorder also experience periods of psychosis that are separate from mood episodes, the diagnosis may be schizoaffective disorder (National Institute of Mental Health, 2020). Bipolar disorder carries one of the highest risks of suicide compared to all other mental disorders, meaning almost half of people with bipolar disorder attempt suicide in their life (National Alliance on Mental Health, 2022). Suicidal behavior is primarily associated with depressed mood cycles - major depressive episodes are associated with the highest risk of suicide, followed by mixed episodes, and finally manic episodes, which are associated with the lowest risk of suicide. In addition, researchers found that risk factors for suicide include male gender, living alone, divorced, no children, Caucasian, unemployment, and a personal history of suicide attempt and family history of suicide attempt or suicide (Miller & Black, 2020). By assessing the risk of suicide in those with bipolar disorder, early intervention and treatment of bipolar depression along with close observation and follow-up is the most effective way to mitigate the risk of suicide. Unfortunately, bipolar disorder is left untreated in half of the diagnosed individuals in any given year. Although there is no cure, the optimal treatment plan for bipolar disorder is a combination of medication and cognitive-behavioral therapy (McIntyre et al., 2020). And while pharmacological treatments have been found to be effective in treating the disorder, they’re not universally available. Culture and society also play key roles in how mental health and mental health treatment are perceived. Luckily, there is change being made and more resources are becoming available to help bring awareness to the accessibility of mental health treatment. If you want to learn more about bipolar disorder, visit the International Society for Bipolar Disorder and International Bipolar Foundation. References
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