Major Depression, Bipolar Disorder, and Suicidal Ideation

Frayer models for these topics Grandiocity Mania Posturing Loose association Euphoria Anhedonia

Insomnia Hypersomnia Passive suicidal ideation Active suicidal ideation

Major Depression Extreme sadness or melancholy Inability to function at work, school, or home Insomnia or hypersomnia Decreased sex drive Isolation Decreased socialization Decreased or increased appetite Anhedonia Decreased energy Hopelessness Self mutiliation Suicidal thoughts (passive or active) Suicide attempts

Depression statistics • 1/3 of patients in outpatient clinics • Total social cost is $16.3 • Each successive generation born since WWII has shown higher rates of depression • Women twice as likely to be diagnosed • Group most susceptible- the young (age 15-19 women;25-29 men)

Self-destructive Patient Ratings •Suicide Awareness (SA)- Check every hour; some thoughts of killing self •Suicide Observation-(SO) Check every fifteen minutes; past attempts •Constant Observation (CO)”arm’s length” precautions; no

Bipolar Disorder

Vincent van Gogh is suspected to have suffered from Bipolar disorder

Bipolar Disorder • • •

• • • • •

Formerly known as Manic Depression First described by Emil Kraepelin in 1899 Manic phase can include elation, euphoria, irritability, and impatience. In extreme cases delusional beliefs about being royalty or having superhuman powers. Followed by episode of major depression. Occurs equally among men an women More prevalent in higher socioeconomic levels Onset between 5 and 60 18X the risk in families Investigating connection with creativity

Who commits suicide?

Did you know that… More than 30,000 people in the United States die by suicide every year. It is this country’s 11th leading cause of death, and is often characterized as a response to a single event or set of circumstances. Unlike popular conceptions, suicide is a much more involved phenomenon. The factors that contribute to any particular suicide are diverse and complex, so our efforts to understand it must incorporate many approaches. The clinical, neurobiological, legal and psychosocial aspects of suicide are some of the major lines of inquiry into suicide. This lecture will present some information from each of these perspectives…

SUICIDE & DEPRESSION WARNING SIGNS AND RISK BEHAVIORS The first step in preventing suicide is to identify and understand the risk factors. A risk factor is anything that increases the likelihood that persons will harm themselves. However, risk factors are not necessarily causes. Research has identified the following risk factors for suicide (DHHS 1999): • • • • • • • • • • • •

Previous Suicide Attempts A Marked Personality Change Loss of Interest in Activities Once Enjoyed Significant Change in Appetite or Body Weight Difficulty Sleeping, Oversleeping, or Difficulty Concentrating Feelings of Worthlessness or Inappropriate Guilt Stress Break-up of a Romantic Relationship Chronic Illness Persistent Boredom and/or Lethargy Isolation, a feeling of being cut off from other people Cultural and religious beliefs—for instance, the belief that suicide is a noble resolution of a personal dilemma

• • • • • • • • • • •

•

Unusual Neglect of Appearance History of mental disorders, particularly mood disorders History of alcohol and substance abuse Family history of suicide Family history of child maltreatment Impulsive or aggressive tendencies (Reckless Behavior ) Barriers to accessing mental health treatment Loss (relational, social, work, or financial) Physical illness Easy access to lethal methods Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or suicidal thoughts Local epidemics of suicide (pacts)

Men vs. Women Males

• • •

•

Suicide is the eighth leading cause of death for all U.S. men (Anderson and Smith 2003). Males are four times more likely to die from suicide than females (CDC 2004). Suicide rates are highest among Whites and second highest among American Indian and Native Alaskan men (CDC 2004). Of the 24,672 suicide deaths reported among men in 2001, 60% involved the use of a firearm (Anderson and Smith 2003).

Females

•

Women report attempting suicide during their lifetime about three times as often as men (Krug et al. 2002).

Most popular press articles suggest a link between the winter holidays and suicides (Annenberg Public Policy Center of the University of Pennsylvania 2003). However, this claim is just a myth. In fact, suicide rates in the United States are lowest in the winter and highest in the spring (CDC 1985, McCleary et al. 1991, Warren et al. 1983).

Occurrence

Suicide took the lives of 30,622 people in 2001 (CDC 2004).

• Suicide rates are generally higher than the national average in the western states and lower in the eastern and midwestern states (CDC 1997). Source: Vital Statistics of the United States

In 2002, 132,353 individuals were hospitalized following suicide attempts 116,639 were treated in emergency departments & released (CDC 2004).

In 2001, 55% of suicides were committed with a firearm (Anderson and Smith 2003).

Protective Factors Protective factors buffer people from the risks associated with suicide. A number of protective factors have been identified (DHHS 1999): •

Effective clinical care for mental, physical, and substance abuse disorders • Easy access to a variety of clinical interventions and support for help seeking • Family and community support • Support from ongoing medical and mental health care relationships • Skills in problem solving, conflict resolution, and nonviolent handling of disputes • Cultural and religious beliefs that discourage suicide and support selfpreservation instincts