Wednesday, May 29, 2013

Wellness: A Holistic Approach to Suicide Prevention

Author: Dr. Sally Spencer-Thomas
           Why do people burnout and find themselves spiraling into hopeless despair? Part of the answer lies in upstream preventative maintenance, or “wellness.” In our very busy world, we all need to figure out how to take better care of ourselves. When people hear the term “wellness” they often just think of physical wellness:  sleeping eight hours a night, drinking 64 ounces of water a day, working out for at least ½ hour three times a week, eating five fruits and vegetables a day, etc.  Physical wellness is important, but it is only one dimension of overall wellness. Mental, social and emotional, and spiritual aspects of wellness are also key and highly related to each other.
I remember my first run after the death of my brother. I had been running as my main form of exercise for almost 8 years before he died. I found that running was the sport for me – someone who valued exercise but didn’t bring many athletic gifts to the table. I started doing marathons in 2002, and found myself hooked. I was training for the Little Rock Marathon in Arkansas when Carson’s suicide literally knocked me off my feet. I was barely able to get out of bed and function each day, let alone train. But somehow, one day I put on my running shoes and headed out the door. Thoughout the whole run, I had tears on my face. For the next 10 weeks, running became my therapy. My time alone, away from all the trauma; my time to grieve and to think. I ran the marathon and dedicated each mile to a memory of our lives together. Today, I continue to run almost daily, and find it is a critical part of my mental health practice.
A large body of research shows a positive association between physical activity and psychological well-being.[1] New research is supporting a connection between exercise and suicide prevention. Even after adjusting for confounding variables such as demographics, depression, alcoholism, and more, the risk for nearly lethal suicide attempts was five times greater among those who had not been physically active in the past month than for those who were.[2] Another study compared athletic and nonathletic adolescents and found that the most athletic felt depressed less often and were much less likely to report suicidal thoughts or attempts.[3] A more recent study found that aerobic activity provided a distinct protection against suicide by reducing the risk of hopelessness and depression. There was one exception to this finding: women who combined frequent physical activity with deleterious dieting behavior had a greater risk for suicidal behavior.[4] So yes, physical wellness is a very important contributor to overall health, but there is much more to wellness than this.
Mental wellness is about always sharpening our skills and committing to lifelong learning.  Mental wellness comes from a sense of inner responsibility to always finding ways to improve – increasing knowledge, asking critical questions, trying new things, advancing skill sets, and so on. Social and emotional wellness is about keeping our relationships and our emotional well-being intact. It’s about conflict resolution, self-esteem, and coping skills. Finally, spiritual wellness is about committing to something larger than us – whether that is participating in our faith community, volunteering to serve the common good, standing up for injustice, or appreciating nature.
As with any preventative maintenance process, each wellness component needs attention over the long term so that we can sustain high performance over time. Unfortunately, when we are in crisis mode, these wellness practices are often the first to go. We cut out sleep, skip our weekly faith services, and drop out of therapy because we are just too overwhelmed with our lives. And just like when we neglect to change the oil and rotate the tires on our car, these decisions come back to haunt us.  
In order to self-assess your commitment to wellness, track the amount of time and money you spend in crisis mode – cramming for exams, dealing with drama in their relationships, tending to illnesses and injuries, and so on – and how much time and money you spend in true wellness practices (escape behaviors like hours of video games and excessive drinking do not count). When you do this, you often quickly realize that one of the reasons you constantly feel in a state of distress is because you are neglecting yourself.
Research tells us that pro-healthy-lifestyle attitudes matter greatly.[5] Those who see health as a value and have an optimistic perspective have built-in buffers against psychological distress. Optimism was actually the best predictor of both psychological well-being and decreased levels of distress. The researchers explained that this positive outlook helped students persevere during difficult times. “Health as a value” was seen in students who are likely to refrain from health-compromising behaviors like substance abuse and who are more like to engage in health-promoting behaviors like working out. This stable, enduring characteristic was linked to psychological well-being.
In closing, sometimes all you need to get through the bumps in life is a little reminder of an Irish proverb,A good laugh and a long sleep are the best cures in the doctor's book.”

[1] Taliaferro, Lindsay, Rienzo, Barbara, Pigg, Morgan, Miller, M. David, and Dodd, Virginia (2008). Associations between physical activity and reduced rates of hopelessness, depression and suicidal behavior among college students. Journal of American College Health, 57, 427-435.
[2] Simon, T., Powell, K. & Swann, A. Involvement in physical activity and risk for nearly lethal suicide attempts. American Journal of Preventive Medicine, 27(4), 310-315.
[3] Ferron, C., Narring, F., Cauderay, M., & Michaud, P (1999). Sport activity in adolescence: Associations with health perceptions and experimental behaviours. Health Education Research, 14(2), 225-233.
[4] Taliaferro, Lindsay, Rienzo, Barbara, Pigg, Morgan, Miller, M. David, and Dodd, Virginia (2008). Associations between physical activity and reduced rates of hopelessness, depression and suicidal behavior among college students. Journal of American College Health, 57, 427-435.
[5] Burris, Jessica, Brechting, Emily, Salsman, John, Carlson, Charles (2009). Factors associated with psychological well-being and distress of university students. Journal of American College Health, 57(5), 536-542.

Friday, May 17, 2013

Suicide Prevention – Everyone has a Role

     Jerry Reed, Director the National Suicide Prevention Resource Center presented the keynote, “The 2012 National Strategy for Suicide Prevention: We all have a role” at today’s Bridging the Divide Suicide Awareness and Prevention Summit in Denver, Colorado.

     Dr. Reed started the day with this quote, “You all have a piece of the suicide prevention puzzle – it’s important to all do our part to advance the cause.”

     Throughout the presentation he helped to connect the many roles that are needed to eliminate the tragedy of suicide. He shared three pillars in a “Model for Action” [Richmond and Kotelchuch’s Health Policy Model, 1997] to frame with broad brushes the work that is needed to create a tipping point of change:

1)     Knowledge base – we need to build an evidence-base to know what works for change and a research agenda to help guide our scientific endeavors
2)     Political Will – we need to generate momentum and energy among our community leaders and influencers
3)     Social Strategy – we need to have a coordinated blueprint for change, to help ensure that all players are working together to agreed-upon outcomes

     Reed shared the history of the suicide prevention movement and how the efforts of a few key survivors of suicide loss translated into some sweeping national changes over the last 15 years, eventually evolving into in the 2010 launch of National Action Alliance of Suicide Prevention .
He shared the launch video, documenting the event that brought together some of our nation’s most influential leaders to draw attention to this ground-breaking public-private partnership designed to advance the National Strategy for Suicide Prevention . Some of the voices in the video include:
  • ·       Secretary of Army, “Suicide violates our basic warrior ethos. You never leave a comrade behind.”
    ·       Eduardo Vega, Co-Chair of Suicide Attempt Survivors Task Force: “By holding out the hope for others, we let them know we need them. We need to preserve our greatest asset in our county – our brothers and sisters.”
    ·       Senator Gordon Smith: “Those who do this work, work on the side of angels.” 

     People often ask, “what role can I play?” From researchers, to mental health professionals, to suicide survivors, to the media, to every day citizens, everyone can play a role in the work. Details the individual and systemic contributions are outlined in the National Strategy.

     As a way to help us all remember that many of us carry puzzle pieces in this national effort, Reed quoted the National Strategy for Suicide Prevention dedication:
To those who have lost their lives by suicide,
To those who struggle with thoughts of suicide,
To those who have made an attempt on their lives,
To those caring for someone who struggles,
To those left behind after a death by suicide
To those in recover and
To all those who work tirelessly to prevent suicide and suicide attempts in our nation,
We believe that we can and we will make a difference.