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21УДК 37; ББК 74
DOI 10.24412/2658-63 8Х-2021-2-163-168
© Vashakide N., Devall Ju. 2021
MEASURES OF PSYCHOLOGICAL SUPPORT FOR MINORS PRONE TO SUICIDE IN PANDEMIC CONDITIONS IN THE UNITED STATES
Natalia Vashakide, Natalia Vashakide,
Candidate of legal sciences. Lomonosov University Candidate of legal sciences. Lomonosov University
E-mail: [email protected] E-mail: [email protected]
Julie Devall, Julie Devall,
Tbilisi Social-Economical Institute Tbilisi Social-Economical Institute
Для цитирования: Vashakide N., Devall Ju. Measures of psychological support for minors prone to suicide in pandemic conditions in the United States. Психология и педагогика служебной деятельности. 2/2021. С. 163-168. Научная специальность: 13.00.01 - Общая педагогика, история педагогики и образования.
Abstract. The article raises the question of the impact of Covid-19 on the rise in suicide among American teens. The author examines the relationship between the pandemic and suicidal thoughts of minors and adolescents, and how the spread of the coronavirus pandemic affects the psychological and mental health of adolescents, identifies the risk groups of adolescents in the United States who are at increased risk of suicide in the context of COVID-19, and analyzes psychological prevention and support for adolescents with suicidal behavior in the United States.
Keywords: COVID-19, pandemic, psychological health, suicide, depression, suicide attempts, suicidal behavior.
Introduction
Suicide today is one of the global problems of the modern world community. For this reason, more people die in the world than in total from wars and violent actions. Experts indicate that more than 50 % of deaths from external causes are suicides. The largest number of suicides are people aged 13 to 45 years. According to the World Health Organization (WHO), every 40 seconds a person on the planet commits suicide [1]. More than 800 000 people in the world voluntarily die every year.
According to WHO, with the onset of the pandemic, the number of suicides increased 1.5 times. UNICEF notes that suicide as a cause of death in the context of the spread of coronavirus infection ranks second in the world, behind cardiovascular diseases, but ahead of cancer. Suicide statistics among people between the ages of 15 and 24 are particularly alarming - they rank 2-3 among the causes of death in developed countries. Among children and teenagers, suicide takes 4th place as a cause of death after road traumatism, infectious and oncological diseases in the world [2, 38]. Teenage suicides in the US, as well as in other developed countries, are growing at an alarming rate, ahead of all other age groups. Suicide is the second cause leading to the death of young people aged 15-24 in the United States. This is stated in the report
of the Data Resource Center for Child and Adolescent Health for the six months of 2020. At the same time, statistics do not provide an answer to the question of what exactly contributes to the decision on voluntary retirement. Sociologists and psychologists have yet to understand the causes of this unfortunate phenomenon, but recent research suggests that the increase in completed suicides and suicidal attempts recently are directly related to the coronavirus pandemic, from which it follows that it is necessary to optimize psychological support measures for minors prone to suicide in conditions of continued spread of Covid-19.
Effect of coronavirus pandemic on adolescent
psychological health As you know, suicide is a psychological phenomenon directly related to the psychological health of a person, including adolescents.
According to a survey conducted by the George Kaiser Family Foundation (GKFF), almost half of Americans noted that the coronavirus crisis harms their mental health. The federal emergency hotline for people in emotional distress recorded a more than 1,000 percent increase in calls in April 2020 year compared to the same period last year. In May, an estimated 20,000 people approached the hotline, overseen by the Department of Mental Health and Substance Abuse, an affiliate of the USA. Department of Health
and Human Services. This suggests that fear of infection makes people feel more vulnerable.
Dr. Jones Makeda, a New York psychiatrist, said a colleague recently called because her teenage daughter was trying to hang herself. «For some people who have not learned how to cope with the pandemic, it causes adolescents with psychological health problems to be prompted by» I do not want to die from this disease, I can do it on my own. «The spread of the pandemic changes the thinking and behavior of people and, above all, the unfinished psyche of adolescents, resulting in prolonged depression, which is one of the main causes of suicidal attempts. Depression is characterized by an oppressed mood, severe mental suffering, also, the ability to enjoy, mental activity is reduced, which is accompanied by various deviations in the work of internal organs. Depressive frustration is followed by melancholy, alarm, fear, boredom, and the clinical picture is characterized by a so-called dysphoric background of mood, irritability, irascibility, malignancy, and aggression [3, 113]. The association of adolescent depression with the risk of suicides has repeatedly been proved by numerous scientific studies [4, 83]. In particular, Stephen Telyor, Cayley Lendri, Michel Pluszek, Thomas Fear-gus, Dean Mackay, and Gordon Asmundson developed a model of «a stressful syndrome of COVID» (CSS, 2020), having allocated several various, but interconnected elements that are correlated with depression, alarm and other important indicators that extends also to teenagers [5, 37]. This: fear of danger COVID-19; concern about the social and financial consequences of the virus; associated traumatic stress symptoms, the uncertainty of the future; compulsive verification and support search; self-insulation measures, etc.
As you know, most American schools have closed since mid-March to prevent the spread of coronavirus. And already in April in some states, news began to appear about a surge in teenage suicides. So in California, the superintendent of the school district in Sacramento, Chris Evans, called in early April and said that over the past 24 hours, two high school students committed suicide. The same week, a similar call came to the principal of Bear Creek High School, 50 miles from Stockton, Calif., that one of her students had committed suicide. At the same time, the teenager's mother told local media that the tragic decision of her son was facilitated by social isolation caused by coro-navirus infection.
The pandemic has created clear challenges for schools both in preventing and responding to student suicide. The consequences of CSS, 2020 have seriously affected adolescent mental health, and that they disproportionately affected African-American, Latino, and Asian youth.
According to Rob Coad, a school psychologist and member of the School Safety and Crisis Response Committee of the National Association of School Psychologists, social isolation is especially difficult for adolescents.
«One of their main tasks in life is the development of social ties,» he said.
While the pandemic poses new mental health problems for students, the increase in suicides among adolescents, adolescents, and even children continues.
Even some children as young as 9 have suicidal thoughts, according to a recent study by researchers at Washington University in St. Louis.
«We don't have an absolute explanation for why this is happening, we just know that suicide is a very complex matter and represents a complex set of behaviors and problems,» Coad said. «That's why when we talk about risk factors... it is difficult for us to determine which of these factors put pressure on an individual student». It depends on a lot of reasons.
An increase in depressive moods and an increase in the number of unfinished suicide is also observed among student youth. The loss of jobs and the possibility of eviction caused by the economic recession that the US economy entered in February increase the emotional tension of students.
It is more difficult for school psychologists, counselors, or social workers to control the behavior of students when they are not attending school, but are in distance learning. Experts are alarmed that students in self-isolation mode have reduced communication with peers and adults (coaches of sports teams, heads of sections and studios, teachers in additional courses).
During the pandemic, only parents see the child, «the teacher, working at Zoom with 25 other children, is deprived of the opportunity to control the emotional state of the teenager. As a result, the alarming symptoms of adolescent depression go unnoticed, making it difficult to prevent the risk of suicidal mood. The closure of schools due to the pandemic led to an increased role for the teacher in identifying signs of suicidal behavior in students. In this regard, teachers must know not only risk factors and warning signs but also who in the district to contact when such signs are detected from the student for immediate help.
For example, in the student environment, the warning behavioral signs of suicidal risk may be the distribution of things, a statement about not wanting to live, an assessment of the reaction of others to talk about suicide. The manifestation of such signs requires an immediate response.
Risk factors are depression, mood swings, substance abuse, and loss of loved ones, violence, or suicide committed by someone you know.
Researchers attribute the secondary effects of social distancing to the factors of suicidal risk.
A research team led by Dr. Matt Knock, director of the Laboratory for Clinical and Developmental Research at Harvard University's Department of Psychology, based on data from observations of adolescent behavior at high risk of repeated suicide obtained within six months of being hospitalized after a failed suicide attempt. In total, more than a thousand such adolescents aged 12 years and older were interviewed. According to the results of surveys, it was found that before and after the Covid-19 there was an increase in suicidal thoughts, while the main cause is called «feelings of isolation» Based on empirical data, factors influencing the increase in adolescents at risk of suicide were established, these include:
1) The economic stress caused by the recession, as this worsens the material wealth of the family, as part of the adults faced difficulties and dismissal. Historically, job losses, evictions, and displacement caused by recessions tend to increase the number of suicides. The economic stress caused by the pandemic is particularly negative for graduation students, who have a sense of uncertainty about the future of education.
2) Social isolation is recognized as a key factor in the negative impact of the pandemic on adolescent mental health. Although social distancing remains an important tool to contain the threat of coronavirus, the loss of contact with friends and peers certainly exacerbates the emotional burden that adolescents spoil due to the peculiarities of psychophysical development. Leading suicide theories emphasize the key role of social connections in suicide prevention. People experiencing suicidal thoughts may not have connections with other people and often disconnect from others as suicidal risk increases. Suicidal thoughts and behaviors are associated with social isolation and loneliness. 3 Thus, in terms of suicide prevention, there is concern that the most important public health strategy about the COVID-19 crisis is social distancing. Moreover, family and friends remain isolated from hospitalized people, even if their death is inevitable. As these strategies increase social isolation and loneliness, they can increase the risk of suicide. Social isolation also leads to an increase in the time that adolescents spend on the computer for games, on the social networks of the Internet space, which is also one of the determinants of suicidal behavior. Although social media is becoming increasingly important for maintaining personal contacts, uncertainty about when distance rules can be relaxed only exacerbates emotional stress in some cases.
3) Limited access to public and religious support as a consequence of self-isolation. Many American families, together with children, attend various social
or religious events. Weekly visits to religious services, according to studies, fivefold reduces suicide risk is associated. The effects of the closure of churches and community centers further contribute to self-isolation and thus to the risk of suicide.
4) Obstacles to the treatment of mental illness and access to psychological care. Access to almost all health facilities in pandemic settings is difficult, creating obstacles to the treatment of mental disorders (for example, withdrawal due to restrictions on children when school classes are canceled). The burden on medicine has COVID-19 increased and therefore mental health services are not a priority. Overcrowded emergency rooms hurt not helping adolescents who have survived suicide attempts or are at risk. Although hotlines for such teenagers have Internet consultation services available, waiting times are much longer than usual due to increased demand. This means that teenagers thinking about suicide often have nowhere to turn. Thus, limited access to psychiatric and psychological care negatively affects adolescents prone to suicidal behavior.
5) Illness of loved ones and medical problems. Exacerbation of physical health problems also increases the risk for certain categories of adolescents prone to suicidal behavior. They do not want their loved ones and they die of COVID-19.
6) General national concern. Round-the-clock news media coverage of events about the coronavirus pandemic is an additional stress factor, especially for adolescents who previously had mental health problems. Given the pessimistic nature of information messages, the emotional background they create contributes to the fact that a large number of adolescents are depressed due to the prospect of delaying the pandemic. According to a June report by the American Psychological Association, more than 80% of the US adult population report that the future of the country is a significant source of stress in their lives, which cannot but affect the psychological health of adolescents, as they constantly hear conversations in the family about the aggravation of the situation in the country.
7) Sale of firearms. As the COVID-19 spreads, many news outlets report a surge in arms sales in the United States. And this means an increase in the number of families in which firearm weapons are stored, which is the most common method of suicide in the United States, and access to it by adolescents due to unsafe storage, which also increases the risk of suicide [6].
Similar results were presented in an article written by a group of experts in the field of mental health under the leadership of Mark Regger from the University of Washington [7, 180], in which the economic, psychosocial and connected with health risk factors
which, increase possibilities of suicide among teenagers are also described.
On adolescent risk groups in the USA at increased risk of suicide in COVID-19 settings
According to Dr. Gordon, director of the National Institute of Mental Health, among the groups of adolescents at increased risk of suicide are:
1) Some racial and ethnic groups: black high school students were more likely to attempt suicide than their white peers;
2) LGBTQ adolescents: students who identified as gay, lesbian, or bisexual are more likely to attempt suicide than students who identified as heterosexual.
3) Adolescents who have or had the experience:
- Mental disorders (major depressive, bipolar, behavioral, and psychoactive);
- Psychiatric comorbidity, especially the combination of mood disorders, destructive and substance abuse disorders;
- Family history of depression or suicide;
- The loss of a parent as a result of death or divorce;
- Physical and/or sexual violence;
- Lack of social support;
- Social exclusion;
- Hooligan actions.
However, modern American society is more concerned that the number of suicides and the risk of suicidal behavior is higher in adolescents of this risk group.
According to Heather Kelly, a clinical psychologist at the American Psychological Association, there is an urgent need for more research to find evidence-based ways to prevent suicide and help such adolescents, especially black [8]. In particular, the researchers note that members of black youth have difficulties in accessing health care, they are more often excluded from educational institutions and they are more often subjected to cyberbullying. To the economic stressors in this risk, the group is added discrimination structural racism that occurs in the United States. At the same time, among the problems in this area can be indicated a fairly low percentage of black psychiatrists, psychologists, social workers, and their number does not correspond to the needs of the population. As is known because of psychological factors, ethnic adolescents have greater confidence in an adult of the same ethnic group. To address this problem, the resources of the civil community, ethnic and religious communities must be strengthened. Today, there are good examples of psychological support services collaborating to prevent suicide among black teenagers with the Corinthian Baptist Church in New York, Har-
lem, where there is a free psychiatric clinic, free for parishioners, free for the community. All this is funded and supported by the church.
On measures of psychological prevention and support of adolescents with suicidal behavior in the USA
The universal practice of prevention of suicide behavior practically in all countries is similar. As a rule, several types of prevention of suicide behavior are implemented: specialized psychiatric, psychological, all-medical, social, information training. If to speak about the sequence, then the considered prevention happens also several types.
Primary which is directed to all society, her purpose - prevention of factors of suicide risk and strengthening of mental health of the population. In our aspect of teenagers. Preventive interventions include numerous events, are among the most significant: formation of a healthy lifestyle; responsible illumination of information on suicide in the media; prevention of alcoholism and use surfactant; restriction and ban of access to substances and means of suicide; early identification and treatment of teenagers with mental disorders and existence of behavioral deviations; the programs directed to training in behavior in crises.
An important element of primary prevention -monitoring of suicide risks among youth in each specific staff based on which specific regional programs of prevention have to be developed.
So, a manual was published with methodological recommendations for correct coverage of tragic cases for media specialists.
Secondary prevention is being implemented for suicidal adolescents who have had an unfinished suicidal attempt. The leading role in this direction belongs to experts (psychologists, psychiatrists, social workers, specialists in leaving, workers and volunteers of the centers of overcoming crises, etc.). Such prevention is implemented using telephone consultation in individual, family, and group forms or out-patient and stationary conditions, at home. The main form of secondary prevention - crisis psychotherapy.
The third stage of prevention is the rehabilitation of a suicidal teenager after his removal from a critical condition, assistance to relatives and relatives of the suicidal. At this stage, a set of rehabilitation programs is being implemented that are aimed at preventing the disabling consequences of suicide and repeated suicidal attempts.
In the United States, at the state level, a special service is engaged in the prevention of suicide among adolescents and youth, which is supervised by a branch of the Ministry of Health and Human Services of the country's government. These units of the Anti-suicide
service in various combinations operate in almost all states. Social and psychological care offices provide counseling and preventive assistance to adolescents with a crisis, suicidal state, and develop programs to protect the mental health of young people. In some states, they operate as part of dispensary departments of psychiatric hospitals in state capitals. Crisis departments are organized based on multidisciplinary hospitals. Their main area of activity is therapeutic and diagnostic assistance in neurotic depression, psychopathic reactions that occur with pronounced suicidal tendencies.
However, while researchers saved up the considerable scientific layer of developments [9, 527], the uniform state program of prevention of suicidal behavior among youth and teenagers within education systems, health care, law enforcement agencies, social services in America during the modern period is absent.
Representatives of the scientific community [10, 311] note that they have to become the main directions of prevention early diagnosing of groups of suicide risk, performing prevention of alcoholism and drug addiction among the population and creation of the full structure of links of the special suicide service in each staff of the American state.
Within the whole country work only the National line of the help with prevention of suicides with uniform phone 1-800-273-TALK (8255), also teenagers with behavioral problems can call service Crisis Text Line, having sent the text message of «TALK» to number 741741.
In the conditions of a pandemic, the scientific community urges to take more active actions for mitigation of her potential unforeseen consequences for prevention of growth of teenage suicides that have to become today are national a priority for public health care.
In this direction the following efforts which can be formulated as follows are necessary:
1) «Physical, but not social distance». Despite the name, social distancing demands physical space between people, but not a social distance. Efforts that teenagers from risk group stayed in touch with experts are necessary, continued to maintain significant relations by phone or Skype with persons who can quickly and professionally help them. For this purpose, it is necessary to use actively and possibilities of social networks.
2) Tele - Mental Health. COVID-19 became an impulse for the expansion of telemedicine in the USA. This special network can render emergency (within an hour) the consulting help of leading experts for areas in which there are no necessary reNo 2 / 2021 nEflAI
sources. The WWW-server which provides access to some information services, including various Internet resources is the basis for the project: forums, debatable groups, databases. Means of the software of teleconferences allow users to look through materials of other participants, including video and audio-fragments, graphics, and some other data. The program provides an exchange of views between specialists in the most various subjects: consultations on the treatment of certain patients, discussion of the general questions and treatment of various diseases, application of new methods of diagnostics, and some others. Unfortunately, such centers in the aspect interesting our work, not in all states. Considerable experience in the prevention of suicides including among teenagers is saved up by specialists of telemedicine network of Queensland is created with the participation of faculty of psychiatry of the University of Queensland and the Center of mental health of Royal hospital of Brisbane. In hospital eight modules for carrying out videoconferences which are used to improve internal communication as «videophones» are installed. With their help the contact between the doctor and the patient is facilitated, besides, they are used for administrative purposes and training. Unfortunately, in other states, the treatment of teenagers with suicidal ideas using telemedicine resources lags from the general telemedicine, especially in rural areas far behind. At the same time, it is necessary to eliminate inequality in access to the computer and the high-speed Internet. Additional researches, change of culture, mentality, and, perhaps, even legislative protection is necessary to facilitate providing treatment for prevention of suicides of teenagers which otherwise will appear unaided. Nothing will be received.
3) Increasing access to mental health services.
As precautionary measures concerning COVID-19 are the priority in medical institutions today, it is important not to stop treatments of teenagers with crises of mental health. Procedures of identification and prevention of COVID-19 which reduce access to medical mental health services (for example, reception cancellation, sending the patients home) shouldn't exclude screening on the crisis of mental health of teenagers. It is necessary to provide medical institutions that are engaged in the identification of symptoms of COVID-19, specialists, psychiatrists who would be engaged in the screening of psychological problems today.
4) Remote prevention of suicides. There are evidence-based data on the efficiency of measures of support of the persons inclined to a suicide which
were developed for remote realization. For example, some short-term contact interventions (telephone outreach work) and the Letters of Care program reduced the level of suicides in randomized clinical trials. The subsequent contact can be especially important, especially for young faces in which symptoms of COVID-19 and having risk factors of suicide are revealed.
5) Active help of media. It is necessary to recommend to all editions to advertise more actively the uniform National line of the help with prevention of suicides (1-800-273-TALK) which continues to work also in the conditions of a pandemic.
Conclusion
Despite the established relationship between the spread of COVID-19 and the increase in the number of suicides among adolescents, a positive effect is also possible in such conditions. Researchers predict the possibility of reducing suicide rates in the United States, including among adolescents, as was the case in the moments after past national disasters (for example, September 11, 2001, terrorist attacks). One hypothesis is the so-called unification effect, where people who experience a common negative experience can support each other, thereby strengthening social ties. Recent advances in technology (e.g., videoconferencing) can contribute to synergies. Epidemics and pandemics can also change views on health and mortality, making life more precious, death is more frightening, and suicide less likely.
Concerns about the second wave of the pandemic and the intensification of COVID-19 prevention measures should not lead to minimizing the psychological support of minors prone to suicide within the framework of public health should not be undertaken. However, they should be implemented in an integrated manner. And every resident of the United States should know that if he or one of the familiar minors has thoughts of suicide, then you need to call the National Suicide Prevention Line by calling 1-800-2738255, which works 24 hours a day, seven days a week.
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