According to the American Foundation for Suicide Prevention, 90% of suicides committed in the United States occur in persons with a diagnosed psychiatric condition. Over 50% of people who die by suicide are diagnosed with major depressive disorder. In any given year, 25 million Americans are suffering from depression. These statistics are striking, and they indicate a need for us to better understand how depression can lead to suicidal thoughts and actions. Based on the numbers, most Americans will have a friend or family member who is at risk at some point in their lives. The purpose of this blog post is to discuss the role of depression and suicide; how we may prevent some suicides by better understanding depression; and how to give hope to those with chronic depression who experience suicidal ideation before they attempt suicide.
While it is true that 25 million Americans meet diagnostic criteria for major depression, many of them never have suicidal thoughts. If suicide becomes an option, many of them change their minds or never seriously think about acting on their thoughts. How can we manage depression so that people don’t lose hope and decide there are no other options? What factors contribute to the decision that suicide is the best option? What factors may contribute to the loss of hope? Below are some points to consider to increase our understanding of the link between depression and suicide.
Early Detection and Treatment Can Make a Difference: our goal should be to educate depressed people about their symptoms and the influence of biological and environmental factors such as genetics and stress. Helping people understand that having depression isn’t their fault decreases their shame and possibly allows them to retain some hope of improvement. The longer that someone has suffered from depression without treatment, the less likely they are to actively engage in treatment and believe that it will help.
Social Support Can Make a Difference: educating spouses, parents, siblings, significant others, and anyone else close to the person could help in a couple of ways. First, the more family members and friends understand about depression, the less likely they are to blame the person, shame them, or lose their patience. The second reason to educate loved ones is to make them aware of their own need for emotional support. It is common to suffer from feelings of shame and blame when you live with or are often around someone who is chronically depressed.
Treating Substance Abuse When It Occurs with Depression: statistics show that when alcohol addiction is factored in, the rate of suicide in depressed persons increases from 50% to 75%. This significant increase warrants specific attention to treatment for alcohol dependence. The best treatment facilities understand the role of dual diagnosis and focus on treating both conditions since the depression may have been present prior to the substance abuse.
Focus on the Role of Hope: many people become suicidal when they believe all other options have been exhausted. People become suicidal when they believe they are a burden to others, and they have nothing to offer. In retrospect, the friends and relatives of those who have committed suicide recognized the possibility but did not know the gravity of the person's hopelessness. When people begin to withdraw from their life, we can begin to assess their level of hope. Missing work or quitting their job, spending most of their time alone, or giving away their possessions are more obvious signs. More subtle signs may be that the person avoids conversations with close friends and family, ends treatment with their therapist or psychiatrist, or loses interest in things they used to do regularly and enjoy. Noticing differences in the person’s affect (no smiles or laughter) and seeing them less at family gatherings or social events can be signs that are often overlooked. While family members and friends may realize the person is depressed, they may dismiss behaviors that signal the situation is getting worse.
Seek Treatment for Depression That Is Evidence-Based: it is very important that people suffering from chronic depression seek treatment that includes scientifically validated approaches. Talk therapy is not enough in these situations. The therapy sessions should be frequent, sometimes two or more times a week; include specific goals; include spouses or other loved ones as appropriate in some of the work; and should teach coping skills. People are more likely to regain hope if they see a clear vision forward of how they can experience relief from their symptoms. If a psychiatrist is part of the treatment plan, persons experiencing chronic depression should see their psychiatrist on a regular basis to determine whether the medication regimen is appropriate or sufficient to address the severity of the person’s symptoms. Patients who see their care providers more frequently and have clear goals are more likely to believe their providers care about their well-being. This can also be a factor in restoring hope during a dark period in their life.
Preventing suicide in persons with chronic depression is a difficult process. There is no treatment or no treatment provider that can prevent every suicide from happening. But if we know the risks and the benefits of good treatment, we can restore hope to many who are contemplating suicide as their only option.