The Role of Public Health in Reducing Suicide Risk During COVID-19

September 10, 2020 | Mary Terzian

Since mid-March, most of us have been social distancing, wearing masks, and self-quarantining if we’ve been exposed to the coronavirus, per CDC guidelines. These safety precautions, although critical to our health and safety, restrict our ability to gather with friends, loved ones, behavioral health care providers, and other members of our social support network.

In addition, these precautions impede our ability to engage in the recreational, cultural, and community activities that help many bond with others, find enjoyment in life, and buffer job or family stress. This means people must connect with others over the phone or internet and find other ways to unwind. For rural or low-income residents who lack access to the internet, the social isolation is even more profound.

For reasons like these, COVID-19 has elevated our nation’s stress level. When not managed properly (or without any buffers like social support) stress is associated with increased depression and anxiety. Some research has already established links between COVID-19 and depression and anxiety, with one study finding U.S. adults at least three times more likely to screen positive for depressive or anxiety disorders in 2020, compared with 2019.

Depression and anxiety, and other known risk factors for suicide, such as substance misuse, opioid overdose, and unemployment, have all increased since the onset of COVID-19. COVID-19 has also been associated with a surge of firearm sales, which might be—according to one California-based study on first-time gun ownership—predictive of suicide by handgun, with 54 percent of gun suicides occurring after one year of purchase.

Because COVID-19 impacts risk factors for suicide, such as depression, anxiety, substance misuse, and unemployment, the implications for suicide prevention are many. And with September being Suicide Prevention month, it’s a good time to take stock of how public health leaders can reduce suicide risk during this pandemic.

First, states should connect populations of greater risk for suicide to needed mental health services and other supports. In addition, state-led suicide prevention efforts should focus on populations typically not at risk for suicide who are experiencing COVID at high rates, such as Latinx and African Americans. Data from major cities like New York City and Chicago reveal that these racial and ethnic minority populations are more likely to die of COVID-19 than non-Hispanic whites—a fact explained by inequities in the social determinants of health.

To the extent possible, states should remove barriers to healthcare utilization and work to connect the unemployed to job opportunities, the homeless to supportive housing, and persons with substance use disorders to addiction treatment and recovery support programs. Some state health agencies, like Minnesota’s, are partnering with nonprofits to form suicide prevention task forces that involve a range of stakeholders. Other state health agencies, like Washington’s, are requiring that health care professionals take a suicide prevention course. Efforts like these are needed to prevent suicide on multiple fronts.

There are also other strategies beyond just utilizing the governmental health department. For instance, home-based primary prevention programs such as the Nurse-Family Partnership (which has been found to reduce depressive/internalizing symptoms in young children) have been adapted so that practitioners are trained to connect with families via telephone and phones are provided to families who need them.

And some promising school-based programs, such as the Sources of Strength suicide prevention program, have converted to a virtual format that features numerous online resources and trainings using cloud platforms such as Zoom. Although the jury is still out as to whether they will have the same favorable impacts as their in-person versions, it is reasonable to assume that they are having some impact.

Unfortunately some evidence-based programs, such as the Good Behavior Game (a classroom-based program which has been found to reduce suicidal ideation and attempts in young adults) and the Blues Program (a group cognitive behavior training program for high school students who report depressive symptoms) may not be able to be conducted virtually. More adaptations of evidence-based programs proven to reduce depressive, anxious, or suicidal symptoms are needed—especially for youth and the middle-aged.

This pandemic is particularly taxing to social service workers and healthcare workers on the front lines, caring for patients with COVID-19 and making difficult decisions about their care on a daily basis. Given the psychological toll of the pandemic on essential workers, it is important to establish and support behavioral health initiatives that educate them on ways to cope with the stress and also connect them to services. The same is true for patients diagnosed with COVID-19.

State epidemiologists should conduct targeted mental health surveillance of populations at risk of suicide, such as LGBT youth, American Indian and Alaska Native groups, the middle-aged, and other populations we are able to track using existing surveillance systems, like the Youth Risk Behavior Surveillance System and Behavioral Risk Factor Surveillance System. State health agencies can play an important role by partnering with the healthcare and social services sectors to ensure at-risk and underserved populations are supported during and after the pandemic.

To gather more information about suicide prevention, you may wish to consult a list of suicide prevention and other resources, the Suicide Prevention Resource Center’s list of programs and resources, and CDC’s technical package on suicide prevention.