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Pandemic May Contribute to More ‘Deaths of Despair’

Pandemic May Contribute to More ‘Deaths of Despair’

Learn how isolation and uncertainty are fueling this crisis and how to spot warning signs that someone is at risk.

Updated on June 12, 2020 at 3:00pm EST.

The prolonged social and economic fallout of the COVID-19 pandemic, particularly isolation, unemployment and food insecurity, could worsen an already troubling trend in the United States: rising suicide rates.

A growing number of mental health experts have cautioned against a spike in “deaths of despair” as many Americans are not only struggling with fears of infection but also coping with a range of additional stressors—all with no end in sight.

In May, the U.S. unemployment rate fell slightly to 13.3 percent, but nearly 43 million Americans have filed for unemployment benefits over the 11 weeks between mid-March and June 2020.

Meanwhile, U.S. Census Bureau survey data released on May 20 suggests the pandemic is weighing heavily on the minds of Americans, with nearly 30 percent of adults reporting feelings of anxiety or depression. The civil unrest that has erupted across the United States in response to enduring racial injustice and police brutality has added even more emotional strain.   

Defining ‘deaths of despair’
Deaths of despair—those resulting from suicide or self-poisoning with alcohol or drugs—have been climbing steadily in recent years as many people grapple with financial worries, isolation, systemic racism and limited access to affordable health care, according to the Well Being Trust.

Suicide is currently the tenth leading cause of death in the United States, the Centers for Disease Control and Prevention (CDC) reports. In 2017 alone, more than 47,000 people in the U.S. took their own lives. Suicide is also the second leading cause of death among people between 10 and 34 years old.

And now, COVID-19—a highly contagious respiratory infection that brought the world to its knees in just a matter of months—has added to this burden indefinitely.

“Many people are feeling a complete hopelessness and fear of the unknown,” says Asim A. Shah, MD, chief of psychiatry at Houston’s Ben Taub Hospital and professor and executive vice chair of the Menninger department of psychiatry at Baylor College of Medicine. “And loneliness during the pandemic can cause more despair.”

Looming mental health crisis
As people around the world have been forced into various degrees of social isolation and many are facing more anxiety and financial insecurity, a report from the United Nations (UN) urges world leaders to prepare for a mental health crisis.

Among those at particularly high risk are frontline healthcare workers, older people, teens and children as well as those with pre-existing mental health conditions and those caught up in conflict and crisis, according to UN Secretary-General António Guterres.

The UN report also points out that many people who were able to manage anxiety before the pandemic are less able to cope due to “multiple stressors generated by the pandemic.”

In 2018 alone, there were more than 180,000 deaths of despair in the U.S., the CDC reports. Research suggests that now, as the pandemic persists, more people may have thoughts of suicide or self-harm and potentially act upon them. A May 2020 study released by Well Being Trust and the Robert Graham Center for Policy Research in Primary Care and Family Medicine estimates that sluggish economic recovery combined with high unemployment could contribute up to 150,000 deaths of despair over a 10-year period.  

An April 2020 article in JAMA Psychiatry argues that the unprecedented steps taken to “flatten the curve,” particularly the call for social distancing, has the potential to contribute to a spike in suicide risk.

Social isolation can take an emotional toll
In recent years, the climbing suicide rate has been linked to the opioid crisis. “But the wave of despair we’re seeing now is very different,” Dr. Shah argues. It’s marked by “touch deprivation” or “touch starvation,” he contends.

“It’s a phenomenon that’s very unique and very important. Human beings are used to touching other humans,” Shah says. With social distancing, the virus has curtailed touch, which can affect people’s oxytocin levels, he explains.

Dubbed the “love hormone,” oxytocin is an important neurotransmitter, or chemical messenger in the brain. It’s involved in human bonding—between mothers and infants, couples and other social connections. Researchers have long investigated the role of oxytocin in stress relief, building trust and easing anxiety.

Touching and hugging can help stimulate the release of this chemical, Shah points out. “Some oxytocin is even secreted when we shake hands,” he says. Now that people must practice social distancing, that release of oxytocin is diminished, which may contribute to feelings of sadness and depression, Shah adds.

These effects may be compounded by spending a lot more time at home and not being able to engage in certain activities or, in some cases, even see family or friends.

Support systems are faltering
Meanwhile, many Americans who rely on their religious communities or other groups that have temporarily transitioned to virtual celebrations or gatherings may be feeling more isolated and less supported during these challenging times. The JAMA Psychiatry paper suggests this could lead to increased risk for suicide.

Complicating matters, many people, particularly those worried about exposure to the coronavirus that causes COVID-19, may delay seeking mental health care. In some cases, those who would benefit from the support of a trained professional may not realize teletherapy has emerged as a vital resource during the pandemic.

Easing the pain during troubled times
Socializing—even while keeping our distance—is more crucial now than ever in order to help curb depression and avoid deaths of despair, says Shah. That means being physically but not socially distant, he explains.

In fact, Shah says he would like to replace the term “social distancing” with “physical distancing.”

Why? “Human beings are made to socialize with each other. Even the words ‘social distance’ make people feel lonely, isolated and depressed. Wear a mask and keep six feet distance,” Shah says, “but socialize within those parameters.”

Other ways to stay connected and ease pandemic-related despair:

Take advantage of technology. Reach out to others by calling them on the phone. Also, try to embrace video conferencing platforms, like Zoom and FaceTime, to connect with family, friends, elderly relatives and neighbors virtually. Some amount of oxytocin is still released when connecting online or by phone—just by seeing or hearing other people, says Shah, which can help improve mood. “You can have that closeness,” he says. “We need to use tech to our benefit.”

Take comfort in a pet. Another way to raise oxytocin is to cuddle up with your cat or pet your dog. “Having pets is protective,” Shah says. Touching a pet can release the same amount of the hormone as hugging a friend, he points out, noting that he’s seen plenty of depressed and even suicidal patients who persevere out of devotion to their animals. “Pets really help people who are lonely,” Shah adds.

Be aware of those at higher risk. Maintaining regular contact with friends and family members at high risk for depression or self-harm is paramount, particularly front-line workers, those who are older or have pre-existing mental health issues or substance abuse problems, Shah advises.

Seek virtual support. Mental health concerns, including anxiety and depression, are treatable with either medication, talk or behavioral therapy or a combination of the two. If you or someone you care about need counseling as the crisis unfolds, take advantage of telemedicine.

Most people with Wi-Fi and a smartphone, tablet or computer can “see” a healthcare provider virtually for medical advice and keep follow up visits without leaving their home. If you don’t have video conferencing capabilities or your Wi-Fi connection is too weak, however, a phone consultation can be arranged.

Know when to seek immediate help
Red flags that someone may be suicidal and in need of immediate help may include dramatic mood swings, talking about being in unbearable pain, aggressive behavior as well as feeling trapped or like a burden to others.

But even more subtle changes in someone's personality, behavior or how they express their emotions could be a warning sign.

If you believe that you or someone you know is at risk for suicide, trust your instincts. Don’t be afraid to ask direct questions, such as “Are you thinking about hurting yourself or dying?” Having this candid talk won’t make someone more likely to take their own life. It could actually have the opposite effect. Giving people the opportunity to open up about their feelings may reduce the likelihood that they act on suicidal thoughts.

People considering suicide can also reach out to the Crisis Text Line by texting ‘HELLO’, ‘HOME’, START’ or ‘NAMI’ to 741741. They will be connected with a person who will listen to their concerns without judgement. They can also call the National Suicide Prevention Lifeline at 1-800-273-8255.

Knowing that suicide rates in the U.S. could rise, Congress is working to pass legislation introduced back in 2019 that will establish a new three-digit number to reach the national suicide prevention and mental-health crisis hotline, making it easier for people to seek help.

It would take about 18 months to implement but people would only need to dial 988 to seek help, similar to calling 911 for emergencies or 311 for city information and service.

If you’re with someone who is actively considering suicide, do not leave that person alone. Call 911 right away or go to the nearest emergency room.

Medically reviewed in June 2020.

Sources:
MA Reger, IH Stanley, TE Joiner. “Suicide Mortality and Coronavirus Disease 2019—A Perfect Storm?” JAMA Psychiatry. Published online April 10, 2020.
American Psychological Association. “How will people react to the new financial crisis?”
U.S. Bureau of Labor Statistics. “Employment Situation Summary.” Friday, June 5, 2020.
U.S. Department of Labor. “Unemployment Insurance Weekly Claims.” June 11, 2020.
U.S. Census Bureau. “Weekly Census Bureau Survey Provides Timely Info on Households During COVID-19 Pandemic.”
Well Being Trust. “Projected Deaths of Despair from COVID-19.”
National Institute of Mental Health. “Suicide.”
United Nations. “UN leads call to protect most vulnerable from mental health crisis during and after COVID-19.”
World Economic Forum. “U.N. warns of global mental health crisis due to COVID-19 pandemic.”
Psychology Today. “Oxytocin.”
Brain & Behavior Research Foundation. “‘Love Hormone’ Oxytocin Shows Promise in Treating Anxiety Disorders.”
K Uvnäs-Moberg, L Handlin, M Petersson. “Self-soothing behaviors with particular reference to oxytocin release induced by non-noxious sensory stimulation.” Frontiers in Psychology. Jan 12, 2015.
Penn Medicine. “Can You Kiss and Hug Your Way to Better Health? Research Says Yes.”
American Foundation for Suicide Prevention. “Risk factors and warning signs.”
Congress.gov. “S.2661 - National Suicide Hotline Designation Act of 2020.”
Federal Register. “Implementation of the National Suicide Hotline Improvement Act of 2018.”

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