(Find the original article on BP Magazine's website.)
Substance abuse, personal crises, and a history of unstable temperament and impulsive behavior compound the effects of severe depression in risk of suicide.
By Melvin G. McInnis, M.D.
Suicidal thoughts are common in most mood disorders. Any person who has depression of any appreciable severity is likely to at least occasionally harbor dark thoughts, often of death and ranging from overt plans to end their life to plea-bargaining with God to take them to heaven as soon as possible. Suicidal behavior—acting on the thought—occurs in one-third of individuals with bipolar disorder at some time in their life.
What factors are associated with suicide?
Our medical understanding of suicide behavior is based on “psychological autopsies,” in which researchers review the records of individuals who died by suicide. Often the researchers have contacted family members to determine the individual’s state of mind preceding the event. Common features include the presence of depression, alcohol or drug abuse, and a history of unstable temperament and impulsive behavior. More than 85 percent of individuals who die by their own hand have a psychiatric illness.
Identifying and treating depression is one of the best ways of preventing suicide. Offering treatment for substance abuse disorders and addressing crises in personal and social relationships can offer the person a way forward—but no single factor outweighs the effect of depression.
Scores of scientific articles and books have been written about identifying risk and protective factors for suicide behavior. The depressed, isolated, and older male with substance abuse issues who has access to the means to end his life is often considered to be at higher risk, while the younger, impulsive person in a relationship crisis is at risk for an attempt that is interpreted as a plea for help.
Every individual with depression enters a risk period for self-harm that could lead to suicide-related behavior. As a depression lifts, the energy levels may improve while the emotional states lag behind. The combination of improved energy in the context of a continuing depressed mood is a risky period and should be closely monitored.
What can I do to manage my suicidal thoughts?
Personal prevention strategies should always be discussed with your treatment provider. I have found the following two-prong technique helpful for many of my patients in squelching suicidal ruminations: The first point is to avoid engaging in an internal debate that touches on anything related to death or suicide (for example, “Is life worth it?”). Second, counter intrusive thoughts with your own repetitive thought, such as “This is not an option for me now” or “I will move forward, it will be OK.” It can be any simple sentence that you repeat over and over in your mind to displace intrusive ruminations. It’s like finding an unwanted salesperson at your door—you repeat “No thank you, I’m not interested” until they go away.
How can I reduce my loved one’s risk of suicide?
Family and friends concerned about loved ones might consider a frank conversation that could be along the lines of “I know that thoughts of wanting to fade away or even die are part of depression. How bad do they get for you?” At any level of concern, it is advisable to request permission to attend an appointment with your loved one and raise your concerns with the care provider. Access to obvious means of self-harm should be removed.
The signs of imminent suicide are often concealed by the individual, as they know that if anyone realizes their plans they will intervene. If there is any concern over suicide risk of a loved one, act on it. Ask your loved one about suicide. Tell them your concerns. Talk to a health-care provider. Call a hotline or psychiatric emergency service. If you believe there is imminent threat, seek advice from the police and courts.
Suicide is one of the most difficult behaviors to predict; there is no fail-proof measure. That doesn’t mean we can’t do everything in our power to prevent it.
***
Find more Ask the Doctor columns written by Dr. McInnis here.