Health & Wellness

Youth Suicide Rates Doubling--Working to Reduce the Trend With Suicide Prevention Leader-Holmdel's Dr. Christine Moutier

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Suicide Prevention Advocate: Dr. Christine Moutier, Chief Medical Officer, American Foundation for the Prevention of Suicide. Credits: AFSP
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HOLMDEL, N.J. - When one would guess what the 2nd leading cause of death is for young people in the U.S. ages 15-34, most people are shocked to hear that the answer is death by suicide.  Tragically, that is a fact. Almost 45,000 Americans die every year by suicide. According to the American Foundation for Suicide Prevention (AFSP), on average there are 121 suicides a day—16 of them a day are youths in America. On top of that, data suggests that for every life lost by suicide there are on the average 25 who survive an attempt. According to a report recently released by the Center for Disease Control (CDC), the suicide rate among teenage girls continues to rise and hit a 40-year high in 2015, with suicide rates doubling among girls and rising 30 percent among teen boys and young men.  Many experts on the topic agree that suicide in many cases can be preventable with awareness and intervention, beginning as early as middle school--yes middle school.  The suicide rate among children between the ages of 10-14 doubled between 2007-2014, according to a study released by the CDC earlier this summer. This marked the first time that suicide surpassed car accidents as a cause of death for that age group.
 
September 10th, through Saturday September 16th, is National Suicide Prevention Week, implemented to raise awareness that suicide is preventable, improve education about mental health and suicide, and to decrease the stigmatization regarding the struggles that lead to suicide.  The more open people are to talking about their actual experiences of depression, anxiety or life pressures, the more people who are at risk for suicide can get the support they need.
 
According to the CDC, there is a suicide every 13 minutes in the United States. Sometimes there are obvious warning signs, diagnosed depression, substance abuse, or a person may even verbalize that they don’t want to live, but in many cases suicide is like a thief in the night with no obvious warning signs, even to very close loved ones of the victim.  It’s not unusual that in addition to total devastation, loved ones left behind are completely shocked. The truth is suicide does not discriminate. According to the National Institute of Health (NIH), people of all genders, ages and ethnicities can be at risk for suicide. From very social and seemingly happy star athletes to those who are visibly suffering, or someone known to be bullied by others, to high achievers-- suicide does not discriminate.  According to the Nation's largest Analysis of Veteran Suicide conducted in 2016, Veterans account for 18 percent of all adult suicides, and approximately 20 suicides a day. In this report VA Under Secretary for Health, Dr. David J. Shulkin says, "One veteran suicide is one too many....we as a nation must focus on bringing the number of Veteran suicides to zero."  According to The New England Journal of Medicine, approximately one-third of all suicide attempts are impulsive acts.  There are many who survive a suicide attempt who recall regretting their impulsive decision instantly. They were fortunate enough to live through the attempt to be able to talk about it. 
 
 
To further understand this complex health crisis and realize ways that we as a community can raise awareness, TAPinto Holmdel & Colts Neck interviewed Suicide Prevention Advocate and Holmdel resident, Chief Medical Officer of the American Foundation for Suicide Prevention, Dr. Christine Moutier.
 
Dr. Moutier, we know that factors such as depression, substance abuse, trauma, being abused (including repetitive bullying), as well as a family history of suicide or mental illness can all be factors that may lead someone on the path to suicide. What about the person who is not dealing with any of those factors, at least there is no history of them dealing with any of those factors. In your expert opinion, can someone have a temporary break and lose it for one brief moment in time, that perhaps would not have occurred again had they survived?
 
Moutier:  “Suicide is not related to weakness or cowardice, but rather to the piling up of life stressors and health changes, which converge like a perfect storm at a moment in time in a person’s life, increasing their risk of suicide. When people become distressed and suicidal, their thinking changes, the way the brain functions changes, thoughts become more rigid, coping strategies get narrowed down.  So, people who are extremely intelligent and normally very resilient with many levels of coping strategies can have those strategies and creative solutions temporarily disabled by the acute crisis driven physiological changes in the brain and body. This is one of the things research has demonstrated very clearly that helps us to understand how even the strongest and solid individuals can succumb to suicide. The important thing to know is that usually the perfect storm is brewing for a period of time, which can provide an opportunity for seeing the warning signs once we know what to look for, and giving the person tremendous support and professional help.”
 
One of the goals of National Suicide Prevention Week is to decrease the stigmatization that surrounds suicide with regard to mental health, seeking help, and suicide in general. Dr. Moutier can you please speak to ways we can help with that? 
 
Moutier: “There is a call to action about the important change in language in order to further remove stigma from suicide. Oftentimes there is inappropriate use of language when describing suicide. The way suicide is described and discussed is important so we can shed the old myths that keep struggles silenced. We are encouraging all to use non-stigmatized language when discussing suicide, specifically use of the terminology ‘commit/committed suicide,’ we would suggest using ‘died by suicide’ or ‘ended his/her life.’  Before science shed light on the drivers of suicide risk, societies treated suicide as a morally reprehensible or criminal act, which the term ‘commit’ still connotes. For those reasons, with advocacy efforts, in 2016 the Associated Press Style Book made the change, essentially banning the use of the phrase ‘commit suicide’ from journalistic writing.”
 
Dr. Moutier, what warning signs and risk factors should we be aware of regarding suicide, at the same time knowing in many cases signs are subtle and harder to recognize?
 
Moutier: “While many people keep their distress private, and in many cases, especially with highly successful individuals, they are so good at cloaking their distress, that any glimpse of changes in behavior and mood should be noted and explored in a caring way. When mental health starts to deteriorate, behavior changes can look like many things; anger/agitation/irritation/substance use, in addition to the more obvious signs like withdrawing from friends and activities and isolating. Especially for men and many very ‘high functioning’ people with depression, anxiety or addiction, they are less likely to show signs of sadness, and more likely to have a shorter fuse, increase their way of ‘controlling life,’ drinking, etc. This can feel more aggressive in a relationship, but can actually indicate a time of vulnerability for the individual. The risk associated with being a high functioning person is not as much about the stress these individuals endure, but about their sense of perfectionism and the lack of permission they give themselves to be human, seek mental healthcare when needed, make mistakes and learn from them, and to tolerate humiliation or perceived failure.”  Moutier recommends this list of the most frequent warning signs associated with increasing suicide risk: https://afsp.org/about-suicide/risk-factors-and-warning-signs/
 
Dr. Moutier, often when someone dies by suicide there is an overwhelming amount of guilt and self- blame that the deceased person’s loved ones go through. What can we say to them that may help them heal?
 
Moutier: “The suicide loss survivors I know are so strong. They come to realize that their loved one was in unbearable pain and that blaming themselves or a particular event doesn’t really make sense or help them to heal. One of the most important things for survivors is to give themselves time, connect with people and resources who can support them- especially other loss survivors.  The grief journey is not an easy one, but survivors do heal and find new ways to make meaning of their loss.  
A life event can play a precipitating role for suicidal behavior, but without other underlying risk factors, life events aren’t thought to cause suicide on their own. Suicide is not a one cause/effect phenomenon. Research demonstrates that in every case of suicide that has been studied, there are multiple risk factors that converge. So, even though it’s easiest to identify the last stressors and events that occurred in the person’s life—those are what we can see in hindsight—what we can’t always see are the indicators that other risk factors, often internally, were present or worsening. One problem with the public perception of suicide is that when someone dies by suicide, the environmental factors are noted as the cause. These are understandably the factors most visible and easily identified as potential answers to the question of why someone took their life. People see a life event—like a breakup, or bullying, or a job loss—and then they see the person die by suicide, so they might assume the person ended their life because of that stressful life event.  However, that is not the full story. What others don’t know is that the person who died may have had genetic risks for suicide. Maybe they were suffering from depression or anxiety, and their work life became increasingly more stressful. Their symptoms of depression and anxiety could have made the situation at work even worse, or the work stress could have made their depression worse. Perhaps they’d also been drinking more than normal. Cognitive changes during the acute state of distress can lead to distorted perceptions and more rigid problem- solving capacity—all powerful potential contributors to suicide risk. We also know that when a perfect storm of colliding risk factors occurs, particularly when lethal means are accessible, suicide risk escalates. The key is that all of these factors in combination contribute to suicide. Preventing suicide happens every day when we recognize risk factors, open up caring conversations, and address those risk factors through support and professional help.”
 
Thank you Dr. Moutier for your unyielding dedication to suicide prevention and awareness. 
For more information on Dr. Moutier’s ongoing advocacy efforts at the American Foundation for Suicide Prevention
visit https://afsp.org/our-work/advocacy/  
 
For more information on suicide prevention visit The American Foundation for Suicide Prevention at www.afsp.org
What can we all do in our day to day lives to raise awareness and help prevent suicide? Start by talking about it with our families and our friends. Support/volunteer with organizations that provide suicide prevention programs. Implement awareness and prevention programs in our schools, religious organizations and communities. Be kind and teach our children to be kind and compassionate. Share suicide awareness and compassion and kindness messages on your social media accounts. Learn to re-speak suicide terms. Never use the word commit or committed when speaking about suicide--that stigmatizes suicide and is very hurtful to the surviving loved ones of a suicide victim.  Look for warning signs and if your gut is telling you something is wrong talk to the person compassionately and without judgment, ask them if they have thoughts of ending their life, and guide them towards getting the help they need, or if you don’t know them well enough speak to someone close to them. Understand that suicide does not discriminate and can happen in any family, in every community, and that people hide distress so the behavioral changes you can see may be the tip of the iceberg of their true suffering. Below is an informative and actionable video on advocacy:

 

If you or anyone you know is having suicidal thoughts: talk to a trusted adult or call the National Suicide Prevention Hotline at 1-800-273-TALK (8255), or reach out to the Crisis Text Line and text TALK to 741-741.
This is a documentary with Dr. Moutier and suicide loss survivors. For loss survivors and to learn more about connecting with others click here: https://afsp.org/find-support/ive-lost-someone/survivor-day/ 
The Journey Film:

 

About Holmdel resident Christine Moutier, M.D., Chief Medical Officer

Dr. Christine Moutier knows the impact of suicide firsthand. After losing colleagues to suicide, she dedicated herself to fighting this leading cause of death. As a leader in the field of suicide prevention, Dr. Moutier joined AFSP in 2013, and has revitalized AFSP’s Education team, re-launched its Loss & Healing department, and expanded AFSP’s support to include those with lived experience of suicide.

She has testified before the U.S. Congress on suicide prevention, she was the host of AFSP’s latest documentary on surviving suicide loss, The Journey, and has appeared as an expert inThe New York Times, The Washington Post, Time magazine, The Economist, The Atlantic, the BBC, CNN, and other print and television outlets.

Throughout her career she has focused on training healthcare leaders, physicians, and patient groups in order to change the healthcare system’s approach to mental health, fighting stigma and optimizing care for those suffering from mental health conditions. In addition to co-founding AFSP’s San Diego Chapter, Moutier co-led a successful suicide prevention and depression awareness program for health science faculty, residents, and students, which featured AFSP’s groundbreaking Interactive Screening Program.

Since earning her medical degree and training in psychiatry at the University of California, San Diego, Moutier has been a practicing psychiatrist, professor of psychiatry, dean in the medical school, medical director of the Inpatient Psychiatric Unit at the VA Medical Center in La Jolla, associate director of the UCSD Outpatient Psychiatry Services Clinic, and she attended the Consultation-Liaison Service and Neuropsychiatric and Behavioral Medicine Unit at UCSD Medical Center. She also served as a co-investigator for the Sequenced Treatment Alternatives to Relieve Depression study (STAR*D), a large National Institute of Mental Health trial on the treatment of refractory depression.

Moutier has authored articles and book chapters for publications such as the Journal of the American Medical Association, Academic Medicine, theAmerican Journal of Psychiatry, the Journal of Clinical Psychiatry, Psychiatric Times, Depression and Anxiety, and Academic Psychiatry.

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