Transcript A discussion about depression and suicide

A discussion about
depression
and suicide
Dr. Maria Lorente-Foresti
San Mateo County
Office of Diversity and Equity
www.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.
.
What comes to mind when you hear
the word “mental health”?
.
1:4
Prevalence of any mood
disorder among adults
.
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
.
.
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
Suicide
Signs 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
• D epressed mood
• P leasur/interst (lack of) • R uns slow
• A gitation
• A ppetite disturbance
• C oncentration
• G uilt, worthless, useless
• E nergy
• S uicidal thoughts
Mood Disorder
prevalence
Disorders:
Prevalence:
• Major Depression
4.9%
• Bipolar I
3.2%
• Bipolar II
0.8%
• Postpartum Depression
0.5%
• Seasonal Affective
Disorder
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
.
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
• Living alone
• Marital Status
• Widowed, divorced
• Increasing in adolescence and
• Use of alcohol or other
elderly
substances
• Culture
• White and rising rates in
Native Americans
• Chronic physical illness
• Mental illness
• 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 • Increasing alcohol or drug
oneself
use
• Seeking access to means
• Talking or writing about
death, dying or suicide
• Feeling hopeless
• Withdrawing from family,
friends, society
• Demonstrating rage and
anger or seeking revenge
• Appearing agitated
• Feeling worthless or
engaging in risky activities • Having a dramatic change
in mood
• Feeling trapped
• Giving things away
From the Mental Health First Aid Curriculum
Myths and facts
MYTH
FACT
• People who talk about killing themselves • Suicidal people are ambivalent about dying;
they may desperately want to live but can’t
rarely commit suicide.
see alternative to problems.
• The suicidal person wants to die and feels
• Asking lowers their anxiety & helps deter
there is no turning back.
suicidal behavior. It also allows for accurate
risk assessment.
• If you ask someone about their suicidal
intentions, you will only encourage them
• Not all suicidal people are depressed. Once
to kill themselves
they make the decision, they may appear
happier/carefree.
• 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.
75% of suicidal individuals will visit a
physician within the month before they kill
themselves
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 reassuring
Check 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 available
Do 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: 650-5790359
• 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:
•
•
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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 [email protected]
Office of Diversity & Equity ~ www.smchealth.org/ODE