But how can loved ones “be there” while also practicing physical distancing in light of COVID-19?

“If you love someone, the greatest gift you can give them is your presence.”

-Thich Nhat Hanh, Buddhist monk, peace activist, and author

By Alan R. Teo, M.D., M.S., and Aaron Call, Ed.M.

What does it mean to “give someone your presence?” Is that actually a “great gift” when someone you care about is suffering from depression? What do people who have struggled with suicidal thoughts seek in their closest personal relationships?

These are the kinds of questions that led us to talk candidly with patients at the VA Portland Health Care System, with the goal of better understanding their life experiences with depression.

While we undertook this research prior to the arrival of COVID-19, what we learned may have particular relevance as we confront the challenges and changing circumstances that have come with it. Millions of people are suddenly finding themselves out of work, dealing with the loss of loved ones, and physically isolated. Such conditions may lead a person to be at increased risk of depression and in need of support.

Many of the patients we spoke with described their closest sources of support as individuals who could be there for them. Now “being there” is not a term that health researchers typically—if ever—use to describe the support patients receive from others. So we next tried to figure out what exactly veterans meant.

As we combed through the transcripts of these interviews, we identified some important patterns and themes. These led us to propose a definition for “being there,” shown in the figure below.

Being physically close to a patient, say living just a short drive away, was one of the key components of being there. Meeting up frequently, or reliably answering the phone, were other ways veterans defined someone who was there for them.

As we all do our part to slow the spread of COVID-19 by staying home and physically distant from others, it’s critical that we consider ways we can still be there for each other and stay connected. For instance, in a previous study, we found that older adults who used video chat—presumably to stay in touch with family and friends—had a significantly lower risk of depression symptoms when assessed two years later.

Why does this matter? Over the past few decades, we’ve seen mounting evidence of the importance of social connections for our health and happiness. Numerous studies have found people with strong social connections to be more likely to have better physical and emotional health, while people less connected socially seem more likely to be depressed and exhibit suicidal behaviors. The potential protective factor provided by having close supports available may be especially important for populations at increased risk of suicide, such as veterans.

These research findings have led organizations including the  Centers for Disease Control and National Academies of Sciences, Engineering, and Medicine, as well as a former U.S. Surgeon General, to recommend the health care system—and our communities—spend more energy and resources to combat loneliness and social isolation.

To be sure, even before trying to be physically distant to slow the spread of the novel coronavirus, there were many challenges in this fight. The patients we interviewed, for instance, told us about obstacles that make them less likely to ask someone to “be there.” They described concern about being a burden or making loved ones worry about them. Many also talked about having streaks of self-reliance and independence, a sense of identity common in veterans, that makes it hard to ask for help.

While there is a lot of evidence that social connections are vital, it’s not always clear how to translate that knowledge into actions. Based on this study, we are suggesting ways to improve public messaging around suicide prevention.

For example, #BeThere is a suicide prevention campaign that encourages us to make time and reach out to loved ones who are struggling emotionally. This campaign might be strengthened by also directly addressing the obstacles—shown in the figure below—that stymie individuals from asking for or accepting help.

There are other implications, such as for how clinicians communicate with patients with depression or suicidal thoughts. Our full findings and recommendations are published in The Journal of General Internal Medicine.

If you or someone you know is having a mental health crisis or suicidal thoughts, call the National Suicide Hotline at 1-800-273-TALK (8255), text HOME to 741741, or go to SpeakingOfSuicide.com/resources for a list of additional resources.

Dr. Alan Teo is an Associate Professor of Psychiatry at Oregon Health & Science University.

Mr. Aaron Call is a Research Assistant at the Center to Improve Veteran Involvement in Care at the VA Portland Health Care System.