SUICIDE
Suicide is the eighth leading cause of death in America. It is the third leading cause of death in the 15-24 year age group. For every completed suicide, there are estimated to be 50 to 200 attempts. Suicide and depression are closely linked since most people who commit suicide have been clinically depressed for some time. Depression is typically characterized by a number of symptoms. These may include depressed mood most of the day, lack of enjoyment of usual activities, irritability, poor concentration, difficulty making decisions, sleep problems (too much or too little), lack of energy, feelings of guilt or worthlessness, recurrent thoughts of suicide or death, and changes in appetite. The depressive phase of bipolar disorder is also a high risk time for suicidal thoughts or behavior.
Depression includes negative thoughts as well as the physical symptoms and low mood states. Depression may be linked with medical illness, hormonal imbalances, nutritional deficiencies, substance abuse or medication side effects. Severe stress or loss may trigger depression and a feeling of hopelessness. Many people, especially men and certain ethnic groups, view depression as a sign of weakness and are ashamed to seek help. Drug and alcohol abuse are particularly high risk behaviors for completed suicides. The drugs or alcohol (or both) are frequently used to numb strong feelings of sadness, shame, guilt or hopelessness found in depression. The obvious effects of the drug use on behavior may mask the underlying depression, making it difficult to identify and treat the depression.
Suicide rates for adolescents and elderly are twice that of the general population. Behavioral changes to watch for in adolescents that may indicate a high risk for depression and suicide include aggression, extreme self-criticism, refusal to cooperate with others, behavioral problems in school or work, risk taking behavior, and sudden drops in school performance. Depression in the elderly is often overlooked by attributing the symptoms to medical illness or the incorrect assumption that depressive symptoms in the elderly are part of normal aging.
Depression is a treatable illness that will not go away by being ignored. The irrational thinking that often accompanies depression can make suicide appear to be a logical escape from seemingly irresolvable or intolerable situations. Untreated depression is estimated to lead to one out of six people to commit suicide. This fact alone makes depression a life threatening illness that should be taken seriously by the depressed person, their family and their physician.
Depression can be successfully treated by psychotherapy, medication or a combination of both. Studies show the best results from a combination of the two methods. Psychotherapy is usually oriented towards identifying and changing thoughts, emotions and behaviors that contribute to depression. This cognitive-behavioral approach is highly effective for all but the most severely depressed people. Persons with the most severe and disabling major depression will often need to be stabilized with anti-depressant medication before therapy can be started.
People with extremely high risk of suicide should be hospitalized until treatment lowers the risk and outpatient therapy can be started. Warning signs of high risk may include making final arrangements (changing a will, giving away personal belongings, putting financial affairs in order), a sudden elevate mood when the decision to end life is made, self destructive behavior, statements about death or suicide, having a concrete plan and the means to carry it out (guns, pills for an overdose, etc.).
If someone you know is talking about suicide, listen to them with respect and acknowledge their suffering. Do not make moral judgments that might increase their feelings of guilt or worthlessness. Recognize that the person is crying out for help, even if they are hostile or seem to reject a suggestion of help. If a suicide attempt seems highly likely or imminent, do not leave the person alone. Arrange for someone to be with the person continually. Then either call a suicide hotline or 911, or take them to a mental health center, hospital emergency room, their psychiatrist or physician.
There is no certain way to prevent suicide. Recognizing the warning signs and getting help form qualified professionals can markedly lower the risk of completed suicide.
Daniel Blodgett MD