Suicide Risk and Prevention Across Generations

Suicide ranks as the eleventh leading cause of death in the United States. We have lost loved ones across the generations.

• Older Americans are disproportionately likely to die by suicide. Although they comprise only 12 percent of the U.S. population, people age 65 and older accounted for 16 percent of suicide deaths in 2004.
• Suicide is the second leading cause of death in college students and the third leading cause of death in adolescents.  Every day 14 teens take their own lives.
• According to the Centers for Disease Control and Prevention, for the second year in a row, middle -aged adults have the highest suicide rate in the country, surpassing even older Americans.
• While there are many factors that contribute to suicide, an important new study identifies two factors that have been associated with increased risk for suicidal thought and behavior across the lifespan – hopelessness and lack of connectedness to others.
• Hopelessness may be driven by different circumstances across the generations, but it generally equates to a feeling of despair, of no hope for change in the future. It is encompassed in the Three I’s of a situation that feels intolerable, interminable and inescapable.
• Lack of connectedness will differ depending on age and expectations but generally equates to the feeling of not belonging, loneliness, lack of connection to those who care, lack of actual social contacts or perceived lack of social contacts. Hopelessness underscores it with the assumption that it will never change.
• The study’s authors, Stephanie Daniel and David Goldston examine these factors in each age group with the goal of identifying cognitive-behavioral interventions that might reduce risk.  Beyond their valuable intended goal, the study has additional potential.
• It raises our consciousness to signs of hopelessness and lack of connection in those around us from each of these age groups.
• It invites us to consider that a direction for protection from suicide may be to consider how these different generations can actually help each other.
• It is worth remembering that there was a time when family members of many generations lived together. Be it on a farm or in a three story building in the city, family members directly or unwittingly were involved with each other in a way that often protected them from despair and loneliness.

• PROTECTION ACROSS GENERATIONS
• The Older Generation
• Informed Friends and Family: Much as we have stressed the importance of parents and significant adults understanding the warning signs of suicide in teens and young adults – we need adult children, friends and health professionals to recognize the same in the older generation.
• Recognizing Depression– Depression, one of the conditions most commonly associated with suicide in older adults, is a widely under-recognized and undertreated medical illness. Research reports that many
older adults who die by suicide visited a physician within a month before death.  Perhaps projecting how they might feel if older, ill or facing the loss of friends, family members and even health care professionals may too often assume that depression fits the circumstances of the elderly.
• The reverse is true.
• Research tells us that older people, despite increasing health issues and less mobility, are on the average, happier and less stressed than younger people.
• Sadness, lack of appetite, isolation, sleeping all day and lack of interest in things etc. are not a normal part of aging.
• Those older people who do suffer from depression often feel no one cares about them and there is no one to care for. They feel of little value to other members of their family, often feeling that suicide would remove them as the burdensome family member.
• When such symptoms are present, help is needed and in those cases where depression is suspected and diagnosed, treatment in the form antidepressant medications, psychotherapy, or a combination of the two, have proven to be effective.
• Facilitating Social Connection
• Protection from the hopelessness and loneliness that can risk suicidal thinking is enhanced social connection.  Elder adults may be aware that they need and enjoy each other’s company but may despair as they lose a friend, can no longer drive or feel their physical illness makes socializing impossible. Family members who see the value in advocating for, transporting or finding a way to facilitate participation of  elder friends and relatives with their peers play a crucial role.
• Intergenerational Connection
• Work, altruism, and gratitude are antidotes to hopelessness and often foster social connection.

On a weekly basis I have watched a group of high school students serve as wheel chair porters for the residents in a Nursing Home who want to go to Bingo, sit on the terrace, or go to the TV room. The seniors talk and thank and make a “fuss” over the students as they head to their destinations and as the students help out with cards, snacks etc. What I have been struck by is seeing the students in the lobby, some of whom have special learning needs, laughing and enjoying themselves as  a social group- it is clear that this is a mutually protective experience.

Another group of teens were given the assignment to record the family history of the oldest member in their family- something that underscored the older family member’s value and the teens sense of purpose.

An elderly gentleman who lived alone volunteered to walk the dog for his neighbors who both worked- they were so grateful, he was so delighted with them and their pet.

Groups of elderly females led by high school seniors recorded their best recipes for a competitive collaborative cookbook contest- everyone was passionate about winning.

The Middle-aged – Baby Boomer Generation

It has come as a surprise that middle-aged adults have registered the highest suicide rate in the country, even higher than the elder population. Of this group, men age 45-54 have the highest rate of suicide. Gender here is crucial – across ages, men die by suicide far more frequently than women – although women make more attempts.

It has been hypothesized that economic meltdown, the unemployment rate and lack of affordable health care may contribute to the despair of this middle-aged group, all of which are relevant in terms of hopelessness and lack of social connection.

Particularly for men, status, viability, and social contacts are often associated with work. Unemployment becomes not only a financial problem but the loss of a social network. Women have more comfort and confidantes in work and non-work friends and are less defined only in terms of their job or profession. Women are also more likely to acknowledge emotional needs and seek help.

CARING FOR EACH OTHER

Because the middle-aged generation is sandwiched between elder parents and young adults and teens, they may benefit from advocating for and caring for the other generations but they may need to utilize each other to address hopelessness and social isolation.

Partner Care – Those who have partners have the benefit of someone to observe signs of hopelessness and isolation and to respond. They are in a position to seek professional help with their partner, to remind their partner of his/her multi-dimensional roles as father, spouse, brother etc. as well as provider, to problem solve economic issues, to underscore the reasons to live, to recall the resiliency that has worked for them in the past, and to hold out hope for the future by staying connected.

Buddy Care – One the most powerful antidotes to the barriers for seeking help is to hear a buddy acknowledge that he has been depressed and hopeless and that he benefited from getting professional help. Most people help themselves as well as their friends when they step-up- be it recommending a mental health professional, helping with job prospects, taking some time to share a sport or just spending time and checking in. As they say with uniformed service groups – no one knows your buddy like you.

Group Care – Groups are a proven way to address hopelessness and isolation. Groups provide validation, problem solving techniques, normalization of feelings, opportunities to help others and the feeling of support from others.

A university program for displaced professionals found from the feedback that the most valuable aspect for the men and women who attended was being in the company of others who were suddenly without jobs trying to re-define themselves. The camaraderie was so helpful that it reduced the hopelessness. Many felt that they eventually found jobs because they had the motivation from the group support to keep looking.

A newly divorced father who felt he would lose connection to his children joined a men’s group run by a mental health professional and found that his worst fears were common and there were things he could do to enhance his life and the connection with his children.

A single unemployed female attorney was encouraged to join a networking group about which she was very anxious- only to find others who were eager to work together to consider new business opportunities and well as social plans.

Teens and Young Adults – The Future Generation

The risk of suicide in the teen and college age population continues to frighten and startle us. For those groups the inability to see beyond the immediate situation, the lack of experience with seeking or getting help and the fear of rejection and feelings of vulnerability can create great hopelessness. For them the lack of social connection and social stigma implied in the loss of a friend, cyber bullying, letting down the team, or breaking up with a boyfriend can become a life or death situation.

The most effective suicide prevention for teen and young adults is intergenerational.  Programs like the Lifelines Program, that involve and train teens, parents school personnel to recognize and respond to the FACTS (Feelings), A (Actions), C (Changes in Patterns), T (Threats) and S (Situations)that are warning signs, empower and connect generations to reduce risks.

Recognizing that young adults, away from home on large college campuses may find it difficult to reach for social connection or directly call for help when hopeless, the American Foundation for Suicide Prevention has offered help with a new anonymous online Interactive Screening Program ISP. In some ways the adult generation has found a bridge to care for young adults by using cyber space. Findings showed that 85% of those students who answered the online questionnaire had depression or were a suicide risk. Of those who followed up and began treatment 75% would not have sought help without the ISP program.

The need to protect and care for each other may be a natural and powerful way to reduce suicide risk across generations.

References

Daniels, S. & Goldston, D. (2011) “Hopelessness and Lack of Connectedness to Others as Risk Factors for Suicidal Behavior Across the Lifespan: Implications for Cognitive-Behavioral Treatment.” Cognitive and Behavioral Practice, Received 4 May 2010; Accepted 21 May 2011. Available online 14 June 2011. http://www.sciencedirect.com/science/article/pii/S1077722911001039

American Foundation for Suicide Prevention http://www.theovernight.org/index.cfm?page_id=A4F81BE0-7E90-9BD4-C10FBFE9858594A9

Suicide Prevention Resource Center http://www2.sprc.org/bpr/lifelines-postvention-responding-suicide-and-other-traumatic-death

Suzanne Phillips, PsyD Bio

Dr. Phillips is a licensed Psychologist, Psychoanalyst, Diplomat in Group Psychotherapy and Co-Author of Healing Together.

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