FACTS, STATS, AND HELPFUL INFO ABOUT SUICIDE AND DEPRESSION
FACTS, STATS, AND HELPFUL INFO ABOUT SUICIDE AND DEPRESSION
Now that we’ve covered some overarching issues in the posting “Suicide and Depression”, I’d like to give you some basic information about depression (MDD) and then suicide. The following is the American Psychiatric Association’s (APA) definition of what constitutes a Major Depressive Episode (MDE) (Diagnostic and Statistical Manual of Mental Disorders, 5th Ed., 2013, p 160-161).
5 or more of these Symptoms occur more days than not in the past 2 weeks or longer
Depressed mood (sad, empty, hopeless), or irritability in children and adolescents
Markedly diminished interest or pleasure in all, or almost all, activities
Weight-significant loss or gain (>5% body weight), decrease or increase in appetite
Insomnia or hypersomnia (too little or too much sleep)
Psychomotor agitation or retardation, observable by others
Fatigue or loss of energy
Feelings of worthlessness or inappropriate guilt
Diminished ability to think or concentration, or indecisiveness
Recurrent thoughts of death, recurrent suicidal ideation without plan, or suicide attempt or a specific plan for suicide.
Symptoms must cause clinically significant distress or impairment in social, occupational, or other areas of functioning
Symptoms not attributable to the physiological effects of substance or a medical condition.
The MDE is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
There has never been a manic episode or a hypomanic episode.
It should be noted that if you qualify for a Major Depressive Episode (MDE), then the diagnosis of Major Depressive Disorder is warranted. If someone has all the above symptoms but has had a manic or hypomanic episode, then a diagnosis of Bipolar II Disorder is appropriate. Also, you may see the above symptoms in other situations like when a person is grieving. In this case, a professional should help you assess if your symptoms are part of the grief process or MDD.
As you may have noted above, thinking about suicide (suicidal ideation), having a plan for suicide, or a suicide attempt are listed as a symptom of depression. The word suicide refers to when someone acts intentionally to take their own life. First, I’d like to give you some statistics about suicide and then some basic information about what to do if you think someone is suicidal.
Let’s begin with some statistics about suicide. This information comes from The American Foundation for Suicide Prevention (https://www.afsp.org) which utilized data collected by the CDC (Centers for Disease Control) for their figures. For many years, suicide has been the 10th leading cause of death in United States. In 2011, the most recent year where statistics are available, 39,518 suicides were reported. This translates to a suicide rate of 12.3 people out of every 100,000, or, in other words, someone died by suicide every 13.3 minutes in this country. “At least 90 percent of all people who died by suicide were suffering from a mental illness at the time, most often depression” (https://www.afsp.org/research/frequently-asked-questions). While women attempt suicide more often than men, men complete suicide more often than women. This has been linked to the lethality of the method chosen: men most often choose firearms while women choose poison or medications. While younger people attempt suicide more often, older people complete suicide more often. Finally, while numbers of suicide attempts are not confirmed, surveys suggest that 1 million people a year engage in intentionally inflicted self harm (https://www.afsp.org).
Because I often work with lesbian, gay, bisexual, transgender, queer or questioning (LGBTQQ) clients, the following data from the Trevor Project (www.thetrevorproject.org) show how this population is at an even greater risk than the general population when they are young.
Lesbian, Gay, and Bisexual (LGB) youth are 4 times more likely, and questioning youth are 3 times more likely to attempt suicide than their straight peers. … Nearly half of young transgender people have seriously thought about taking their lives, and one quarter report having made a suicide attempt. … LGB youth who come from highly rejecting families are 8.4 times as likely to have attempted suicide as LGB peers who reported no or low levels of family rejection. … (And) each episode of LGBT victimization, such as physical or verbal harassment or abuse, increases the likelihood of self-harming behavior by 2.5 times on average. (http://www.thetrevorproject.org/pages/facts-about-suicide, retrieved Sept. 21, 2014)
These data are important because they reflect how harmful homophobia and transphobia can be, and how those who are in a sexual or gender minority can feel persecuted and overwhelmed by their experience. This data in no way indicates that LGBTQQ people have higher rates of mental illness, but the data are a reflection of minority stress.
Another group that I work with, those with chronic or terminal medical conditions and , specifically, those with chronic pain, are also at increased risk for suicide. The think tank Demos, utilizing data in Britain, found that 10% of suicides were linked to chronic illness or terminal illness (http://www.theguardian.com/society/2011/aug/23/suicide-chronic-illness-study).
Another important subset of chronic medical conditions that I work with are my clients with chronic pain, and they are also at increased risk. In the U.S., Ilgen, et al. (2013), analyzing data on over 4 million people from National Death Index and treatment records from the Department of Veterans Healthcare System found that elevated suicide risks were observed for non-cancer pain conditions with the greatest risks being for those with back pain, migraine, and psychogenic pain. Psychogenic pain had the highest incidence of suicide. (http://www.ncbi.nlm.nih.gov/pubmed/23699975). The group In the Face of Pain (www.inthefaceofpain.com) has a great fact sheet on Depression and Pain (http://www.inthefaceofpain.com/content/uploads/2012/07/Depression_FactSheet_2012.pdf) that reports information from various research articles. They noted that chronic pain and depression co-occur in 30% – 50% of cases. Also, chronic pain increases the risk for suicide in those with depression. Studies revealed high rates of suicidal thoughts and suicide attempts in those with chronic pain. One survey found that 50% of chronic pain patients had serious thoughts of committing suicide because of their pain. One example was from those treated at a pain center for non-cancer chronic pain. They found that 19% reported current passive suicidal thoughts, 13% had active thoughts, 5% currently had a plan for suicide, and 5% reported a previous suicide attempt. Just a note, patients should tell their doctor/psychiatrist that they have both depression and chronic pain since SNRI antidepressants may be more effective than the classic SSRI antidepressants.
Finally, another group at special risk for suicide are members of the armed forces and veterans. Remember the data from 2011 that said that in the United States the rate of suicide was 12.3 people out of every 100,000. Here are the rates that USA Today reported from updated Pentagon data (http://www.usatoday.com/story/nation/2014/04/25/suicide-rates-army-military-pentagon/8060059/).
In 2012, among full-time soldiers, the suicide rate rose to its highest at 29.7 deaths per 100,000. Also in 2012, The Army National Guard rate reached 30.8 deaths per 100,000. These numbers are staggering. They indicate how important it is to help our current and former Armed Services personnel to get past any social stigma and administrative failures to get mental health treatment.
Now that you have the data about who may be at risk. Let me share with you specific warning signs of suicide that you should be aware of. The following information comes from The American Foundation for Suicide Prevention (https://www.afsp.org).
WARNING SIGNS OF SUICIDE
People who kill themselves exhibit one or more warning signs, either through what they say or what they do. The more warnings, the greater the risk.
The Person’s Talk
If a person talks about:
Killing themselves.
Having no reason to live.
Being a burden to others.
Seeking revenge.
Feeling trapped.
Unbearable pain.
The Person’s Behavior
A person’s suicide risk is greater if a behavior is new or has increased, especially if it’s related to a painful event, loss, or change.
Increased use of alcohol or drugs.
Looking for a way to kill themselves, such as searching online or buying a gun.
Acting recklessly.
Withdrawing from activities.
Sleeping too much or too little.
Visiting or calling people to say goodbye.
Giving away prized possession.
Suffering from Panic attacks.
(https://www.afsp.org/preventing-suicide/warning-signs-and-risk-factors, retrieved Sept 25, 2014)
Finally, if you are suicidal or you are worried someone you love is suicidal, please act to get help. It is better to act, than regret not reaching out for help later. Not everyone knows this, but you can call 911 in an emergency and the officers are trained to assess if someone needs to be seen immediately due to risk of suicide or other incapacitating mental illness. They will then escort you or your loved one to the Emergency Room. Below is a list of some other options.
If suicide is a concern but not imminent (about to happen in the near future)-
Call your therapist or your loved one’s therapist
Call a support hotline
A few examples
Suicide Prevention Hotline: 1-800-273-TALK (8255)
San Francisco Suicide Prevention: 24 Hour Crisis Line: (415) 781-0500
Trevor Project: 24/7 Crisis Line - 1-866-488-7386 (for LGBTQ youth)
If suicide is imminent –
Get the suicidal person to your nearest hospital emergency room
Call 911
Call a suicide support hotline (see examples above)
Get to a Psychiatric hospital walk-in clinic
Get to an Urgent care center/clinic
If you’re not sure whether suicide is imminent, assume that it is and seek help immediately. It is better to get professionals involved who can make a thorough assessment.
In summary, it is important to remember that depression (MDD) is more than being a little blue, but once identified responds well to treatment. This can be the critical difference between those with MDD who suicide and those who do not. If you or someone you know struggles with MDD or thoughts of suicide, please seek professional help.
I hope that this information was interesting and helpful to you, and that you will consider returning in the future. My next post will be more information on Chronic Pain and Depression.
Michelle E. Mason, PhD, Clinical Psychologist, PSY23467
September 29, 2014
If you would like additional information about me or my practice you may find it on my website (www.adiffpath.com), or you can call me at 510-506-50921, or email at mmasonphd@comcast.net.
