The link between COVID-19 and suicide: What parents should know

By Dr. Meredith Dennis, post-doctoral fellow at CHOC Children’s; and Alva Alvarez and Christopher Reeves, mental health social workers

It is an understatement to say that living through the COVID-19 has been tough. For kids and teens already struggling with mental health issues like depression, their symptoms may have worsened with the added stress of COVID-19. No parent wants to imagine that their child would think about ending their life or hurting themselves in any way, but the reality is that kids and teens are not immune to severe symptoms of depression like suicidal thoughts. Unfortunately, we have seen a negative impact of everything that comes with the COVID-19 pandemic on child and teen mental health, including increased suicidal thoughts. This can raise many questions and concerns for parents. Why is this happening? What can I do about it? How can I make sure my child is safe?

A good place to start as a parent is to be aware of the risk factors for suicide. Among others, here are things that could increase risk for thoughts of suicide:

  • Feeling like a burden. If your child believes they are a burden to people in their life, this increases risk for suicide. Keep in mind that it doesn’t matter whether or not this is actually true. It’s about what your child may mistakenly believe.
  • Being disconnected or isolated from others. No matter how much support you try and give, your child may feel lonely or think no one cares about them. This may be especially true if your child feels they do not have any friends.
  • Repeated engagement in self-harm behaviors or suicide The more your child harms themselves or makes attempts at dying, the “better” they get at it. They are also better able to tolerate pain — studies show they experience less pain with more self-harm —, and become less scared of dying.
  • If your child believes that things will stay this way and not get better, there is greater risk. Again, this is not about what is actually happening, but what your child believes to be true.

The COVID contribution

Our lives are nearly unrecognizable these days amid the COVID-19 pandemic. So many elements have changed as we work together to follow various safety guidelines. From the way we go to school and work to the way we interact with our social groups, this new way of life has vastly transformed our routines. Furthermore, these changes occurred suddenly and without warning. It is no wonder that we are seeing increases in symptoms of depression and anxiety, as well as in suicidal and self-harming behaviors. Here are some specific ways COVID-19 may be affecting mental health:

  • Sudden disconnect from peers and support groups outside of the home may increase feelings of isolation while also deterring one’s motivation to seek support, knowing they are unable to interact face to face.
  • Most opportunities we used to enjoy for fun and relaxation have been closed, canceled or restricted. There are limited replacement options. Daily life is now filled with more stress and less fun, making it harder to ignore feelings of loneliness, sadness, worry and hopelessness.
  • Separation from stressful situations within the home may not be possible due to safety precautions. While confined to your home, your child may begin to focus more on their current stressors with little or no distraction from them.
  • A major challenge many families face in these times is financial insecurity or loss of income. Though young, kids and teens are often acutely aware of their parents’ stress. Knowing that parents are worried about finances can increase a youth’s perception of being a burden, and thus increase risk for suicide.
  • Increased exposure to social media and news coverage could lead to increased thoughts and risk of suicide for your teen. Since youth’s activities are severely restricted now, many are spending more time on their screens. This means increased exposure to “doom and gloom” news coverage as well as increased exposure to negative online peer interactions. These things increase hopelessness that the pandemic will ever be resolved and decrease the sense of social connectedness. Increasing suicidal thoughts and behaviors means kids and teens are more frequently exposed to this content online. We know this is a dangerous risk factor for youth suicide.
  • Decreased physical activity along with an increase in screen time may diminish one’s ability to focus throughout the day and negatively affect sleep. Poor sleep and diminished concentration may lead to impaired judgment. This is a recipe for misinterpreting the environment — for example, believing no one cares about them, or feeling like they are a burden.

Accidental adult errors

More often than not, caregivers are doing a great job of reaching out for support and guidance when it comes to a child’s mental health. There are times, however, when adults inadvertently engage in verbal and non-verbal behaviors that can increase or exacerbate risk factors for suicide in children. While these behaviors can be perceived as harmless by adults, to a young person who is already struggling with suicidal thoughts, they can make the difference between ideation and intent. Examples of these behaviors can include:

  • Avoiding conversations about the current state of events, including COVID-19, may accidentally increase distress in youth. This may include avoiding discussing your own thoughts and feelings regarding the impact of COVID-19. Attempting to protect children from the current state of life creates the impression that COVID-19 is too scary to talk about, potentially increasing anxiety or hopelessness about the situation.
  • However, oversharing information — such as financial burdens, parental stress, workload and constant news updates — can also increase suicidal ideation in adolescents by creating what feels like a flood of negative messages that they feel they can’t escape from.
  • Adults sometimes try to help youth feel better by telling them they are overreacting, that things aren’t that bad, or by saying things could be worse. This accidentally increases the intensity of those emotions, leading to escalations of experiences like depression, anxiety and self-harming behaviors.
  • Expecting children and teens to continue functioning at the same pre-COVID-19 levels can place unrealistic pressure on them. Many adults continue to struggle with symptoms of grief related to COVID-19 losses that may be financial, emotional or social.As a result, adults have had to make adjustments to their own expectations for “normal” functioning. Youth also need to know that they are allowed to make adjustments and that not everything needs to be perfect.

Action steps to support children and teens suffering during COVID-19

There are things you can do as a parent, guardian or caregiver to help children and teens who are suffering during this time. Kids are resilient, meaning they have the ability to “bounce back” when difficult things happen. There are also several protective factors to be aware of that are helpful in lowering the chance your child will experience more serious risk. Here are a few ways you can help:

  • Stay connected. With social distancing guidelines in place, it may be difficult to find safe and appropriate ways to keep your child socially engaged that meet your needs. Set up virtual hang-outs with friends, or meet at an outdoor space like a park where social distancing can be maintained if everyone agrees to wear a face covering.
  • Stick to a routine. Maintaining predictability in the day can help your child build structure and have a sense of security. Daily routines also help increase engagement in activities, which can increase feelings of accomplishment and self-confidence, directly reducing things like hopelessness and feeling like a burden.
  • Have a conversation. Setting aside time to talk to your child about how they are feeling is important. Give them a safe space to share their thoughts and feelings. Show them you are there to help by validating them and being supportive. Let them know it’s OK to feel the way they feel and that you will get through it together.
  • Find time for self-care. Keep your child engaged in things they like that are fun and/or relaxing. It works best if you do this with them! Do fun things or a favorite activity, do things you are good at, learn a new skill, and keep them involved in extracurricular activities like sports or clubs if possible.
  • Take care of basic physical needs. A healthy body helps us be as prepared for the daily stresses as possible. Get enough sleep, move your body and eat balanced foods.
  • Limit screen time. Even though our lives revolve almost exclusively around screens, make time to disconnect and seek social connection, fun, relaxation and joy using “old school” ways.
  • Self soothe. We could all use some extra comforting these days. Teach your children to use their physical senses to comfort themselves by listening to relaxing music, finding a soft comfort object such as a blanket or T-shirt, or using a favorite scented candle or lotion.
  • Seek mental health support when needed. If your child seems to be having a pretty hard time and does not already have mental health services like therapy or counseling in place, this would be a great time to start. Medication may also be an option. Talk to your doctor, insurance, or school about where to get connected.
  • Get immediate help if needed. If your child continues to express thoughts about harming themselves or dying, go to the nearest emergency room or call 911.
  • Help your child identify reasons to live. What is important to your child? What are their values and goals? Helping them get connected to these things can be a very powerful way to recognize that they have things in their lives that are important and matter – and that this situation is not going to last forever.
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A psychologist’s tips for self-care

By Dr. Micaela Thordarson, pediatric psychologist at CHOC Children’s

Self-care is the critical maintenance we need to be able to keep functioning. Sometimes self-care is compared to the way we care for our cars. Often, self-care is talked about as the equivalent to getting your car detailed or putting on a special coat of wax to keep the color shiny. But actually, self-care is much more closely comparable to putting gas in your car. If you don’t stop for gas every so often, your car will stop functioning – no matter how much you want to keep driving down the road! It’s the same for self-care. Without self-care, your brain, body and emotions will simply shut you down and make continued functioning impossible.

Examples of self-care

Self-care takes many different forms! There are the essentials like eating, drinking water, bathing and sleeping. As silly as that sounds, simply stop for a moment and think about how often this week you skipped a meal or prioritized something else over getting a good night’s sleep.

There are also a wide range of other forms of self-care that are tied directly to a person’s specific preferences! Extroverts practice self-care by engaging in enjoyable social interactions while introverts may curl up on their own with a great book or an exciting new TV show. High-energy folks tend to prefer self-care like exercise or exhilarating hobbies, while others may want peaceful or calming activities to recharge or find joy.

The most rewarding forms of self-care are also determined by whatever challenges exist in a person’s life. Right now, during the COVID-19 pandemic and stay-at-home orders, many people are feeling isolated, so they are using technology to connect and practicing self-care by reaching out to loved ones in new ways. Others are experiencing cabin fever and so they take a break from their daily responsibilities to walk around their neighborhood.

Self-care for parents

Parents are being asked to take on more during these times than ever before. With schools and many offices closed, many parents are juggling working from home, monitoring their child’s distance learning, organizing activities to keep kids entertained and engaged, and more. That is why it’s important for parents and caregivers to practice self-care.

I think the best metaphor for this is the use of oxygen masks on planes. Taking care of yourself makes it possible for you to care for others. If you fall apart, everyone who relies on you will also be feeling lost or unraveled! Caregivers are often so selfless; I find it’s helpful to point out that taking care of ourselves is just one more way we take care of others.

Proper self-care improves productivity, improves mood, improves attention and concentration, increases patience, and increases the rewarding experiences that you can have when serving in a caregiving role!

What happens when we ignore self-care

Think of practicing self-care like a bank account. There are baseline transactions that must occur every day, like eating and sleeping. Beyond that, the need for self-care varies with daily stresses. The number of stressors in a day are like withdrawals and thus determine the balancing requirements for self-care, which are like deposits.

Ironically, the more stressed we are, the less we tend to prioritize self-care, which can lead to very serious things like burnout or “breakdowns.”

Burnout is probably the biggest outcome of neglecting self-care. Other things include increased chances of getting sick, increased unpleasant emotions, decreased hope and/or productivity, or a feeling of helplessness.

Wanting to give up, feeling apathetic or disengaged, an increase in irritability, a decrease in patience, frequent judgment thoughts towards your kids, and resentment are all signs more self-care is needed STAT!

If you feel “too busy” for self-care

Stopping for self-care makes you better at your job. When you have the patience to stop and take a breath before snapping, or the concentration to remember every last little detail, you are on your A-game. So basically, if you want to be performing at your absolute best, self-care is one requirement to get there — and stay there!

Self-care doesn’t have to cost money or take much time. Pausing for one minute just to take five slow breaths can make a massive difference in your day! Or, when you get in your car, before starting the ignition, take a moment to pick your favorite music or flip through a photo album on your phone of treasured memories is another tiny thing to do for yourself.

How a psychologist practices self-care

I can also be guilty of saying, “I’m too busy for this” so one thing I’ve learned to do is to simply stop and do nothing for one minute. No thinking, no planning, no texting, no calling, no reading emails. Just sit there and either look out the window or take some breaths or think about what it feels like to sit on the beach.

I also love the outdoors, so for self-care I spend time hiking to take a break from human interaction since I get so much of it daily. Before the stay at home orders were in place, sometimes I would go by my siblings’ homes and borrow my nephews to get to have some silly, bouncy, fun time if that’s the mood I need! On particularly packed days, my self-care is as simple as making sure I eat lunch and take bathroom breaks, even if it means I am running a few minutes late.

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Meet Dr. Micaela Thordarson

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Micaela Thordarson, lead psychologist, ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program at CHOC Children’s.

dr-micaela-thordarson
Dr. Micaela Thordarson, lead psychologist, ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program at CHOC Children’s.

Q: What is your education and training?

A: I earned my bachelor’s degree in psychobiology from UCLA with a minor in Spanish. I earned my PhD and master’s degree in clinical psychology from Palo Alto University with a specialization in children, adolescents and families. I completed my pre-doctoral internship with Nationwide Children’s Hospital in Columbus, Ohio, and my post-doctoral fellowship with Geisinger Health Systems in Pennsylvania.

Q: What are your special clinical interests?

A: I am particularly passionate about working with high-risk pediatric patients. I have done a great deal of work with suicidal and self-harming youth and their families. As a bilingual clinician in Spanish and English, I am also very interested in the interactions between mental health and cultural identities, for example, race/ethnicity, gender, religion and age.

Q: How long have you been on staff at CHOC?

A: I joined CHOC in October 2017.

Q: What are your most common diagnoses?

A:  Depression, anxiety, and major life stressors are the most common difficulties our patients face.

Q: What would you most like community/referring providers to know about the ASPIRE® Intensive Outpatient Program at CHOC Children’s?

A:  Our eight-week intensive outpatient mental health treatment program – the only pediatric-dedicated one of its kind in Orange County — is designed to serve a broad range of emotional and behavioral difficulties for high-school aged teens 13-18. It includes individual and family sessions, and crisis support as needed. If the teens and families you serve could possibly benefit from an intensive program, please don’t hesitate to reach out to me. Additionally, we aim to collaborate closely with all the important stakeholders in our patients’ lives. This includes primary care physicians, psychiatrists, therapists, educators and coaches.

Q: What would you most like patients and families to know about ASPIRE®?

A:  While our program is hard work, it’s pretty fun to be a part of! The daily after-school programming for teens and their families is all interactive, including art and other expressive therapies, and designed to teach and practice new skills in fun ways.

Q: What excites you most about the program?

A: I am so excited to be able to offer a very important service to teens and families who are in crisis and need extra support. The program we offer is guided by research and has been carefully constructed to generate the best outcomes possible.

Q: What inspires you most about the care being delivered at CHOC?

A:  I have worked with a number of different organizations and teams since I began my career in the mental health field. The team at CHOC is unparalleled in its enthusiastic dedication to innovation and excellence in the care of children.

Q: Why did you decide to become a psychologist?

A:  I fell in love with the field of psychology immediately after taking my first job at a crisis shelter for teens. Getting to witness, and even participate in, the incredible changes these youths made in their lives in a few short weeks was inspirational. I knew that was work I wanted to be a part of for the rest of my career.

Q: If you weren’t a psychologist, what would you be and why?

A:  Either a zookeeper, so I could spend time with cool animals every day, or a Disney princess at one of the theme parks so I could wear awesome costumes and play with kids all day.

Q: What are your hobbies/interests outside of work?

A:  I love spending time with my family, hiking with my dog, and eating delicious food. I have a huge family and we have a lot of fun together!

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