Jamie Ducharme

- #CheslieKryst
- American lawyer, Miss USA 2019

Cheslie Kryst Visits "Extra"

#CheslieKryst in New York's Times Square on Nov. 18, 2019

It’s an idea that in one form or another has been repeated again and again. #CheslieKryst had so much. She seemed so happy. She didn’t fit the mold of someone who dies by #suicide.

Kryst, an entertainment reporter, former lawyer, and #MissUSA 2019, was a successful young #Black #woman in a country that often assumes #suicide primarily affects white, visibly depressed middle-aged men, the Willy Lomans who populate #American culture. So the shock that followed news of her death Sunday—which the New York medical examiner confirmed to be caused by #suicide—was predictable. It also revealed a dangerous gap between reality and what many believe about #suicide and prevention in the #UnitedStates.

It’s true that, in raw numbers, white #men account for more #suicide deaths in the U.S. than any other demographic group. But that obscures a more complicated picture. #Suicide rates are actually highest among #American #Indian/Alaska Native people, according to U.S. #CentersforDiseaseControlandPrevention (#CDC) data—something rarely mentioned in conversations about #suicide. What’s more, the most recent #CDC data available suggest that, following years of increases across demographic groups, #suicide rates among white people in the U.S. declined from 2019 to 2020, contributing to a 3% overall drop in #suicide deaths in that time period. But there were no statistically significant declines in #suicide rates for #Black #Americans, or other #Americans of color; in fact, for some #racial or #ethnic groups, rates increased from 2019 to 2020. Among #Black #youth and young #adults in particular, #suicide rates have climbed steadily over the past two decades.

When a high-profile, successful, young #Black #woman like Kryst dies by #suicide, “these things are brought to the limelight of the public,” says Michelle Vance, an assistant professor of social work and sociology at the North Carolina Agricultural and Technical State University who recently co-authored a paper on #suicide among #Black #women. “But these things are happening every single day in our communities.”

Misunderstanding the ways in which #suicide affects #Americans of color can lead to confusion—not just among members of the public, grieving family, and friends, but also practitioners who may be used to assessing #suiciderisk through a lens of whiteness, Vance says. Frequently, as has been the case in the days after Kryst’s death, inaccurate ideas about #suicide and suicidal thinking are repeated, potentially contributing to future situations in which those at risk go unnoticed by peers and professionals alike.

“I’ve been searching my brain thinking, What did I miss? What did I not see?” CBS This Morning host Gayle King, who was a mentor and friend to Kryst, told TIME, recalling a final conversation the two shared in December. “How could I miss the signs? There were no signs. That’s the truth.”

#CheslieKryst and her mother, moments after Kryst was crowned #MissUSA 2019, in Reno, Nev., on May 2, 2019

That mismatch between presentation and risk is not uncommon, says Rheeda Walker, a clinical #psychologist and professor of #psychology who directs the University of Houston’s Culture Risk and Resilience Lab. (Those who know someone who dies by #suicide, particularly someone who masked their pain or did not comport with common ideas about #mentalhealthcrisis, often feel guilty, Walker says, but should give themselves some grace as they grieve. Prevention is a long-term activity, rarely possible in the final crisis.)

“She was a very high-functioning individual. So people assume. She doesn’t present like someone who is depressed and downtrodden,” Walker says. “But two things come to mind for me: When we work with clinical #patients, oftentimes the ones who are least depressed are the ones actually who give me the most pause…. The other thing is that people oftentimes don’t look like what they are going through.”

While #suicide has long been viewed as an affliction of middle age, among #peopleofcolor in the #UnitedStates, those 30 and under are at greatest risk. And warning signs of #suicide risk may show up differently in younger populations and across #racial and #ethnic groups. As Lillian Polanco-Roman, an associate professor of #psychology at the New School for Social Research, points out, data that compare #suicide rates among older populations suggest that fewer #Black people die by #suicide, as if there were something guarding them from it, while failing to capture the reality of what is happening before people reach that age.

“The narrative, how it has been spun before is ‘oh, #communitiesofcolor have this protective factor,’” she says. But in fact, “those who are most vulnerable…they’re not caught by our safety nets. They don’t get that extension in life to make it to middle age.”

#JamesDonaldson notes:

Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.

Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.

Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle

 

#CheslieKryst and her mother.

A research letter published in 2021 found that, from 2014 to 2019, #suicide rates among #Black people in the U.S. increased by 30%, even as rates among white people began to drop by the end of that time period. Among #children, the trends have been even more startling, especially among #Black #girls, for whom #suicide death rates increased by 182% from 2001 to 2017, according to a study published in 2019. #Suicideattempts among #Black #youth of all genders have also grown more frequent in recent years, according to a 2019 study published in Pediatrics.

A delay in statistical reporting makes it difficult to say with authority how the #pandemic may have affected the situation. Still, some studies help fill in the gaps. For example, an international 2021 research review incorporating data from 54 studies concluded that suicidal thinking and #behavior has become more common during the #pandemic than before it, particularly among young people and #women. Studies have also shown that rates of #depression and #anxiety—both of which are considered risk factors for #suicide—were higher in 2021 versus 2020, particularly among #peopleofcolor. According to #CDC data from January and February 2021, more than 41% of U.S. #adults said they’d felt symptoms of #depression or #anxiety in the past week, compared to 36% in the summer of 2020. What’s more, 47% of #Hispanic/#Latino #adults and nearly 45% for #Black #adults said they’d experienced recent #depression or #anxiety in the 2021 survey.

Another paper, published in the Lancet Regional Health—Americas, found that almost a third of U.S. #adults reported elevated symptoms of #depression in the spring of 2021. Depressive signs were most common among people in low-income households and those who experienced multiple stressors related to the #COVID-19 #pandemic, such as job loss or death of a loved one. Those stressors have not been equally distributed: In the early days of the #pandemic in particular, #peopleofcolor in the U.S. died from #COVID-19 at significantly higher rates than white people. As of June 2020, 31% of #Black #Americans and 17% of #Hispanic #Americans said they knew someone who had died from #COVID-19, compared to just 9% of white #Americans. And as of May 2021, about 40% of #Black #adults said someone in their household had lost a job or wages due to the #pandemic.

It would be easy to say that changes in #suiciderisk in the #BlackAmerica have crept up on the country, Polanco-Roman says. But research going back decades showed an increase in #suicide among young #Black #men from the 1960s to the 1990s, followed by a decade-long decrease and stabilization—and then, in the 2000s, another increase among all groups, with a disproportionate share of the growth occurring among younger #Latino, #Native, #Asian, and #BlackAmericans. Even before the #pandemic, #suicide risk among #peopleofcolor in the #UnitedStates was concentrated among the young. (In fact, Polanco-Roman notes, the data for #Americans of color look more like those for #suicide risk in low- and middle-income countries in #LatinAmerica and #Africa, where rates are highest among young people—suggesting that those countries may be a valuable source of information and guidance.)

“Culture, environment influences #suicide risk,” says Polanco-Roman, “That, I think, is recognized. But to what extent and in what ways, we still need more research.”

Limited research and understanding of these facts may be causing public health officials and the general public to fritter away opportunities to intervene and keep young people of color alive.

Research informs treatment, public health interventions and even what the public understands about #suicide risk. In the #UnitedStates there’s been significant conversation about firearms access and #suicide risk, for example; that focus may help to save the lives of middle-aged #men in particular, who are more likely to die after using a firearm. But young #Americans who die by #suicide are more likely to use other methods, which have not received the same level of attention.

It’s no coincidence that efforts to prevent #suicide in #Blackcommunities remain less effective than they could be.

“We are working on improving our #suicideprevention strategies, and our #suicide intervention, but we are not centering other lived experiences, namely those who are not white,” says Polanco-Roman. “Our prevention strategies are not culturally responsive. They’re most responsive to white populations, who are better represented in the research that we carry out.”

The assumption that #suicide can be addressed in universal ways is one problem. Systemic #racism also plays a significant role in the failures of #suicideprevention. It shapes who has access to quality #mentalhealthservices, and other social resources such as education, quality housing, and employment, as well as who is exposed to violence, unemployment, hunger, abuse and other chronic stressors that compromise #mentalhealth and development over the course of a person’s life.

#Suicide is highly complex phenomenon. Though people who die by #suicide may experience traumatic experiences leading up to their deaths, there is rarely a single cause or trigger; some people may not even exhibit what most consider visible warning signs. Still, #suicide is preventable with the right mixture of interventions and ongoing support. The #AmericanPsychiatricAssociation has found that access to mental and physical health care is a buffer against suicidal thinking and #behavior, along with social and community support.

It is particularly devastating, then, that in the U.S., #mentalhealthcare is least accessible to #peopleofcolor, who are known to face a disproportionate amount of #stress and trauma. As of 2019, about 20% of the white U.S. #adult population received #mentalhealthcare, while less than 10% of #adults identifying as #Black, #Hispanic, #Asian, or Pacific Islander/Native Hawaiian did. (Interestingly, 7.1% of white #Americans still said they had an unmet #mentalhealth need, a higher percentage than any other single #racial or #ethnic group.) Research has also shown that #children and #teenagers of color are less likely to have received #mentalhealthcare before dying by #suicide, compared to white #youth.

The #pandemic did little to eliminate those disparities. While the rise of teletherapy helped some people connect with a #mentalhealthpractitioner for the first time, relatively high earners and white people reported the largest jumps in telehealth usage through spring 2021. Whether online or in person, care is still out of reach to many people due to cost, difficulty finding providers who accept insurance, and a glaring lack of clinicians of color, to name only a few barriers.

“Socioeconomic status is not the whole story,” says Dr. Amanda Calhoun, a psychiatry resident affiliated with the Yale School of Medicine. There are plenty of #peopleofcolor who can easily find and afford treatment. Finding a therapist who understands their lived experience and “what it is to be a person of color in America” is much harder—not only because psychiatry is a predominantly white field, but also because medical schools offer limited training on the intersection of #race and #mentalhealth, Calhoun says. “You could be alienating many #Black people who have the means to access the #mentalhealth system, but they frankly don’t trust it,” she says. That will likely continue to be the case until the medical system learns to attract people from all backgrounds and offer comprehensive training that goes beyond the experiences of white #Americans.

These are not inherently intractable social phenomena beyond human control. They are the results of decisions made about research funding, housing, education, food, health care, and other policies. When the #pandemic arrived in a country that made those decisions, it rendered the #suiciderisk mitigation strategies that involve our private lives, rather than clinical settings, all the more important. For Black women, research suggests that list of #mentalhealth protections includes things like close personal ties, hugging, and frequent physical contact with family and friends, Walker says. Church attendance or maintaining a spiritual practice and sense of belonging or connection to a community. The ability to go to happy hour with coworkers and talk about a boss who hands out discrimination as often as assignments. But in the #pandemic, much of that became physically dangerous.

“It really is multi-layered,” Walker says. “Why I do the work that I do is that people habituate to this pain. A lot of folks are struggling. But most folks aren’t going to try to take their lives. And for me I know that it’s because of what we call protective factors, the psychological buffers. It’s all of that that usually provides this kind of layer of protection.”

Some of those layers were already eroding before the #pandemic, Walker says. And that’s something worth talking about and working to repair, she says. That’s a form of public health work, stuff that keeps people alive. It’s also practical and in the individual’s control.

“I don’t think we can do much about the other risk factors in the short term,” Walker says. “You know, between #racism and microaggressions, what you gon’ do?”

#CheslieKryst was a #woman with a bachelor’s degree, a law degree, and an MBA. She practiced law and did pro bono work that ultimately liberated a man convicted of drug charges from a life prison sentence. She served as #MissUSA and unapologetically appeared on stage with natural, curly hair and a more muscular body—shaped by years as a Division I college athlete—than the typical pageant contestant. She then switched careers and quickly won two Daytime Emmy awards. “She was a sparkle. I called her walking sunshine,” Gayle King says.

#MissUSA #CheslieKryst walks on stage during the 2019 #MissUniverse pageant at the Tyler Perry Studios in Atlanta on Dec. 8, 2019.

Kryst had also publicly described talking with a counselor and exercise as essential to her #mentalhealth; in a statement released on Wednesday, her mother said she was living with “high-functioning #depression,” a term that the University of Houston’s Walker says is not a precise medical diagnosis but an apt way to describe real pain that the sufferer is able to mask. Beyond that, there is much we do not know and cannot know about Kryst’s experiences.

What we do know is that the effects of overlapping #racism and #sexism may amplify stressful experiences. In some cases, they become risk factors for #suicidalbehavior, Vance and her co-author Jeannette Wade, an assistant professor of sociology at North Carolina Agricultural and Technical State University, concluded in their recent paper, published in the Journal of Racial and Ethnic Health Disparities. “When you take the idea of being a #Black #woman and having to live in a #sexist society, a #racist society, and then add things like having to head a household…that is creating a unique risk,” Wade says.

At the same time, #Black #women are often expected in their friend and family circles to operate like unshakable trees planted beside the water, deeply-rooted and able to weather any storm, Walker says. And the way that #racism and #sexism combine often forces these same women to present themselves publicly as not only unflappable, but capable of superhuman feats. It’s what a society like this one requires of them simply to be regarded as fully human by others.

One of the most widely cited theories of #suicide—known as Joiner’s theory, named for the clinical #psychologist who developed it—holds that three things are consistently present among those who die by #suicide, Walker says. The first is the sense that one does not belong. The second is the individual feels or believes themselves to be a burden to others. The third is the capacity to overcome the powerful human instinct to survive, the ability to intentionally and seriously injure oneself. But those factors are not always the only considerations: Subsequent research that Walker, Jasmin R. Brooks, and others conducted affirmed a relationship between the capacity for suicide and a habituation to pain or risk. But for #Black #adults, experiences with discrimination were more predictive than the risk-taking or ability to tolerate physical pain.

Walker emphasizes that she does not know Kryst or any details of her life beyond what Kryst made publicly available. But what Kryst did share is likely familiar to many of those who come from similar backgrounds, and points toward some of the findings of Walker’s joint research: In various forums, Kryst described frequent experiences with microaggressions, outright #racism, #sexism, and society’s fading interest in #women over the age of 30. She also, Walker notes, described the way that, at what appeared to be wonderful moments in her life, online commenters sometimes told Kryst to kill herself.

To Walker, the many public appeals since Kryst’s death for those who are suffering to reach out to others for help are yet another one of those prevalent but dangerously inexact ideas about #suicide and prevention. What’s needed is for all of us to take the initiative. Consider those around us. Reach out when we see or even suspect someone we know is experiencing something difficult or painful. Do not presume that a person is OK or would ask for help if needed. Do not assume a person’s race or age or outward demonstrations of happiness mean they don’t need to know someone cares, to be listened to rather than hushed with bromides and reflexive, relentless #American positivity.

#Suicide is stigmatized and difficult to talk about. But studies—albeit, many focused on white people—have repeatedly shown that asking someone whether they have considered #suicide does not increase their risk of planning or attempting it, and may help get them into treatment. In some cases, difficult conversations may be lifesaving.

“I talk about a psychological fortitude rating, 0 to 10, 10 being the highest,” Walker says. “And some of us are operating at 6 and lower.
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