1. Depression and suicide

2. 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

3. 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

4. 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

5. 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

6. How common is depression?
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

7. 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

8. 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

9. What causes depression?
Risk factors
Stress
Isolation: no one with whom to share worries
Perceived lack of practical support

10. 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

11. Why does depression occur?
Physical illness
Strokes
Heart disease
Cancer
Chronic painful conditions
Infections
‘flu
Glandular fever
Alcohol

12. Management of depression
Pharmacotherapy
Psychotherapy / counselling
Occupational therapy
Hospitalisation
Electroconvulsive therapy

13. Management of depression
Pharmacotherapy
Antidepressants
SSRIs
Tricyclics
MAOIs
Antipsychotics
Lithium

14. Management of depression
Psychotherapy
Cognitive
Behavioural
Family therapy
Marital therapy

15. 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

16. 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

17. Suicide
The intentional ending of one’s own life

18. Suicide in Ireland 2004
457 suicides: 14 / population aged >14 years
356 males
101 females
83 / male population aged years
77 / male population aged years

19. 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

20. 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

21. 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

22. 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?

23. 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

24. Suicide attempt in a young person
Is 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. What help is available for depression?
CBT
a type of talking treatment that helps someone understand their thoughts, feelings and behaviour

36. Information sources Aware, 72 Lower Leeson Street, Dublin 2.
Lo-Call: (helpline only)
Tel: (01)
Fax: (01)
Samaritans, Marlboro Street, Dublin 1.
Tel:
You can find
Solas, (bereavement helpline for children),
Barnardo's, Christchurch Square, Dublin 8,
Tel: (01) (Mon-Fri 10am - 12noon)
Console,
All Hallows College, Drumcondra, Dublin 9
Lo-call helpline: (Mon-Fri 9:00am - 5:00pm) Hours may vary during holiday periods
Tel: (01) (Mon-Fri 9:00am - 5:30pm)
Fax: (01)
Low-cost one-on-one counselling service for anyone affected by suicide. Also run therapeutic support groups and courses (low-cost). Provide referral service.

37. Information sources National Suicide Bereavement Support Network,
P.O. Box 1, Youghal, Co. Cork,
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, Cork
Tel: (021)
Irish Association of Suicidology,
16 New Antrim Street, Castlebar, Co. Mayo
Tel: (094)
Fax: (094)

38. 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.
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 , ext. 146; fax ; or you can download them from

39. 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

40. 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

41. 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

42. but do tell their family
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: , 1993

43. 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

44. 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

45. 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
(seven years): total €17m spent on suicide prevention

46. 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