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Depression and suicide

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Title: Depression and suicide


1
Depressionand 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?
  • 300 000 people in Ireland suffer from depression
  • gt5 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 illnessconclusion
  • 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 illnessconclusion
  • 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 ones own life

18
Suicide in Ireland2004
  • 457 suicides 14 / 100 000 population aged gt14
    years
  • 356 males
  • 101 females
  • 83 / 100 000 male population aged 15-24 years
  • 77 / 100 0000 male population aged 25-34 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..
  • Patients 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
  • Dont 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 1890 303 302 (helpline only)
  • Tel (01) 661 7211
  • Fax (01) 661 7217
  • E-mail aware_at_iol.ie
  • Samaritans, Marlboro Street, Dublin 1.
  • Tel 1850 60 90 90
  • You can find www.samaritans.org
  • Solas, (bereavement helpline for children),
  • Barnardo's, Christchurch Square, Dublin 8,
  • Tel (01) 473 2110 (Mon-Fri 10am - 12noon)
  • E-mailsolas_at_barnardos.ie
  • Console,
  • All Hallows College, Drumcondra, Dublin 9
  • Lo-call helpline 1800 201 890 (Mon-Fri 900am -
    500pm) Hours may vary during holiday periods
  • Tel (01) 857 4300 (Mon-Fri 900am - 530pm)

37
Information sources
  • National Suicide Bereavement Support Network,
  • P.O. Box 1, Youghal, Co. Cork,
  • E-mail nsbsn_at_eircom.net
  • 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) 4277 499
  • E-mail nsrf_at_iol.ie
  • Irish Association of Suicidology,
  • 16 New Antrim Street, Castlebar, Co. Mayo
  • Tel (094) 925 0858
  • Fax (094) 925 0859
  • E-mail office_at_ias.ie

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.
    www.changingminds.co.uk
  • www.depressionalliance.org
  • www.thecalmzone.net
  • www.thesite.org/info/health/depression
  • www.lifesigns.ukf.netwww.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-mailbooksales_at_rcpsych.
    ac.uk, or you can download them from
    www.rcpsych.ac.uk.

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 itseriously
  • 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 23244-255, 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
  • 1997-2003 (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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