December 02, 2020
By Julie Gould
In a special communication article recently posted in JAMA Psychiatry, Christine Moutier, MD, chief medical officer of the American Foundation for Suicide Prevention, explains opportunities COVID-19 presents for suicide prevention. According to Dr Moutier, political will, federal investments, and the global community are vital for suicide prevention.
“Prior to the pandemic, many countries were engaging in suicide prevention strategies, and although the overall global burden of suicide deaths has increased, some national efforts were beginning to see positive results,” Dr Moutier wrote. “There are actionable steps that policy makers, health care leaders, and organizational leaders can take to mitigate suicide risk during and after the pandemic.”
To better understand why she wrote this article, how suicide prevention efforts have been proven to be effective, and why during and following the current pandemic, ramping up suicide prevention efforts must be done, and will make a critical, life saving difference, we spoke with Dr Moutier.
What existing data led you to write this special communication article?
The background for my Special Communication article in JAMA Psychiatry titled “Suicide prevention in the COVID-19 Era: Transforming Threat into Opportunity” includes the following three areas:
- Data from current suicide and vital registration surveillance in multiple countries, allowing us to assess whether COVID is impacting suicide rates in multiple countries since the start of pandemic in early 2020.
- Data from polls/surveys in the U.S. and the EU show self reported impacts of the pandemic on the populations’ mental health.
- Data from a larger previous literature on suicide risk factors allows us to evaluate how the pandemic may influence suicide population risk.
Please briefly describe your article. Was any evidence/data particularly surprising?
Considering many media outlets and some politicians made predictions that the pandemic and shelter-in-place and other public health measures would lead to escalations in suicide rates, the data thus far indicating no evidence of this may surprise some. We have long known that risk factors such as deteriorating mental health, problems accessing mental healthcare, social isolation, increases in substance use, financial strain, disruptions in relationships and social supports, trauma/violence in the home and discriminatory health inequalities for some populations-- all increase suicide risk. And all of these factors have been exacerbated by the pandemic- not all of them for all people but some for many people.
The most important message from my article is that suicide prevention efforts (when implemented and scaled up) have been proven to be effective, reducing risk, and driving down suicide rates. Now is a time in history, during and following this pandemic, when ramping up suicide prevention efforts must be done, and will make a critical, life saving difference.
What are the possible real-world applications of this paper in clinical practice?
The applications for clinicians and health system leaders include the importance of making the changes to practice that have been most effective at reducing suicide risk. Those actions are outlined in my JAMA Psychiatry paper briefly (since the article includes an overarching public health strategy) and in more detail in other papers including:
- Universal screening for suicide risk across not only behavioral health, but primary care and Emergency Departments
- Using the current methods for suicide risk assessment such as the NIMH’s ASQ Pathway
- Employ brief interventions like Safety Planning and Lethal Means Counseling
- Discuss these plans with the patient and their identified family/friends
- Systematically reach out to the patient with a series of Caring Communications
- Provide Crisis resources and referral for suicide preventive care such as CBT, DBT, CAMS or Attachment Based Family Therapy (ABFT)
Do you intend to expand upon this research?
Yes, I have a clinical handbook on suicide prevention that will provide more detailed, practical in-the-moment steps for clinicians across any healthcare setting or specialty, co-authored by Drs. Stephen Stahl and Anthony Pisani, releasing in early 2021 (part of the Cambridge University Press Stahl Clinical Handbook Series).
And our participation in the International Covid-19 Suicide Prevention Research Collaboration’s “Living Review” including suicide surveillance across many coutries will continue over the coming months.
Is there anything else pertaining to your research and findings that you would like to add?
My paper is a call to action for leaders in health systems and clinicians, and also for policy leaders at national and local levels. Thank you very much for highlighting the messages and findings from this article.
About Dr Moutier
Christine Moutier, MD, has served as the chief medical officer of the American Foundation for Suicide Prevention (AFSP) since 2013, ensuring that evidence-informed strategies are used to identify areas of opportunity for their research grants program, and that their chapters’ work across all 50 states, advocacy efforts at the federal and state levels, and prevention and support programs are effective and impactful.
Some highlights from her recent work include: testifying before the U.S. Congress and providing multiple Congressional briefings on suicide prevention, presenting to the White House, advising the National Academy of Sciences, authoring a Special Communication for JAMA Psychiatry on suicide prevention during COVID-19, co-anchoring CNN’s Emmy Award winning Finding Hope suicide prevention town hall, and appearing as an expert in The New York Times, The Washington Post, Time magazine, The Economist, The Atlantic, the BBC, and other media outlets.
Dr Moutier’s work in suicide prevention began with personal experiences of loss and lived experience during her academic medicine career at the University of California, San Diego. There she served as assistant dean for medical education and student affairs in the School of Medicine, Professor of Psychiatry, and medical director of the Inpatient Psychiatric Unit at the VA Medical Center in La Jolla, treating diverse patient populations from Asian refugees to Veterans to corporate and academic leaders. She served as 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 C. Suicide Prevention in the COVID-19 Era: Transforming Threat Into Opportunity [published online ahead of print, 2020 Oct 16]. JAMA Psychiatry. 2020;10.1001/jamapsychiatry.2020.3746. doi:10.1001/jamapsychiatry.2020.3746