Spring Blue(s)

Photo credit: Josephine Ensign, 2015

Why do spring and depression go together? The seasonality of illness is fascinating and is proof that our environment matters quite a lot to our individual and collective/public health. In temperate regions of the world, injuries and drownings go up in the warmer months, and deaths from influenza and carbon-monoxide poisoning go up in the colder months. These make sense. But when we think of depression and suicide risk, most of us would guess that these peak in the fall and winter months–what with decreased hours of sunlight and the stresses of some of the major holidays. In the U.S., September is National Suicide Prevention Month and October is National Depression Awareness Month, and many news reports continue to falsely link higher rates of depression and suicide with fall and early winter.

Yet studies worldwide find that depression and suicide rates peak in late spring and early summer. High pollen counts, increased hours of sunshine, higher temperatures, and even an increase in thunderstorms (ah–that Shakespearean pathetic fallacy!) have been linked to higher rates of depression and suicide. Within psychology and sociology circles, this seasonal link is theorized to be from the fact that people generally have increased social pressures and interactions in the spring, which can increase stress. (see “The Season of Renewal and Suicide” by Brian Palmer, Slate, 12-7-12).

The most current statistics from the CDC on the leading causes of death in the U.S. (for 2013), list suicide (intentional self-harm) as the tenth leading cause of death, with the total number of deaths by suicide as 41,149. (Suicide is the second leading cause of death for young people ages 15-24 years.) This continues the upward climb of suicide deaths in our country since the start of the Great Recession, with the largest increase being in people 45-64 years of age (peak wage-earning years.) With the possible exception of unintentional injuries, such as motor vehicle accidents, suicide is our most preventable form of mortality. And suicide deaths have serious impacts on the family members, friends, co-workers, and care providers who knew and loved the people who killed themselves. Note: they did not ‘commit’ suicide as is still too commonly used; suicide is not a crime or a sin–it is a preventable travesty. Using the term ‘commit suicide’ adds to the already debilitating stigma of mental illness.

So what are interventions that work to help prevent deaths by suicide?

1) Train healthcare providers to screen for depression, drug/alcohol use, bullying at school (for young people), history of adverse childhood events (especially sexual abuse), and suicidal ideation and attempts. In primary care screening for depression and suicide risk (as well as intimate-partner violence), a standard question is “Do you have access to a firearm?” This screening question seems so obvious, as access to a lethal weapon is an important part of the overall risk assessment. Over half of all deaths by suicide are by firearms. But now in Florida that healthcare screening question is illegal for physicians and nurses to ask their patients. (See James Hamblin’s 8-11-14 article in The Atlantic, “The Question Doctors Can’t Ask.” ) And other (mostly Southern, no surprise) states have similar legislative ‘healthcare gag orders’ pending.)

2) Educate the general public about the warning signs of severe depression, problematic drug/alcohol use, and suicide–and give them the proper tools to be able to intervene effectively. Reinforce the fact that talking about suicide in a supportive way does not encourage suicide (just as talking about sex or drug use with adolescents does not encourage them to have sex and use drugs.) An excellent (free and 24/7) resource is the National Suicide Prevention Hotline at 1-800-273-TALK (8255). They can connect people with local crisis centers and assistance.

3) Implement a community-wide public mental health promotion (and depression/suicide prevention) program. One such model program that is cost-effective and that could be replicated in the U.S., is New Zealand’s All Right? Wellbeing Campaign, a Healthy Christchurch project that is being led by the Mental Health Foundation and the Canterbury District Health Board. As they state, “All Right is a social marketing campaign designed to help us think about our mental health and wellbeing. It’s about helping people realise that they’re not alone, encouraging them to connect with others, and supporting them to boost their wellbeing.” Although targeted at earthquake recovery efforts in the Christchurch area, this public mental health campaign could be most effective at building community resilience before major disasters occur.

My students and I stumbled across the work of the All Right? Wellbeing Campaign while we were in Christchurch last year studying community health. I wrote about it in a series of blog posts, including “New Zealand Postcards: The Allrighties” 2-3-14. Some of our health-focused students ‘brought this home’ to Seattle and started the student-led “What’s Up UW?” community for promoting social and emotional wellbeing.

From the All Right? Wellbeing Campaign, Christchurch, New Zealand.




To Forgive, Divine: Medical Errors and the Consequences for Nurses, Part II

Alexander Pope dying; from the title page to W...
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“Good-nature and good-sense must ever join; To err is human; to forgive, divine.”~Alexander Pope, Essay on Criticism

The topic of my last post “To Err Is Human” hit a raw nerve for many people. Since the post, I have heard directly from numerous former co-workers and parents of NICU patients of Kim Hiatt’s who are devastated by the news of her suicide. Many other people who did not know her personally are distressed over her death, and seek to understand what went wrong at a systems level—what we can do to prevent this from happening to other nurses.  I am struck by the inadequacy, irony, and inaccuracy of the Seattle Times article last week, “Nurse’s Suicide Follows Tragedy.” Her suicide is part of the tragedy; her suicide does not follow the tragedy. The role of local media—not only the Seattle Times but more importantly KOMO News—in this tragedy is a topic I do not possess the psychic distance to be able to address.  Of course, we the news-munching public are also culpable, since we engorge ourselves on ambulance-chasing, witch-hunting, tabloid-line blurring ‘news’ stories.

I try to keep my personal blog separate from my life as a faculty member at the University of Washington School of Nursing. But on this topic the lines blur. I listened to some of my current nursing students, as well as some very wise local nurses outside of the UW, and—with the blessing and assistance of many of my UW colleagues—we are offering a forum/panel discussion on Tuesday May 10th, 3-5pm Hogness Auditorium, UW Health Sciences Building. It is open to the public, so please join us if you can. The tentative title is the title of my last blog post, “To Err is Human: Medical Errors and the Consequences for Nurses” because—well, that is what the panel discussion will be about. So far for the panel we have top-ranking representatives from the Washington State Nursing Care Quality Assurance Commission, the Washington State Nursing Association, an area suicide prevention program for health care professionals, and Joanne Silberner from the UW Department of Communications (to discuss the role/responsibilities of the media). For those of you who don’t know, May 10th is during National Nurses Week.

As I told my students this week, the news of the suicide of Kim Hiatt has re-opened wounds of my own. The topic of a future post (and a chapter in a book I am writing), I experienced the fallout in my own life of an investigation/threatened suspension of my nursing license early in my career. It was due to a (still) anonymous complaint about the scope of my practice back when the nurse practitioner role was very new and in a more conservative state than Washington. I was (I think) eventually cleared of any wrongdoing, but the stress of that time cascaded into my divorce, loss of my job, episodes of homelessness, and a bitter vow to leave nursing. The overwhelming feelings of shame, isolation, betrayal/loss of trust in the health regulatory system, led me to contemplate suicide. I did not have the media hounding me. It has taken me 25 years to be able to process those events and be able to talk about it with other nurses. Silence can be deadly.