SBB University Mental Health Series presents: Depression, Suicide and the Holiday Season. Today's speaker is Cassandra Cote', RN with WellBridge Hospital Greater Dallas/Kindred Behavioral Health.

The video of this presentation may be watched at the bottom of this article. Cassandra reviews some of the content for you here. 

Society and the media have turned the holidays, especially Christmas in to a time of obligatory traditions and responsibilities, more than it ever was before. The pressures can be relentless this time of year to make the season “merry and bright” for all of those around you, often times at the cost of your own sanity and happiness! 

Think about this for a moment. Do you feel like you HAVE to do some particular tradition, event, party or dinner? Do you HAVE to put up Christmas lights even if they really aren’t in the budget this year? Do you HAVE to make cookies for the office, even though you’re exhausted and have other things you’d rather do? Do you HAVE to go to church with the family on Christmas eve, just because that’s what we are expected to do? What about hosting family for dinners, or buying gifts for every boss, uncle or cousins girlfriend on the list?

Do you feel anxiety just hearing this list of obligations that many of you can completely relate to? I know I do. For several years now starting sometime in September or October I will have occasional nightmares that it is Christmas eve and I’m at the store trying to buy gifts for my whole list because I put it off out of dread and now there’s nothing good left, the lines are around the buildings, it’s 8pm and the pressure is on! I’m thinking of how I’m missing out on Cocoa and Christmas stories, and will be up until 6am on Christmas morning just trying to get it all wrapped!! It’s enough to give anyone ulcers.

Let me ask you,

Do we have to do all of these things? Do we want to do all of these things? What happens when we feel like we have failed our own expectations? We missed the candy canes for the Christmas morning hot cocoa and now it’s no longer perfect. Is it possible there is another way?

I’ve listed the 5 most typical reasons for holiday depression.  

1. We feel overwhelmed by all the things we are expected or expect ourselves to accomplish or participate in. It’s too much, and the pressure becomes defeat, despair and depression.
2. We long for what was before. Maybe there was a time in our lives when the holidays were everything you could have dreamt of. The right people, the right stage of life with motivation, the finances and the support to put together a season that was incredibly fulfilling for us.
3. We feel an obligation we know we cannot oblige – either because we do not have the capacity to put in the time or effort or perhaps we don’t have the finances to do what we think is required or expected of us. Maybe that expectation is even self imposed.
4. Finances have us in a spot where we cannot, or maybe SHOULD not – do all the things we wish we could especially this year, when so many people have experienced lay-offs, cut backs or a long stint of illness because of the pandemic.
5. Finally – Family & friends… Perhaps we are unable to be with the ones we want to celebrate with. This could be for so many different reasons for instance, the death of a loved one. Distance, Isolation. COVID is a glaring reason this year. This reason, isolation and the pandemic effects our elderly patients this year the greatest. Especially those being cared for in a facility setting.
6. Memories of Holidays past One final reason for an increase in depression over the holidays for our elderly population especially – is the memories of holidays from the past – that come out the strongest at this time of year. These memories can create a longing for connection or a frustration knowing the connection is lost.

Sometimes as we age, the holidays no longer seem very jolly, and we don't feel like celebrating much anymore. What used to be a joyous occasion can change and take on new meanings as life throws us curve balls.

We think we're supposed to be exceptionally happy this time of year, but that expectation alone can cause people of all ages to become sad or depressed. Caregivers and older adults are especially susceptible to the holiday blues. “As a caregiver, you can be prone to adopting your loved one's melancholy feelings or anxiety and vice versa

While the holidays may not be the same as they were in the past, there can still be plenty of reasons to celebrate. One of the most important things to remember is that it's okay to enjoy the holidays as they are now. Old memories hold a special place in your heart, but there is always enough room to add new ones.

Let’s talk about some practical advise to deal with these holiday stressors we have talked about.

There’s Too much to do!!!

By definition – caregivers (all of us) have too much to do already, let alone adding decorating, dinners, shopping and wrapping to that list!

To keep from feeling overwhelmed and out of control,

1. Be realistic!!
   1. Perhaps this year a 5 course dinner is not practical!
2. Focus on what YOU and what those the very closest to you NEED
   1. instead of what others expect of you.
3. Prioritize and Downsize Holiday tasks
   1. Decide which decorations are most important and compromise. For example put up the tree lights and the mantle decorations but skip the outdoor lights this year.
   2. Consider drawing names and each person, or each family buying gifts for only one person/family? IN my family the adults each get one gift and we all buy for the kids. This means I have about 8 gifts to buy instead of 29 gifts. I enjoy giving to the kids, so this makes me happy!
   3. Same idea applies to dinners. Don’t make 6-8 dishes, instead choose the 3-4 most important dishes to your family. You could also try a new tradition this year and make it a potluck. If everyone pitches in it makes your job much easier!

Speaking of pitching in –

4. Accept help
   1. when others offer it and ask for help when you need it. It makes others feel great to help those that they care about. You may be blessing them in a roundabout way!!
5. Make lists.
   1. It helps to see what exactly needs to be done, and it gives you a sense of accomplishment when you cross off completed tasks

Financial Pressures

Finances are another notorious source of stress during the holidays. Money is often already tight for seniors and caregivers alike. Spending also tends to increase this time of year on things like gifts, holiday meals and basic necessities like heating, warm clothing etc..

Be proactive!

1. Set a budget. Making a budget frees you from contemplating over and over, “Can I really afford this?” It takes emotions out of your holiday shopping and allows you to remain objective. Either it fits the budget or it doesn’t. It may seem like a bummer to live by a budget, but it’s far better than realizing after the holidays that you spent far more than you could afford.

1. Remind your loved ones that less expensive gifts can be just as thoughtful and useful as more expensive ones.
2. Make baked goods or create handcrafted gifts for family and friends.
3. Have your family members draw one or two names for gifts, instead of having everyone buy presents for each person. This may help other family members save money as well.
4. Don’t wait until the last minute to mail cards or buy presents. Take care of a few items each day to complete tasks with minimal stress and expense.
5. Remember that less can be more.. Sometimes a simplistic holiday with a small dinner and fewer, very heartfelt gifts is more gratifying

Social Isolation due to the pandemic or other reasons:

1. Make a concerted effort to reach out to the people you enjoy.
2. Plan some online events for the family
   1. Netflix has group watching parties
   2. Use Google Hangouts or WhatsApp to have a family quiz night, caroling night or reminiscing night.
3. Up your holiday/Christmas card game this year
4. Find a new tradition that is ALL ABOUT YOU (and your household) such as – an outdoor event – going to the zoo – a nature preserve, having a game night or movie marathon.

Dealing with Death:

One of the biggest challenges is dealing with the loss of a loved one. Whether it was a recent loss or the loss occurred a decade ago. The holidays often highlight their absence and bring intense feelings of grief loneliness and emptiness. You may even battle guilt for enjoying moments of the holiday.

Consider the following ideas:

• Place the person's picture in a place of prominence at home.
• Light a memorial candle.
• Begin a new tradition
• Make a photo album of previous holidays together to focus on positive memories.
• Set aside a time so that everyone who wants to can share a memory or a funny story about the deceased.
• Toast to your loved one.
• Go to a religious service
• Volunteer to help those in need.
• Talk with someone. A counselor, or someone who can empathise and let you process without judgment.

Remember that not everyone grieves in the same way. There is no accepted norm. You may cry at the drop of a hat, while someone else is more stoic. Some people may grieve for weeks, and others mourn for years. Understand that the holidays won't be the same as they used to be, but recognize that the “new normal” can be fulfilling in other ways.

Strategies for Avoiding Holiday Depression:

There is no reason to wait until depression happens to act on it, because there are approaches that can help prevent and minimize the symptoms. Generally, what can help is not being too hard on yourself for the difficulty you may be experiencing. Try to:

• Keep a regular schedule and build in breaks. Adequate rest and self care is crucial, especially during the hectic holiday season.
• • Schedule in times to pamper or care for yourself. Do something you love or do nothing at all but you HAVE to be purposeful about it!
• Set realistic expectations of what the holidays will be like and realistic expectations for yourself regarding your participation.
• Avoid feeling guilty for picking and choosing which holiday gatherings you attend
• Make sure you get regular exercise. It's typical for people to stop doing the healthy things they usually do because of holiday activities and the inclement weather. Make exercise a top priority, even its only twenty minutes each day.
• Avoid overeating at every meal. Save indulging for special meals, like the big family dinner or the pot luck at work. Balancing indulgence with light, healthy meals will help you feel less lethargic and improve digestion.
• Be careful about the amount of alcohol you drink, alcohol is a depressant.

Depression may occur at any time of the year, but the stress and anxiety during the months of November and December may cause even those who are usually content to experience loneliness and a lack of fulfillment that leads to depression, anxiety and a decreased quality of life. If these symptoms persist after the holidays, or you’ve already had them and they worsen due to the holidays please see your doctor, a psychiatrist or a counselor to get some extra help.

Consider medication if your doctor agrees that it is appropriate. It is not a sign of weakness and it will not FIX it but it can take the edge off, making it more manageable for you.

If your feelings worsen and thoughts of suicide creep in, please visit your nearest hospital, get an evaluation at an ER or a hospital such as WellBridge in Plano or call the suicide help line at 1-800-273-HELP.

Let’s switch gears for a moment now and discuss Suicide and the holidays.

First, let me tell you the good news… Suicide rates actually drop during the holidays statistically! This is great news for society in general but means nothing to the individual who is experiencing severe depression, feelings of helplessness, loneliness and lack of hope and is considering ending their life.

Suicide is the 10th leading cause of death in the United States. It was responsible for more than 48,000 deaths in 2018, resulting in about one death every 11 minutes. Internationally that rate climbs to 800K deaths and one death every 40 seconds. 

Statistically, 25 times more people consider suicide than actually die from it. In 2019 12 million American adults seriously contemplated suicide. 3.5 million made a plan and 1.4 million attempted to end their life.

These are ONLY the reported cases. It is believed that the number of unreported cases if known would increase each of these numbers by 9x. Many “accidental” overdoses were intentional but not classed as such… car accidents that may have been intentional or other “accidents”. Many people never report their suicidal thoughts or that they were making a plan or that they made an attempt because they are embarrassed and do not want to be stigmatized or cause their families heartache and worry. So instead they suffer alone, quietly.

It is a mistake to think that elderly people don’t consider or attempt suicide. Those over 75 years of age make up the largest group of people who complete suicide. At that age many feel there is no hope left, they are a burden and no one would miss them.  

What is the impact?

In addition to the number of people who are injured or die, suicide also affects the health of others and the community. When people die by suicide, their family and friends may experience shock, anger, guilt, and depression. The economic toll of suicide on society is immense as well. Suicides and suicide attempts cost the nation almost $70 billion per year in lifetime medical and work-loss costs alone.

People who attempt suicide and survive may experience serious injuries, such as broken bones or brain injury. These injuries can have long-term effects on their health. People who survive suicide attempts may also experience depression and other mental health problems.

Many other people are impacted by knowing someone who dies or by personally experiencing suicidal thoughts. Additionally, being a survivor or someone with lived experience increases one’s risk for future suicide.

THE TAKE HOME MESSAGE:

Pay attention to your loved ones silent and sometimes not so silent signals.

Warning signs of suicidal thoughts or planning can include:

• Often talking or writing about death, dying or suicide
• Making comments about being hopeless, helpless or worthless
• Expressions of having no reason for living; no sense of purpose in life; saying things like "It would be better if I wasn't here" or "I want out."
• Increased alcohol and/or drug misuse
• Withdrawal from friends, family and community
• Reckless behavior or more risky activities, seemingly without thinking
• Giving away belongings
• Dramatic mood changes – especially from depressed to happy!!! Weird huh?
• Talking about feeling trapped or being a burden to others

The number one mistake people make is they don’t ask.

The uncomfortability only lasts about 8 seconds, but the reward could be a lifetime.

Ask, what do you mean by…..?

Then ask blatantly and boldly. Do not mince words. “hurt yourself” is not effective.It may not hurt them to end their pain and misery, it might be merciful in their minds!!

 You must ask, “Are you considering ending your life?” or “Have you had thoughts of killing yourself?”

If the answer is yes – do not leave them alone until you have delivered them to help.

Possible resources for help:

Locally – Emergecny rooms!! 24/7

MHMR’s – great for uninsured IF during business hours

WellBridge for 24/7 assessment

Nationally:

The suicide Prevention Helpline – 800-273-HELP (68,680 calls first month!)

 If you have been affected by suicide, reach out to someone at NAMI or a counselor – you deserve someone to walk by your side to help you sort it all out.

View the video of the presentation.