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 | | From: | Anonymous | | Subject: | SUICIDE | | Date: | Sun, 23 Jan 2005 13:12:22 -0000 |
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 | Depression and Suicide
SUICIDE True or False:
Suicide attempters are just looking for attention
False. While attention is what they indeed often receive, individuals
who attempt suicide do so for a wide variety of complex reasons. Dismissing
a suicide attempt as an attention-seeking action can lead to intentional or
unintentional loss of life
Once suicidal, always suicidal
False. While someone who completes a suicide is likely to have
attempted before, for many the suicidal crisis is soon past and may never
recur.
There is a 'suicidal type'
False. Suicide is the great equalizer - individuals of many different
personality types and all social classes and from all walks of life are
counted among the statistics.
Asking a person to discuss his/her self-destructive thoughts will
likely trigger a suicide attempt
False. The opportunity to share their fears and thoughts about death
is welcomed by the person-at-risk. Channels of communication that are opened
will reduce suicide as a taboo subject and will eliminate the denial of some
strong emotions. Taking, by itself, will not necessarily prevent suicidal
death, although talking about suicide in the presence of a caregiver will
likely minimize the occurrence of suicidal behavior.
Suicide is generally committed without warning
False. Clues to suicide can be recognized in 70-80% of
persons-at-risk. These clues can be transmitted by feelings, thoughts,
activities, and physical state signals. They may be subtle or direct. All
communications about suicide intent must be taken seriously.
The motives for suicide are easily established
False. Many different factors interact as predisposing and/or
precipitating causes of suicide. There is no unitary theory that
comprehensively explains a person's motivation to die by suicide.
Suicidal people clearly want to die
False. Most are weighing a balance between life and death up to the
last moments before the act. The rationalization "if a person really wants
to kill him/herself, nobody can stop him/her" overlooks the notion that the
person-at-risk can change his mind.
Men have the highest rate of suicidal behavior in North America
False. While males have the highest rates of completed suicide,
females have vastly higher rates of non-fatal self-injury (attempted suicide
and parasuicidal behavior)
Someone who threatens suicide will not really do it
False. While they may indeed be crying for help, if the cry goes
unheeded they may feel even more helpless, hopeless, and alone - which
increases the risk of suicide.
A tendency to commit suicide is inherited
False. There is no evidence that suicide is genetically determined.
There may be a tendency to model a family member's problem-solving and this
is known as "familial transmission". There is some evidence that siblings,
offspring, and "survivors" of those who completed suicide are themselves at
increased risk of suicidal behavior.
Improvement in emotional state means lessened risk of suicide
False. The turmoil and indecision of a life versus death outcome may
have been settled with a determined choice for death. Emergence from
depression usually means changes in sleep, appetite, and activity prior to
the 'lifting' of the depressed mood. This may mean that there is an interval
during which the person is energized enough to carry out a suicidal act. It
is very important to be vigilant with a depressed person who, for no reason,
appears calm, settled or serene.
Depressed People are More Likely to Die by Suicide
True. The majority of people who have depression do not kill
themselves. However, being depressed does increase a person's risk for
suicide. The risk of death by suicide may increase with the severity of the
depression. For example, approximately 2% of people who get treated for
depression as an outpatient die by suicide. For people who get treated for
depression in a hospital (as an inpatient), the rate of death by suicide is
twice as high (4%). For people treated for depression in hospital after
talking about suicide or attempting suicide, the risk is even higher (6%).
There are important differences in death by suicide for men and women with a
history of depression. Approximately 7% of men and 1% with a lifetime
history of depression will die by suicide.
Factor that increase risk of suicide
1. Marital Status
Persons married with children are at lowest risk, persons never
married are highest, and intermediate are persons widowed, separated or
divorced. Risk is high during first 6-12 months of marital loss.
2. Age
Risk for completed suicide rises steadily with age to 55-65 for women
and 75-85 for men. Early peak during adolescences, ages 15-19 years.
Predominant age group for attempts is 20-35. Fifty percent of attempters are
under age 30.
3. Sex
Completed suicides 3 times more common among men. Attempted
unsuccessful suicides 3 times more common among women.
4. Religion
Higher rates among Protestants than Catholic and Jews.
5. Ethnic Background
Higher among immigrants, especially from countries with high suicide
rates. Japan, Hungary and Sweden.
6. Isolation
Higher among persons living alone without social or familial ties.
7. Insomnia
Severe insomnia, even without depression, if unrelieved may lead to
suicidal action.
8. Drugs & Alcohol
Have an effect that may 'release' latent depression and suicidal urges
that are otherwise self- controlled.
9. Family History
Especially if parent of same died by suicide.
10. Previous attempts
10% unsuccessful attempters eventually succeed. Higher risk if earlier
tries were dangerous acts.
11. Recent loss
Loss of loved person, prestige or position, self-esteem
12. Recent Childbirth
Post-partum depression may not be evident.
13. Mental status
Presence of depression, intent to die, formulated suicidal plan,
statement that personal affair have been arranged, personal belongings given
away or sold, by end of interview patient looks tense and is unable to plan
any alternative immediate course of action (e.g., cannot commit to return to
discuss his/her problem further).
Approximately 15% of depressive patients ultimately commit suicide.
But 80% of persons who commit suicide give definite warning signs about
their intent. An examination of the literature reveals a number of
pre-suicidal indicators:
1.. expression of suicidal thoughts
2.. prior suicidal attempts
3.. giving away prized possessions
4.. depression over broken relationships
5.. despair over a chronic illness or personal problems
6.. change in eating or sleeping habits
7.. marked personality change
8.. abuse of alcohol or drugs
9.. a sense of hopelessness
10.. being anxiety prone
11.. experiencing of social exclusion (e.g., romantic breakups, loss
of employment)
12.. feelings of guilt or self-shame
13.. shame over personal failure
14.. insecurity about one's capabilities
15.. feelings of worthlessness
16.. depressed mood
17.. preoccupation with self
18.. sense of time drastically limited to the present
19.. thinking becomes extremely concrete and rigid
20.. thought processes become inflexible
21.. creative problem-solving capabilities curtailed
22.. goals become extremely short-term
23.. behavior impulsive, lack of anticipated consequences
24.. passivity, tendency to deny responsibility for one's action
25.. identify with the role of victim
26.. suicidal history in family members
27.. suicidal plan
28.. availability of weapons
29.. high frequency of recent stressful events
30.. high expectations followed by a failure to live up to those
expectations
Measures to assess suicidal potential:
Adult suicidal ideation questionnaire (Reynolds, 1991)
Suicide Probability Scale (Cull & Gill, 1982)
Suicide Intent Scale (Beck et al., 1974)
Hopelessness Scale (Beck e tal., 1974)
Reasons for Living Inventory (Linehan et al., 1983)
Suicidal Behaviors Questionnaire (Linehan & Nielsen, 1981)
Parasuicide History Interview (Linehan, 1989)
What do Do/What not to Do/Questions to Ask
DO:
a.. Take them seriously
b.. Allow person to express feelings
c.. Listen to them without judging them
d.. Involve community resources or family
e.. Look at the overall picture. The person may present well, but
there may be a number of growing stressors
f.. Contract with the person for his/her safety
g.. Make concrete plan with the person (i.e., where to stay, next
appointments, phone numbers)
h.. Take to hospital emergency for an assessment
DON'T:
a.. DO NOT leave the person alone
b.. DO NOT tell the person that he/she doesn't mean it
c.. DO NOT explain away the symptoms or feelings
d.. DO NOT promise to hold the suicide plan in confidence
e.. DO NOT use self-disclosure as a means to make the person feel
better or promise not to suicide
f.. DO NOT be afraid to take control of the situation when the
person is unable to assure you of his/her safety, even if he/she becomes
angry
g.. DO NOT allow the person to lead you to believe that you are the
only person who understands him/her or the only person he/she can talk to
QUESTIONS TO ASK
a.. Do you feel safe?
b.. Do you feel lonely/isolated/alienated?
c.. Do you feel helpless/hopeless/worthless?
d.. Do you have a plan? How? When? Where? Do you have accessibility
to the means?
e.. Have you had thoughts/plans/attempts previously?
f.. Do you believe the method to kill yourself will result in your
death?
g.. What is your view of death?
h.. Do you have supports?
i.. Do you currently enjoy the things you usual enjoy? (friends,
hobbies, )
j.. Are you experiencing a change in your eating and sleeping?
k.. Do you find your emotions difficult to handle
(crying/anger/fear)?
l.. Do you notice a decrease in your energy?
m.. How long have you felt this way?
n.. Can you contract not to hurt yourself for a specific periods of
time?
o.. Are you using drugs or alcohol to help make yourself feel
better?
What can be done on a preventative and treatment basis with suicidal
patients?
a.. In collaboration with the patient, develop and implement a plan
to remove weapons and take appropriate safety precautions. This may involve
contacting significant others.
b.. Probe the patient's level of hopelessness by asking: "What, if
anything, prevents you from taking your life?" This question will provide
opening to explore reasons for living and move toward problem-solving.
c.. Help normalize depression - you might comment: "given your life
circumstances I can understand that you might be depressed. Depression and
disappointment should be viewed as a normal part of life rather than
believing that such feelings should not exist. That does not make the
emotional pain any less, but I can understand what might lead you to be so
depressed". Moreover, convey that it is understandable that someone might
consider suicide when she/he sees not other way to fulfill his/her desires.
If someone felt that there was no other way to handle the "emotional pain",
or if someone feels that "the emotional pain will never end".
d.. Reframe suicide as a problem solving strategy and convey to
patient that he or she is wrong in his/her belief that suicide is the ONLY
solution or for that matter the BEST solution to his/her problem(s): "if you
believe that suicide is the only solution then that is the depression
speaking".
e.. Help the patient engage in problem-solving by tracing how he/she
came to the solution that suicide was the only or the best solution. Trace
thinking processes. Help the patient generate alternatives. Use imagery of
various possible solutions.
f.. Have the patient imagine his/her completed suicide and then
confront 'illogical justifications' such as: "my family will be better off
without me", "my family's pain will stop", or "I will remove the burden from
my family and friends."
g.. Discuss with the patient the advantages/disadvantages of solving
the immediate problem by means of suicide versus the long-term effects on
others such as family members. Ask what legacy the patient wants to leave
his/her children? What does he/she want to be remembered for?
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| | From: | israel t | | Subject: | Re: SUICIDE | | Date: | Sun, 23 Jan 2005 11:27:20 GMT |
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A good and informative message.
Excellent.
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| | From: | Steel Golem | | Subject: | Re: SUICIDE | | Date: | Mon, 24 Jan 2005 08:22:32 GMT |
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"israel t" wrote in message
news:878y6kz8j2.fsf@kafka.homenet...
>
> A good and informative message.
> Excellent.
My thoughts exactly!
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