American Foundation for Suicide Prevention: An Original Analysis
Author’s Note
I wrote this paper for my CMN 161: Health Communications class to research more about suicide in the U.S. I first explore the suicide crisis in the U.S. from multiple different perspectives in order to understand the factors that lead to increased suicidality and the current interventions that exist for tackling the suicide crisis. Later on in the paper, I then discuss the purpose and effectiveness of the #RealConvo campaign conducted by the American Foundation for Suicide Prevention during May 2019. Overall, I was interested in researching more about this topic because of my passion for the mental healthcare field and wanting to further my knowledge on this subject.
Introduction
Despite the increased awareness of the importance of addressing and preventing the onset of mental health crises, suicide rates increased by 30% from 2000-2018. However, these rates did slightly decrease in 2019 and 2020. Overall, there was approximately one death by suicide every 11 minutes in 2020 (Centers for Disease Control and Prevention [CDC], 2022). These alarmingly high rates have a distressing societal impact and negatively impact communities due to the shock, guilt, anger, anxiety, depression, and suicidal ideation that may result from the loss of a loved one. To address this concern, in May 2019, the American Foundation for Suicide Prevention (AFSP) successfully conducted the campaign #RealConvo, in honor of Mental Health Awareness Month. This intervention worked to foster meaningful conversations amongst one’s family, friends, and loved ones to build interpersonal connectivity and community, as a way to potentially lower suicide rates. Ultimately, the purpose of developing a strong support network for this intervention was based on the fact that time and time again, research has found that connectivity is a strong protective factor against suicide (CDC, 2022).
This paper first explores research from academic sources and suicide-related data from organizations, which have major implications for the campaign’s success, as discussed in the latter part of this analysis; the theoretical frameworks are then examined to investigate the effectiveness of the intervention #RealConvo and how it can be further improved.
Overview of Research on Suicidality
Research from multiple sources illustrates that suicide is a leading cause of death in the United States, and has the potential to impact anyone regardless of background, including age, race/ethnicity, gender identity, and sexual orientation. According to the AFSP (2022), “Suicide is the 12th leading cause of death in the US”; in 2020 alone, 45,979 Americans died by suicide and there were an estimated 1.20 million suicide attempts nationwide. Furthermore, CDC (n.d.) data indicated that suicide was one of the 10 leading causes of death in the U.S. during 2020 for both sexes, all ages, and all races, with the suicide rate for people ages 10-14 being the highest at 21.9%. However, there is no absolute count of suicide attempt data, as the CDC is primarily able to gather this information based on non-fatal injuries from self-harm and survey data (AFSP, 2022).
Possible Factors Leading to Increased Suicidality
Despite extensive research focusing on the factors leading to these higher rates of suicide, it is difficult to identify clear reasons behind this phenomenon, for heritable, psychosocial, demographic, and biological factors can potentially lead to increased suicidality (Turecki & Brent, 2016). For instance, in their research paper, Martínez-Alés & Keyes (2019) argued that the increases in suicide rates seem to be correlated with increases in mood disorders, as well as drug use and overdose. Although there seems to be no significant change in these factors among adolescent boys, this is still significant to note because mood disorders and depressive symptoms seem to be drastically increasing in adolescent girls. While research about affective disorders impacting adults is more complex, it still suggests that those with low socioeconomic status are more heavily impacted by such mental illnesses; thus, economic decline and unemployment are two additional factors that lead to increased suicidal ideation (Martínez-Alés & Keyes, 2019).
Moreover, it is crucial to focus on how high-risk groups for suicide are affected differently, with adolescents being one such group, particularly since this age is affiliated “ … with a heightened risk for both the onset and the escalation of suicidal thoughts and behaviors,” (Burke et al., 2015, p. 1145). Another high-risk group involves those who use substances: in a research study conducted by Walsh et al. (2018), substance use was correlated with significant distress in several multivariate analyses and predicted the first onset of suicidal ideation in subjects.
Impacts of Suicide
As the CDC (2022) explains, both suicide and suicide attempts lead to serious physical, emotional, and economic impacts that not only affect the individual but their community and loved ones as well. Family and friends of individuals who die by suicide may experience thoughts of ending their lives, due to the shock, guilt, anger, anxiety, depression, and suicidal ideation that may result from losing someone by suicide. Furthermore, the CDC (2022) estimates that “Suicides and suicide attempts cost the nation almost $70 billion per year in lifetime medical and work-loss costs alone.” In light of these serious negative impacts that suicide has on individual, interpersonal, and societal levels, it is crucial to recognize the fact that this phenomenon is largely preventable with everyone playing a proactive role. In fact, “93% of adults surveyed in the U.S. think suicide can be prevented,” based on data from the ASFP (2022). In this way, it is important to recognize that it is essential to provide support by identifying and addressing the signs of suicide within an individual, which will additionally curb the physical, emotional, and economic impacts that result from suicide, resulting in a society with healthier well-being for all.
Factors Leading to Suicidal Ideation
To develop a comprehensive public health approach to address suicide prevention, it is first vital to recognize the factors that lead to suicidal ideation. One such factor is violence, including child abuse, bullying, and/or sexual violence.
Furthermore, suicide rates var;y drastically depending on certain demographic characteristics such as age, gender, ethnicity, race, and sexual orientation (ASFP 2022), and thus it is essential to acknowledge the systematic disparities that affect minority communities nationwide. As shown by statistical reports from the CDC (2022), “By race/ethnicity, the groups with the highest rates [of suicide] are non-Hispanic American Indian/Alaska Native people followed by non-Hispanic White people.” Especially amongst American Indian/Alaska Native populations who face disproportionately higher rates of suicide and mental health disorders than other groups in the U.S., connectedness has been shown to play an important role in protecting against suicide ideation (American Psychiatric Association [APA], n.d.).
The CDC (2022) also asserts that suicide rates are higher for Americans who live in rural areas, are veterans, identify as being a part of the LGBTQ+ community, are middle-aged adults, people of color, and tribal populations. While data published by the ASFP (2021) asserts that further research is necessary to understand the impact that suicidal ideation has on the LGBTQ+ community, ASFP researchers assert that queer adolescents are at a higher risk of suicide as opposed to heterosexual or cisgender adolescents. Altogether, these marginalized communities “ … may disproportionately experience factors linked to suicide, such as substance misuse, job or financial problems, relationship problems, physical or mental health problems, and/or easy access to lethal means” (CDC, 2022).
Interventions for Preventing/Reducing Rates of Suicidality
Despite these health disparities, there are a variety of interventions that have been implemented to improve the well-being of individuals. These include school, workplace, community-based, and multicomponent primary care interventions, which can aid mental healthcare and reduce access to suicide means (Turecki & Brent, 2016). In particular, psychotherapy is exceptionally successful in lowering suicidal behaviors, particularly dialectic behavior therapy. In this form of treatment, “ … patients are taught how to think about their and other people’s actions as the result of underlying thoughts and emotions, thereby improving their ability to understand their own and others’ perceptions…” (Turecki & Brent, 2016, p. 1236). This form of psychotherapy has also proved to be effective when treating young adults; in a study by Burke et al. (2015), researchers found that suicidal ideation rates were lowered when young adolescents responded to negative affect with distraction and problem-solving. Burke et al. (2015) found that strategies to engage in such cognitive tasks were effectively implemented in dialectical behavior therapy for adolescents, leading to fewer responses of depressive affect, in turn reducing suicidal behaviors.
Along with the use of such treatments, it is also important to observe the role that media plays in suicidal tendencies; Martínez-Alés & Keyes (2019) argue that theoretically, the media “ … can reduce the population’s ‘cognitive-access’ to suicide by purposely avoiding the coverage of key news, like an emerging suicide method or the suicide of a celebrity” (p. 104). Similarly, the reduction approach has proven to be effective in reducing access to lethal means as well; research has shown that ease of access to means of suicide heavily influences impulsive suicidal behaviors.
#RealConvo— A Brief Overview
The intervention, #RealConvo for Mental Health Awareness Month led by the ASFP in May of 2019 focused on inspiring people to have meaningful conversations with family, friends, and loved ones about their mental health to foster connectivity, which, as previously discussed, is a protective factor against suicidal ideation and behaviors. By utilizing social media and partnering with famous influencers and celebrities, such as Rebecca Black, ALOK, and Andy Lassner, along with famous media companies like Netflix, ASFP concentrated on providing individuals with practical advice about how to have effective conversations with those suffering from mental health issues. The campaign planners achieved this by providing resources through their website, which educated individuals on how to have an effective conversation about sensitive topics and offered a collection of real-life stories about other people’s experiences with suicide. The #RealConvo campaign was primarily conducted through social media to thoroughly engage their audience throughout the month. To promote user engagement, ASFP created a variety of fun online features such as a Challenge sticker, GIPHY stickers, and a custom Augmented Reality filter for Instagram stories for participants to engage with their followers. Correspondingly, the campaign’s target audience was wide-ranging—essentially anyone who was struggling with their mental health, which included people of all demographics (relating to age, gender, race/ethnicity, sexual orientation, geographic location, and more).
Theoretical Application of the Effectiveness of #RealConvo
There are multiple theories that illustrate the effectiveness of this intervention. First and foremost, the organization of the campaign through social media exemplifies the implementation of the uses and gratifications theory, which suggests that having participants thoroughly engage themselves with the message of the campaign leads to meaningful reflection and understanding of the campaign’s goals. This was demonstrated by encouraging individuals to tag their friends to join them in the challenge, have a meaningful conversation with them, and share their experiences with others through the interactive Instagram stickers and filters. The fact that the campaign planners organized the intervention through social media is also significant; they were able to successfully reach their target audiences in a cost-effective manner (since utilizing social media is free for the most part, disregarding staffing costs). Moreover, the campaign coordinators did an excellent job complementing the use of mass media (social media) and interpersonal channels (inspiring participants to support each other in their mental health struggles). In this way, the media channels influenced individuals’ topics of conversation, while the interpersonal channels fostered a sense of community and were more influential in getting people to participate. Furthermore, the campaign managers skillfully applied the theory about nonprofits and social media engagement relating to information dissemination, dialogic communication, and mobilization and action (Lovejoy & Saxton 2012; Guo & Saxton 2014). ASFP ensured that they provided their audience with enough information regarding the importance of mental healthcare (information dissemination) along with establishing equal opportunities to engage in dialogue and mobilization/action to motivate participants to engage in serious conversations with close friends and family about mental healthcare. This was demonstrated by the fact that by the end of the month, the campaign web page got a total of 15k views, with a total of 6.2k new followers, added across all social media channels (ASFP, n.d.).
Theoretical Application of the Ineffectiveness of #RealConvo
On the other hand, there are a couple of theoretical frameworks that demonstrate the intervention’s ineffectiveness. Although this campaign was largely successful in influencing individuals to start having conversations about mental health, there was a lack of recognition of the ways demographic diversity impacts such discussions. This was shown by the fact that no resource on the campaign website or social media tailored certain strategies or focused on the different factors that uniquely affect minority racial/ethnic, religious, and LGBTQ+ communities, as well as gender identity and age groups. Thus, the near absence of narrowcasting by this campaign hindered efforts to make close connections with hard-to-reach and other smaller communities based on these demographics. Additionally, this campaign’s dominant social media presence could also have led to risks of message distortion: some may argue that the generality of the campaign’s message to initiate conversations about mental health may prove to be ineffective, especially for those with serious mental illnesses. Thus, people with such attitudes may believe that this campaign is only for those who are simply going through a rough time in life, either from certain lived experiences or from mental illness, as opposed to addressing suicidality.
Overall Evaluation of the Effectiveness of #RealConvo
The effectiveness of this intervention led to quite a few successes. Through their online resources, the campaign facilitators shared other people’s real-life stories about how suicide impacted their lives, which was a great initiative to create a sense of community, even through an online platform. In this way, participants could know that they are not the only ones struggling with their mental health, which is a major factor in protecting against suicidality, as demonstrated by research about the benefits of having close social connections for one’s health and well-being.
Additionally, there is a comprehensive list of resources on the campaign website to get access to mental healthcare, including options for crisis intervention and psychotherapy. This is essential, especially since research shows that psychotherapy treatments and regular check-ups for mental disorders are effective in protecting against suicidal behavior (Turecki & Brent, 2016). Furthermore, having the resources on the campaign website in Spanish was a practical strategy to address linguistic differences, especially since minority communities have more difficulty accessing mental health treatment resources (APA, n.d.). Having these resources in Spanish was slightly helpful for addressing some minority needs. However, even though there was this acknowledgment of minority needs, it was still too limited to be truly inclusive of everyone.
Despite these successes, there was one major failure of this campaign, which was a lack of recognition of the different factors that uniquely impact individuals based on their backgrounds. Knowing these factors beforehand can aid in having more effective conversations, especially since the inaccessibility of high-quality mental healthcare services, the cultural stigma around mental healthcare, discrimination, and a lack of awareness about mental health often have detrimental effects on racial/ethnic, gender, and sexual minorities (APA, n.d.). In spite of this major failure, overall, it can be speculated that the campaign potentially succeeded in its goal of lowering suicide rates by building community online and stimulating discussion about self-care.
Potential Improvements to #RealConvo
For this intervention to be more effective, it can further segment the audience to cater to diverse needs. The online campaign resources primarily provide general tips and information about how to communicate to help individuals navigate complex topics, such as suicide and mental health. However, these general guidelines may not necessarily be beneficial for everyone due to individual differences regarding diagnosed/undiagnosed mental disorders, suicidal tendencies, self-harm, age, gender identity, race/ethnicity, socioeconomic status, sexual orientation, etc. Thus, if the resources were tailored to individuals’ unique identities and offered a more nuanced approach, the campaign would be more effective.
Furthermore, this campaign could be even more successful if there were resources that provided examples of effective conversations that participants could read before engaging in a conversation of their own with a loved one (to avoid becoming overwhelmed from reading through the lists of effective strategies on the campaign website).
Conclusion
In conclusion, high suicide rates remain a serious cause for concern in today’s society; despite being predominantly preventable, it is one of the leading causes of death in the U.S. The #RealConvo campaign implemented by the ASFP was successfully executed through social media to educate and raise awareness about initiating conversations regarding mental health in participants’ interpersonal relationships to foster connection and fight against suicide. Despite the lack of narrowcasting, other suicide prevention campaigns can look to the ASFP for guidance, and work on addressing the continuing mental health disparities that marginalized communities face. Especially since researchers project that more than half of all Americans will become a part of an ethnic minority group by 2044, (APA, n.d.) an equitable approach to mental healthcare must be found for everyone in society to thrive, regardless of one’s background.
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