by Brittany Stahnke, DSW, LCSW, LMFT
Suicide rates have been on the rise since the emergence of COVID-19. In fact, suicide is the second-leading cause of death in age groups up to age 34 (Hedegaard et al., 2021). Along with the number of completed suicides, the number of attempts is climbing. In 2022, whereas 1.6 million adults attempted suicide, 13.2 million adults considered suicide in this same year (U.S. Department of Health and Human Services, n.d.).
Many issues surrounding suicide rates are well-known. Mental illness. Access to firearms. Poverty. Some are lesser-known and can only be explored in smaller, more in-depth studies. Although most research is comprised of large demographic data sets that cannot speak to the experiences of the sufferers themselves, smaller studies can do just this. Understanding trends on a personal level may illuminate further systemic issues left unknown otherwise.
Emotional Dysregulation
In one small interview study (Stahnke et al., 2022), all participants expressed a kind of emotional dysregulation—an inability to handle emotional overwhelm and/or “overwhelmingly empty” feelings that caused them to desire suicide during these times: “...I thought that suicide was the only way to make the mental/psychic pain stop.” These participants did not desire death but felt a need for the feelings they were experiencing to end (Akotia et al., 2019). Participants felt too much or too little, and they did not seem to know how to handle such an over- or under-abundance of emotion. As participants experienced a feeling of emotional overload, some drew close to suicide.
In our society, children are not taught widely how to cope with or accept their feelings in safe, appropriate ways. Emotional regulation skills are not taught consistently in homes or schools, with the preference being to hide feelings. This may one day lead to destructive behavior toward oneself or others. To curtail suicide rates, all people need to learn these skills as they are growing up and coping with various situations—situations we are all sure to fall upon in our lives and need to have the skills to manage. Further, information gathered from participants supports the idea that individuals with such emotional regulation abilities can steer themselves away from suicidality.
Participants expressed a lack of long-term relief even when acting on these feelings by screaming, cutting, and attempting suicide. The feelings don’t leave, and accepting this helps participants to learn to live with them instead, if they choose. Essentially, they can “learn to [live] with those types of feelings.” Though the feelings may not be a choice, what individuals do with their overabundance of feelings is. They have the choice to distract themselves, to live with the feelings, and/or to do something productive with the feelings.
The development of positive defense mechanisms, such as humor or directing such energies creatively or productively (sublimation), is a decision one can make if one chooses to live, no matter what happens and what one’s feelings may be. Therapists may also incorporate emotional regulation and distress tolerance skills, such as those in Dialectical Behavioral Therapy, into all sessions and with all clients who struggle with depression and suicidal tendencies. People need to understand that no matter how they are feeling or thinking, they always have the choice to get help, to keep on going, and to live.
Minimizing Stigma
Unfortunately, access to treatment and support is often barred by the felt stigma in society for needing mental health help and, even more so, for feeling suicidal. An inability to feel safe was expressed in this study:
I think it could be prevented if somebody knows, if it’s acknowledged…I mean, as a child I remember a lot of adults around me knew something was going on, but they really didn’t do anything, they didn’t want to be rude, they wanted to be polite, not ask questions…they wouldn’t dig deep.
This participant pointed out the feeling that “like if that was not the case so much, people would be like ‘I am struggling, and I could ask for help, and it is okay.’” However, people “are afraid to seek out that help” because “they think that therapy is weak.” All suicide prevention efforts should be public with no effort to hide the availability of help. This way, if one needs help, they will know where to turn. This will all contribute to changing the taboo nature of suicide, eventually saving lives of individuals who feel safer to speak up.
In 2022, 13.6% of adults 18-25 had serious consideration of suicide, and likely, the reality is that there are many more (U.S. Department of Health and Human Services, 2023). If those who are suicidal knew that so many people have felt the way they do, would they reach out to those who have felt it? Would they allow help from those who understand and have survived? Several individuals in this study who overcame their propensity toward suicide only did so by opening up to other people. Perhaps the suicides that can be prevented are those that are voiced.
Although some suicides will not be prevented, society can focus on preventive measures such as providing space and support for those who are struggling and choose to live—a way “out” for them that is not suicide. Examples include community centers and, most importantly, a society that does not shun the person’s struggle against suicide. Connection can give one not only hope, but also a sense of meaning in life, which research has shown is a protective factor against suicide (Stahnke et al., 2022; Costanza et al., 2019; Wilchek-Aviad & Malka, 2016). With a society of people willing to open up about suicidality and widespread emotional regulation education, perhaps—over time—suicide may become a focused personal concern rather than a national crisis.
References
Akotia, C. S., Knizek, B. L., Hjelmeland, H., Kinyanda, E., & Osafo, J. (2019). Reasons for attempting suicide: An exploratory study in Ghana. Transcultural Psychiatry, 56(1), 233–249. https://doi.org/10.1177/1363461518802966
Costanza, A., Prelati, M., & Pompili, M. (2019). The meaning in life in suicidal patients: The presence and the search for constructs. A systematic review. Medicina, 55(8), 465. https://doi.org/10.3390/medicina55080465
Hedegaard, H., Curtin, S.C., & Warner, M. (2021). Suicide mortality in the United States, 1999–2019 (NCHS no. 398) [data brief]. CDC.
Stahnke, B., Gaumond, C., & Davis, R. (2022). Experienced causes of suicidal intent: A grounded theory analysis. Crisis, Stress, and Human Resilience: An International Journal, 4(1), 32-52.
U.S. Department of Health and Human Services. (2023). Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health, SAMSHA. (No. PEP23-07-01-006). https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-nnr.pdf
U.S. Department of Health and Human Services. (n.d.). Suicide. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/suicide
Wilchek-Aviad, Y., & Malka, M. (2014). Religiosity, meaning in life and suicidal tendency among Jews. Journal of Religion and Health, 55(2), 480–494. https://doi.org/10.1007/s10943-014-9996-y
Brittany Stahnke, DSW, LCSW, LMFT, is an assistant professor of social work at East Tennessee State University, where she does research on mental health, suicide, and families.