COVID-19 Kills in More Ways than One: The Novel Coronavirus and Suicide

Janet L. Cummings, Psy.D., DBH (Hon.)
Chairman of the Board, Cummings Graduate Institute for Behavioral Health Studies

August 18, 2020

For some months now, we’ve all been watching the number of COVID-19 cases in the United States and throughout the world rise on a daily basis. We have also watched with horror as the death toll has risen to numbers that most of us have a hard time even comprehending, and there does not seem to be an end in sight for the Global Pandemic.

Not everyone realizes that COVID-19 doesn’t just kill by physically attacking the bodies of its victims. It also kills indirectly when it becomes a contributing factor in suicide death. While the top epidemiologists and medical researchers in the world are looking for ways to prevent and treat COVID-19, behavioral care providers need to focus on preventing and treating the mental/emotional problems that the Global Pandemic is fostering. For the early months of the Global Pandemic, medical researchers were focused almost solely on the physical aspects of the novel coronavirus — understanding how the virus spread from animals to humans and how it spreads from person to person, how long it can live on surfaces and whether or not it becomes aerosolized, how it enters host cells, how it causes cytokine storm in some patients, how it creates blood clots, and how to treat severe COVID-19 infections and prevent deaths. However, we are now at a point in the Global Pandemic where we’re starting to realize the devastating psychological toll that COVID-19 can have on many people, even on those who have not become physically ill from it.

It seems like an understatement to say that lives have changed dramatically since the discovery of the novel coronavirus. Businesses and schools have closed. Some businesses are not able to recover financially and will remain closed permanently, and many individuals and families have been devastated economically. Some students have reaped little benefit from online learning or other homeschooling methods (Adverse consequences of school closures, 2020), with students from poorer and/or immigrant families being the most negatively affected (Nuamah, 2020).

COVID-19 has caused many people to suffer profound losses, even if they have not contracted the disease, including loss of their job, loss of financial stability, loss of food security, loss of social contacts, loss of freedom, and many other losses. Poorer individuals and people of color have suffered disproportionately (Poverty, 2020). Those who have become ill with COVID-19 have suffered the physical consequences of the illness, including ongoing respiratory system damage and loss of taste and/or smell.

Loss of any kind is a significant risk factor for suicide, regardless of what has been lost (physical or mental health, job, stability, sense of purpose, relationship, freedom, etc.) (Suicide Prevention, n.d.). Loss can cause depression, and as losses accumulate, the risk for suicide increases. COVID-19 and the economic repercussions of the Global Pandemic have caused major losses for many people, both in terms of the significance of the loss and number of the losses.

Social contacts are protective against physical diseases and mental health problems (Harvard Health Publishing, 2010), but COVID-19 has brought about closures of some of the places that people typically gather; it has caused limitations on the number of people who can gather at once, and it makes socializing a challenge because of the need for masks and the need for social distancing. Most people have been cut off from their positive social relationships, to lesser or greater degrees, because of the need to reduce the spread of COVID-19. Unfortunately, what may need to happen to prevent COVID-19 infections (social distancing) can quickly become social isolation and a contributor to depression and suicide (Olson, 2017).

There does not seem to be an end in sight for the Global Pandemic. Economies reopen, only to close again due to resurgences in COVID-19 cases. Schools are reopening, only to see increases in COVID-19 cases. Many people are feeling an increased sense of hopelessness, especially as unemployment benefits run out and politicians reach impasses on stimulus programs to help suffering people and businesses. When loss and depression reach the point of hopelessness, the risk for suicide increases dramatically (Konsky, et al., 2012). As the Global Pandemic continues unabated and people continue to suffer losses, more people will likely reach the point of hopelessness, where they feel as though suicide may be the only way out for them.

As though all this were not enough, the Global Pandemic has made access to healthcare services more difficult, with some providers denying services to people who feel ill and with other providers offering only tele-health visits. Unfortunately, not everyone benefits from tele-health services as much as they would from in-person services (Cortez, 2020), and as a mental health service provider, this author can attest that it is far more difficult to assist patients with mental health problems remotely than it is face-to-face. Poorer patients often lack access to the technology needed to make the most of tele-health visits, and older adults may not have the technology skills necessary to participate in a videoconference (Cortez, 2020). People who are feeling depressed, hopeless, and suicidal may find it especially difficult to engage with a provider via tele-health, thus creating barriers to receiving the mental health services that they need and increasing their sense of isolation.

If someone is feeling depressed and hopeless in the midst of the Global Pandemic, what can they do?

By all means, reach out for mental/behavioral health services. Try tele-health, or better yet, see if there is a mental health service provider who is willing to work face-to-face (with social distancing precautions in place). If access to a mental health professional simply is not possible, talk with trusted family and friends, those people who are supportive and who know how to listen non-judgmentally. Most importantly, don’t lose those important social connections. People may have to socialize differently (over the phone or videoconferencing instead of face to face, eating take-out food together instead of sitting in a pub or restaurant together, or gathering in smaller groups), but it doesn’t mean we have to give up those health-promoting and life-saving connections with other people that we care about and that care about us.

With the Global Pandemic and its pervasive effects on the lives of so many people, mental health professionals cannot afford to rely on service delivery systems and techniques that worked well during a different set of national and global circumstances. It is imperative that healthcare providers learn to make the most of tele-health to avoid doing a disservice to their patients who have no choice but to rely on tele-health visits. It is also imperative that mental healthcare professionals understand the impact of the Global Pandemic on a myriad of mental and emotional issues, including depression and suicidality, as well as how these issues affect some populations (the poor, the elderly, and people of color) disproportionately. At CGI, the faculty is actively helping our Doctor of Behavioral Health candidates become leaders who can bring to healthcare what is needed to address the mental health impacts of the Global Pandemic and beyond.

References

Adverse consequences of school closures. (2020, May 13). Retrieved August 13, 2020, from https://en.unesco.org/covid19/educationresponse/consequences

Cortez M. (2020, August 04). Telehealth hasn’t helped everyone. Retrieved August 13, 2020, from https://www.bloomberg.com/news/newsletters/2020-08-04/telehealth-hasn-t-helped-everyone

Harvard Health Publishing. (2010). The health benefits of strong relationships. Retrieved August 13, 2020, from httPps://www.health.harvard.edu/newsletter_article/the-health-benefits-of-strong-relationships

Klonsky, D., Kotov, R., Bakst, S., Rabinowitz, J., & Bromet, E. (2012, February). Hopelessness as a predictor of attempted suicide among first Admission patients WITH Psychosis: A 10-year cohort study. Retrieved August 13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330175/

Olson, R. (2017, December 15). Social connectedness and suicide prevention. Retrieved August 13, 2020, from https://www.suicideinfo.ca/resource/socialconnectedness/

Poverty. (2020). Retrieved August 13, 2020, from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/poverty

Nuamah, S. (2020, June 15). School closures always hurt. They hurt even more now. Retrieved August 13, 2020, from https://www.edweek.org/ew/articles/2020/06/09/school-closures-always-hurt-they-hurt-even.html

Suicide prevention. (n.d.). Retrieved August 14, 2020, from https://www.samhsa.gov/find-help/suicide-prevention

Suicide Prevention Resources

Trevor Project
24/7 Hotline: 1-866-488-7386
Educational Resources for schools

National Suicide Prevention Lifeline
Lifeline:1-800-273-8255
Languages: English, Spanish
Hours: Available 24 hours
Note: The FCC has designated 988 as the new US nationwide number for the National Suicide Prevention Lifeline to be completed by July 2022. In the meantime please continue to share 1-800-273-TALK (8255) with anyone wishing to connect to the Lifeline. As of the publishing date of this article (Aug. 18, 2020) 988 is NOT CURRENTLY ACTIVE nationally and may not connect callers to the Lifeline.

Postpartum Support International (PSI)
PSI Helpline: 1-800-944-4773
#1 En Espanol or #2 English
Or Text:
English: 503-894-9453
Español: 971-420-0294

Explore additional articles on suicide prevention

Prevent Suicide by Recognizing Early Warning Signs by Dr. Janet Cummings, Psy. D.

Preventing Suicide Part 2: Verbal, Non-Verbal, and Tactile Indicators by Dr. Janet Cummings, Psy.D.

Suicide in School Shooting Survivors by Dr. Janet Cummings, Psy.D.

Testimonials

“As a member of the AAPI community, I’m very familiar with the barriers to mental health services and the need to break through the glass wall of cultural stigma that prevents many from receiving potentially life–saving treatment. I was the only Asian American person in my master’s cohort, the only Asian American person in many of my clinical work settings, the only Asian American person to walk into many of the professional settings that I pushed myself to show up to. In my current practice, I’m constantly reminded by my patients of how difficult it is to find an Asian American mental health provider, though this reminder constantly informs me that more needs to be done for my community. Day after day, I read stories of Asian American people who die by suicide as a consequence of our culture’s avoidance of mental health topics. As a DBH, my biggest goal is to use my expertise in whole–person care to amplify the conversation around mental health and help my community understand that mental healthcare is not a privilege that we are not entitled to, it is a crucial part of our healthcare that will manifest differently in us than what many Western psychology or psychiatry textbooks will describe, and that our unique experience of mental health issues are valid, important, and is time to be part of the larger conversation.”
Willam Chum, LMHCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - September 16, 2022

“The DBH represents something that I've always embraced in my professional career. And that's collaboration and working across a lot of different disciplines to make sure you’re delivering the best care for the patient. Everything is about being patient centered about finding innovative ways and creative ways to collaborate with other professionals.”
CDR Sean K. Bennett, LCSW, MSWAC, BCDDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - October 10, 2023

“This program will change how you present to the world, not just as a professional but as an individual. Understand this is work but the work is worth it and the journey is undeniably transformative. If you are seeking a doctorate for the title, this is not the program for you. If you are seeking a doctorate to interrupt and disrupt the course of healthcare, then this is the program for you. You won’t find a more supportive program with professors who are dedicated to your success and your education. This program is not about the regurgitation of information. It is about the appropriate applied application of knowledge and information to push forward and become an advocate for equitable and quality care for all.”
Brandy K. Biglow LMHC, CCTP, QSDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - February 5, 2024

“The Doctor of Behavioral Health (DBH) program has definitely transformed my understanding of behavioral health. Understanding the links between physical and mental health has taught how to make better treatment decisions. The DBH program has also given me insights that otherwise would not be possible and allows me to view individuals through a lens that I was previously ignorant of. This program has helped me grow into a more confident individual, provider, and parent.”
Cory H. Cannady, BCBA, LBADBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 13, 2024

“The DBH program has been a pivotal turning point in my understanding and application of behavioral health principles. Recently, the concept of ‘whole person health’ has gained widespread attention in healthcare circles, becoming somewhat of a buzzword. Like many others, I embraced this term, believing in my capacity to deliver comprehensive care.

Prior to my engagement with the program, my approach, albeit well-intentioned, lacked an appreciation for the intricate interplay between physical and mental health. More importantly, the role of unmet social needs as a catalyst for health disparities was a dimension I had not fully integrated into my practice. The DBH program illuminated these connections, offering me a robust framework to understand and address the multifaceted needs of individuals, especially within marginalized communities.

Additionally, the confidence I have gained through the DBH program extends beyond theoretical knowledge. My role as a connector and advocate for these individuals has become more pronounced, driven by a deep-seated commitment to fostering accessibility, equity, and comprehensiveness in care.”
Michelle Stroebel MA, NCC, LCMHC, NADD-CCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - June 12, 2024

“I have worked in behavioral health for the entirety of my professional career starting with college internships up to my current role as Deputy Executive Commissioner of Behavioral Health for the Texas Health and Human Services Commission. While I have years of experience in the field, the DBH program at Cummings has framed my perspective as leveraging therapy as a first line of intervention. As a public servant, much of the work I do is usually in the aftermath of crises or when the system is being forced to respond to a service gap. However, the DBH program takes a much more proactive and integrative approach to health. This perspective/approach has the potential to positively shape policy in Texas in my role as a public servant charged with addressing the safety net needs of the most vulnerable constituents in Texas.”
Trina K. Ita, MA, LPCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - July 10, 2024

“CGI feels like a community of long-lost cousins that finally met as adults and we realized that we share the same goals. The support from the faculty and classmates have been nothing short of amazing. I can reach out to my advisor at any given time to discuss course work, career endeavors, or to just vent about life. There is a feeling of closeness and belongingness at CGI that is just unmatched. I am very happy to be a member of the family and will continue to spread the word of how great this DBH program is.”
Michelle Francis, LCSW/LICSW-QSDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - September 10, 2024

“The DBH program’s mission, purpose, and objective say it all: We strive for intentional care outcome improvement practices that exemplify whole person-centered integrated healthcare advanced competency. The program of study drives insights and awareness of the ever-changing patient population and multidisciplinary practice environments to change how the world experiences healthcare. This is further reinforced by the pillars of medical literacy, integrated behavioral health intervention, and entrepreneurship skills and expertise. Development growth is needed to prepare the aspiring DBH for the future of the shifting healthcare marketplace through international networking in a growing community of disruptive innovators and an evolving movement toward systemic healthcare change. I feel that I will be positioned alongside a fellowship of like-minded professionals trying to improve the quality of healthcare service delivery value and outcome sustainability.”
Jose Mathew, LCSW, LAC, ACS, EMDR-T, CCTP-IIDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - October 8, 2024

“The DBH program has reinforced my vision of viewing behavioral health (BH) as an integrated component of the healthcare system rather than a siloed service. As a practitioner in the focused BH realm of substance use disorder (SUD) treatment, I observe on a regular basis how identifying and serving SUD patients is often missed, ignored and stigmatized in primary healthcare, despite the fact that early intervention at these check-points often has the potential to intervene earlier and lessen the negative SUD outcomes frequently seen by the time a patient reaches specialty SUD services. Reinforcement received in my DBH program has motivated me to promote integration as a leader in my workplace and is a primary factor in considering the long-term trajectory of my individual career path.”
Kenneth L. Roberts, MPS, LPCC, LADCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - November 5, 2024

“By becoming a DBH, I have found that I am able to have different conversations with different people. Before having my doctorate degree, I was able to speak to certain items in behavioral health, but was only seen as a licensed therapist where as a doctor, I am able to speak to the changemakers and policy makers in a more collaborative manner which then allows us as a group to enhance the services we are providing. I also found that as a DBH, my confidence in the treatment room has improved immensely and cases that may have been more difficult for me before are no longer as difficult due to the training I have received in the program.”
Dr. Allison Earl, DBH, LPC-SDBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - November 13, 2024

“I think the DBH is quite groundbreaking, it allows you to study from anywhere in the world. The support is fantastic, and you can make out of the DBH what you want. Unlike standard professional doctorates, the DBH was trying to break new ground, not trying to go over just old ground. It greatly encourages its students to be those people who break new ground.

As a person who actually has a disability, I found CGI staff to be very supportive, very accommodating. If I need extensions, they are always there. In fact the staff will reach out and check on you, if they haven’t heard from you in a very short period of time. Which I have never had from any other university.

I find the community of fellow DBH students absolutely wonderful, we reach out across numerous social media platforms, we email each other. Doesn’t matter where I am in the world or where they are in the world, everyone is supportive. Its support, support and encouragement with the DBH.”
Jason P. Sargent, B Policing, GDip Psych, MSW, JPDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - December 10, 2024

“Graduating from the DBH program has influenced and enhanced my approach to addressing behavioral health challenges and making a difference in the field by preparing me to become a serious business owner. Through the DBH program, I understand now that becoming a business owner not only assists me in reaping the financial benefits of working for myself, but the program also offers me a sense of freedom to make a difference in an individual’s life.”
Dr. Rebecca K. Wright, DBH, LBA, BCBA, QBADBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - December 18, 2024

“I have always wanted to pursue a higher degree but never found a program that met my needs. When I investigated the DBH program, I can honestly say I was excited. It was a program that would expand my knowledge in behavioral health but also how it relates to physical health. The philosophy of treating the whole person was exactly what I was looking for.”
Elizabeth Nekoloff, M.Ed., LPCC-S, NCCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - January 16, 2025

“Prior to obtaining my DBH, I practiced behavioral health within the boundaries of behavior analysis. The DBH degree has given me the ability to broaden my scope of competence allowing me to provide a higher quality of care to my clients through a person-centered approach, while still staying within my scope of practice. I was in the beginning stages of opening my business when I enrolled in the DBH program which set my trajectory towards being a stronger leader. The program equipped me with essential healthcare leadership and entrepreneurial skills, allowing me to ensure high-quality services for my clients and foster a supportive work environment for our staff. It has also given me the confidence to expand my business and pursue other healthcare ventures, reaching a broader range of patients in need.”
Dr. Pauline Tolentino Pablo, DBH, BCBA, IBADBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - January 21, 2025

“Although I have worked with many patients who have mental health diagnoses, or behaviors which make managing their medical diagnoses and day to day life difficult, the DBH program at CGI is broadening that knowledge and providing a deeper understanding of behavioral health and how best to help these individuals manage their health and improve their quality of life. This will allow me to provide and advocate for more meaningful and seamless integrated care, providing new tools for my intervention toolbox, and the confidence and skills to collaborate within and lead whole person focused interdisciplinary teams. I also anticipate building upon my knowledge as a nurse case manager and long time caregiver, as well as my personal passions and professional vision, learning about processes and operations, to be in position to start up and lead my own company one day, offering the services and care I know every person should have access to.”
Hollie Wilson, MSN, RN, CCMDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - February 11, 2025

“The Doctor in Behavioral Health (DBH) program has changed my understanding of the subject and career path. Before this academic journey, my knowledge of behavioral health was primarily theoretical, including essential ideas and methods. However, the DBH curriculum combined intense academic research with practical application, helping me understand behavioral health from multiple angles. Recognizing mental health as part of total health changed my perspective. The biopsychosocial model, which showed how biological, psychological, and social variables affect mental health, was stressed in the DBH curriculum. This comprehensive approach made me realize how complex human behavior is and how important it is to address mental health issues. Effective interventions must target the individual’s surroundings, relationships, and life experiences, not just symptoms. The curriculum also gave me enhanced evidence-based practice training to execute successful solutions. Studies methods and data analysis classes improved my critical thinking and allowed me to evaluate and apply behavioral health studies. This gave me the confidence to contribute to the field’s knowledge base through practice and research.”
Dr. Rhea Hill, DBH, LPCDBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - February 17, 2025

“The DBH program will open opportunities for me to contribute to healthcare system innovation, particularly through trauma-informed care and integrated behavioral health settings. I will be better positioned to advocate for and implement holistic care models that improve health outcomes for underserved populations. Ultimately, this program will help me transition into higher-level roles, such as a director or consultant in behavioral health, where I can influence broader system changes and contribute to the future of healthcare delivery.”
DeKyn Rashad Peters, MPH-CHES,BSW/BA,APCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 4, 2025

“The DBH program has been integral in preparing me for leadership roles by providing a solid foundation in both the theoretical and practical aspects of leadership within the behavioral health sector. Through coursework, case studies, and hands-on experiences, I have learned to lead with empathy, data-driven decision-making, and strategic planning. The program has also honed my skills in organizational development, communication, and policy advocacy, equipping me to effectively lead teams, drive impactful change, and foster environments that promote positive behavioral health outcomes. With this training, I am confident in my ability to lead initiatives that address systemic barriers and improve care delivery.”
Dr. Jerrika Henderson, DBH, CMHCDBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - March 18, 2025