I live and work in Colorado, a beautiful state that can look to an outsider like a year-round playground of sunshine and skiing. But my state has a big problem: suicide rates that are among the highest in the country.

It’s a growing crisis. The National Center for Health Statistics recently reported that the suicide rate across the U.S. increased 35% between 1999 and 2018, the last year with complete statistics.

Suicide is a complex issue, usually without a single reason for its occurrence. Risk factors include social stressors, substance abuse, and mental illness like depression. When I talk with patients in the emergency department or teach medical students and residents, I point out the common thread of hopelessness.

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I also talk with them about another reason why suicide rates are high in Colorado and the rest of the Mountain West: available firearms. If someone is feeling hopeless and can’t see another way out, and that person reaches for a gun to attempt suicide, in 9 of 10 cases they will die. There won’t be a chance for family or friends to intervene, for 911 to send paramedics, or for doctors in the emergency department to stabilize them with antidotes or other treatments.

Colorado has been tackling its suicide problem through innovative programs, private-public partnerships, and a comprehensive approach with attention to the various at-risk subpopulations.

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And then the coronavirus showed up, trailing fear and anxiety in its wake. It triggered panic-buying of toilet paper and a spike in sales of firearms and ammunition. Schools are closed and Colorado is — like most states — under a stay-at-home order. There are concerns about increased use of alcohol, social isolation, and abuse among trapped families. The disruption in the medical system may prevent people with chronic mental health conditions from getting the therapy or medications they need. Skyrocketing unemployment rates and a looming recession add stress.

So will Colorado and other states see rises in suicide rates over the coming months?

Maybe. It does seem like a perfect storm, with an explosion of risk factors, existential anxiety, and even more access to firearms. And calls and texts to crisis lines have increased.

But maybe not. Maybe there is hope.

Neighborhoods in Colorado have started howling outside every evening. It’s our version of Italians singing and New Yorkers clapping, with an outdoorsy twist. The howling shows support for frontline health care providers, grocery workers, and other essential employees. But it’s also a cry that we’re still here, that we’re a pack. It’s a simultaneous expression of communal grief and celebration.

The stress of isolation has brought focus to creative ways to connect with others, whether it is through virtual religious observances or best practices for teleworking. There’s renewed attention to the importance of sharing emotions and the mental health benefits of exercise. For many, it has slowed down life by cancelling business trips and social commitments, resulting in more time with family and potentially stronger and healthier emotional connections.

There are glimmerings on the horizon that the Covid-19 epidemic might eventually lead to an improved medical and public health infrastructure. Racial disparities in Covid-19 fatality rates are highlighting the need to address disparities in health conditions and health care access. The navigation of daily life during the pandemic highlights disparities in socioeconomic status, where staying home is, in so many ways, a privilege.

With luck and leadership and the actions of many, our country’s experience with Covid-19 can lead to positive changes to address homelessness, joblessness, food and housing insecurity, and the many other social issues that plague our society and may increase suicide risk. We can hope that the Covid-induced shift to telemedicine will increase availability to services for mental health and addiction. We can hope for — and demand — resources for comprehensive suicide prevention programs like the U.S. Department of Veterans Affairs PREVENTS initiative.

In the end, positive outcomes are up to us. We don’t have to be passive passengers riding the Covid-19 wave. Each of us has a role to play, and even small steps can help prevent suicide and save lives.

Look out for your friends, family and neighbors. Know how to spot when someone might be thinking of suicide or at risk for it. If you’re worried, ask! It’s okay to ask someone if they’re having thoughts of suicide, and don’t worry about what words you use; just show you care. Make sure you lock up guns, toxic medications, and other potential suicide methods. And if you are having thoughts of suicide, reach out for help.

When I get discouraged about my state’s suicide rate, I remember that our history is full of stories of colorful, tough characters. My favorite pioneer is the “Unsinkable Molly Brown,” an immigrant who lived in a two-room log cabin before striking it rich in the mining boom. Her story, like ours, is not just about being a stoic individual. She survived an unexpected and unprecedented disaster: the sinking of the Titanic on April 15, 1912. And she saved others by loading lifeboats before she got on one and by encouraging the women in her boat to keep rowing.

We can all be Molly Browns and get through Covid-19 and whatever comes after, especially if we’re in it together.

Emmy Betz, M.D., is an emergency physician and researcher at the University of Colorado Anschutz Medical Campus.

  • I wonder if there is a connection between Marijuana use and suicide, seems suicide increases as this and other mood drugs are used. 🤔

  • Between Covid 19 and Trump, I don’t see any future for 99% of the people here in this country. If I don’t end up with Covid19 and I get through this mess, I will be looking to leave the US as soon as possible, especially if Trump wins reelection, I will be gone the day after the election, probably to Canada and then who knows where. I will pull all of the money out of my 401K and take only the bare essentials. Hit the road in my car and just pay my car payments and F the rest of it. It’s either this plan, death by Corvid 19 or a gun in my mouth, that is where I’m at.

  • But we are not all in this together because sone of us have lost everything….and most of you don’t care.

  • Yeah I’m sure hearing the whole neighborhood making howling noises is going to help the recently made redundant employee feel better about him/herself

  • The suicide rate will undoubtedly go up here in Colorado, and nationwide. But not for the reasons cited above. In just one month, from mid-February to mid-March 2020, doctors’ prescribing of benzodiazepines and antidepressants skyrocketed by 34% and 18% respectively, according to a recent report by Express Scripts. The suicides will occur when those new patients, many of whom were experiencing perfectly normal stress and anxiety under the circumstances, decide they want off their new meds. Their doctors then rip them off their meds with a “safe” taper over 4-6 weeks, causing severe withdrawal-induced suicidal ideation and disinhibition in some, causing them to reach for a gun in a moment of severe despair. It’s long past time for primary care doctors, psychiatrists psychiatric nurse practitioners, and ER doctors own up to their role in the suicide epidemic, and to pay attention to emerging research on the severity of psychiatric drug withdrawal, as their colleagues at the American Psychological association finally are: https://www.apa.org/monitor/2020/04/stop-antidepressants?fbclid=IwAR2qE2loRovSZRAcSl3901lkLSsOf1yOEM_8NJxsiSLT4U36sp20kYjQdno COVID19, combined with increased tele-health services, have simply served as a perfect storm to accelerate the already irresponsible over-prescribing of psychiatric medications.

    • Thank you for this comment. I was put on effexor when I was 16. It took 14 years to get off of it. The first time I tried, I became emotionally disregulated and uninhibited. Which was entirely new. Even when I had been depressed I hadn’t had those problems. I also couldn’t sleep and had brain zaps. A perfect recipe for suicide. At that time, doctors didn’t know about brain zaps, so I felt crazy. At 18, my doctor stated that it was impossible that I was feeling what I was feeling. I tried 5 more times to get off effexor, before succeeding. I could have killed myself any one of those times. Depression runs in my family. But suicide doesn’t. It is insane that any general practitioner can prescibe these drugs to anyone at anytime… often before therapy or a leave of absence. It’s also insane that, once on an antidepressant, a person can lose medical coverage and become medically unsupervised. For sure, if prescriptions of antidepressants are going up we’re going to see more suicides.

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