A discussion about depression and suicide

Dr. Maria Lorente-ForestiSan Mateo County Office of Diversity and Equitywww.smchealth.org/ode

Workshop Description:

Goals: • To learn about how depression is diagnosed

and affects those around us. • To learn about suicide and how to respond

when an individuals expresses suicidal ideation.

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What comes to mind when you hear the word “mental health”?

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1:4

Prevalence of any mood disorder among adults

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Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.

Prevalence of Major Depression among adults

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Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.

.• The economic burden of mental illness in the

United States is substantial—about $300 billion in 2002. Mental illness is an important public health problem in itself—about 25% of U.S. adults have a mental illness—but also because it is associated with chronic medical diseases such as cardiovascular disease, diabetes and obesity.

• Other published studies report that about 25% of all U.S. adults have a mental illness and that nearly 50% of U.S. adults will develop at least one mental illness during their lifetime.

MMWR/September 2, 2011/Vol. 60: Mental Illness Surveillance Among Adults in the United States

Depression and SuicideSigns and Symptoms of Depression

Emotions:

• Sadness, anxiety, guilt, anger, mood swings, lack of emotional responsiveness, feelings of helplessness, hopelessness and irritability

Thoughts:

• Frequent self-criticism, self-blame, pessimism, impaired memory and concentration, indecisiveness and confusion, tendency to believe others see one in a negative light and thoughts of death and suicide

From the Mental Health First Aid Curriculum

.Signs and Symptoms of Depression

Behaviors:

• Crying spells, withdrawal from others, neglect of responsibilities, loss of interest in personal appearance, loss of motivation, slow movement and use of drugs and alcohol

Physical:

• Fatigue, lack of energy, sleeping too much or too little, overeating or loss of appetite, constipation, weight loss or gain, headaches, irregular menstrual cycle, loss of sexual desire andunexplained aches and pains

From the Mental Health First Aid Curriculum

Depression in the workplace

• Decreased productivity• Morale problems• Lack of cooperation• Safety problems, accidents• Absenteeism or presentteeism• Being tired all the time• Complains of unexplained aches and pains• Alcohol or other drug misuse

From the Mental Health First Aid Curriculum

Types of mood disorders

• Major Depressive Disorder• Bipolar Disorder• Postpartum Depression• Seasonal Affective Disorder

From the Mental Health First Aid Curriculum

Major depressive disorder

5 of the following symptoms, must include one of the first two, occurring almost every day for two weeks

• Depressed mood• Loss of pleasure of interest• Appetite change• Sleep disturbance• Behavioral activation or slowing• Feelings of worthlessness or guilt• Difficulty concentrating or making decision• Recurrent thoughts of death

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR; APA, 2000

Depressive symptoms mnemonic: Space Drags

• S leep disturbance• P leasur/interst (lack

of)• A gitation• C oncentration• E nergy

• D epressed mood• R uns slow • A ppetite disturbance• G uilt, worthless,

useless• S uicidal thoughts

Mood Disorder prevalence

Disorders:• Major Depression• Bipolar I• Bipolar II• Postpartum

Depression• Seasonal Affective

Disorder

Prevalence:

4.9%3.2%0.8%0.5%13%

Risk factors for depression

• Distressing or uncontrollable event• Exposure to stressful life event• Difficult childhood• Ongoing stress and anxiety• Another mental illness• Previous episode of depression• Family history• More sensitive emotional nature

From the Mental Health First Aid Curriculum

Risk factors for depression

• Illness that is life threatening, chronic or associated with pain

• Medical conditions• Side effects of medications• Recent childbirth• Premenstrual changes in hormone levels• Lack of exposure to bright light in winter• Chemical (neurotransmitter) imbalance• Substance misuse

From the Mental Health First Aid Curriculum

What would you do?

During a phone call a friend tells you that she’d rather not wake up or she wished she was never born. (Someone told you about a week ago that she broke up with her partner). What would you do?

• Please break into small groups and discuss your thoughts.

From the Mental Health First Aid Curriculum

suicide• 10th leading cause of death in the US (38,364 people a year) ~ 2001.• One person dies by suicide every 13.7 minutes in the US.• Among people aged 15 to 24, suicide is the 3rd leading cause of death.• The suicide rate for young men in the US is the highest in the world.• Research shows that during our lifetime 20% of us will have a suicide

with in our immediate family and 60% of us will personally know someone who dies by suicide.

• Firearms are the most commonly used suicide method accounting for 49% of suicide deaths.

• 90% of suicides are committed by people suffering from psychological disorders • 60% are associated with mood disorders• 25% to 50% with alcohol use and abuse• 10% Borderline Personality Disorder

With all that we know… suicide is not predictable. Individuals of all races, creeds, incomes and educations levels due by suicide.

McIntosh, J. L., & Drapeau, C. W. (for the American Association of Suicidology). (2012). U.S.A. suicide 2010: Official final data. Washington, DC: American Association of Suicidology, dated November 28, 2012, downloaded from http://www.suicidology.org.

US suicide rates over time

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From American Foundation for Suicide Prevention

Assess for risk of suicide or harm

The most common crisis to assess for with depression symptoms are:

• Suicidal thoughts and behaviors• Non-suicidal self-injury

From the Mental Health First Aid Curriculum

Suicide risk assessment• Gender

• Male

• Age• Increasing in adolescence

and elderly

• Culture • White and rising rates in

Native Americans

• Chronic physical illness• Mental illness

• Living alone• Marital Status

• Widowed, divorced

• Use of alcohol or other substances

• Less social support• Previous attempt• Organized plan• Easy access to lethal

means

From the Mental Health First Aid Curriculum

Warning signs of suicide• Threatening to hurt of kill

oneself• Seeking access to means• Talking or writing about

death, dying or suicide• Feeling hopeless• Feeling worthless or

engaging in risky activities• Feeling trapped

• Increasing alcohol or drug use

• Withdrawing from family, friends, society

• Demonstrating rage and anger or seeking revenge

• Appearing agitated• Having a dramatic change

in mood• Giving things away

From the Mental Health First Aid Curriculum

Myths and facts• People who talk about killing themselves

rarely commit suicide.

• The suicidal person wants to die and feels there is no turning back.

• If you ask someone about their suicidal intentions, you will only encourage them to kill themselves

• All suicidal people are deeply depressed

• Suicidal people rarely seek medical attention.

• Most people who die by suicide have given some verbal clues or warning signs.

• Suicidal people are ambivalent about dying; they may desperately want to live but can’t see alternative to problems.

• Asking lowers their anxiety & helps deter suicidal behavior. It also allows for accurate risk assessment.

• Not all suicidal people are depressed. Once they make the decision, they may appear happier/carefree.

• 75% of suicidal individuals will visit a physician within the month before they kill themselves

MYTH FACT

Questions to ask• Ask the person directly whether he or she is

suicidal:• Are you having thoughts of suicide?• Are you thinking of killing yourself?

• Ask the person whether he or she has a plan:• Have you decided how you are going to kill

yourself?• Have you decided when you would do it?• Have you collected the things you need to carry

out your plan? From the Mental Health First Aid Curriculum

How to talk with a person who is suicidal

• Discuss your observations with the person• Ask the questions without dread• Do not express a negative judgment• Appear confident, as this can be reassuringCheck for Two Other Risks:• Has the person been using alcohol or other

drugs?• Has she or he made a suicidal attempt in the

past? From the Mental Health First Aid Curriculum

How to Help• Let the person know you are concerned and

are willing to help.• Express empathy for what the person is going

through.• Encourage the person to do most of the

talking.• State that thoughts of suicide are often

associated with a treatable mental disorder.• Tell the person that thoughts of suicide are

common and do not have to be acted on.From the Mental Health First Aid Curriculum

Keeping the person safe

• Provide a safety contact number that is available at all times• Help the person think about people or things that have been

supportive in the past• Find out whether those supports are still availableDo Not:• Leave an actively suicidal person alone• Use guilt and threats to try to prevent suicide

• You will go to hell.• You will ruin other people’s lives if you die by suicide

• Agree to keep their plan a secret

From the Mental Health First Aid Curriculum

Keeping the person safe

• Mental health professionals always advocate seeking professional help for someone who has suicidal thoughts.

• The person may be very reluctant to involve a professional helper.

• Try to involve the person in the decisions making about what should be done, who should be told and how to seek professional help.

• If the person has a weapon or is behaving aggressively, call law enforcement.

From the Mental Health First Aid Curriculum

Help is available

• National suicide hotline: 1-800-273-TALK (8355)• San Mateo County Suicide Prevention Center: 650-

579-0359• San Mateo County ACCESS line: 1-800-686-0101• Call 911• If safe to do so, take person to the nearest

emergency room• Seek help from a mental health professional

Mental health first aid

What is Mental Health First Aid? First aid is the help given to an injured person before medical treatment can be obtained. Mental Health First Aid is the help provided to a person developing a mental health problem or in a mental health crisis. The first aid is given until appropriate professional treatment is received or until the crisis resolves.

In a FREE 12 to 16 hour course, learn about:• A 5‐step action plan to help an individual in crisis.• The warning signs of emotional distress.• The resources available.

For more information please contact: Dr. Jei Africa at 650-573-2714 or Jafrica@smcgov.org

Office of Diversity & Equity ~ www.smchealth.org/ODE