More than 40,000 people die by suicide each year in the United States. Millions more struggle with thoughts of suicide according to a September 2016 report from the Substance Abuse and Mental Health Services Administration (SAMHSA).

A look at the numbers:

• Nearly 10 million U.S. adults (4 percent) had serous thoughts of suicide in the past year.
• Rates of suicidal thoughts varied by age:
  • Young adults, age 18 to 25: 8.3 percent.
  • Adults age 40 to 54: 3.5 percent.
  • Adults 65 and older: 1.8 percent.
• More than one quarter of adults (28.6 percent) who experienced a major depressive episode in the past year had serious thoughts of suicide.
• Non-fatal suicide attempts result in more than 700,000 emergency room visits each year.

The Depression and Bipolar Support Alliance (DBSA) wanted to better understand how people cope with these distressing thoughts. DBSA conducted an informal, anonymous online survey of its constituents in 2013. The survey looked at where people turn for help with thoughts of suicide and what resources are most helpful.

The most commonly used sources of support were mental health professionals, family members and peers. Among the sources of support identified as most helpful were:

• Talking to a therapist or counselor
• Talking to a psychiatrist
• Attending a support group
• Going online for peer support
• Talking to peers

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While more than 80 percent of the respondents felt talking with mental health professionals was helpful, more than half reported being reluctant to talk with health care providers about suicidal thoughts. According to previous research, only half of people who experience suicidal thoughts receive care from a mental health professional.

Peer support services* were considered very helpful by survey participants; however, they had relatively low use. This represents a missed opportunity, according to the survey authors. “Increasing awareness and availability of organized peer support resources could have significant benefit for people who experience suicidal thoughts,” the study authors noted.

A variety of self-care strategies were used by the vast majority of survey respondents. Spiritual practices, such as meditation, prayer and other personal spiritual practices were identified as particularly helpful. Experience with emergency rooms and crisis lines and talking with clergy were used less frequently and perceptions of helpfulness were more mixed.

Among the self-care strategies identified as most helpful were:

• Exercising
• Doing things to stay busy
• Doing things with other people
• Turning to prayer, meditation or spiritual practices
• Watching films, TV or other entertainment

More than half of respondents had turned to alcohol or street drugs to cope with suicidal thoughts. However, among those, more than two-thirds found them to be not helpful or harmful.

References

1. Substance Abuse and Mental Health Services Administration (SAMHSA). Suicidal Thoughts and Behavior among Adults: Results from the 2015 National Survey on Drug Use and Health, Sept. 2016 www.samhsa.gov/data/sites/default/files/NSDUH-DR-FFR3-2015/NSDUH-DR-FFR3-2015.pdf
2. U.S. Centers for Disease Control and Prevention, WISQARS (Web-based Injury Statistics Query and Reporting System), 2016.www.cdc.gov/injury/wisqars/fatal_injury_reports.html
3. Ahmedani BK, et al. Suicide thoughts and attempts and psychiatric treatment utilization: information prevention strategies Psychiatric Services, 63:186-189, 2012
4. Depression and Bipolar Support Alliance (DBSA). Getting Help for Suicidal Thoughts Survey, Summary Report: April 2014.www.dbsalliance.org/pdfs/surveys/SuicidalThoughtsSurveyReportSummary41114.pdf

*Peer supporters, or peer specialists, are people who use their experience of recovery from mental health disorders to support others in recovery. They often have formal training and help others by teaching skills, modeling recovery and sharing their knowledge.

Tracy Thompson begins her thoughtful book The Ghost in the House with two brilliant sentences: “Motherhood and depression are two countries with a long common border. The terrain is chilly and inhospitable, and when mothers speak of it at all, it is usually in guarded terms, or in euphemisms.”

If depression happened in a vacuum, it would be so much easier.

But it doesn’t. It happens in the context of a family, raising kids, being responsible for other human beings even as you can’t take care of yourself.

My Worst Fear for My Children

“Even when it is relatively mild, depression may cause subtle shifts in the interactions between mother and child, and a mother’s depression may negatively affect her child’s development and well-being,” explains Ruta Nonacs, MD, PhD, in A Deeper Shade of Blue.

This is my worst fear for my kids — that my tears, anxiety, apathy, and sadness will destroy them and will cause them to have psychiatric conditions down the road. In the midst of an uncontrollable crying session, I hear Jackie Onassis’s words: “If you bungle raising your children, I don’t think whatever else you do well matters very much.”

The other day, my son, daughter, and I were in Michaels, the craft store picking up some face paint for spirit week at school.

“Can I have some gum, Mom?” my son asked me. We’re in the candy aisle.

“Sure,” I said, putting aside my efforts to de-sugar him.

“Do you want anything?” I asked my daughter.

“Yes,” she said. She looked up at me with tears in her eyes. “I want you to not be depressed.”

My heart broke in half.

Ten minutes earlier I was crying in the car. The painful ruminations wouldn’t stop, and I felt besieged by anxiety. As much as I try my best to hide my symptoms from them, not crying in front of them feels like not being able to pee during the day. The tears flow like Niagara Falls.

“Sweetie, I know you want that,” I said to her. “I want that, too. And I will get there. I promise. The magnets [transcranial magnetic stimulation, or TMS] are helping me, and I am getting better.”

I offered her hope even as I couldn’t access it myself.

Later, I cried to a friend.

“I’m ruining them,” I told her. “They need another mom — a more stable, capable woman who can run them to Michaels without tears running down her cheeks.”

“You can’t put the pressure of being well or being perfect on yourself,” she said. “That burden is too heavy.”

She urged me to forget about all the statistics that haunted me — studies that suggest children of parents with mood disorders have a much greater risk of developing psychiatric disorders themselves.

“Look at all the kids whose moms have breast cancer,” she explained. “They cope. They become resilient. They know their mom is ill, and they just might develop more compassion and empathy as a result. They might grow in ways they wouldn’t have if they hadn’t had to deal with it.”

“The difference is that a mom with breast cancer doesn’t feel the kind of guilt that you do about having cancer,” she continued. “She usually doesn’t fault herself for having to go through chemotherapy and losing her hair.”

She’s right about that. The guilt associated with this illness is what imprisons depressed mothers and stymies recovery.

In order to be the best mothers we can be, we must move beyond our guilt and focus all of our energy on doing whatever we can do to get better. In my case, that’s going to my TMS treatments, doing yoga, talking to friends, eating the right foods, lowering stress, sleeping, and calming myself down as much as possible. We can’t entertain statistics about how our crying might psychologically damage our kids — we just can’t go there. We must pray the serenity prayer with conviction so that we can separate the things we can change (like seeking the best treatment possible and taking care of ourselves) from the things we can’t (like symptoms that come with our present condition).

I Will Be Back to Myself One Day

A few years ago I wrote a children’s book for kids with a depressed parent calledWhat Does “Depressed” Mean? It included messages like “You are not to blame” and “Don’t take it personally” and “You are still loved.” But the concept that I think is most important for kids to hear (and for depressed persons to hear as well) is that “Your loved one will be back.”

I paraphrased this paragraph to my daughter in Michaels:

It is hard to imagine that the person who is now depressed will one day be back to herself. It is scary when you think that she might be sad for the rest of her life. However, you must trust that the same person who read bedtime stories to you, or tickled you until you screamed “Stop!” or took you on Saturday errands will be back! For real!

Yes, for real.

We’ve come a little way in reducing the stigma that’s associated with mental illness, but not nearly far enough. Consider these results pulled from a public attitude survey in Tarrant County, Texas, conducted by the county’s Mental Health Connection and the University of North Texas in Denton to determine the community’s view of mental illness:

• More than 50 percent believe major depression might be caused by the way someone was raised, while more than one in five believe it is “God’s will.”
• More than 50 percent believe major depression might result from people “expecting too much from life,” and more than 40 percent believe it is the result of a lack of willpower.
• More than 60 percent said an effective treatment for major depression is to “pull yourself together.”

Unfortunately, these beliefs are often held by those closest to us — by the very people from whom we so desperately want support.

Resenting them for their lack of understanding isn’t going to make things better, though. It almost always makes things worse. Whenever I hit a severe depressive episode, I am reminded once more that I can’t make people understand depression any more than I can make a person who hasn’t gone through labor understand the intense experience that is unique to that situation. Some people are able to respond with compassion to something that they don’t understand. But that is very rare.

Don’t Mistake Their Lack of Understanding For a Lack of Love

Whenever I try to open the doors of communication and express to a family member or friend how I am feeling — when I try to articulate to them the pain of depression — and am shut down, I usually come away extremely hurt. I immediately assume that they don’t want to hear it because they don’t love me. They don’t care enough about me to want to know how I am doing.

But distinguishing between the two is critical in maintaining a loving relationship with them. My husband explained this to me very clearly the other day. Just because someone doesn’t understand depression or the complexity of mood disorders doesn’t mean they don’t love me. Not at all. They just have no capability of wrapping their brain around an experience they haven’t had, or to a reality that is invisible, confusing, and intricate.

“I wouldn’t understand depression if I didn’t live with you,” he explained. “I would change the subject, too, when it comes up, because it’s very uncomfortable to a person who isn’t immersed in the daily challenges of the illness.”

This is a common mistake that many of us who are in emotional pain make. We assume that if a person loves us, he or she would want to be there for us, would want to hear about our struggle, and would want to make it better. We want more than anything for the person to say, “I’m so sorry. I hope you feel better soon.”

The fact that they aren’t able to do that, however, does not mean they don’t love us. It just means there is a cognitive block, if you will, on their part — a disconnect — that prevents them from comprehending things beyond the scope of their experience, and from things they can see, touch, taste, smell, and feel.

Don’t Take It Personally

It is incredibly difficult not to take a person’s lack of response or less-than-compassionate remark personally, but when we fall into this trap, we give away our power and become prey to other people’s opinions of us. “Don’t Take Anything Personally” is the second agreement of Don Miguel Ruiz’s classic The Four Agreements; the idea saves me from lots of suffering if I am strong enough to absorb the wisdom. He writes:

Whatever happens around you, don’t take it personally … Nothing other people do is because of you. It is because of themselves. All people live in their own dream, in their own mind; they are in a completely different world from the one we live in. When we take something personally, we make the assumption that they know what is in our world, and we try to impose our world on their world.

Even when a situation seems so personal, even if others insult you directly, it has nothing to do with you. What they say, what they do, and the opinions they give are according to the agreements they have in their own minds … Taking things personally makes you easy prey for these predators, the black magicians. They can hook you easily with one little opinion and feed you whatever poison they want, and because you take it personally, you eat it up ….

Protect Yourself

I have learned that when I fall into a dangerous place — when I am so low thatmindfulness and other techniques that can be helpful for mild to moderate depression simply don’t work — I have to avoid, to the best of my ability, people who trigger feelings of self-loathing. For example, some people in my life adhere tightly to the law of attraction and the philosophies of the book The Secret by Rhonda Byrne that preach that we create our reality with our thoughts. They have been able to successfully navigate their emotions with lots of mind control and therefore have trouble grasping when mind control isn’t enough to pull someone out of a deep depression.

I struggle with this whenever I fall into a depressive episode, as I feel inherently weak and pathetic for not being able to pull myself out of my pain — even if it means simply not crying in front of my daughter — with the type of mind control they practice, or even mindfulness or attention to my thoughts. This, then, feeds theruminations and the self-hatred, and I’m caught in a loop of self-flagellation.

Even if they aren’t thinking I’m a weak person, their philosophies trigger this self-denigration and angst in me, so it’s better to wait until I reach a place where I can embrace myself with self-compassion before I spend an afternoon or evening with them. If I do need to be with people who trigger toxic thoughts, I sometimes practicevisualizations, like picturing them as children (they simply can’t understand the complexity of mood disorders), or visualizing myself as a stable water wall, untouched by their words that can rush over me.

Focus On the People Who Do Understand

In order to survive depression, we must concentrate on the people who DO get it and surround ourselves with that support, especially when we are fragile. I consider myself extremely lucky. I have six people who understand what I’m going through and are ready to dole out compassion whenever I dial up their numbers. I live with an extraordinary man who reminds me on a daily basis that I am a strong, persevering person and that I will get through this. Whenever my symptoms overtake me and I feel lost inside a haunted house of a brain, he reminds me that I have a five hundred pound gorilla on my back, and that my struggle doesn’t mean that I am a weak person not capable of mind control. At critical periods when I’m easily crushed by people’s perceptions of me, I must rely on the people in my life that truly get it. I must surround myself with folks who can pump me up and fill me with courage and self-compassion.

Depression support groups — both online and in person — are invaluable in this regard for offering peer support: perspectives from people in the trenches who can offer key insights on how to deal with the invisible beast. I created two online groups, Group Beyond Blue on Facebook and Project Beyond Blue, but there are many forums worth checking out, like the ones at Psych Central. Actual support groups hosted by such organizations as National Alliance on Mental Illness (NAMI)and Depression and Bipolar Support Alliance (DBSA), and support offered by a therapist, are also great resources to help give you the coping tools you need to get by in a world that doesn’t get it.

Depression is different from other illnesses in that, in addition to the physiological symptoms (loss of appetite, nervousness, sleeplessness, fatigue), there are the accompanying thoughts that can be so incredibly painful. For example, when myRaynaud’s flares up, the numbness in my fingers can be uncomfortable, but it doesn’t tell me that I am worthless, pathetic, and that things will never ever get better. During severe depressive episodes, however, these thoughts can be life-threatening: They insist that the only way out of the pain is to leave this world.

Being able to manage our thought stream will direct us toward health, as our thoughts are constantly communicating with the various systems of our body, either sending certain glands or organs an SOS in distress, or a note that everything is fine, resulting in calm. But being able to harness this craziness in the midst of depression and anxiety is so very difficult.

Here are some of the ways I try to let go of the thoughts that cause depression and anxiety. Some days I am much more successful than others.

Identify the Distortions

I have benefited immensely from David Burns’ book Feeling Good: The New Mood Therapy — from doing the cognitive behavioral therapy exercises he prescribes to identifying the various distortions in my own thinking that he presents in his book and his workbook. They include:

1. All-or-nothing thinking You look at things in absolute, black-and-white categories.

2. Overgeneralization You view a negative event as a never-ending pattern of defeat.

3. Mental filter You dwell on the negatives and ignore the positives.

4. Discounting the positives You insist that your accomplishments or positive qualities don’t count (my college diploma was a stroke of luck … really, it was).

5. Jumping to conclusions You conclude things are bad without any definite evidence. These include mind reading (assuming that people are reacting negatively to you) and fortune telling (predicting that things will turn out badly).

6. Magnification or minimization You blow things way out of proportion or you shrink their importance.

7. Emotional reasoning You reason from how you feel: “I feel like an idiot, so I must be one.”

8. “Should” statements You criticize yourself or other people with “shoulds,” “shouldn’ts,” “musts,” “oughts,” and “have-tos.”

9. Labeling Instead of saying, “I made a mistake,” you tell yourself, “I’m a jerk” or “I’m a loser.”

10. Blame You blame yourself for something you weren’t entirely responsible for, or you blame other people and overlook ways that you contributed to a problem.

It doesn’t take long to identify one or more of these in your thinking. Just recognizing these traps can be helpful. You might then try one of the methods listed in Burns’ 15 Ways to Untwist Your Thinking. A warning, though: I’d wait until you have emerged from a severe depressive episode before you attempt some of these exercises. I’ve made the mistake of trying too hard to “fix” my thinking during severe depression, which has made it worse. It’s better to focus on the other ways listed below.

Focus on the Present

Although every self-help book I read touches on this, I am just beginning to really learn what it means to focus on the present and to appreciate the healing power of mindfulness, which, according to meditation teacher and bestselling author Jon Kabat-Zinn, is “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” If we continue to practice this, he explains, “this kind of attention nurtures greater awareness, clarity, and acceptance of the present-moment reality.” It’s not that we don’t feel the hurt, rage, and sadness that lives at the surface of our minds. It’s not an attempt to escape all the suffering that is there. But if we can observe all of our projections into the past and future — and all of the judgments that are part of our thought stream — and simply get back to what is happening right now, right here, we can allow a little room between our thoughts and our reality. With some awareness, we can begin to detach from the stories that we spin and from the commentaries that are so often feeding our pain.

One of the best ways we stay present is by keeping our attention on our breath. Vietnamese Zen Buddhist Thich Nhat Hanh instructs us that with each in-breath, we might say, “Breathing in, I know that I am breathing in.” And with each out-breath, “Breathing out, I know I am breathing out.” In his book You Are Here, he explains that mindful breathing is a kind of bridge that brings the body and the mind together. We start by this simple gesture of watching our breath, and then by this mindfulness of breath we begin to stich the body and mind together and generate a calm that will penetrate both.

Apply Self-Compassion

“Self-compassion doesn’t eradicate pain or negative experiences,” Kristin Neff, PhD, explains in her book Self-Compassion. “It just embraces them with kindness and gives them space to transform on their own.” It gives us the “calm courage needed to face our unwanted emotions head-on.” When I’m in the most pain — especially during a severe depressive episode — it is self-compassion more than anything else (cognitive behavioral therapy techniques, mindful breathing, etc.) that saves me and restores me to sanity. Nhat Hanh says that we should treat our depression tenderly, as we would treat a child. He writes:

If you feel irritation or depression or despair, recognize their presence and practice this mantra: “Dear one, I am here for you.” You should talk to your depression or your anger just as you would to a child. You embrace it tenderly with the energy of mindfulness and say, “Dear one, I know you are there, and I am going to take care of you,” just as you would with your crying baby.

It is so easy to be so cruel to ourselves without even realizing it. The ruminations that are part of depression beat us down and shred us until there is practically nothing there. That’s why it is so critical to apply self-compassion from the start, and treat ourselves, as well as our depression, as the scared little child that needs comforting, not scorn.

Acknowledge the Transience of Things

One of my favorite prayers is St. Teresa of Avila’s “Bookmark” that says:

Let nothing disturb you,

Let nothing frighten you,

All things are passing;

God only is changeless.

Patience gains all things.

Who has God wants nothing.

God alone suffices.

If the religious language bothers you, Eckhart Tolle says much the same when he writes in A New Earth:

Once you see and accept the transience of all things and the inevitability of change, you can enjoy the pleasures of the world while they last without fear of loss or anxiety about the future. When you are detached, you gain a higher vantage point from which to view the event in your life instead of being trapped inside them.

Absolutely everything, especially our feelings and emotions, is impermanent. By simply remembering that nothing ever stays, I am freed from the suffocating thoughts of my depression — the formidable fear that this sadness will always be with me, as well as the circumstances that are causing it. By acknowledging the transience of life, I am again called to pay attention to the present moment, where there is more peace and calm than I think.

Join Project Beyond Blue, the new depression community.

Photo credit: Cara Slifka/Stocksy

According to the American Foundation for Suicide Prevention, 42,773 Americans die by suicide each year. That’s 117 people every day.

When you think of what may be causing these suicides, instinctually, you might assume depression and/or mental illness. And you wouldn’t be wrong: 90% of children and adolescents who die by suicide live with a mental health condition.

But have you ever thought about other possible factors that could lead to suicide? Take, for example:

Farming

Farmers, fishers and foresters have the highest suicide rate of any profession in the United States. According to the Center for Disease Control (CDC), 85 suicides occur for every 100,000 farmers.

This may be surprising considering the obvious benefits of farming: spending time outside, getting plenty of physical activity, eating fresh and healthy food, etc. But farmers also spend long periods of time working alone and may feel isolated. Their work is not only physically demanding, but also stressful due to many factors that are outside of their control, such as: corporate agriculture, livestock disease, poor harvests, climate change and government legislation.

When any (or all) of these things lead to depression, what could they do about it? Farming somewhat requires living in a rural area, so there is a very likely chance they may not have access to mental health services.

Firearm Prevalence

Many studies have shown that people who have died by suicide likely lived in homes with guns. But did you know that individuals who live in states with a high firearm prevalence have a higher risk for suicide as well? One study showed that the suicide rate for 40 million people living in the states with the highest firearm prevalence was almost twice as high as 40 million people living in the states with the lowest firearm prevalence.

This may seem like an obvious correlation to suicide as guns provide the means to complete the act. But in the same study, both the high-gun states and the low-gun states had the same amount of suicides occur from a method other than guns. Which means that access to guns were not the reason the suicide rate was higher in the gun-prone states.

Research conducted in another study: Guns and Suicide: Correlation or Causation? similarly found that non-gun suicide rates are not significantly lower in places with more gun ownership even though the overall suicide rate is higher. This suggests that people living in high-gun states have higher suicidal tendencies.

Altitude

Have you ever felt sad when spending an extended period of time in the mountains? Maybe vacationing in a ski resort? Researchers believe low oxygen and thin air can be linked to depression and higher suicide rates. A study published in High Altitude Medicine and Biology compared the suicide rate in over 2,500 U.S. counties and determined that there is a strong positive correlation.

Population/Region

The areas in the country with the lowest suicide rates are also some of the most populous areas, including Washington D.C. and New York City. Comparatively, the suicide rate is more than 300% higher in Alaska and Montana.

This may be due to a lack of access to services or simply because there are more activities and coping mechanisms in a major city.

The Economy

The state of the economy impacts everything—our ability to secure a job, how much interest we pay on our loans, our buying power, among other things. So when the economy is weak, it can lead to significant stress for the people affected.

Research has found suicide is highest when the economy is weak. One study looked at the history of the national suicide rate and found the Great Depression to be the time period with the highest suicide rate.

Lithium

While all of these factors seem to increase the suicide rate, Lithium is an element that leads to the opposite. Lithium has been used for many years as a method of treatment for people living with depression. But it is also a naturally occurring element in water depending on the geographic area.

While drinking water with Lithium in it would be a far smaller dose than a prescription of Lithium from a psychiatrist, evidence suggests that these small doses decrease suicide rates significantly.

Many studies have been conducted over the past 25 years all across the world to test this theory and a recent review of epidemiological studies showed that nine out of 11 studies found that lithium in local water had beneficial outcomes.

Discovering what causes the suicide rate to fluctuate could help us to uncover better methods of prevention. This Suicide Prevention Awareness Month, help us in our cause to learn more and prevent suicide from happening.

– See more at: http://www.nami.org