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Suicide Prevention: What to Know

September 9, 2024

Part 1: Children/Adolescents

By Dr. Stacey Gagliano

Suicidal ideation is a serious concern that affects individuals across all ages and backgrounds. Suicide is the 11^th leading cause of death in the United States. In 2021, suicides nearly doubled the number of homicides in the U.S. and in 2022, it was the second leading cause of death for those aged 10-14 and 25-34, and the third for those aged 15-24. Unfortunately, suicide rates have seen a troubling increase over recent years. From 2000 to 2018, the rate of suicides in the U.S. rose by 37%.

Understanding who is at risk and recognizing the warning signs can be crucial in preventing tragedy and providing timely help. In this two-part blog, we’ll explore key factors that contribute to an increased risk for suicidal ideation, important warning signs to be aware of, as well as what you can do if someone you know is struggling with these thoughts and feelings.

Who is at Risk? – Youth

Identity questions: Struggles with sexual or gender identity can lead to increased risk.
Victims of bullying.
Access to lethal means: Availability of firearms or other means can heighten risk. Firearms were involved in over 50% of all suicide deaths in 2022.
History of self-harm or previous attempts.
Mental health diagnoses such as anxiety and depression, and/or struggles with chronic medical conditions.
Recent loss: Youth experiencing significant losses are at higher risk.
Witness to violence or family history of suicide.
Lack of social support: can increase feelings of isolation.
Lack of access to mental health resources or services.
Stigma: Cultural or societal stigma around seeking help can prevent individuals from reaching out.

Recognizing the Warning Signs

Verbal threats of death, seeking access to weapons, and/or talk of death/dying
Hopelessness and rage: Feelings of despair, rage, or seeking revenge
Changes: Neglecting personal appearance, changes in appetite, and/or withdrawing from friends/family
Engaging in reckless behavior
Feeling trapped: A sense of being trapped with no way out
Making arrangements: Preparing for end-of-life matters, like updating a will or saying goodbye
Increased substance use
Mood swings: Dramatic changes in mood or personality
Loss of purpose: Feeling that life has no meaning or purpose

What Can I Do to Help?

If you are the parent/guardian of a child who struggles with or is at risk for suicidal ideation,

Take steps to reduce access to lethal means in your home.
- Remove all firearms from the home, or at a minimum, ensure that they are all locked and inaccessible to your child. Store bullets separate from the guns.
- Secure all medications and sharp objects in your home as well.
Seek the support of a mental health provider. Ensure that an appropriate safety plan is created.
In the case of an emergency, call 911 or bring your child to your nearest emergency room for an evaluation. You may also wish to contact mobile crisis intervention services in your area.

Hotlines

Suicide Prevention Lifeline: Call or text 988
Crisis Text Line: Text TALK to 741-741
National de Prevencion del Suicidio: 1-888-628-9454
The Trevor Project (Crisis line for LGBTQ+ youth): 1-866-488-7386
National Teen Dating Abuse Helpline: 1-866-331-9474
The National Runaway Safeline: 800-RUNAWAY (800-786-2929)

Check our social media for more resources and useful information.

Sources

American Foundation for Suicide Prevention. (2024, May 11). Suicide statistics.

https://afsp.org/suicide-statistics

Centers for Disease Control and Prevention. ((2024, April 25). Suicide facts.

https://www.cdc.gov/suicide/facts/index.html

National Institute of Mental Health. (2024, February). Suicide statistics.

https://www.nimh.nih.gov/health/statistics/suicide

National Vital Statistics System. (2024). Mortality 2018-2022 on CDC WONDER Online

Database. Centers for Disease Control and Prevention. http://wonder.cdc.gov/mcd-icd10-expanded.html

Rejuvenate your Relationships:

August 6, 2024

Applying the Gottman Method, by Emily Israel, M.S.

Relationships can provide us with comfort, security, enjoyment, pleasure, love, companionship, support, safety, and care. However, we can feel very distressed when our relationships lack these positive experiences. Most of us have experienced challenges in relationships with a partner or loved one at some point. There are ways to support the development of healthy relationships, as well as ways to help a relationship that has become more conflictual become healthy once again.

John Gottman, Ph.D., and his wife Julie Gottman, Ph.D. spent many years researching aspects that support healthy couple relationships and found tools that can benefit both couples and other relationships.

Ways to support a healthy relationship according to Gottman Research:

Get to know the other person’s needs, values, past experiences, priorities, and stresses.
Experience and express love to those with whom you share a relationship (more specific to romantic partners but can apply to other loved ones).
Turn towards your loved one and respond when they engage you. Create opportunities to spend time together to support the building of connection.
Try to view the person from a positive perspective.
Management of Conflict
- Engage in active listening skills to develop empathy: listen intently to the person’s feelings and acknowledge them by validating and summarizing what you heard them say.
- Avoid defensiveness: Take accountability and create an improvement plan. Acknowledge your role in an argument and pick one way you might make it better.
- Avoid attacking the other person’s character or criticizing them: Start with “I feel” and describe what created the feeling without attacking without directing at them and share what you need to feel better.
- Resist Stonewalling: Stonewalling is when we become frustrated in a conflict and we walk away from our significant other or withdraw. When you are tempted to tune out a loved one, consider engaging in self-soothing techniques and taking a timed break to give yourself time to calm down instead. This break should be no more than 24 hours and is meant to bring down each person’s heart rate so that you can re-engage effectively.
Discuss future dreams and understand each other’s goals to create shared meaning.
When one person is stressed about something such as an incident at work, unrelated to the relationship, join in on how they feel and support their position on the issue.
Demonstrate trust and commitment to one another.

If you would like to develop these skills further and rejuvenate any of your relationships, please contact us at the Center.

Pandemic Holidays: Different Doesn’t Have to be Bad

November 17, 2020

By Dr. Christina Carson-Sacco

This year has altered our lives in too many ways to count. The holidays in 2020 are sure to be impacted as well. With COVID restrictions, many of us will not be able to travel or gather safely. Traditions may not happen in the same way. For some there have been very real losses of family and friends, employment or financial insecurity, and estrangements over politics. Regardless of the reasons, this holiday season will likely present significant challenges at the end of an already challenging year.

Identify your Feelings: It is likely that you are more emotional than usual. Start by taking some quiet moments and sorting through the many emotions you are having. Try to identify what the exact emotions are and where they are coming from. You may be surprised to find that some of your emotions aren’t actually connected to the holidays, but are tied to other aspects of 2020.

Acknowledge your Losses: Whether it is loss of people in your life, financial security, freedom to gather/travel, routines like going into an office or participating in sports, or just a general sense of safety in the world, it is critical that you take some time and recognize what you have lost and how you’re feeling about it. It does not help to deny the significance of these losses, though once you have acknowledged your feelings, don’t get stuck dwelling on them.

Resist Romanticizing Past Holidays: It is normal to have an idealized vision of what the holidays are like. But if we are honest with ourselves it isn’t all wonderful. There is a lot of normal stress associated with our typical holidays; financial strain, relationship tension, an overwhelming number of additional chores, and trying to make things perfect. Too often, we try to make ourselves and others happy with material things. For some there are struggles with spending, food, alcohol and unhealthy relationships. Be realistic about the holidays.

Focus on What Is Really Important: Stop and take a moment to think about what is truly meaningful for you at this time of year. It may be family, but only certain ones. Maybe friends are higher on your list than family. Are the spiritual roots of the holidays the most important parts? Does charity figure heavily into what’s important to you? Maybe what you love best is having some time off for relaxation? How can you safely engage in what is most meaningful to you? Try to think outside the box. Come back to this when you lose focus.

Look for the Good: With so much negative noise in 2020, it is sometimes hard to hear the good. Turn down the television. Step away from your social media. Go outside and take a deep breath. Now, think of one thing that you are grateful for. Maybe it is small, like the smell of clean sheets. Maybe it is big, like having a safe home to shelter in. It could be a friend who checks in on you. Or it could be that you are grateful you are in a position to support someone else. Though you may have never planned to work from home, maybe you’re grateful to not have to fight traffic or pay for gas commuting to an office. If you’re a front line worker, while it is stressful, you may be grateful to be able to make a huge difference in the lives of so many vulnerable people. Your children could be sad about not attending school or activities, but they may appreciate slowing down and family time. Or maybe you’re just thankful for comfortable slippers, sweatpants and Netflix. Whatever it is for you, try to find the good.

Control What you Can Control: Keep in mind that you do indeed have control over many aspects of what your holidays will look like. This may be a chance to let go of the parts of the holidays you don’t like; cut out the traditions that don’t work for you. This may be the excuse you need to take a break from unhealthy relationships. You have control over how you wrap up 2020.
• Be aware of your self-care. Especially this year, when emotions are running high, be sure to be on top of eating, sleeping, hydrating, and getting some time moving outdoors. Don’t
underestimate the value of taking a few deep breaths and doing some brief meditation. Many guided meditations are available free in apps or online. Set budgets for spending. Limit drugs and alcohol. Many support groups are now available online. If you are struggling, reach out to a psychologist or your family physician for help. Keep up good boundaries with others. Be aware of a tendency you may have to try to make others happy by forgoing your boundaries. It is ok to say no. If some family or friends challenge you, find ways to connect safely. Avoid hot-button topics or engage in structured activities with individuals that you may clash with.
• Find connection. If you’re alone, the end of the year gives you the opportunity to engage in some serious self care and restoration. Consider pushing outside your comfort zone and reaching out to others you’d like to be closer to. So many people are wishing for more connection this year. Religious institutions are offering community, even if virtually. Many online groups offer connection, as well. Volunteering to help others will help you meet likeminded folks.
• Different doesn’t have to be bad. If your loved ones are apart and you’re dreading another Zoom gathering, add some fun with competition. Who can make the best decorated cake, wreath, gingerbread house, cookies, or ugly sweater? Whose menorah made from things around the house does everyone like best? Which household can win the viral Tik Tok dance off? Play games over technology. If family is near by, do a socially-distant potluck. Have each household cook a dish and drop off portions on each other’s porches. Then zoom in and enjoy together. Traditionally, many families are so busy they rarely spend a lot of time talking during the holidays. This year, each member can take turns telling stories about the past or sharing their hopes and prayers for the new year. Maybe your loved ones can do a craft together over Zoom which they donate to a charitable organization. If we get lucky with mild weather, take a family walk or gather safely outside around a fire pit. Lastly, who says you cannot celebrate your holiday at a different time of year? Why not plan to have a holiday do-over as soon as it is safe to do so? Kwanza part two in February? Christmas or Hanukkah repeat in March? It may not be the same, but it can still be good and incorporate those parts of the holidays that you love the most.

With so much of the world feeling out of our control, if we acknowledge our feelings and shift our focus to what is important and positive, while taking good care of ourselves, we can take control of our holidays and have a meaningful end of 2020.

Dr. Christina Carson-Sacco is a clinical psychologist and a partner with The Center for Neuropsychology and Counseling, P.C. with offices in Warrington and Lafayette Hill, Pennsylvania. She is available for public speaking and consultation. To learn more about her practice visit www.TheCenterInWarrington.com

Other helpful resources:
https://www.cdc.gov/
https://findhelp.org/
https://suicidepreventionlifeline.org/
https://www.samhsa.gov/
https://www.aa-intergroup.org/
https://www.thetrevorproject.org/

Sometimes It Helps to Name It: Talking About Loss During a Pandemic

April 17, 2020

By Dr. Christina Carson-Sacco

In Pennsylvania, where I live, we are about a month into the ‘lockdown’ caused by the COVID-19 pandemic. I’ve noticed there is a shared feeling among family, friends and patients. It’s like someone draped a blanket full of heavy feelings over the world. It’s even affecting our sleep, as most are tossing and turning with vivid, scary dreams.

Because so many people are struggling, it is important to recognize the evidence that suggests giving a name to the feelings and speaking about them can be helpful. In short, I think what we are all feeling is Loss and the resulting Grief.

In this unstable and uncertain time, it is easier to identify the anxiety we are feeling. But as time has dragged on, for many this has turned into loss and grief.

Sadly, for some, it is tangible loss due to the death of a loved one at a time when it is impossible to gather and mourn. For others it is a loss of less tangible things like routine, freedom, and normalcy.
Others have felt the loss of special events like celebrating birthdays, graduations, proms and other important milestones.
Most people are feeling a loss of connection with others due to the need for social distancing.
Some have lost financial security and jobs.
For many, there is a loss of a sense of safety and knowing what the future holds. People everywhere are feeling the change that is happening in the world as a loss. Maybe they are grieving for what they thought the future would look like. In many ways, this pandemic reminds me of the change in our country after the tragic events of 9/11. We all are grappling with the knowledge that things will be different after the pandemic, though we don’t know exactly how.

After we name it, what can we do?

First, don’t compare your losses to the losses of others. All are real and important. Just because someone else’s loss seems bigger than yours, it doesn’t make your pain any less valid. Have self compassion and allow yourself the space and time to grieve for your losses. Keep in mind that there is no ‘right’ way to grieve. As long as it doesn’t harm yourself for others, however you or your loved ones are doing it, is ok.
Crying is a natural human way to cope with pain. Go ahead and cry; find privacy to do so if you need to. Keep in mind children may be crying more, too. Or sometimes they show their grief by throwing tantrums or being defiant.
Then express it. Say it out loud to those who support you. Write about it. Make art. However you prefer to do it, just get it out.
Taking time to meditate, while doing some deep belly breathing, can help us cope with challenging emotions. There are many great, free meditation videos online or apps for your phone. Aim to take a few quiet moments to breathe and meditate each day.
Try to stay present and focus on what is within your control. Sometimes our grief can take us down the path of ruminating on the ‘what ifs.’ When this happens, bring yourself back to the present moment. One way to do this is to look for 5 things in your surroundings and focus on each one for a moment. Another way is to use your 5 senses by finding one thing you see, one thing you smell, one thing you taste, one thing you feel, and one thing you hear.
Even in times of tragedy, there are positives, though we may have to search for them. Limit your exposure to negative media stories. Spend some time each day looking for the good around you, however small. Maybe there are wildflowers blooming along the path where you walk. Maybe there are news stories about people helping others. Maybe you find joy in the funny things your pets do or a special song. Search out at least one thing that makes you smile each day.
Lastly, if you are in need of support, reach out to a professional. Many psychologists are providing video or phone sessions. Some organizations are offering online support groups. See the resources below.

Dr. Christina Carson-Sacco is a clinical psychologist and a partner with The Center for Neuropsychology and Counseling, P.C. with offices in Warrington and Lafayette Hill, Pennsylvania. To learn more about her group practice visit www.TheCenterInWarrington.com

Other helpful resources:

Tips for Caring for your Mental Health during a Pandemic – by Dr. Christina Carson-Sacco

March 27, 2020

I have to admit, I never imagined I’d ever type the words “caring for your mental health during a pandemic,” but I guess that is a big part of this. No one expected to experience this and most do not have a reference point of some experience to draw upon. We are in uncharted territory, which is leaving many unsettled, scared, sad, angry, frustrated, or just confused. Our everyday lives have been turned upside down, and we feel powerless to stop it.

Attachment 1 — Tips for Caring for your Mental Health during a Pandemic - by Dr. Christina Carson-Sacco 3

Here are some tips, born out of my 20 plus years as a psychologist, including my recent work helping my clients weather this storm.

Focus on what you can control. Life may feel very out of control right now. Often, we get stuck ruminating on the things we can’t control. The people not practicing social distancing. The stock market ups and downs. What can you control? If you catch yourself focusing on the uncontrollable, take a deep breath and choose one thing to focus on that you can feel power over. One thing you can control is choosing to participate in activities that make you feel better. I sometimes say, “As long as it doesn’t hurt you or someone else, and is legal, I don’t care what it is, just do it.”

Keep perspective. What is happening is scary and we must take precautions. However, it is easy to engage in catastrophic thinking. Most people who get sick will have mild symptoms. There are ways to protect yourself and your loved ones. Vaccines and medicines are being developed.

Limit your exposure to media. Having tons of information at our fingertips is both a blessing and a curse. When we are stuck inside, it is normal to scroll through social media or have the news on the television in the background.

Make an effort to only check the news once or twice a day.
Get away from social media, or at the very least, consume selectively. Unfollow extremely negative sites or people. Purposely follow positive sites like Upworthy or Good News Network.
Be aware that much of the information you receive from soft sites or family and friends may not even be accurate. Try to only get news about the pandemic from reliable sources like the Centers for Disease Control (CDC).

Stay connected. While we are practicing social distancing, we may feel lonely. Being physically apart does not have to mean being disconnected. It just may require some creativity or extra effort.

Using virtual ways to connect can be fun. Facetime, Skype, and Zoom are great ways to see people you haven’t seen in a while. Think about organizing virtual book clubs or religious studies. Games can be played virtually like Pictionary, Heads Up, Scategories or trivia. Netflix Party is a way to watch movies with your friends.
Post videos of your performances if you have a talent to share.
Offer to tutor someone or read to someone.
You are allowed to walk, run, or bike, so go meet a friend and stay 6 feet apart.
Have a picnic but bring your own food and stay apart.
Garden together or help a neighbor with their garden.
Even writing letters and putting them in the mail can help us feel connected to others around the world who are going through this with us.

Have good boundaries. While we need to stay connected, we may need to do it carefully. Some people in our lives, maybe including those we are stuck in the house with, may not always be good for our mental health. Respect that everyone is dealing with this in their own way. Take some physical space away from one another. Limit contact with people in your life who are very stressful, including on social media. Ask others to respect your needs.

Appreciate what is good. Many of us are facing new challenges, but are being given the gift of time and being forced to slow down. Hopefully, soon our lives will return to normal and for many that means running from activity to activity in very busy lives. What can you do now that you don’t feel you normally have time for?

Talking to someone you haven’t connected with in a while or who may be alone
Reading
Crafting
Learning something new like a language, a craft, a skill, or a recipe (now is a great time to teach life skills to kids)
Cooking or baking
House projects
Games
Home spa days
Cuddling with pets
Puzzles
Exercise (look for free videos online)
Meditation (there are many free apps or online videos)
Exploring the outdoors including places a bit farther away than we’d normally go
Doing something to help others, even small, can make us feel more in control

One note of caution: comparing yourself to others can be harmful. Be careful not to fall into the trap of holding up your friends’ social media posts as examples of what you should be doing. You don’t have to run really far, repaint your house, or teach your child physics. Do what works for you and your family.

What to say to children. Answer their questions in an honest but age-appropriate manner. Keep the news off and their access to online coverage limited. Be a good role model for self care and know they will pick up cues from you on how to feel about this. Remember you have more control than you may realize over how they will experience this unusual event. I had a child say to me today, “I hope summer is like this but just with more freedom.” I was happy to hear they are enjoying this down time and hope that’s what they will remember when they look back on 2020.

Reach out for help. Notice if you are struggling to sleep or eat. If you are having a lot of physical symptoms of stress like muscle pain, headaches, stomach distress, racing heart, or shortness of breath, it may be anxiety. Crying often or having many angry outbursts may be signs you are struggling. Also using alcohol or drugs to cope may mean it’s time to reach out for help. Getting help may mean connecting to supportive people in your life. Maybe it means finding an online tutor for your child or financial support through a community agency. It could mean finding an online support group. For example, Alcoholics Anonymous is holding virtual group meetings. There are hotlines for those that need to talk and are in crisis through the National Suicide Prevention and SAMHSA with both text or phone options.

Many psychologists are offering telepsychology sessions using HIPPA compliant video formats. Our office is supporting patients through these platforms in order to keep our patients and staff safe from the virus, while still caring for patients’ mental health. Let us know if we can help you through this challenging time.

Dr. Christina Carson-Sacco is a clinical psychologist and a partner with The Center for Neuropsychology and Counseling, P.C. with offices in Warrington and Lafayette Hill, Pennsylvania. To learn more about her group practice visit www.TheCenterInWarrington.com

Other helpful resources:
Center for Disease Control
Find Help Assistance Programs
The Nation Suicide Prevention Lifeline (800-273-8255)
Substance Abuse and Mental Health Services Administration
Alcoholic Anonymous Online Intergroup
The Trevor Project (support for our LGBTQ community)

The Center for Neuropsychology and Counseling

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Uncategorized

Suicide Prevention: What to Know

Rejuvenate your Relationships:

Pandemic Holidays: Different Doesn’t Have to be Bad

Sometimes It Helps to Name It: Talking About Loss During a Pandemic

Tips for Caring for your Mental Health during a Pandemic – by Dr. Christina Carson-Sacco

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