How To Prevent Suicide

Your Life Can Be Amazing.  Listen To
This Interview And Learn How It Gets Better.
Contributions by:  Darlene Albury and Simone Ravicz

All About Suicidality
by Dr Simone Ravicz  
 
From the horse’s mouth:  I spoke with one of my previous patients after our meeting and she shared with me that during our therapy, I had stopped her from killing herself. She stated I had talked her out of it.  This dispels one of the biggest false beliefs about suicide, namely, that nothing can stop somebody who is intent on killing themselves.  Remember, people are generally ambivalent when saying, I want to kill myself or I can’t go on or I don’t want to live anymore.  Part of them wants to live and part of them wants, not so much death, as an end to the pain.  Give them the sense that there can be more to their life.  If they have a family or close friends, help them to think about the pain they will cause the family members or friends.  There is nothing more painful to a family than to lose a family member this way.
 
You might think the person’s problems aren’t sufficient to warrant their killing themselves and that they are just exaggerating their desires.  We can’t assume anything, and this assumption can prove deadly wrong.  What matters is not how bad the problem is, but how badly it’s hurting the person who has it.
 
About 75% of people will do things before a suicide attempt indicating their great depression or distress.  People who say they are suicidal need attention right away.
 
My patient said she did NOT want to hear that things would “get better.”  She wanted to feel listened to, accepted, and cared for.  When someone tells you they’re suicidal, it is the part of them that wants to live that is talking to you.  She told me it was essential that she felt she was speaking with someone with direction and who was caring.  Evidence confirms that people who admit it to you believe you are more caring, more informed about dealing with misfortune, and more willing to protect confidentiality.  They have a positive view of you.
 
 WHAT TO DO:
 
 The most important thing to do is to listen and let the person vent.  You don’t even have to speak very much, and do not worry about looking for any magic words.  Show caring through your voice and demeanor.  Tell the person you are glad he/she opened up to you.  Be patient, accepting and sympathetic.  Do not try to give advice or become argumentative. If they mention anything about suicidality, ask them if they are having suicidal ideation.  They will actually appreciate it as you are showing that you care and take them seriously.  Allow them to vent and share their pain with you.  Find out whether they have a plan and/or means. Urge them to seek professional help.  I think we should all have a list of multiple suicide prevention centers for the states we usually cover.   Also, as we speak to them, convey that you can look up a phone number while they are on the line with you.  Tell them the people at the centers are very caring, it is confidential, and they are there especially to help situations like theirs.  Www.samaritans.org is available 24 hours/day and there are 400 centers in 38 countries.  They can be telephoned at 1.800.273.TALK.
 
 Many people have a number of stressors which may underlie suicidality: Loss of health (real or imaginary); loss of job, home, status, money, and self-esteem; divorce, end of a relationship, family stress; death of a family member or friend; alcohol or substance abuse; severe anxiety and/or depression (or feeling very good just after having been very depressed); chronic pain; new or changed diagnoses; stressful times such as holidays or just after release from the hospital; feelings of hopelessness, worthlessness, powerlessness, shame, guilt or self-hatred.
 
 People with PTSD may also be at risk for suicide.  There are three groups of symptoms to pay attention to if someone mentions them: I) Re-experiencing the trauma a)intrusive memories of the event; b)flashbacks; c)nightmares; d)intense distress when remembering the trauma; e)intense physical reactions to reminders of the event.   II) Avoidance and numbing a)avoiding activities, places, thoughts, and feelings reminiscent of the trauma; b)inability to recall important aspects of the trauma; c)loss of interest in activities and life; d)emotional numbness, detachment; e)sense of a limited future.   III) Increased anxiety and emotional arousal  a)difficulty sleeping; b)irritability or angry outbursts; c)difficulty concentrating; d)hypervigilance (on constant alert); e)jumpiness or an exaggerated startle response. 
 
Treatments, such as EMDR (likely the most effective technique for PTSD and being used increasingly by the VA), cognitive behavioral techniques, and tapping, can be extremely useful and, if the person has a doctor, could be wisely recommended. 

I Hope you find this helpful.
Dr Simone Ravicz
                                                                                                                                                              

Symptoms, Stages of Depression & Suicide
By: Darlene Albury

Many individuals lack awareness of what major depression is, how it presents itself, and its course of progression and outcomes. The essential feature or symptom of a depressive episode is a period of at least two (2) weeks during which there is either depressed mood or the loss of interest in or pleasure in nearly all activities. In children or adolescents, the mood may be irritable rather than sad. There must be at least four additional symptoms from a list that includes changes in appetite or weight, sleep, and psycho motor activity; decreased energy; feelings of worthlessness, hopelessness or guilt; difficulty thinking, concentrating, or making decisions; recurrent thoughts of death or suicidal ideation, plans, or attempts.

For depression to be considered as the possible problem and/or diagnosis, a symptom must either be newly present or clearly worsened compared with the person's previous pattern of behavior or status. The symptoms must persist for most of the day, nearly every day, for at least two (2) consecutive weeks. The episode must be accompanied by clinically significant distress or impairment in social, occupational, or other important areas of functioning. For some individuals with milder episodes, functioning may appear to be normal, but requires markedly increased effort.

The mood in a depressive episode is often described by the person as depressed, sad, hopeless, or discouraged. In some cases, sadness may be denied at first, but may subsequently be aroused by interview (pointing out that the individual looks or sounds as if he or she is about to cry). In some individuals who complain of having no feelings, or feeling anxious, the presence of a depressed mood can be guessed from the person's facial expression and behavior. Some individuals emphasize physical complaints (e.g., bodily aches and pains) rather than reporting feelings of sadness. Many individuals report or exhibit increased irritability, persistent anger, a tendency to respond to events with angry outbursts or blaming others, or an exaggerated sense of frustration over minor matters. In children and adolescents, an irritable or cranky mood may develop rather than a sad or dejected mood. This presentation should not be confused with a spoiled child pattern of irritability when frustrated.

 Loss of interest or pleasure is nearly always present, at least to some degree. Individuals may report feeling less interested in hobbies, “not caring anymore,” or not feeling any enjoyment in activities that were previously considered pleasurable. In some individuals, there is significant reduction from previous levels of sexual interests or desires. Appetite is usually reduced, and many individuals feel that they have to force themselves to eat. Other individuals, particularly those encountered in ambulatory settings, may have increased appetite and may crave specific foods. There may be a significant loss or gain in weight, or in children, a failure to make expected weight gains may be noted.

The most common sleep disturbance associated with depressive episode is insomnia. Individuals typically have middle insomnia (waking up during the night and having difficulty returning to sleep) or terminal insomnia (waking too early and being unable to return to sleep). Initial insomnia (difficulty falling asleep) may also occur. Less frequently, individuals present with oversleeping (Hypersomnia) in the form of prolonged sleep episodes at night or increased daytime sleep. Sometimes the reason individual seeks treatment is for the disturbed sleep.

 Psycho motor changes include agitation (e.g., the inability to sit still, pacing, hand-wringing; or pulling or rubbing of the skin, clothing or other objects). The psycho motor agitation must be severe enough to be observable by others and not represent merely subjective feelings. Decreased energy, tiredness, and fatigue are common. An individual may report sustained fatigue without physical exertion, even the smallest task seems to require substantial effort.

Worthlessness or guilt associated with a depressive episode may include unrealistic negative evaluations of one's worth or guilty preoccupations or reflections over minor past failings. Individuals often misinterpret neutral or trivial day to day events as evidence of personal defects and have an exaggerated sense of responsibility for unbecoming events. The sense of worthlessness or guilt may be of delusional proportions. Blaming one's self for being sick and for failing to meet occupational or interpersonal responsibilities as result of the depression is very common.

Associated features: With ndividuals with depressive episodes there is frequently present tearfulness, irritability, brooding, obsessive contemplation, anxiety, phobias, excessive worrying over physical health, and complaints of pain (e.g., headaches or joint pain, abdominal, or other pains). Some individuals have panic attacks that occur in a pattern that meets criteria for panic disorder. Some individuals note difficulty in intimate relationships, less satisfying social interactions, or difficulties in sexual functioning. There may be marital problems, occupational problems, academic problems, alcohol or other substance abuse, or increased utilization of medical services. The most serious consequence of a depressive episode is attempted or contemplated suicide. Suicide risk is especially high for individuals with psychotic features, a history of previous suicide attempts, a family history of completed suicides, or concurrent substance use. There may also be an increased rate of premature death from general medical conditions. Depressive episodes often follow psychosocial stressors (e.g., the death of a loved one, marital separation, divorce).

Depression, manic depression, schizophrenia, substance abuse, eating disorders, and severe anxiety increase the probability of suicide attempts and contemplations. Most individuals who commit suicide have a diagnosable mental health problem and usually have a physical illness.

Symptoms can cause significant personality changes and changes in work habits, making it difficult for others to empathize with the depressed individual. Some symptoms are so disabling that they interfere significantly with the patient's ability to function. In very severe cases, people with depression may be unable to eat or even to get out of bed. Symptomatic episodes may occur only once in a lifetime or may be recurrent, chronic, or longstanding; in some cases, they seem to last forever. Occasionally, symptoms appear to be precipitated by life crises or other illnesses; at other times, they occur at random. Clinical depression commonly occurs concurrently with, or can be precipitated by, injury or other medical illnesses and worsens the prognosis for these illnesses. Even the diagnosis of concurrent illness is made much more difficult by the presence of depression.

The differential diagnosis of depression contains numerous physical, emotional, and psychological disorders, including the following:

• Alcohol and substance abuse
• Anorexia nervosa
• Anxiety disorders
• Conversion disorder
• Delirium
• Dementia
• Elder abuse
• Human immunodeficiency virus-1 (HIV-1) encephalopathy
• Acquired immunodeficiency virus (AIDS)–related dementia
• Hyperparathyroidism
• Myopathies
• Panic disorder
• Child abuse and child sexual abuse
• Schizophrenia
• Drug and chemical toxicities
• Withdrawal syndromes
• Posttraumatic stress disorders
• Postpartum depression
• Postpartum psychosis
• Sheehan syndrome
• Chronic fatigue syndrome
• Liver failure
• Vitamin deficiency
• Medication adverse effects
• Medication abuse/overdose
• Withdrawal from abused substances
• Apathetic thyrotoxicosis (in elderly persons)
  

"Truly a Myth"

 The (APPC) The Annenberg Public Policy Center, also tracked daily suicide rates to determine whether they are higher during the holiday season. On the basis of official suicide deaths in the United States, the months of November, December, and January typically have the lowest daily rates of suicide in the year, they report. "Despite what many believe, the holiday-suicide link is truly a myth," the APPC says. There is clearly a seasonal pattern to suicide rates, with rates highest usually in the spring and summer months.

"The return of the holiday-suicide connection may be related to the fact that the adult (ages 25+) suicide rate has increased in recent years in step with the great recession," noted APPC's Dan Romer, PhD, who has directed the study since its inception. "With more people affected by suicide, news stories about suicide may be more common over the holidays, bringing the myth back to our attention."

 The APPC cautions that stories in the media that make suicide appear more common during the holidays may encourage vulnerable individuals to consider it. "Although we have no direct evidence for such an effect of the holiday myth, other evidence indicates that the media can influence vulnerable people to attempt suicide. This has led various public health agencies and organizations to encourage more accurate reporting about suicide by the news media (see www.reportingonsuicide.org)," the APPC said in a statement.

According to the Centers for Disease Control and Prevention, suicide is the tenth leading cause of death in the United States. It is the second leading cause of death for people aged 15 to 25 years, and the fourth leading cause of death for those between the ages of 25 and 44 years. It is now a greater cause of death than traffic fatalities.

APPC. Published online December 4, 2012.

Incidence associated with depression is difficult to specify, but the morbidness of depression takes the omportant form of completed suicide, the eighth leading reported cause of death in the United States. Depression is a potentially life-threatening mood disorder that affects individuals. It is reported that depressed patients are more likely to develop type 2 diabetes, and cardiovascular disease. Over the next 20 years, bipolar depression is proposed to be the second leading cause of disability worldwide and the leading cause of disability in high-income nations, including the United States.

 In addition to sizable pain and suffering that interfere with individual functioning, depression affects those who care about the ill person, sometimes destroying family relationships or work mechanics between the patient and others therefore, the human cost in suffering cannot be overestimated.

The majority of individuals with depression do not realize that they have a treatable illness, and do not seek treatment. It is also reported that only 50% of individuals diagnosed with major depression received any kind of treatment, and only 20% of those individuals receive treatment consistently. Continual ignorance about depression and misunderstanding about it by the public, and even some health providers, as a personal weakness or failing that can be willed or wished away, lead to painful disapproval of and avoidance of the diagnosis by many persons who are affected by the disease.

Suicide: According to statistics, more men than women kill themselves; but more women than men attempt suicide. Suicide occurs across ethnic, economic, social and age boundaries. Suicide is preventable. Most suicidal individuals desperately want to live; they are just unable to see alternatives to their problems. Most suicidal individuals give definite warning signals of their suicidal intentions, but others are often unaware of the significance of these warnings, or unsure of what to do about them. Talking about suicide does not cause someone to become suicidal. Surviving family members not only suffer the loss of a loved one to suicide, but are also themselves at a higher risk of suicide and emotional problems.

Major depression is the psychiatric diagnosis most commonly associated with suicide, and the lifetime risk of suicide is among those who go untreated for depressive disorders. It is of vital importance that professional care providers, home care providers as well as individuals are educated about mood disorders, and what the lack of treatment and care can potentially lead to and also putting others at risk.

Thank you for reading
Darlene Albury