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Depressionand suicide
What is depression?
Transient depressed mood in reaction to negative experiences is normal
Feeling sad is a normal reaction to experiences that are stressful or upsetting
Most people, children as well as adults, feel low or `blue' occasionally
Depression becomes an illness when the depressed mood is serious and prolonged, and is accompanied by other symptoms and disturbances of functioning
Clinical features of depression Depressed mood Loss of interest and enjoyment Reduced energy: tiredness, decreased
activity Reduced attention, concentration Ideas of guilt, worthlessness Low self-esteem Hopelessness Suicidal ideation / actions
Signs of depression
Moodiness, irritability - easily upset, `ratty‘, tearful
Withdrawal - avoiding friends, family and regular activities
Feeling guilty or bad, being self-critical and self-blaming - hating yourself
Feeling unhappy, miserable and lonely a lot of the time
Feeling hopeless and wanting to die Finding it difficult to concentrate Not looking after your personal
appearance
Signs of depression
Changes in sleep pattern: sleeping too little or too much
Tiredness and lack of energy Changes in appetite Frequent minor health problems,
such as headaches or stomach-aches
Some people believe they are ugly, guilty and have done terrible things
How common is depression? 300 000 people in Ireland
suffer from depression >5% of population suffers
from a depressive illness at any one time
12% of adults at some time in life experience depression severe enough to warrant treatment
How common is depression? More common in females Most common between the
ages of 25 and 44 years 15-20% of cases run a chronic
course Accounts for up to one-third of
psychiatric admissions
What causes depression?
Life events / personal experiences
Family breakdown: marital separation, divorce Bereavement: death or loss of a loved one Neglect Abuse Bullying Physical illness
Depression can be triggered if too many changes happen in life too quickly
What causes depression?
Risk factors Stress Isolation: no one with whom to
share worries Perceived lack of practical support
What causes depression?
Biological factors genetic factors: depression may
run in families more common in females chemical changes in part of brain
that controls mood prevents normal brain functioning causes symptoms of depression
Why does depression occur? Physical illness
Strokes Heart disease Cancer Chronic painful conditions
Infections ‘flu Glandular fever
Alcohol
Management of depression Pharmacotherapy Psychotherapy / counselling Occupational therapy Hospitalisation Electroconvulsive therapy
Management of depression Pharmacotherapy
Antidepressants SSRIs Tricyclics MAOIs
Antipsychotics Lithium
Management of depression Psychotherapy
Cognitive Behavioural Family therapy Marital therapy
Depression as an illness:conclusion Very common Distressing and disabling for
patient and family Potentially serious
consequences Very treatable An illness which should bear
no stigma
Depression as an illness:conclusion Very common Distressing and disabling for
patient and family Potentially serious
consequences Very treatable An illness which should bear
no stigma
Suicide
The intentional ending of one’s own life
Suicide in Ireland2004 457 suicides: 14 / 100 000
population aged >14 years 356 males 101 females
83 / 100 000 male population aged 15-24 years
77 / 100 0000 male population aged 25-34 years
Suicide – risk factors
Psychiatric illness Depression: 10-15% suicide in major
depression Bipolar disorder: 10-15% suicide
Schizophrenia: 10% suicide
Alcohol, drug dependence: 15% suicide
Increased risk of suicide in a young person Depression or serious mental
illness; risk can be greatly reduced by treatment
Using drugs or alcohol when upset Previous attempts Planning how to die without being
saved A relative or friend who tried to kill
themselves
Who is most at risk of suicide? Young men Mental health and personality problems Following stressful event – usually relationship
problems Serious problems with the police, family or school for a
long time Abusing drugs or alcohol: highest risk of death by
suicide Some will already be seeing a counsellor, psychiatrist
or social worker Others have refused normal forms of help: trying to run
away from their problems?
sometimes the young person will have shown no previous signs of mental health problems
If there is a suicide attempt, ask….. Why now?
When did s/he feel so badly he wanted to die?
How did s/he cope previously? What is different now?
If there is a suicide attempt….. Patient’s denial of suicide ideation
cannot be equated with an absence of suicide risk
Opinion of family or significant others is of utmost importance
Suicide attempt in a young personIs this just attention-seeking? NO. Attempted suicide is always serious S/he needs:
Understanding of what s/he has been feeling
Someone to listen Someone who is prepared to help
Be aware: s/he may find it hard to put feelings into words
Why do young people try to kill themselves? Feeling sad and lonely; as if no
one really likes you Feeling that you are a failure Feeling that you just upset people Feeling that no one would care if
you were dead Feeling angry but unable to say so Feeling hopeless about the future
Why do young people try to kill themselves?Often, several upsetting things have
happened over a short time and one more upset or rejection is the ‘last straw’ An argument with parents Breaking up with a friend Being in trouble
Why do young people try to kill themselves? Trying to cope independently with
very upset feelings, or difficult problems, for the first time
Don’t know how to solve their problems, or lack the support they need to cope with a big upset
Feel overwhelmed and see no other way out
Why do young people try to kill themselves? Decision to attempt suicide may be
made quickly without thinking Just want problems to disappear No idea how to get help Feel as if the only way out is to kill
themselves
Specialist help after a suicide attempt Urgent assessment by a doctor as
soon as possible even if they look OK; harmful effects of an overdose can sometimes be delayed
Overdose with paracetamol is common: serious liver damage possible
Specialist mental health assessment aims to discover the causes of the problem
Specialist help after a suicide attempt Usual for parents or carers to be involved in
treatment understand the background to what has
happened work out together what help is needed;
another attempt is likely if help needed is not received
Treatment may involve individual or family work Small number of young people who try to kill
themselves really do still want to die serious depression other mental health problem
What help is available for depression?Helping yourself
Talking to someone you trust, and who understands lightens the burden work out practical solutions to problems
eg exam stress: talk to teacher or school counsellor.
Keep as active and occupied as possible Avoid over-stressing yourself Pregnancy: see your general practitioner or
family planning clinic Remember, you are not alone - depression is a
common problem and can be overcome
What help is available for depression?Parents and teachers: Very hard for young people to put
their feelings into words Help by
asking sympathetically how they are feeling
listening to them
What help is available for depression?Specialist help Seek if depression is chronic and
causing serious difficulties General Practitioner
referral to child and adolescent mental health service if indicated
Many young people will get better on their own with support and understanding
What help is available for depression?Specialist help for severe and
persistent symptoms
Psychological therapy, such as CBT Antidepressant medication
Needs to be taken for six months after the young person feels better
Fluoxetine is the only antidepressant for which there are reasonable data on efficacy in young people
What help is available for depression?CBT
a type of talking treatment that helps someone understand their thoughts, feelings and behaviour
Information sources
Aware, 72 Lower Leeson Street, Dublin 2.Lo-Call: 1890 303 302 (helpline only) Tel: (01) 661 7211Fax: (01) 661 7217E-mail: [email protected]
Samaritans, Marlboro Street, Dublin 1. Tel: 1850 60 90 90You can find www.samaritans.org
Solas, (bereavement helpline for children), Barnardo's, Christchurch Square, Dublin 8, Tel: (01) 473 2110 (Mon-Fri 10am - 12noon)[email protected]
Console, All Hallows College, Drumcondra, Dublin 9Lo-call helpline: 1800 201 890 (Mon-Fri 9:00am - 5:00pm) Hours may vary during holiday
periods Tel: (01) 857 4300 (Mon-Fri 9:00am - 5:30pm)Fax: (01) 857 4310E-mail: [email protected] Low-cost one-on-one counselling service for anyone affected by suicide. Also run
therapeutic support groups and courses (low-cost). Provide referral service.
Information sources
National Suicide Bereavement Support Network, P.O. Box 1, Youghal, Co. Cork, E-mail: [email protected] Offers support and information to those bereaved by suicide.
Holds seminars, information days, training days, etc
National Suicide Research Foundation,1 Perrott Avenue, College Road, CorkTel: (021) 4277 499E-mail: [email protected]
Irish Association of Suicidology, 16 New Antrim Street, Castlebar, Co. MayoTel: (094) 925 0858Fax: (094) 925 0859E-mail: [email protected]
Information sources: UK
“Changing Minds: Mental Health: What it is, What to do, Where to go?” A multi-media CD-ROM on mental health that looks at depression. www.changingminds.co.uk
www.depressionalliance.org www.thecalmzone.net www.thesite.org/info/health/depression www.lifesigns.ukf.net
www.selfharmalliance.orgwww.nhsdirect.nhs.uk
The Mental Health and Growing Up series contains 36 factsheets on a range of common mental health problems. To order the pack, contact Book Sales at the Royal College of Psychiatrists, 17Belgrave Square, London SW1X 8PG; tel 020 7235 2351, ext. 146; fax 020 7245 1231; e-mail:[email protected], or you can download them from www.rcpsych.ac.uk.
How can parents help?
Notice when your child seems upset, withdrawn or irritable
Encourage him to talk about his worries
Show you care by listening Help him to find his own solutions to
problems Get help if family problems or
arguments keep upsetting you and your child
How can parents help?
Practicality of medication in the home
Buy blister packs of medicine in small amounts: helps prevent impulsive suicides after a row or upset Getting pills out of blister pack takes longer
than swallowing straight from a bottle May be long enough to make someone
stop and think about what they are doing Keep medicines locked away
How can parents help?
Coping with a suicide attempt Natural to feel angry, frightened or
guilty May also be hard to take it
seriously Difficult to know what to do for the
best Seek independent help and advice
25% of patients at risk for suicide do not admit suicide ideation to clinicians
but do tell their family
Fawcett J et al. Psychiatr Ann 23:244-255, 1993
The majority of patients who commit suicide do not communicate their suicide intent during their final appointment
Isometsa ET et al. Am J Psychiatry 1995
Review of risk factors in 100 patient who
made serious suicide attempts 69 patients had only fleeting or no
suicidal thoughts before they made an attempt
None had a specific plan before the impulsive suicide
Most had no history of suicide attempt: first attempt in 67%
Hall RC et al. Psychosomatics 1999
Suicide prevention in Ireland: government spending 2003: 336 people died on Irish
roads 2003: 444 people died by suicide
2003 (one year): €17m spent on road safety
1997-2003 (seven years): total €17m spent on suicide prevention
Suicide prevention in Ireland: government spending 1997: 11% of Dept of Health spend
was on mental health
2004: 6.9% of Dept of Health spend was on mental health
Thanks, Michéal and Mary
