Stephen O’Connor, PhD, associate director of the UofL Depression Center, will present “Understanding and Recovering from Suicidality” at 7:30 p.m. at St. Paul United Methodist Church, 2000 Douglass Blvd. The lecture is sponsored by the and .

Depression is an important topic to focus on for suicide prevention, but there is much more to suicidal experiences that are not explained or characterized by depression, O’Connor said.

“This is a misunderstood topic and we want people to better understand how to conceptualize why people develop suicidal thoughts,” O’Connor said. “Although the majority of people who have suicidal thoughts are experiencing depression, most depressed people are not suicidal. Therefore, the public needs to understand how depression indirectly impacts suicidality, whereas other factors are more directly related to suicide risk.”

The best treatments that help people recover from a suicidal crisis address the experiences and reasons that people have for feeling like death is a good option, he said.

For more information, call the Depression Center at 502-588-4886.

Allison Tu, a senior at duPont Manual High School who led the student group, and Stephen O’Connor, PhD, associate director of the UofL Depression Center who guided the students in research, presented findings during the on Sept. 11 at the UofL Clinical and Translational Research Building.

The student group, comprised of teens across the state, is called the Student Alliance for Mental Health Innovation and Action () and is supported by the Kentuckiana Health Collaborative, a nonprofit organization that aims to improve health and the health care delivery system in greater Louisville and Kentucky.

StAMINA conducted a needs assessment of the state and held focus groups in urban and rural areas with high school students and parents to uncover what interferes with students acknowledging they have mental health issues and receiving treatment. The group also interviewed mental health professionals and pediatricians.

Factors that contributed to mental health stigma among high school students included negative representation of mental health in media and stigma from peers and parents who do not have a positive attitude about mental health, Tu said. The group found differences between rural and urban residents.

“Because there is more racial and ethnic diversity in urban settings, one of the big drivers of mental health stigma is ethnic heritage,” Tu said. “African-American and Asian-American students talked a lot about how culturally, mental health was often ignored. With rural students, generally there was more stigma resulting from religious factors. Some students said they would talk to their parents about mental health issues, and their parents would respond, ‘you’re not praying enough.’”

Messages that parents express about mental health impact a child’s views, said O’Connor, who guided the research design, and taught the students how to lead focus groups and conduct qualitative data analysis.

“The gatekeeper for getting children to treatment is often going to be a parent, so parental views on mental health are likely going to impact whether a child is taken to treatment,” O’Connor said. “The parent also is helping the child understand what they’re experiencing, so if the parent doesn’t have a good idea about what symptoms of mental illness represent, then the child is probably not going to understand either.”

Solutions to mental health stigma among teens may include a new mental health education requirement for high school freshmen or a social media campaign to amplify the visibility of resources, said Tu, who also stressed the need for parents to be educated on mental health issues and resources available for their children.

According to the Centers for Disease Control and Prevention, suicide rates have increased 25 percent nationwide, with Kentucky experiencing a 36.6 percent increase between 1999 and 2016.

Researchers with the CDC found that more than half of people who died by suicide did not have a known diagnosed mental health condition at the time of death. Several factors contribute to risk for suicide, including relationship problems, substance misuse, physical health problems and stress tied to jobs, money, legal issues or loss of housing.

, PhD, associate director of the , urges people to reach out to others who they suspect are contemplating suicide.

“The stigma of experiencing suicidal thoughts is often a barrier for people to express what they’re going through. The best way to break that barrier is by having conversations, no matter how uncomfortable they may be,” said O’Connor, a clinical psychologist.

Guidance on conversation starters is available at , a campaign by the that provides video scenarios and other information on reaching out to those who are struggling.

According to the National Institute of Mental Health, the behaviors listed below may be signs that someone is considering suicide:

• Talking about wanting to die or wanting to kill themselves.
• Talking about feeling empty, hopeless or having no reason to live.
• Making a plan or looking for a way to kill themselves, such as searching online, stockpiling pills or buying a gun.
• Talking about great guilt or shame.
• Talking about feeling trapped or feeling that there are no solutions.
• Feeling unbearable emotional or physical pain.
• Talking about being a burden to others.
• Using alcohol or drugs more often.
• Acting anxious or agitated.
• Withdrawing from family and friends.
• Changing eating and/or sleeping habits.
• Showing rage or talking about seeking revenge.
• Taking great risks that could lead to death, such as driving extremely fast.
• Talking or thinking about death often.
• Displaying extreme mood swings, suddenly changing from very sad to very calm or happy.
• Giving away important possessions.
• Saying goodbye to friends and family.
• Putting affairs in order, making a will.

If you are having thoughts of suicide, several resources are available. Call the National Suicide Prevention Lifeline 24/7 at 1-800-273-8255. The service is available to everyone. The deaf and hard of hearing can contact the line via TTY at 1-800-799-4889. All calls are confidential.

provides emergency psychiatric services 24/7 with specialists who stabilize adults experiencing mental health crisis. To contact emergency psychiatric services, call 502-562-3120.

, which includes the UofL Depression Center, provides treatment for mental health issues including addiction, anxiety disorders, bipolar disorder, depression, geriatric psychiatry and women’s mental health. For appointments, call 502-588-4450.

Active Minds RSO

The University of Louisville has an Active Minds RSO on campus. The group’s mission is to make sure every student knows that mental illness is treatable, suicide is preventable, and help is available.

 indicate there are significant barriers to treatment for people who have made suicide attempts and highlight the need to improve assessment and intervention for survivors of self-inflicted gunshot wounds, especially while hospitalized for their injury.

Stephen O’Connor, PhD, associate director of the , and other researchers analyzed electronic medical records from 128 survivors of self-inflicted gunshot wounds treated at a trauma center in Nashville, between 2012 and 2015 to identify factors associated with denying a suicide attempt to medical staff. Twenty-nine percent of patients denied their injuries resulted from a suicide attempt. Of those cases, 43 percent had questionable circumstances, and the denial of suicide attempt was coded as a suspected false denial.

The study noted cases that appeared to be obvious false denials of suicide. Clinician quotations from medical transcripts included “he shot himself when confronted by police” and “left voicemails on wife’s phone saying goodbye,” according to the study.

O’Connor said people likely deny suicide attempt because of the stigma surrounding the act, not wanting the incident documented on medical records and the reluctance to be admitted to inpatient psychiatric care because of family or job responsibilities.

“As a provider, it’s a friction point when you’re trying to help but you may not be getting the whole story from the patient,” O’Connor said. “The hospital psychiatry consultation and liaison service has to figure out quickly if patients are at imminent risk in the hospital and upon discharge to the community once medically stable.”

Hospitalized patients who denied a suicide attempt were nearly 11 times more likely to be discharged to home rather than to inpatient psychiatric care.

Brief psychological interventions implemented in the hospital while patients recover from potentially intentional, self-inflicted injuries are a solution to treatment barriers. These may include the Safety Planning Intervention, in which a clinician and patient identify warning signs that might precipitate a suicidal crisis and develop coping strategies, and the Teachable Moment Brief Intervention that pinpoints factors underlying a suicide attempt and plans for outpatient mental health services.