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1 Depression and suicide. What is depression? Transient depressed mood in reaction to negative experiences is normal Feeling sad is a normal reaction.

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Presentation on theme: "1 Depression and suicide. What is depression? Transient depressed mood in reaction to negative experiences is normal Feeling sad is a normal reaction."— Presentation transcript:

1 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 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 AwareAware, 72 Lower Leeson Street, Dublin 2. Lo-Call: (helpline only) Tel: (01) Fax: (01) SamaritansSamaritans, Marlboro Street, Dublin 1. Tel: You can find Solas, (bereavement helpline for children),olas Barnardo's, Christchurch Square, Dublin 8, Tel: (01) (Mon-Fri 10am - 12noon) ConsoleConsole, 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 NetworkNational 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 FoundationNational Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork Tel: (021) Irish Association of SuicidologyIrish 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 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


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