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It is National Suicide Prevention Week September 10th to the 16th, with September 10th being World Suicide Prevention Day! If you search the word suicide on Google you will receive 1,190,000,00 results to peruse. You will find information on definitions, terminology, statistics, risk factors, prevention, unlimited resources, and much more. So, with all this available at our fingertips, why is it so difficult to talk about suicide? The word itself is somewhat unpleasant with a harsh edge to it. The word originates from the two Latin words, sui and caedere, which when combined means to “kill oneself”. Suicide has an extensive history, going back more than 2, 000 years. A very significant part of this history is the stigmatization of suicide. The stigma related to suicide has continued through the years and greatly contributes to the reluctance to talk about suicide. Stigma can also increase the risk of suicidal behaviors as it contributes to the reluctance to seek treatment. While stigma can be a significant risk factor it is important to recognize other elements that contribute. Let’s Talk About Risk Factors and Warning Signs First, it is important to realize that experiencing risk factors does not mean that suicide will be attempted. However, it is important to recognize and have an awareness of them. Some common risk factors are.
The focus of National Suicide Prevention Month is to create awareness and provide education to assist everyone in having direct and candid conversations related to suicide. An important part of this is understanding what prevention consists of. While there are many resources available, the Centers for Disease Control and Prevention (CDC) has highlighted this serious public health issue by developing the Suicide Prevention Resource for Action. This strategy is based on the knowledge and evidence that suicide prevention saves lives. While this is a comprehensive public health approach, what can we, as individuals, do to contribute to the prevention of suicide? Becoming involved, increasing awareness and knowledge about suicide is important, and there are programs available to assist with this. The program QPR (Question, Persuade and Refer) is a national suicide prevention training program, with the mission of saving lives and reducing suicidal behavior. The program trains individuals to become Gatekeepers, who will recognize the warning signs of suicide, know how to offer hope, and know how to get help and save a life. Everyone can be a Gatekeeper! Let’s Talk About the Faces of Suicide We cannot talk about suicide and not discuss the statistics that are related to this subject. In 2021, 48,183 Americans died as a result of suicide, making suicide the 11th leading cause of death in the United States. Approximately 132 Americans die from suicide every day, with one suicide related death every 10.9 minutes. It is important to talk about these statistics as it gives insight to the gravity and seriousness of the situation. However, we need to put faces to our numbers and remember the individuals and everyone affected by this. The American Foundation for Suicide Prevention (AFSP) is promoting this cause with the ‘Talk Away the Dark’ campaign, which focuses on personal stories and viewpoints. By looking at the actual ‘Faces of Suicide’, it is evident that suicide impacts all ages, genders, and cultures. It is important to remember that every number coincides with one of these faces. While suicide may be an unpleasant word, it is a word that we need to be comfortable saying and talking about. Even if it is difficult. “It is time we shed a light on this leading cause of death. It is time we talk away the dark” (AFSP, 2023). Peggy Fossen, DNP, RN, CNE References AFSP( 2023). National Suicide Prevention Week. https://afsp.org/national-suicide-prevention-week/ CDC(2022).Suicide Prevention Resource. https://www.cdc.gov/suicide/resources/prevention.html Faces of Suicide. https://www.facesofsuicide.com/ IASP (2023). World Suicide Prevention Day. https://www.iasp.info/wspd/ Lu DY, Wu HY, Cao S, Che JY. Historical analysis of suicide. Journal of Translational Genetics and Genomics. 2020; 4(3): 203-9. http://dx.doi.org/10.20517/jtgg.2020.33 NIH (2023). Suicide Prevention, https://www.nimh.nih.gov/health/topics/suicide-prevention QPR Institute. What is QPR? https://qprinstitute.com/about-qpr SAVE. Suicide Statistics. https://save.org/about-suicide/suicide-statistics/ SPRC. Topics and Terms. https://sprc.org/topics-and-terms/ Tadros, G., & Jolley, D. (2001). The stigma of suicide. The British Journal of Psychiatry, 179(2), 178-178. doi:10.1192/bjp.179.2.178 Vocabulary.com. https://www.vocabulary.com/dictionary/suicide
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One of the certainties of life is that we will all experience grief in one form or another. While we will experience grief, will we really understand what is happening as we go through this process. Yes, this is a topic that most people would rather not talk about, or avoid as it can be an uncomfortable one, or maybe it awakens unpleasant memories.
However, having some insight and knowledge about this experience may just help you understand your feelings and behaviors when grief happens. Definitions Let’s start with some basic definitions and clarifications regarding grief. Along with the term grief, there are some other terms that may be used interchangeably. You may hear the words bereavement and mourning. While there are similarities, there are also some significant differences.
What Happens When We Grieve When someone is experiencing the grief process, it is unlikely that time will be given to analyzing the feelings and behaviors they are experiencing. Elisabeth Kubler-Ross provided understanding and awareness of these feelings with her research on the grieving process, and publication of the book “On Death and Dying.” While her book was first published in 1969, it is still referenced frequently and introduced the Kubler-Ross Model with the five stages of grief and loss.
While everyone copes differently, grief can affect the mind, body, and spirit, and can demonstrate the following symptoms.
Complicated Grief While experiencing the above symptoms can be a normal part of the grieving process, there are times when grief becomes overwhelming, incapacitating, and will not improve as time goes on. This is referred to as complicated grief. While it is uncertain why complicated grief occurs in some individuals, it is important to recognize the signs, symptoms, and complications, as they can lead to serious outcomes if not addressed. Signs, Symptoms, and Complications
We know grief happens, and we know everyone will react and cope differently when it does. But knowing there are some coping strategies to help us get through the grieving process is also important. Here are some suggestions which may make the process easier.
Angie Cartwright founded Grief Awareness Day in 2014, and it is recognized every August 30th. Her motivation was to provide education, increase awareness on the uniqueness of grief, and to honor her late Mother. There are many helpful sources available which provide education, information, and resources. So, take some time this August, specifically on August 30th, to check out some resources and become familiar with what is available and where you can find support when you need it. And remember there is no right way or wrong way to grieve, just your way. - Peggy Fossen DNP, RN CNE References Cleveland Clinic. Grief. https://my.clevelandclinic.org/health/diseases/24787-grief Elisabeth Kubler-Ross Foundation. https://www.ekrfoundation.org/elisabeth-kubler-ross/biography/ Elisabeth Kubler-Ross Foundation. On Death and Dying. https://www.ekrfoundation.org/5-stages-of-grief/on-death-and-dying/ Good Grief. Grief Resources. https://good-grief.org/resources/ Grief Recovery Method. Grief Awareness Day; Normalizing Grief and Grief Recovery. https://www.griefrecoverymethod.com.au/grief-awareness-day-normalizing-grief-and-grief-recovery/ Holland, K. (2023). The Stages of Grief and What to Expect. https://www.healthline.com/health/stages-of-grief#7-stages Mayo Clinic. Complicated Grief. https://www.mayoclinic.org/diseases-conditions/complicated-grief/symptoms-causes/syc-20360374 Moore, M. (The Difference Between Mourning and Grieving.(2022). PsychCentral. https://psychcentral.com/health/mourning-vs-grief National Grief Awareness Day. https://nationaltoday.com/national-grief-awareness-day/#:~:text=This%20National%20Grief%20Awareness%20Day,we%20know%20who%20are%20grieving. The Difference Between Grief and Bereavement. (2012). https://www.differencebetween.com/difference-between-grief-and-vs-bereavement/ Vasquez, A. (2022). Is Bereavement the same as Grief. https://www.joincake.com/blog/bereavement-vs-grief/ It is well-known that the number of individuals with a mental health disorder has increased significantly in numbers. While mental illness is not selective and impacts those of all races, ethnicity, religions, and gender, there are significant differences in access to mental health services, resources, and care for minorities. While everyone experiencing a mental health disorder deserves quality mental health care, it has become apparent this is not the case. The challenge to access and receive mental health care is greater for minorities in the United States. “Have you ever tried to unlock a door that wouldn’t open? At first, you think, you might be doing something wrong. Maybe there is a trick to it. You pull the key back a little-doesn’t work. You wiggle the key-doesn’t work. You keep trying, but the door stays locked. After a while, you realize the problem isn’t you, it’s the key”. There are certain challenges to accessing care which are universal to all populations such as, availability of appointments, insurance issues, and finding providers. However, in addition to these barriers, minority populations face additional and unique challenges. These unique challenges contribute to the disparities in access to mental health care for minorities. Awareness and identification of challenges may assist in understanding why this disturbing issue exists. Why There are effective treatments and care for mental health disorders and mental health care. That is not the problem. The problem appears to be that minority populations have less access to these, and when care is provided there is a chance it will be at a lower level of quality. So, what are some contributing factors to this.
While all the above are important; stigma is the one factor which should not be ignored, as it is extremely significant in the struggle to access care in the African American Communities. While this certainly should not be ignored in other populations, evidence shows that mental health issues are associated directly to the psychological stress of systemic racism. In the African American community this results in African American adults reporting serious psychological stress 20 percent more than those in the white community. The evidence also supports the distrust in the care and the hesitancy to seek mental health care. While the evidence supports the fact that mental illness stigma is higher among minorities, what are the proposed solutions. Solutions One study states that “anti-stigma strategies related to metal illnesses according to specific racial and/or ethnic backgrounds with the intention to improve mental health outreach” is indicated. Yes, this sounds good, but changes need to be made on an individual, organizational, and systemic level. Everyone needs to have role in promoting equity. While there are too many proposed solutions to discuss here, there is something that all individuals can start with. That is understanding personal bias. There are tests available to assist in identifying bias, and increasing awareness. Education and increasing awareness on mental health equity and prioritizing minority mental health is the focus of the CDC as National Minority Mental Health Month is recognized this month of July. Both sites provide information and multiple resources promoting awareness on minorities and mental health, and ensuring this issue is addressed not just in the month of July. Sharing these resources, educating others, and promoting awareness is a valuable way to ensure this issue gains the attention deserved. Mental health disorders are treatable, but only if access to appropriate care and treatment is available to all. Everyone should work together for this equity so everyone can experience the best mental health possible. Peggy Fossen DNP, RN CNE References Bell CC, Jackson WM, Bell BH. Misdiagnosis of African-Americans with Psychiatric Issues - Part II. J Natl Med Assoc. 2015 Mar;107(3):35-41. doi: 10.1016/S0027-9684(15)30049-3. Epub 2015 Dec 2. PMID: 27282721. CDC. (2023). Prioritizing Minority Mental Health. https://www.cdc.gov/healthequity/features/minority-mental-health/index.html DBSA. Statistics about Disparities in Mental Health Care. https://www.dbsalliance.org/education/disparities-mental-health-care/ Dworak-Peck, S. (2019). Why Mental Health Care is Stigmatized in Black Communities. https://dworakpeck.usc.edu/news/why-mental-health-care-stigmatized-black-communities He, S. (2020). How would You Tackle Mental Health Disparities. Psychiatric Times. https://www.psychiatrictimes.com/view/how-would-you-tackle-mental-health-disparities OMH. Mental and Behavioral Health. African Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=24 Eylem, O., de Wit, L., van Straten, A. et al. Stigma for common mental disorders in racial minorities and majorities a systematic review and meta-analysis. BMC Public Health 20, 879 (2020). https://doi.org/10.1186/s12889-020-08964-3 SAMHSA. Behavioral Health Equity. https://www.samhsa.gov/behavioral-health-equity/black-african-american SAMHSA. African American Behavioral Health Center of Excellence. https://www.samhsa.gov/african-american-behavioral-health-center-of-excellence Shushansky, L. (2017). Disparities within minority mental health care. NAMI. Post Traumatic Stress Disorder
When we hear the term Post Traumatic Stress Disorder, or PTSD, many of us automatically think of this as a condition experienced by military personnel, or veterans, resulting from combat or other service-related trauma. This perception is certainly not unwarranted as many of these individuals do suffer from PTSD, and awareness of the disorder increased during and after the Afghanistan and Iran operations. While PTSD was recognized as a formal diagnosis in 1980, the recognition and awareness has continued to evolve, and in 2013 PTSD was recognized as a Trauma- and Stressor-Related Disorder in the DSM V. We now realize that anyone can experience PTSD, at any age, and the disorder occurs after experiencing a traumatic event. This includes childhood abuse, domestic abuse, and relationship violence. PTSD and Abuse/Violence It is estimated that approximately 6 out of 100 people will experience PTSD in their lifetimes. It is also proven that women will develop the disorder more frequently than men. Statistics indicate that 10% women will experience PTSD compared to 4% of men. This significant difference is linked to the type of trauma women are subjected to, which have a higher risk for PTSD. This trauma could include domestic violence, sexual assault, physical assault, or emotional abuse. Health professionals are now recognizing the strong link between emotional abuse, domestic abuse, and PTSD. The goals of emotional abusive behaviors are to control, scare, and manipulate. Domestic violence includes intimate partner violence (IVP), and can include:
PTSD and Complex Post Traumatic Stress Disorder Symptoms of PTSD can develop within three months of the traumatic event, or later, and can be classified into re-experiencing, avoidance, arousal and reactivity, or cognition and mood symptoms. Some examples of these include.
So how do we distinguish between PTSD and CPTSD? As discussed previously CPTSD results from chronic abuse or trauma. Along with the circumstances we discussed previously, this could also include child abuse. Also, along with the symptoms of PTSD, individuals suffering from CPTSD will have additional symptoms. These include:
Coping with PTSD What help is available for those that experience PTSD? While some medications are used in the treatment of PTSD, other therapies are widely used. These include:
Peggy Fossen, DNP, RN, CNE References BrainLine (2023). All about brain injury and PTSD. https://www.brainline.org/article/dsm-5-criteria-ptsd Bridges to Recovery. https://www.bridgestorecovery.com/post-traumatic-stress-disorder/can-emotional-abuse-cause-ptsd/ Cleveland Clinic (2023). CPTSD (Complex PTSD). https://my.clevelandclinic.org/health/diseases/24881-cptsd-complex-ptsd NIH (2014). Trauma-Informed Care in Behavioral Health Services. https://www.ncbi.nlm.nih.gov/books/NBK207201/ Miao XR, Chen QB, Wei K, Tao KM, Lu ZJ. Posttraumatic stress disorder: from diagnosis to prevention. Mil Med Res. 2018 Sep 28;5(1):32. doi: 10.1186/s40779-018-0179-0. PMID: 30261912; PMCID: PMC6161419. Tull, M. (2020). Dialectical Behavioral Therapy (DBT) for PTSD. VeryWellmind. https://www.verywellmind.com/dbt-for-ptsd-2797652 Tull, M. (2021). How PTSD is treated. VeryWellmind. https://www.verywellmind.com/ptsd-treatment-2797659 University of South Carolina School of Medicine. Post Traumatic Stress Disorder. https://uscmed.sc.libguides.com/c.php?g=885034&p=6359964 US Department of Veteran Affairs. PTSD: National Center for PTSD. https://www.ptsd.va.gov/understand/types/violence_ipv.asp Vernor, D. (2019). PTSD is more likely in women than men. NAMI. https://www.nami.org/Blogs/NAMI-Blog/October-2019/PTSD-is-More-Likely-in-Women-Than-Men Mental Health Awareness Month is a perfect time to remember just how important our mental health is. Good mental health contributes to our physical health, our relationships, our work, and our overall outlook on life. Take a minute to think about that, and just how essential good mental health is. So, how do we take care of something of such importance? While there are many strategies to put into our toolbox, learning effective coping skills should be at the top of the list. Coping skills can fall into different categories such as distraction, physical, self-soothing, processing, grounding, and sensory. As everyone is different and unique, coping skills should be individualized. Choose what works best for you.
While we can’t talk about all the coping skills available, lets focus on a few.
Get Creative Let’s get creative. If you are thinking you are not the creative type, and would not even know where to begin, learning a new hobby or craft is a great coping strategy. While there are many creative arts to choose from, it has been proven that making pottery has therapeutic benefits, and can decrease feelings of depression and stress. The creativity involved in this activity results in a positive outlet for feelings and can be a wonderful coping strategy. Making pottery also allows for self-expression and is an alternative way of expressing feelings, other than speaking. The process is very hands on and provides a relaxing tactile experience. This can be very calming and can decrease stress levels. If you do not have access to a studio that offers pottery making you can get oven bake clay and all the supplies you need at a local craft store, or Hobby Lobby. So, along with making some beautiful pottery, you learn a very beneficial coping skill. Pottery is not the only creative activity available to help us cope and improve our mental well- being. Some other examples include painting, drawing, gardening, photography, or even coloring. Drawing, Coloring, including Mandala, can relieve stress and anxiety. A recent study supports that these artistic endeavors can reduce stress and anxiety. The Benefits of Nature We all know that walking is a great for our physical health, but what about our mental health? The benefits of walking are many and include decreasing stress levels and improving mood and depression. This occurs due to our body releasing endorphins, which can make us feel good. If you want some extra benefits, choose a natural area to walk and connect with nature. Studies show that walking in nature increases the stress relief even more. If you are feeling down, or experiencing depression, a nature walk may be just the thing to chase the blues away and lessen feelings of depression. Research showed that frequent walks in a natural environment decreases the feelings of depression. Nature has so much to offer us, something as simple as listening to rain or the rustling of leaves can be soothing with a calming and relaxing effect. This can be very beneficial for those who are experiencing sleep difficulties or anxiety. Processing Strategies Another great coping skill, that can be done outside or inside, is journaling. Journaling helps decrease anxiety and stress by providing a way to work through and process your feelings. It allows one to clarify thoughts and feelings and to write your worries down. Journaling can also help by organizing chaotic thoughts. Writing those thoughts down on paper can make them more manageable. So, grab a pen and some paper, put on some relaxing music, and start journaling. The relaxing music also has its advantages, making it another effective coping strategy. Listening to soothing music can enhance your experience as it regulates emotions and promotes relaxation. It can also chase away those negative thoughts and feelings. Many studies have proven that listening to music can decrease feelings of depression and anxiety and even improve our immune system! These are just a few of the many coping skills available for your toolbox. What’s important here is that you find what works for you and your unique needs. So, be creative, enjoy nature, organize your thoughts by journaling, calm yourself by listening to relaxing music, and remember. Your mental health is worth it! Peggy Fossen DNP, RN, CNE References Chakraborty, S. (2020). How is Creativity and Coping Interconnected. PsychoLogs. https://www.psychologs.com/CREATIVITY-AND-COPING/ Conway, B. (2022). Exploring Pottering for Mental Health Wellbeing At The Heart Studio. LIFL. https://www.lifeinthefingerlakes.com/exploring-pottery-for-mental-well-being-at-the-heart-studio/ Kvarnstrom, Elizabet. (2015). The Shape of Healing: The Power of Pottery in Mental Health Treatment. https://www.bridgestorecovery.com/blog/the-shape-of-healing-the-power-of-pottery-in-mental-health-treatment/ McConatha, J., (2021). Creative Coping in Troubled Times. Psychology Today. https://www.psychologytoday.com/us/blog/live-long-and-prosper/202108/creative-coping-in-troubled-times Ryback, R. (2016). Music’s Power Explained. Psychology Today. https://www.psychologytoday.com/us/blog/the-truisms-wellness/201601/music-s-power-explained Scott, E. (2022). Journaling to Cope with Anxiety. VeryWell Mind. https://www.verywellmind.com/journaling-a-great-tool-for-coping-with-anxiety-3144672 Siri Jakobsson Støre & Niklas Jakobsson (2022) The Effect of Mandala Coloring on State Anxiety: A Systematic Review and Meta-Analysis. Art Therapy, 39:4, 173-181, DOI: 10.1080/07421656.2021. Taylor, M. (2021). Adult Coloring Books: 7 Benefits of Coloring. WebMD. https://www.webmd.com/balance/features/benefits-coloring-adults |
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