The Implications for Healthcare Financing & Sustainable Innovation Strategies in Suicide Prevention Efforts

DNP 711 - Week 13:

INTRODUCTION/OVERVIEW: The Implications for Healthcare Financing & Sustainable Innovation Strategies of Suicide Prevention

From the 2020 Suicide Prevention Action Plan, in Arizona, the past ten years is continuing to reveal a dark trend arising in both the total number and frequency in suicide rates (ADHS, 2020). For both 2017 and 2018, suicide was the 8th leading cause of deaths among Arizona residents (ADHS, 2020). Depression and suicide as a significant public health crisis account for more than 40,000 deaths in the U.S. annually (Bridge et al., 2014; CDC, 2017a). In 2015, on average, there were 129 suicides per day, and self-injury/suicide cost the U.S. $69 billion (AFSP, 2019b). The estimated average cost per suicide death is more than $1.3 million (Shepard et al., 2016). Despite the immediate impacts that loss of life by suicide incurs, high emotional and economic costs also compound, resulting in about $44.6 billion annually in combined medical and work loss costs in the U.S. alone (Twenge et al., 2018). Most of the total costs associated with suicide deaths result from the lost productivity of individuals (97 percent) compared to the minimal costs associated with medical treatment (3 percent)(Shepard et al., 2016). In 2017, suicide attempts reached an estimated 1,400,000 people (AFSP, 2109b). In 2013, the total cost valuation estimates of suicide and suicide attempts were $93.5 billion, which is indicative that for every $1.00 spent on psychotherapeutic interventions and prevention efforts saved $2.50 in the costs attributable to suicide deaths (Chisholm et al., 2016; Shepard et al., 2016). Even using the most conservative estimates, the potential benefits that result from interventions such as general suicide education and peer support programs total at least $22 million per year (Sari et al., 2008).

Suicide ranks as the second leading cause of death among people ages 10-34 and a significant global public health crisis.3,6 Suicide rates increased by 24% within the past 15 years (CDC, 2017b). The time spent by adolescents and emerging adults in the past decade doubled (Ofcom, 2017; Orben & Przybylski, 2019). Adolescent mental health issues continue to rise sharply, especially among females (Twenge et al., 2018). Dependence on our mobile devices and social media use may increase our current mental health crises, especially among emerging adults and adolescents. Understanding how digital technological advances influence the mental health of young adults could impact our abilities of suicide prevention and self-harm reduction efforts.

The activation of any advocacy plan requires creative and innovative uses of environmental resources, and in many instances, also includes engaged participation in professional and specialty associations (Patton, 2014). Whereas, policy implementation involves another set of common elements such as goal refinement, influential application, strategic issue framing, and audience targeting to ensure that communication efforts are successful in their delivery of information (Patton, 2014). Specific to the sustainability issues of suicide prevention efforts, another element critical to advocacy planning is resource assessment to evaluate what is currently available or need future procurement before policy implementation begins, which often includes human resources analyses, data resources, economic projections, and communication capabilities evaluation (Patton, 2014).

Many private entities and public sector institutions are working to improve suicide awareness and prevention efforts. However, the resilience capacity and sustainability of these groups is dependent on financial resource management and fundraising capabilities. The American Foundation for Suicide Prevention (AFSP), as the largest private-sector organization, spent more than 37 million dollars in 2019 on operational costs associated with suicide awareness and prevention (AFSP, 2019a). The AFSP is an example of an organization that provides extensive human resources and financial capital investment into the “research, education, and advocacy actions against this leading cause of death” (AFSP, 2020). The AFSP mission statement presents that they are “dedicated to saving lives and helping those affected by suicide" (AFSP, 2020). Organizationally, much of the AFSP's work focuses on fostering and building "a culture of mental health awareness by funding scientific research, educating the public about mental health and suicide prevention, advocating for public policies in mental health and suicide prevention, and supporting survivors of suicide loss and those affected by suicide in our mission” (AFSP, 2020).

Many other private sector organizations (e.g., AAS, NAASP, ICRC-S, SAVE), like the ones highlighted in previous blog posts, raise and spend substantial amounts of financial capital annually (AAS, 2020; NAASP, 2020; ICRC-S, 2020; SAVE, 2020). However, the public sector institutions outspend and assume most of the annual financial burden associated with suicide prevention efforts. Some of the public sector institutions contributing to the efforts of suicide prevention in the United States are the National Institutes of Health (NIH) through its subsidiary of the Substance Abuse and Mental Health Services Administration (SAMHSA). Of the various contributing public organizations, the most significant source of financial support comes from the federal government. For example, trends in recent spending suggest that SAMHSA expends approximately $50 million each year on suicide prevention where the funneling of the majority of these funds are towards the disbursement of grants, maintenance of the suicide prevention hotline, and funding for Zero Suicide programs (SAMHSA, 2018). Another example of a public sector institution that contributes to much of the programmatic spending related to suicide prevention efforts is the National Institute of Mental Health (NIMH), another division of the NIH, which is accountable for oversight of evaluating and selecting studies to be funded (NIMH, 2019). Many lines of current funded-research often focus on prevention techniques and improved methods for identifying at-risk individuals (NIMH, 2019). In contrast, others concentrate on the best methods for encouraging health professionals to utilize the validated and reliable methods previously developed for the identification or treatment of at-risk individuals (NIMH, 2019).

While policymaking advancements do not occur instantaneously or within a political or social vacuum, it is an iterative process that becomes evolutionary and adaptive because of an accumulation of collaborative engagement between various policymaking actors and agents. From the executive or legislative realms to the public or private sector partnerships, Longest (2014) argues that, within foundationally complex domains, such as healthcare services delivery, a bias exists for incrementalism, iterative adjustment, or continuous modification in policy scaling and execution. Essentially, what Longest (2014) is re-presenting is the idea of "kaizen" or continual improvement, which has been a core ideal of product manufacturing for decades (Sutherland, 2014). One of the distinct benefits of such procedural iteration is the overall gain or potential maximization of resilience for both organizations and policymaking efforts. The relationship between sustainability and resilience is that they both seek to improve long-term prospects; sustainability by making choices that lessen the burdens born by the environment, and resilience by developing the capacity to make timely changes before cost expenditures become prohibitive (Valikangas, 2010). Many of the policy proposals and policymaking efforts within Arizona and outlined throughout this blogging project, specifically regarding suicide prevention and self-harm reduction measures for young and emerging adults, focus on this iterative approach, which allows for the underlying "economic and social systems to adjust [adequately] without being unduly threatened by change" (Longest, 2014).

References:

American Association of Suicidology. (2020). About AAS. Retrieved from https://suicidology.org/about-aas/

American Foundation for Suicide Prevention. (2019a). American foundation for suicide prevention financial report. Retrieved from https://www.datocms-assets.com/12810/1577067401-american-foundation-for-suicide-prevention-6-30-19-final-1.pdf

American Foundation for Suicide Prevention (AFSP). (2019b). Suicide statistics: U.S. 2019. Retrieved from https://afsp.org/about-suicide/suicide-statistics/

American Foundation for Suicide Prevention. (2020). About AFSP: Mission. Retrieved from https://afsp.org/about-afsp/

Arizona Department of Health Services (ADHS). (2020). Suicide prevention action plan.

Bridge, J. A., Horowitz, L. M., Fontanella, C. A., Grupp-Phelan, J., & Campo, J. V. (2014). Prioritizing research to reduce youth suicide and suicidal behavior. American journal of preventive medicine, 47(3), S229-S234.

Centers for Disease Control and Prevention (CDC) Data and Statistics. Fatal Injury Report for 2017 [online]. (2017a) [cited 2020 Apr 19]. Available from URL: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html

Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. (2017b) [cited 2020 Apr 19]. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Available from URL: www.cdc.gov/injury/wisqars

Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry, 3(5), 415-424.

Injury Control Research Center for Suicide Prevention. (2020). Who we are. Retrieved from http://suicideprevention-icrc-s.org/who-we-are

Longest, B. (2014). Health policymaking in the United States (6th ed.). Chicago, IL: Health Administration Press.

National Action Alliance for Suicide Prevention. (2020). About us: Our story. Retrieved from https://theactionalliance.org/about-us/our-story

National Institute of Mental Health. (2019, July). Suicide Prevention. https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml#part_153180

Ofcom. (2017). Children and Parents: Media Use and Attitudes Report. Retrieved from https://www.ofcom.org.uk/research-and-data/media-literacy-research/childrens/children-parents-2017

Orben, A., & Przybylski, A. K. (2019). The association between adolescent well-being and digital technology use. Nature Human Behaviour, 3(2), 173.

Patton, R., Zalon, M, & Ludwick, R. (2014). Nurses making policy from bedside to boardroom. New York: Springer publishing company.

Sari, N., de Castro, S., Newman, F. L., & Mills, G. (2008). Should we invest in suicide prevention programs?. The Journal of Socio-Economics, 37(1), 262-275.

Substance Abuse and Mental Health Services Administration. (2018, September 21). SAMHSA awards $61.1 million in suicide prevention funding. Retrieved from https://www.samhsa.gov/newsroom/press-announcements/201809211000

Shepard, D. S., Gurewich, D., Lwin, A. K., Reed Jr, G. A., & Silverman, M. M. (2016). Suicide and suicidal attempts in the United States: costs and policy implications. Suicide and Life‐Threatening Behavior, 46(3), 352-362. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/sltb.12225

Suicide Awareness Voices of Education. (2020). Who we are. Retrieved from https://save.org/who-we-are/

Sutherland, J. (2014). Scrum: The Art of Doing Twice the Work in Half the Time. New York: Crown Business/Random House.

Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3-17.

Välikangas, L. (2010). The resilient organization: How adaptive cultures thrive even when strategy fails. New York: McGraw Hill Companies, Inc.

The Impacts of Technology Innovations for Data & Privacy

DNP 711 - Week 11:

INTRODUCTION/OVERVIEW: The Impacts of Technology Innovations for Data & Privacy

Recent major health events such as our current COVID-19 pandemic added to the past events of severe acute respiratory syndrome coronavirus (SARS-CoV) in Asia (2002-2003), pandemic H1N1/09 influenza virus worldwide (2009), and the massive outbreak of Escherichia coli O104:H4 in Germany (2011) prompt epidemiologists, public health officials, and infectious disease scientists at government agencies, university centers, and international health agencies to substantially upscale our collective national and international investment in improving methods for conducting infectious disease and public health threat surveillance (Heymann, 2004; Chan et al., 2010; Velasco et l., 2014; WHO, 2017). This exponential upscaling in investment into surveillance efforts should include a multitude of public health threats of which suicide prevention and mental health burden reduction. Furthermore, the once-famous adage of "geography is destiny" is rapidly becoming obsolete and replaced by a new adage or maxim that directs that "connectivity is destiny" (Khanna, 2016). Supported by systems of global infrastructure that morph our divisions into connections, nations to nodal endpoints, and shifts our perspective of the world through the lens of connectivity to an encompassing creation of new ways that we self-organize as a human species (Khanna, 2016). The primary remaining question is whether connectivity continues to be the path of our collective salvation or the next inflection point of human history that we ignore at our peril while also surrendering the future to forces far beyond our control (Wallach, 2015; Khanna, 2016).

It is easy to recognize the prevalence and ever-increasing influence of technological advances in multiple facets and domains of contemporary daily life for individuals on a global scale, which includes all age demographics. What remains challenging to understand is the magnitude and scale of effects on the various demographical age groups and the dichotomy between the intended-use of innovators and the actual-use behaviors or end-user experiences of these technological advancements. Particularly challenging to comprehend or predict is how technological advances interact with both mental health and human behaviors, specifically regarding suicide prevention efforts and suicidal behavior harm-reduction strategies for adolescents and young adults.

Some of my peers and colleagues also identified some of the positive potential aspects that might result from the connection between technology use and suicide-related behaviors, such as advances in telemedicine interventions (Morris, 2020), mobile application development for suicide prevention (Freeman, 2020; NotOK, 2020), medication compliance tracking medical devices (Hartman, 2020). However, all of these suggested connectivity elements are also susceptible to potential compromise or maligned use by bad actors. For instance, telemedicine interventions might provide patient access to quality, but they also provide distinct opportunities for the compromise or breach in personal health information and health records data because of its conduction over internet-based resources (Morris, 2020). The idea of mobile application development for suicide prevention could result positively with the reduction of suicidal events because of the new connection to helpful resources (Freeman, 2020; NotOK, 2020). However, it also leaves individual users vulnerable to data privacy breaches and unwitting targets of third-party marketing campaigns or data repackaging for sale to other unidentified third-parties. Practices that happen as a byproduct of application development and operational funding when venture capital or lack of unicorn-status within the Silicon Valley communities is unachievable. Finally, the idea of medication compliance tracking medical devices is quite dystopian in its distinct ability to both enhance treatment adherence and simultaneously undermine patient autonomy and the right to or expectation of privacy (Hartman, 2020). Thus, while there are possible benefits derived from technological advancements, it is crucial that we also recognize and acknowledge that simultaneously adverse harms also potentially accompany those advances on both the individual and societal levels. We would be remiss in not addressing the potentially detrimental associations that technology use has with overall mental health and suicidal behaviors.

Other more extensive screening studies with nationally representative samples of adolescents and young adults are beginning to make the connection between technology use and increases in depression, self-harm, and suicide (Twenge, 2020a). Other studies since 2010 are making connections between technology use and increases in loneliness (Twenge et al., 2019a), anxiety (Duffy et al., 2019), depressive symptoms (Twenge et al., 2018; Duffy et al., 2019; Keyes et al., 2019), major depressive episodes in the past year (Mojtabai et al., 2016; Twenge et al., 2019b), hospital admissions for self-harm behaviors (or other related nonsuicidal self-injuries)(Mercado et al., 2017), suicidal ideation (Plemmons et al., 2018), self-harm or suicide attempts via poisoning methods (Spiller et al., 2019), suicide attempts (Plemmons et al., 2018; Burstein et al., 2019), self-reported suicidal ideation (Twenge et al., 2019b), and in the overall suicide rate (Twenge et al., 2018; Twenge et al., 2019b; Ruch et al., 2019; Twenge, 2020a). The consensus is growing where the noticeable decline in mental health outcomes is attributable or probably linked to the increasing popularity of and usage-dependence smartphones and social media contemporaneously (Twenge et al., 2018; Keyes et al., 2019; Luby & Kertz, 2019; Spiller et al., 2019; Twenge, 2020a). Excessive technology use, specifically mobile digital and social media, among adolescents may prove particularly costly from a mental health outcomes perspective (Uhls et al., 2017). However, as in the previous examples, there are both positive benefits and adverse harms that accompany technological advancements in society. For instance, recent research and replicative verification studies on the topic of usage amount shows that the best outcomes for mental health occur with little use of mobile digital and social media rather than abstinence or lack of usage (Przybylski & Weinstein, 2017; Twenge et al., 2018; Twenge & Campbell, 2018)

In summary, the duality between potential benefits and adverse harms does not cause us to call for a limitation of technological advancements usage in suicide prevention. Instead, we are offering or advocating for a more deliberative, responsible, and careful approach in the development, deployment, and application of innovative or emerging technologies to our collective efforts of suicide prevention.

References:

Burstein, B., Agostino, H., & Greenfield, B. (2019). Suicidal attempts and ideation among children and adolescents in US emergency departments, 2007-2015. JAMA pediatrics, 173(6), 598-600.

Chan, E. H., Brewer, T. F., Madoff, L. C., Pollack, M. P., Sonricker, A. L., Keller, M., ... & Brownstein, J. S. (2010). Global capacity for emerging infectious disease detection. Proceedings of the National Academy of Sciences, 107(50), 21701-21706.

Duffy, M. E., Twenge, J. M., & Joiner, T. E. (2019). Trends in mood and anxiety symptoms and suicide-related outcomes among US undergraduates, 2007–2018: Evidence from two national surveys. Journal of Adolescent Health, 65(5), 590-598.

Freeman, L. (2020). Help at your fingertips. Retrieved from https://childsuicideawareness.family.blog/2020/04/05/help-at-your-fingertips/

Hartman, M. (2020). Blog 6: Technology innovations and implications. Retrieved from https://childsuicideinaz.family.blog/2020/04/06/blog-6-technology-innovations-and-implications/

Heymann, D. L. (2004). The international response to the outbreak of SARS in 2003. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences, 359(1447), 1127-1129.

Keyes, K. M., Gary, D., O’Malley, P. M., Hamilton, A., & Schulenberg, J. (2019). Recent increases in depressive symptoms among US adolescents: trends from 1991 to 2018. Social psychiatry and psychiatric epidemiology, 54(8), 987-996.

Khanna, P. (2016). Connectography: Mapping the future of global civilization. New York: Random House.

Luby, J., & Kertz, S. (2019). Increasing suicide rates in early adolescent girls in the United States and the equalization of sex disparity in suicide: the need to investigate the role of social media. JAMA network open, 2(5), e193916-e193916.

Mercado, M. C., Holland, K., Leemis, R. W., Stone, D. M., & Wang, J. (2017). Trends in emergency department visits for nonfatal self-inflicted injuries among youth aged 10 to 24 years in the United States, 2001-2015. Jama, 318(19), 1931-1933.

Mojtabai, R., Olfson, M., & Han, B. (2016). National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics, 138(6), e20161878.

Morris, P. (2020). Technology for preventing suicide in Arizona youth. Retrieved from https://suicideawarenessprevention.wordpress.com/2020/04/04/week-11/

NotOK. (2020). Retrieved from https://www.notokapp.com/

Plemmons, G., Hall, M., Doupnik, S., Gay, J., Brown, C., Browning, W., ... & Rehm, K. (2018). Hospitalization for suicide ideation or attempt: 2008–2015. Pediatrics, 141(6), e20172426.

Przybylski, A. K., & Weinstein, N. (2017). A large-scale test of the Goldilocks hypothesis: Quantifying the relations between digital-screen use and the mental well-being of adolescents. Psychological Science, 28, 204–215.

Ruch, D. A., Sheftall, A. H., Schlagbaum, P., Rausch, J., Campo, J. V., & Bridge, J. A. (2019). Trends in suicide among youth aged 10 to 19 years in the United States, 1975 to 2016. JAMA network open, 2(5), e193886-e193886.

Spiller, H. A., Ackerman, J. P., Spiller, N. E., & Casavant, M. J. (2019). Sex-and age-specific increases in suicide attempts by self-poisoning in the United States among youth and young adults from 2000 to 2018. The Journal of pediatrics, 210, 201-208.

Twenge, J. M., & Campbell, W. K. (2018). Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Preventative Medicine Reports, 12, 271–283.

Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among US adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3-17.

Twenge, J. M., Spitzberg, B. H., & Campbell, W. K. (2019a). Less in-person social interaction with peers among US adolescents in the 21st century and links to loneliness. Journal of Social and Personal Relationships, 36(6), 1892-1913.

Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019b). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005–2017. Journal of Abnormal Psychology.

Twenge, J. M. (2020a). Increases in Depression, Self-Harm, and Suicide Among US Adolescents After 2012 and Links to Technology Use: Possible Mechanisms. Psychiatric Research and Clinical Practice, appi-prcp.

Twenge, J. M., & Martin, G. N. (2020b). Gender differences in associations between digital media use and psychological well-being: evidence from three large datasets. Journal of Adolescence, 79, 91-102.

Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2020c). Considering All of the Data on Digital-Media Use and Depressive Symptoms: Response to Ophir et al. Clinical Psychological Science, 2167702619898179.

Uhls, Y. T., Ellison, N. B., & Subrahmanyam, K. (2017). Benefits and costs of social media in adolescence. Pediatrics, 140(Supplement 2), S67-S70.

Velasco, E., Agheneza, T., Denecke, K., Kirchner, G., & Eckmanns, T. (2014). Social media and internet‐based data in global systems for public health surveillance: a systematic review. The Milbank Quarterly, 92(1), 7-33.

Wallach, W. (2015). A dangerous master: How to keep technology from slipping beyond our control. Philadelphia, PA: Basic Books/Perseus Books Group.

World Health Organization (WHO). (2017). WHO guidelines on ethical issues in public health surveillance. Geneva: World Health Organization.

Private Sector Influences on Suicide Prevention in Arizona

DNP 711 - Week 9:

INTRODUCTION/OVERVIEW: Private Sector Influences on Suicide Prevention Efforts in Arizona

For suicide prevention efforts, advancing health policy relies on assistance from the private sector and the influences of their institutions, such as interest groups, and referenced occasionally as "participants without formal government positions" (Kingdon, 2011). The private sector's participation and influence in health policy and care service delivery is neither novel or a passing phenomenon, and the links between the insides and outsides of government are exceedingly challenging to delineate (Kingdon, 2011; De Wolf & Toebes, 2016). Private sector institutional influences often manifest in numerous different ways and often through a multiplicity of various actors or agents, such as service providers, product manufacturers, health management organizations (HMOs), accountable care organizations (ACOs), other small businesses or practice groups, and interest group or professional organizations (Kingdon, 2011; McLaughlin & McLaughlin, 2015; De Wolf & Toebes, 2016). Such a coalitional effort frequently occurs because "citizens with similar common interests form organized 'interest groups' or 'front groups' to secure public policies deemed satisfactory to their goals and objectives" (Stone, 2002; Mason et al., 2012). Moreover, it is arguable that citizens, actors, or agents do not enter into the politics of public life or policy advocacy with their predefined interests but instead that "interests and issues define each other" and find the individuals accordingly (Stone, 2002).

Some the interest groups most critical to defining, scoping, helping, and progressing the efforts of suicide prevention are organizations or associations of multiple individuals, such as the American Foundation for Suicide Prevention (AFSP), Suicide Prevention Resource Center (SPRC), American Association of Suicidology (AAS), the National Center for the Prevention of Youth Suicide (NCPYS), the National Action Alliance for Suicide Prevention (NAASP), Suicide Awareness Voices of Education (SAVE), and the Injury Control Research Center for Suicide Prevention (ICRC-S). Personally, as a member of many of these organizations, I can attest to their efforts to prevent and reduce the occurrence of suicides and its harmful impacts on multiple levels of policymaking and advocacy. Moreover, until the recent and ongoing COVID-19 pandemic, there was attendance scheduled at the annual conference meeting of AAS for whom I serve as an academic per reviewer. Unfortunately, due to COVID-19, the University rescinded all grant-funded travel plans, and the AAS organization canceled the live, in-person event instead opting for a virtual conference held remotely.

The American Foundation for Suicide Prevention

AFSP is a “voluntary health organization that gives those affected by suicide a nationwide community empowered by research, education, and advocacy to take action against this leading cause of death with local chapters in all 50 states as well as programs and events nationwide” (AFSP, 2020). AFSP is dedicated to saving lives and helping those affected by suicide. They create a culture of mental health awareness by funding scientific research, educating the public about mental health and suicide prevention, advocating for public policies in mental health and suicide prevention, and supporting survivors of suicide loss and those affected by suicide in our mission (AFSP, 2020).

The American Association of Suicidology

AAS serves as the national clearinghouse for information on suicide in the U.S. and promotes research, public awareness programs, public education, and training for professionals and volunteers (AAS, 2020). AAS is a not-for-profit organization that encourages and welcomes both individual and organizational members, and also operates the National Center for the Prevention of Youth Suicide (AAS, 2020). The mission statement of AAS is to promote the understanding and prevention of suicide by providing support resources to people who have been affected by it (AAS, 2020). According to AAS (2020), an integral part of accomplishing this mission occurs by directing efforts to advance suicidology as a science through encouraging, developing, and disseminating scholarly work in suicidology. AAS actively promotes research and training in suicidology. AAS also encourages the development and application of strategies that reduce the incidence and prevalence of suicidal behaviors (AAS, 2020). Another focus of AAS is to compile, develop, evaluate, and disseminate accurate information about suicidal behaviors to the public (AAS, 2020). They are fostering the highest possible quality of suicide prevention, intervention, and postvention to the public through the regular publicizing of official AAS positions on issues of public policy relating to suicide.

The National Action Alliance for Suicide Prevention

The National Action Alliance for Suicide Prevention (Action Alliance) is an influential and productive national level public-private partnership charged with championing suicide prevention as a national priority (NAASP, 2020).

Suicide Awareness Voices of Education

SAVE's foundational belief is that suicide is preventable, and everyone has a role to play in preventing suicide through raising public awareness, educating communities, and equipping every person with the right tools to SAVE lives (SAVE, 2020). SAVE is a national 501(c)(3) nonprofit organization in the U.S. and works at the international, national, state, and local levels to prevent suicide using a public health model in suicide prevention, concentrating its efforts on education and awareness (SAVE, 2020). SAVE's mission is to prevent suicide through public awareness and education, reduce stigma, and serve as a resource to those touched by suicide (SAVE, 2020).

The Injury Control Research Center for Suicide Prevention

The ICRC-S is a collaboration of the University of Rochester Medical Center (URMC) and the Education Development Center (EDC), in which both organizations have extensive experience in addressing suicide and suicide prevention (ICRC-S, 2020). URMC directs the Center for the Study and Prevention of Suicide (CSPS), and EDC operates the national Suicide Prevention Resource Center. The ICRC-S is a center-without-walls that promotes a public health approach to suicide prevention through a collaborative process of research, outreach, and education (ICRC-S, 2020). Our goal is to draw suicide prevention directly into the domain of public health and injury prevention and link it to complementary approaches to mental health (ICRC-S, 2020).

References

American Association of Suicidology. (2020). About AAS. Retrieved from https://suicidology.org/about-aas/

American Foundation for Suicide Prevention. (2020). About AFSP: Mission. Retrieved from https://afsp.org/about-afsp/

De Wolf, A., & Toebes, B. (2016). Assessing private sector involvement in health care and universal health coverage in light of the right to health. Health and Human Rights Journal, 18 (2). Retrieved from https://www.hhrjournal.org/2016/12/assessing-private-sector-involvement-in-health-care-and-universal-health-coverage-in-light-of-the-right-to-health/

Injury Control Research Center for Suicide Prevention. (2020). Who we are. Retrieved from http://suicideprevention-icrc-s.org/who-we-are

Kingdon, J. W. (2011). Agendas, alternatives, and public policies (2nd ed.). Boston, MA: Longman.

Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2012). Policy and Politics in Nursing and Healthcare-Revised Reprint (6th Ed.). St. Louis, MO: Elsevier Health Sciences/Saunders.

McLaughlin, C. P., & McLaughlin, C. D. (2015). Health Policy Analysis: An Interdisciplinary Approach: An Interdisciplinary Approach (2nd Ed.). Burlington, MA: Jones & Bartlett Publishers.

National Action Alliance for Suicide Prevention. (2020). About us: Our story. Retrieved from https://theactionalliance.org/about-us/our-story

Stone, D. A. (2002). Policy paradox: The art of political decision making (3rd Ed.). New York: W. W. Norton & Company.

Suicide Awareness Voices of Education. (2020). Who we are. Retrieved from https://save.org/who-we-are/

Public Sector Influences on Suicide Prevention in Arizona

DNP 711 - Week 7:

INTRODUCTION/OVERVIEW: Public Sector Influences on Suicide Prevention Efforts in Arizona

The definition of public sector institutions refers to all of the agencies, offices, and other entities that constitute local, state, and federal governments (Hansen & Paul, 2019). As a bit of review from a previous blogpost that quintessentially introduced this week's subject matter, national-level suicide prevention in the U.S. began in the 1950s and increased through much of the 1980s (NAASP, 2012). From a state-level, suicide prevention efforts begin in the late-1980s and continue to influence policy efforts and topical study until our most contemporary effort of passing the Mitch Warnock Act in 2019 (Governor's Office of Children, 1994; Office of the Governor, 2019). Although several bills are pending during this current state legislative session that continues to address the issue of suicide prevention. However, currently, the most significant effort to align public sector influences and innovative efforts to aid in suicide prevention originate with the Mitch Warnock Act.

For example, the most immediate public sector institution that the Act impacts is the public education system by allowing and mandating educators to receive valuable suicide prevention training at minimum once every three (3) years (Office of the Governor, 2019). One immediate effect that this training requirement has is the direct increase in the promotion of suicide prevention and awareness campaigns. However, another practical impact that the Act has is that the mandatory training requirement also provides practical knowledge and skillset acquisition in recognizing critical warning signs of suicide behavior as well as the application of interventions to increase the efficacy of suicide prevention measures (AFSP, 2019; Office of the Governor, 2019).

Another public sector institution that the Mitch Warnock Act impacts is the Arizona Health Care Cost Containment System (AHCCCS), which is the state-level program or department that administers Medicaid benefits in Arizona (AHCCCS, 2018). Effectively, the Act orders that the suicide prevention training programs used to train and equip those public school educators and administrators adequately are selections determined sufficient by AHCCCS (Office of the Governor, 2019). As of July 2016, all behavioral health services in the state of Arizona moved from jurisdictional purview of the Arizona Department of Health Services to AHCCCS (AHCCCS, 2018). AHCCCS also manages and oversees the functional operation of the suicide hotlines and crisis resources for residents in Arizona (AHCCCS, 2016; AHCCCS, 2018).

CURRENT STATE OF ARIZONA LEGISLATIVE PROPOSALS FOR SUICIDE PREVENTION

During a recent policymaker interview with Jennifer Pawlik, an AZ State House Representative for District 17, we discussed a few of these pending measures or legislative proposals and their relation to the potential impacts that might affect other public sector institutions (Pawlik, 2020). For example, during our February 22nd, 2020 meeting, we discussed HB 2646, which would create a ripple effect throughout the justice system elements of Arizona as they are responsible for criminal prosecutions of violations of Arizona Revised Statutes - A.R.S. § 13-1103. HB 2646 effectively proposes that intentionally advising a minor to commit suicide with knowledge the minor will follow through with the advice as manslaughter (HB 2646). We discussed HB 2764, which would affect the Arizona Department of Insurance (DOI) as they enforce mental health parity (MHP) by establishing the MHP Advisory Committee, the Suicide Mortality Review Team, and the Children's Behavioral Health Services Fund (HB 2764). HB 2764 could potentially impact multiple public sector institutions other than the DOI, such as AHCCCS, AZDHS, and the Arizona Department of Education (ADE). Finally, we also discussed SB 1446, which would impact ADE directly by requiring them to increase awareness of mental health issues in young people (SB 1446a). Specifically, SB 1446 requires student identification cards to include contact information for suicide prevention resources, local crisis centers, or emotional support services (SB 1446b). All of these pending legislative proposals have potential impacts on at least one but likely multiple agencies or public sector institutions, which may also result in a substantial number of unknown secondary effects that might occur in the future with the implementation of passed and adopted legislation.

Arizona is beginning to position itself as a robust progressive state in dealing with and furthering our path forward for suicide prevention efforts. However, substantial work remains before us to ensure our continued progression. We must continue to work diligently on this issue, and passing some of these legislative proposals continues to build that momentum for other additional future gains in policymaking.

References:

American Foundation for Suicide Prevention. (2019). State laws: Suicide prevention in schools (k-12). Retrieved from http://afsp.org/wp-content/uploads/2019/06/AFSP_K-12-Schools-Issue-Brief_6-7-19.pdf

Arizona Coalition for Suicide Prevention and the Arizona Health Care Cost Containment System (AHCCCS). (2018). An end to suicide in Arizona 2018 state plan. Retrieved from https://tst.azahcccs.gov/AHCCCS/Downloads/2018StatePlantoEndSuicide.pdf

Arizona Coalition for Suicide Prevention and the Arizona Health Care Cost Containment System (AHCCCS). (2016). An end to suicide in Arizona 2016 state plan. Retrieved from https://archive.azahcccs.gov/archive/Resources/ADHS%20DBHS%20Guides%20Manuals/State%20Suicide%20Prevention%20Plan/State%20Suicide%20Prevention%20Plan.pdf

Arizona. Legislature. House of Representatives. 2020 Second Regular Session. HB 2646: Manslaughter; Suicide Assistance; Violation. Phoenix, 2020. Retrieved from https://www.azleg.gov/legtext/54leg/2R/summary/H.HB2646_022020_CAUCUSCOW.pdf

Arizona. Legislature. House of Representatives. 2020 Second Regular Session. HB 2764: Mental Health Omnibus. Phoenix, 2020. Retrieved from https://www.azleg.gov/legtext/54leg/2R/summary/H.HB2764_022420_CAUCUSCOW.pdf

Arizona. Legislature. Senate. 2020 Second Regular Session. SB 1446a - SB 1446: Student Identification Cards; Suicide Prevention. Phoenix, 2020. Retrieved from https://www.azleg.gov/legtext/54leg/2R/bills/SB1446S.pdf

Arizona. Legislature. House of Representatives. 2020 Second Regular Session. SB 1446b - Fact Sheet for SB 1446: Student Identification Cards; Suicide Prevention. Phoenix, 2020. Retrieved from https://www.azleg.gov/legtext/54leg/2R/summary/S.1446ED.pdf

Hansen, K, and Paul, N. (2019). Information strategies for communicators: Public sector institutions. Retrieved https://open.lib.umn.edu/infostrategies/chapter/6-2-public-sector-institutions/

Governor's Office for Children. (1994). Adolescent suicide task force: Report and recommendations. Retrieved from http://azmemory.azlibrary.gov/digital/api/collection/statepubs/id/8477/download.

National Action Alliance for Suicide Prevention (NAASP). (2012). National strategy for suicide prevention: Goals and objectives for action: A report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention. Washington, D.C.: U.S. Department of Health & Human Services. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK109918/

Office of the Governor, Doug Ducey. (2019). Governor Ducey Signs Bill Combating Teen Suicide [Press release]. Retrieved from https://azgovernor.gov/governor/news/2019/05/governer-ducey-signs-bill-combating-teen-suicide

Pawlik, J. (2020, February 22nd). An interview with an Arizona elected official/Interviewer: A. Cromar. Doctor of Nursing Practice 711 Assignment, Arizona State University, Phoenix, AZ.

The History & Policy Process of Suicide Prevention in Arizona

DNP 711 - Week 5:

INTRODUCTION/OVERVIEW: The History & Policy Process of Suicide Prevention Efforts in Arizona

Fully understanding the current problem of suicide in emerging, young adults in Arizona requires us to understand the history and policy process of past efforts to address suicide prevention and how they still influence the contemporary problem while also informing both current policy and future policy proposals. Influencing policy creation, government, private institutions, and actors work in concert with one another to affect the political, social, and economic systems as much as the other way around (Kingdon, 2003). The notion that government agencies and organizational actors lack a certain level of institutional autonomy in the policy process is as illusory as it is fallacious and fails to acknowledge the roots of power and influence within the rich heritage of new institutionalism theory (Kingdon, 2003; Greenwood et al., 2013). The long-dominant actors among health care institutions to influence policy development were typically hospitals (community and academic medical centers) (McLaughlin & McLaughlin, 2015). However, even that is now shifting as decentralization or distributed autonomous networking approach is occurring where that long-held process dominance continually erodes into an array of institutions that both deliver health care services and influence policy development. Some examples of decentralized actors acting as new policy players that exert influence are community health centers, specialty hospitals, large integrated systems (HMOs/ACOs), large multi-site practices, state/local government facilities, pharmaceutical companies, and various other actors or vendors (McLaughlin & McLaughlin, 2015). All of which leads us to a conclusion about public policy formation in that the processes are dynamic, fluid, loosely joined, and exceedingly complex (Kingdon, 2003). There are many conceptual frameworks (such as incrementalism, policy streams, stage-sequential, rational decision-making, and the advocacy coalition models) that the policy process consists of and aid in our understanding (Lindblom, 1979; Kingdon, 1995; Ripley, 1996; Longest, 1998, 2006; Weible, 2006). However, all follow the overall premise of increasing complexity, compounded by multi-directionality, and often unbounded by time and geographical proximity.

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THE HISTORICAL PERSPECTIVE OF RELIGION & SUICIDE POLICY

Much of the historical underpinnings of suicide prevention globally and on a national level in the U.S. began with Emile Durkheim (1897), which connects prevention efforts to religious perspectives of suicidal behaviors (Mandhouj & Huguelet, 2016). Particularly in the three largest, monotheistic religions (Judaism, Christianity, and Islam), there is a universal condemnation of suicide as a sin and shameful behavior (Mandhouj & Huguelet, 2016). The irony of Durkheim's argument is that religious belief often moderates or mitigates suicide because of enhanced social cohesion and social integration (Durkheim, 2005, 2012; Mandhouj & Huguelet, 2016). Thus, religious affiliation and involvement often feature significantly negative associations with fewer deaths by suicide, suicide behavior, suicidal ideation, and tolerant attitudes toward suicide (Koenig et al., 2001; Dervic et al., 2004; Koenig, 2009).

U.S. NATIONAL & STATE OF ARIZONA POLICIES FOR SUICIDE PREVENTION

On a national level, the U.S. began suicide prevention efforts in the 1950s with increasing involvement in the issue through the 1980s (NAASP, 2012). Moreover, on the Arizona State level, suicide prevention efforts date back to the late-1980s with multiple taskforces commissioned (Governor's Office of Children, 1994; Office of the Governor, 2019). One of the most successful efforts at researching and furthering suicide prevention efforts at the state level in Arizona occurred in the 2000-2010s. Researchers analyzed the intervention effects of a surveillance system that compared the rates, numbers, and characteristics of suicide deaths and attempts during two related five-year periods (Cwik et al., 2016). The study provided evidence that the suicide surveillance and prevention system reduced suicide deaths and attempts, which was critical to prevention, intervention, and evaluation efforts while other national-level statistics remained unchanged or are increasing (Cwik et al., 2016). As we continue to look at multiple possible solutions for our growing public health crisis of suicide in the 21st-century, we should model our efforts after many successful approaches and should be cautious in allowing limitations on innovative problem-solving approaches. 

References:

Cwik, M. F., Tingey, L., Maschino, A., Goklish, N., Larzelere-Hinton, F., Walkup, J., & Barlow, A. (2016). Decreases in suicide deaths and attempts linked to the White Mountain Apache suicide surveillance and prevention system, 2001–2012. American journal of public health, 106(12), 2183-2189.

Dervic, K., Oquendo, M. A., Grunebaum, M. F., Ellis, S., Burke, A. K., & Mann, J. J. (2004). Religious affiliation and suicide attempt. American Journal of Psychiatry, 161(12), 2303-2308.

Durkheim, E. (2005). Suicide: A study in sociology. New York: Routledge Classics.

Durkheim, E. (2012). Suicide: A study in sociology. Gravesboro, CA: Snowball Publishing.

Governor's Office for Children. (1994). Adolescent suicide task force: Report and recommendations. Retrieved from http://azmemory.azlibrary.gov/digital/api/collection/statepubs/id/8477/download.

Greenwood, R., Oliver, C., Lawrence, T. B., & Meyer, R. E. (Eds.). (2013). The Sage handbook of organizational institutionalism. Thousand Oaks, CA; Sage Publications Ltd.

Koenig, H., Koenig, H. G., King, D., & Carson, V. B. (2001). Handbook of religion and health. New York: Oxford University Press.

Koenig, H. G. (2009). Research on religion, spirituality, and mental health: A review. The Canadian Journal of Psychiatry, 54(5), 283-291.

Lawrence, T. B. (2008). Power, Institutions and Organizations. In the Sage handbook of organizational institutionalism, (pp. 170-197). Thousand Oaks, CA; Sage Publications Ltd.

Mandhouj, O., & Huguelet, P. (2016). Why it is important to talk about religion. In Understanding Suicide (pp. 257-265). Switzerland: Springer International Publishing.

National Action Alliance for Suicide Prevention (NAASP). (2012). National strategy for suicide prevention: Goals and objectives for action: A report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention. Washington, D.C.: U.S. Department of Health & Human Services. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK109918/

Office of the Governor, Doug Ducey. (2019). Governor Ducey Signs Bill Combating Teen Suicide [Press release]. Retrieved from https://azgovernor.gov/governor/news/2019/05/governer-ducey-signs-bill-combating-teen-suicide

The Impact of Healthcare Policy on Health & The Role of Ethics in Decision-Making for Technology/Social Media Use & Self-Harm/Suicidal Behaviors in Arizona’s Emerging Adult Population

DNP 711 - Week 3:

INTRODUCTION/OVERVIEW: The Impact of Healthcare Policy on Health & The Role of Ethics in Decision-Making for Technology/Social Media Use & Self-Harm/Suicidal Behaviors in Arizona’s Emerging Adult Population

Understanding the connection between prevention efforts and healthcare policy requires a brief historical review of suicide in the United States. Suicide is the tenth leading cause of death in the U.S., contributing to more than 40,000 deaths and almost 500,000 emergency department (ED) visits due to intentional self-injury annually (Hogan & Grumet, 2016). American suicide research began primarily in the first half of the 20th-century spurred by the work of Emile Durkheim (2006 [1897]) and focused on a few core tenets of sociological thought about social integration, isolation, cohesion, and support (Wray et al., 2011; Trout, 1980; Kawachi & Kennedy, 1997; and Berkman et al., 2000). Arguably, Durkheim or other branches of sociological theory are the underlying philosophical assumptions of many studies (Wray et al., 2011). These assumptions are essential because of how they also connect to public healthcare policy in that the definition, enforcement structures, and institutional bodies that oversee public policy are sociological functions or elements. For instance, a widely-accepted definition of public policy is "the authoritative decisions made in the legislative, executive, and judicial branches of government that intend to direct or influence the actions, behaviors, or decisions of others" (Longest, 2010, p. 5).

While remaining an element or function of sociology, public policy intersects with technological advancement (such as social media platforms and other mobile digital uses) mainly because of social adaptation and the diffusion of innovation theories (Rogers, 1995 [1962]; Kahle, 1984, 1996). Today, technological advancement and our addiction to it is a driving force of the ever-increasing pace of change globally where cultural and geopolitical shifts follow in its wake (Jehel et al., 2016). The relationship between suicide and technological advancement also remains mixed because of both positive associations to harmful factors resulting in suicide-related outcomes and negative associations to protective factors of suicide prevention efforts. Some examples of positively-associated harmful factors are suicidal normalization, cyberbullying, source of contagion, informational access to encouragement/aid in committing suicide, triggering and competition (social comparison) between users, and workplace automation resulting in human workforce replacement (Marchant et al., 2017; Jehel et al., 2016). Examples of negatively-associated protective factors are increases in access to suicide prevention resources, intervention delivery, crisis support, social isolation reduction, and social connectivity or communication to others (Marchant et al., 2017; Jehel et al., 2016).

SUICIDE PREVENTION POLICY & EFFORTS IN THE UNITED STATES

The first national suicide prevention strategy, released in 2001, emphasized public health measures such as increasing awareness, reducing access to lethal means, providing better access to mental health care services, and stigma reduction of seeking such care or treatment (Hogan & Grumet, 2016). Another effort would later expand those initial suicide prevention efforts, such as the Garret Lee Smith Memorial Act of 2004, which created a grant program for youth suicide prevention funded by the Substance Abuse and Mental Health Services Administration (SAMHSA)(Hogan & Grumet, 2016). Other national efforts established a technical assistance center and crisis call system, also both funded by the SAMHSA. In 2007, the Department of Veteran Affairs established suicide protocols for its facilities and continuous support for a national crisis hotline (Hogan & Grumet, 2016).

SUICIDE PREVENTION POLICY & EFFORTS IN ARIZONA

The White Mountain Apache Tribe, using the Garret Lee Smith Act, created a unique community surveillance system to track and triage suicide deaths, attempts, and ideation that was able to distinguish their tribe's suicide-related rates from others reported by the Indian Health Service (IHS) and the Centers for Disease Control and Prevention (CDC)(Cwik et al., 2016). In 2019, the Arizona State Legislature passed, and Governor Doug Ducey signed the Mitch Warnock Act (SB 1468), which expands suicide awareness and prevention training in Arizona's public schools (Office of the Arizona Governor, 2019). While the possible outcomes of the Mitch Warnock Act are unknown, the White Mountain Apache Surveillance and Prevention System is achieving substantial results that could provide a critical foundational role for future prevention programming and evaluation efforts (Cwik et al., 2016). However, one question that remains unanswered is whether such a tribally-mandated or other government-supported surveillance system is ethically justifiable?

ETHICS & THE AGE OF SURVEILLANCE IN HEALTHCARE SERVICE DELIVERY

In 2005, the WHO established international health regulations (IHR) for surveillance activities offering a multilateral framework for surveillance, notification, and responses to disease outbreaks and other emergencies with potential international public health implications (Velasco et al., 2014). However, the regulations are unclear about data ownership within such surveillance systems, who decides how data usage occurs and to what extent, who decides the identities and qualifications of those decision-makers, and the temporal bounds of data collection, retention, and dissemination. It also leaves murky at best the potential consequences of what happens after surveillance occurs or the cascade of unintended outcomes that may arise thereafter. Nearly a decade later, in 2017, the WHO issued the first international ethics guidelines on public health surveillance, which helps to fill in some of these knowledge gaps but fails to address many other core concerns that an informed citizenry might deem unreasonable (Fairchild et al., 2017; WHO, 2017). The WHO Guidelines for Ethics in Public Health Surveillance only represent a starting point for the sustained discussions that surveillance demands and remains central to the justification of the core activities that surveillance extends beyond the contextual confines of its initial intentions or objectives (Fairchild et al., 2017).

The emergence of multiple forms of unprecedented uses of available health information from both online and real-world sources for assessing the health behaviors of individuals which presents enormous potential for both risks of harm and laudable cures or benefits (Vayena et al., 2012). There are decades of evidence as to the role that public health law and policy (including public health surveillance) play in improving societal health (Chriqui et al., 2011; Thacker et al., 1994, 1989). While law and policy are critical public health tools, essential is our need to remember that tools may be neutral human-created objects that humans choose how to operate or use intentionally for both good and evil purposes (Fairchild et al., 2017; Chriqui et al., 2011).

The possibilities for public health surveillance for suicide prevention efforts or other public health crises are both limitless and contain positive and negative risks or probable outcomes. For instance, surveillance can help create accountable institutions by providing information about health and its determinants and an evidentiary basis for establishing and evaluating public health policy or social organization responses (Fairchild et al., 2017). However, it is crucial that we, as a society, are also able to recognize the "inflection points" that lay before such possibilities and can make well-informed decisions about potential directions for humanity to proceed thereafter (Wallach, 2015). Perhaps, Professor Shoshana Zuboff (2019) best states our present position in the reality of human existence and experience by saying that:

What is at stake here is the human expectation of sovereignty over one’s own life and authorship of one’s own experience. What is at stake is the inward experience from which we form the will to [exercise the strength of individual character] and the public spaces to act on that will. What is at stake is the dominant principle of social ordering in an information civilization and our rights as individuals and societies to answer the questions Who knows? Who decides? Who decides who decides? That surveillance capitalism has usurped so many of our rights in these domains is a scandalous abuse of digital capabilities and their once-grand promise to democratize knowledge and meet our thwarted needs for [an] effective life. Let there be a digital future, but let it be a human future first.

References

Berkman LF, Glass T, Brissette I, Seeman TE. 2000. From social integration to health: Durkheim in the new millennium. Soc. Sci. Med. 51:843–57.

Chriqui, J. F., O'Connor, J. C., & Chaloupka, F. J. (2011). What gets measured, gets changed: evaluating law and policy for maximum impact. The Journal of Law, Medicine & Ethics, 39(1_suppl), 21-26.

Cwik, M. F., Tingey, L., Maschino, A., Goklish, N., Larzelere-Hinton, F., Walkup, J., & Barlow, A. (2016). Decreases in suicide deaths and attempts linked to the White Mountain Apache suicide surveillance and prevention system, 2001–2012. American journal of public health, 106(12), 2183-2189.

Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, Illinois: Health Administration Press.

Fairchild, A. L., Haghdoost, A. A., Bayer, R., Selgelid, M. J., Dawson, A., Saxena, A., & Reis, A. (2017). Ethics of public health surveillance: new guidelines. The Lancet Public Health, 2(8), e348-e349.

Hogan, M. F., & Grumet, J. G. (2016). Suicide prevention: an emerging priority for health care. Health Affairs, 35(6), 1084-1090.

Jehel, L., Arnal, R., Carmelo, D., & Howard, N. (2016). Suicidal Crisis in the Digital Age. In Understanding Suicide (pp. 63-73). Switzerland: Springer International Publishing AG.

Kahle, L. R. (1984). Attitudes and social adaptation: A person-situation interaction approach (Vol. 8). New York: Simon & Schuster.

Kahle, L. R. (1996). Social Values and Consumer Behavior: Research From the. In The Psychology of Values: The Ontario Symposium (Vol. 8, p. 135). Psychology Press.

Kawachi I, Kennedy BP. 1997. Health and social cohesion: why care about income inequality? BMJ 314:1037–40.

Marchant, A., Hawton, K., Stewart, A., Montgomery, P., Singaravelu, V., Lloyd, K., ... & John, A. (2017). A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown. PLoS One, 12(8).

Office of the Arizona Governor, Doug Ducey. (2019, September 11). Governor Ducey Signs "Mitch Warnock Act" With Family, Advocates, Legislators [Press release]. Retrieved from https://goyff.az.gov/goyff/news/governor-ducey-signs-mitch-warnock-act-family-advocates-legislators

Rogers, E. M. (2010). Diffusion of innovations. New York: The Free Press/Simon & Schuster Inc.

Thacker, S. B., Berkelman, R. L., & Stroup, D. F. (1989). The science of public health surveillance. Journal of public health policy, 10(2), 187-203.

Thacker, S. B., & Stroup, D. F. (1994). Future directions for comprehensive public health surveillance and health information systems in the United States. American journal of epidemiology, 140(5), 383-397.

Vayena, E., Mastroianni, A., & Kahn, J. (2012). Ethical issues in health research with novel online sources. American Journal of Public Health, 102(12), 2225-2230.

Trout DL. 1980. The role of social isolation in suicide. Suicide Life-Threat. Behav. 10:10–23.

Velasco, E., Agheneza, T., Denecke, K., Kirchner, G., & Eckmanns, T. (2014). Social media and internet‐based data in global systems for public health surveillance: a systematic review. The Milbank Quarterly, 92(1), 7-33.

Wallach, W. (2015). A dangerous master: How to keep technology from slipping beyond our control. New York: Basic Books/Perseus Books Group.

World Health Organization. (2017). WHO guidelines on ethical issues in public health surveillance. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/255721/9789241512657-eng.pdf

Wray, M., Colen, C., & Pescosolido, B. (2011). The sociology of suicide. Annual Review of Sociology, 37, 505-528.

Zuboff, S. (2019). The age of surveillance capitalism: The fight for a human future at the new frontier of power. New York: PublicAffairs/Hachette Book Group.

Arizona's Understanding of Complexity at the Intersection of Suicide, Mental Health, and Technological Advancement in Society

DNP 711 - Week 1:

INTRODUCTION/OVERVIEW: The Relationship Between Mobile Technology/Social Media Use & Self-Harm/Suicidal Behaviors in Arizona’s Emerging Adult Population

Depression and suicide as a significant public health crisis account for more than 40,000 deaths in the U.S. annually (CDC, 2017; Bridge et al., 2014). In 2015, on average, there were 129 suicides per day, and self-injury/suicide cost the U.S. $69 billion (American Foundation for Suicide Prevention, 2019b). Despite the immediate impacts that loss of life by suicide incurs, high emotional and economic costs also compound, resulting in about $44.6 billion annually in combined medical and work loss costs in the U.S. alone (Twenge et al., 2017). In 2017, suicide attempts reached an estimated 1,400,000 people (American Foundation for Suicide Prevention, 2019b).

Suicide ranks as the second leading cause of death among people ages 10-34 and is a significant global public health crisis (Xiao & Lu, 2019; Bridge et al., 2014). Suicide rates increased by 24% within the past 15 years (CDC, 2015). The time spent by adolescents and emerging adults in the past decade doubled (Orben & Przybyiski, 2019; Ofcom, 2017). Adolescent mental health issues continue to rise sharply, especially among females (Twenge et al., 2017). Dependence on our mobile devices and social media use may increase our current mental health crises, especially among emerging adults and adolescents. Understanding how digital technological advances influence the mental health of adolescents & emerging adults could impact our abilities of suicide prevention and self-harm reduction efforts.

OUR RESEARCH INTEREST

Our research interest focuses on understanding complexity at the intersection of suicide, mental health, and technological advancement in society. Specifically, the purpose of our research is to extensively examine the connections and relationships between mobile digital technology/social media use and self-harm or suicidal behaviors in young/emerging adults. One of the specific aims of our research is to develop a better model to address the complex social and behavioral interactions we have with technology/social media engagement and how it impacts our mental health and suicide risk.

The emerging collection of research exploring the relationship between technology/social media use and self-harm in young people “is rapidly evolving in an attempt to keep up with the continually changing nature of its use” (Marchant et al., 2017, p. 22). After declining or remaining stable for decades, depressive symptomologies, suicide-related outcomes, and suicide deaths are becoming increasingly prevalent among adolescents and young adults in the U.S. between 2010 and 2015, especially among females (Twenge et al., 2017). New media screen time and technological engagement activities require understanding as a critical modern risk factor that influences depression and suicidal behaviors (Twenge et al., 2017). Thus, it becomes critical for us to continue our research work and pending analyses to examine these distinct risk factors while addressing the diverse nature of large population sets (Xiao et al., 2019; Laska et al., 2009).

THE CURRENT POLICY ENVIRONMENT

The State of Arizona stands progressively at a crossroads with some forward momentum and distance down the correct and sustainable path for furthering suicide prevention efforts. However, there is substantial work and effort necessary to continue current progress while also leveraging that success into additional gains for the future.

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Figure 1. Overall suicide facts and figures in Arizona based on the most recent 2017 CDC data. Adapted from the “Arizona State Fact Sheets,” by American Foundation for Suicide Prevention, 2019a. Retrieved from https://afsp.org/about-suicide/state-fact-sheets/#Arizona

CONTEMPORARY RELEVANCE

National trends of suicide rates have been increasing steadily since 2008 (as indicated by the gray-blue line in Figure 2 below). However, the green line (in Figure 2 below) represents both the increased amount and level of fluctuation of the year-over-year change of suicide rates in Arizona (Arizona Child Fatality Review Program, 2019). Such a stark indication would indicate that Arizona, albeit progressing, has substantially more work to accomplish in developing and supporting state-level policies toward suicide prevention and self-harm reduction efforts.

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Figure 2. Rise in mortality rates due to suicide per 100,000 children (ages 0-17) in Arizona from 2013-2018. Adapted from the “Arizona Child Fatality Review Program: Twenty-Sixth Annual Report,” by Arizona Child Fatality Review Program, 2019, p.48. Retrieved from https://www.azdhs.gov/documents/prevention/womens-childrens-health/reports-fact-sheets/child-fatality-review-annual-reports/cfr-annual-report-2019.pdf

We are already aware of the many risk factors associated with self-injury and suicide, as highlighted by earlier studies. It is also crucial to recognize that the association between risk factors and human behavior is much smaller than previously put forth (Arizona Child Fatality Review Program, 2019; Orben & Przybyiski, 2019; Xiao et al., 2019). Such findings can have broad implications for stakeholders and policymaking regarding monetary investments into decreasing technological engagement or social media use to increase the overall well-being and mental health statuses of adolescents and young adults (Orben & Przybyiski, 2019; Department of Health and Social Care, 2018).

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Figure 3. Rise in mortality rates due to suicide per 100,000 children (ages 0-17) in Arizona from 2013-2018. Adapted from “Arizona Child Fatality Review Program: Twenty-Sixth Annual Report,” by Arizona Child Fatality Review Program, 2019, p.48. Retrieved from https://www.azdhs.gov/documents/prevention/womens-childrens-health/reports-fact-sheets/child-fatality-review-annual-reports/cfr-annual-report-2019.pdf

FUTURE DIRECTIONS

Overall, there are substantial limitations in the evidence to-date on the relationships between mobile digital technology/social media use and self-harm or suicidal behaviors in young/emerging adults. Therefore, more studies are necessary to identify further the beneficial and detrimental effects of using evolving technological advancements and social media platforms by adolescents and young adults in the U.S. and elsewhere globally. Prospective, longitudinal investigations are necessary to identify the potential short- and long-term risks, harms, or benefits associated with use (Dyson et al., 2016). However, we must also recognize that we may be at a contemporary inflection point about how we develop, use, and deploy technological advancements in the future and re-evaluate those already in existence.

REFERENCES

American Foundation for Suicide Prevention (AFSP). (2019a). Suicide facts and figures: Arizona 2019. Retrieved from https://afsp.org/about-suicide/state-fact-sheets/#Arizona

American Foundation for Suicide Prevention (AFSP). (2019b). Suicide statistics: U.S. 2019. Retrieved from https://afsp.org/about-suicide/suicide-statistics/

Arizona Child Fatality Review Program (2019). Arizona child fatality review program: Twenty-sixth annual report. Retrieved from https://www.azdhs.gov/documents/prevention/womens-childrens-health/reports-fact-sheets/child-fatality-review-annual-reports/cfr-annual-report-2019.pdf

Bridge, J. A., Horowitz, L. M., Fontanella, C. A., Grupp-Phelan, J., & Campo, J. V. (2014). Prioritizing research to reduce youth suicide and suicidal behavior. American journal of preventive medicine, 47(3), S229-S234.

Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2017) [cited 2019 Jan 23]. Available from URL: www.cdc.gov/injury/wisqars

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