Posted by DaveH (64.252.10.212) on January 17, 2002 at 20:43:58:
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Most people who are depressed do not kill themselves. Nevertheless, it is a potential complication of the disease. In fact, the National Institute of Mental Health (NIMH) states, "Research shows that almost all people who kill themselves have a diagnosable mental or substance abuse disorder or both, and that the majority have depressive illness. Studies indicate that the most promising way to prevent suicide and suicidal behavior is through the early recognition and treatment of depression and other psychiatric illnesses." In 1998, suicide was the eighth leading cause of death for all Americans (up from ninth in 1996) and the third leading cause of death for young people aged 15-24.
Risk Factors for Suicide
Research has shown that people with these risk factors have a higher rate of suicide:
One or more diagnosable mental or substance abuse disorders
Impulsivity
Adverse life events
Family history of mental or substance abuse disorder
Family history of suicide
Family violence, including physical or sexual abuse
Prior suicide attempt
Firearm in the home
Incarceration
Exposure to the suicidal behavior of others, including family, peers, or in the news or fiction stories
The highest rate of suicide was for white men over 85 years of age, but over the last several decades, the suicide rate in young people has increased dramatically. More than 4 times as many men than women die by suicide; however, women report attempting suicide about 2 to 3 times as often as men. Surveys of terminally ill persons indicate that very few consider taking their own life, and when they do, it is in the context of depression.
Is My Patient at Risk?
Danial J. Carlat, MD, in the American Family Physician recommends using "transition questions" to introduce topics like suicidal thoughts.
The most effective approach for assessing suicidal ideation is to ask first about passive suicidal ideation. This sensitive area may be introduced with the question, "With all the depression you've been dealing with, have you ever had the thought that you'd be better off dead?" The most common response is the reassuring, "Oh sure, the thought has crossed my mind, but I'd never do anything to hurt myself." However, if active suicidal ideation is present, one should determine if the patient has a suicide plan in place and estimate how realistic and imminent it is.
A useful tool for evaluating the suicide plan is the SLAP method [original author uncredited]:
Specificity of the plan (more details=higher lethality)
Lethality of method (gun=more lethal than aspirin)
Availability of method
Proximity of rescuer (farther away=higher lethality)
What Do I Do Next?
The American Association of Suicidiology offers these tips for helping someone who is suicidal:
Be direct. Talk openly and matter-of-factly about suicide.
Be willing to listen. Allow expressions of feelings. Accept the feelings.
Be non-judgmental. Don’t debate whether suicide is right or wrong, or feelings are good or bad. Don’t lecture on the value of life.
Get involved. Become available. Show interest and support.
Don’t dare him or her to do it.
Don’t act shocked. This will put distance between you.
Don’t be sworn to secrecy. Seek support.
Offer hope that alternatives are available but do not offer glib reassurance.
Take action. Remove means, such as guns or stockpiled pills.
Get help from persons or agencies specializing in crisis intervention and suicide prevention.
Remember, it is not true that if a person talks about suicide, they will not attempt it. Neither is it true that discussing it might "put ideas into their head." An appropriate risk assessment coupled with empathetic listening will help identify patients who need further help.
If you are outside the clinical setting, access help quickly by calling 1-800-SUICIDE for support and access to resources in your area.
Sources: NIMH: Frequently Asked Questions About Suicide and NIMH: Suicide Facts, unless otherwise noted.