Depression and BiPolar Support Alliance When Suicide Becomes an Option

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Depression and BiPolar Support
AllianceWhen Suicide Becomes an Option

• Donna Holland Barnes, PhD
• Howard University
• NOPCAS, Inc

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Agenda

• Review the literature
• General statistics
• Suicide Myths and Facts
• Clues to look out for
• Assessing and Managing Suicidal Risk
• Q A

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Review of the literature

• Anywhere from 25-50 of patients with bipolar
  disorder have attempted suicide and, between 10
  15 eventually die by suicide (Jamison, 2000
  Pillmann, eet al, 2001 Rihmer, 2002 Mitchell,
  2004)
• Multiple suicide attempts are common among BP
  patients (Michaelis, 2003)
• Treatment with Lithium is associated with reduced
  suicidal risk (Baldessarini, 2001 Sharma, 2003)

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Literature Review (continued)

• Widespread underdiagnosis and undertreatment of
  major depression and BP disorder contribute to an
  unacceptable risk of suicide (Nierenberg et. al,
  2001Lindemann et al, 1999)
• Many of those diagnosed with BP are not on mood
  stabilizers and more effort is needed to do a
  better job in treatment (Shi et al,2004)

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Literature Review (continued)

• Co-occurence alcoholism is associated with a
  higher rate of attempted suicide among family
  members with BP and oftentimes triples the risk
  (Potash et al, 2000 Comtois, 2004)
• For the majority population, attempts among those
  with BP generally occur before the age of 25,
  attempting at a relatively young age (Lopez P. et
  al, 2001)

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General Statistics

• In 2005, we had 32,637 suicides (11.0)
• 23,478 white males (19.7)
• 6,049 white females (5.0)
• 2,429 nonwhite male (9.0)
• 681 non white female (2.3)
• 1,621 black males (8.7)
• 371 black female (1.8)
• 2,188 Hispanic (5.1)
• 392 Native American (12.4)
• 796 Asian/Pacific Islanders (5.2)

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So where does this leave us?
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Suicide Myths
and Facts

• Myth No one can stop a suicide, it is inevitable.
• Fact If people in a crisis get the help they
  need, they will probably never be suicidal
  again.
• Myth Confronting a person about suicide will
  only make them angry and increase the risk of
  suicide.
• Fact Asking someone directly about suicidal
  intent lowers anxiety, opens up communication
  and lowers the risk of an impulsive act.
• Myth Only experts can prevent suicide.
• Fact Suicide prevention is everybodys business,
  and anyone can help prevent the tragedy of
  suicide

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Myths And Facts About Suicide

• Myth Suicidal people keep their plans to
  themselves.
• Fact Most suicidal people communicate their
  intent sometime during the week preceding
  their attempt.
• Myth Those who talk about suicide dont do it.
• Fact People who talk about suicide may try, or
  even complete, an act of self-destruction.
• Myth Once a person decides to complete suicide,
  there is nothing anyone can do to stop them.
• Fact Suicide is the most preventable kind of
  death, and almost any positive action may save
  a life.

How can I help? Ask the Question...
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• Indirect verbal clues
• Im tired of life, I just cant go on.
• My family would be better off without me.
• Who cares if Im dead anyway.
• I wont be around much longer.
• Pretty soon you wont have to worry about me.
• I keep messing up.
• I am really not that important.

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• Behavioral Clues
• Any previous suicide attempt
• Acquiring a gun or stockpiling pills
• Co-occurring depression, moodiness, hopelessness
• Putting personal affairs in order
• Giving away prized possessions
• Sudden interest or disinterest in religion
• Drug or alcohol abuse, or relapse after a period
  of recovery
• Unexplained anger, aggression and irritability

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• Situational Clues
• Being fired or being expelled from school
• A recent unwanted move
• Loss of any major relationship
• Death of a spouse, child, or best friend,
  especially if by suicide
• Diagnosis of a serious or terminal illness
• Sudden unexpected loss of freedom/fear of
  punishment
• Anticipated loss of financial security
• Loss of a cherished therapist, counselor or
  teacher
• Fear of becoming a burden to others

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• Assessing and Managing Suicidal Risk

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How do we know what we know?

• Assessment is based on
• How much we learn from the person
• The context in which suicide is being considered
• Recognition of warning signs
• Presence of risk factors
• Presence of protective factors
• What the suicidal person is willing to do to help
  us save his or her life

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Relationship is Everything!

• How much we learn depends on how much they like
  us, and how much we like them.
• Dont let them tick you off to prove they cant
  be helped.
• Find something to like.
• YOU HAVE TO REMAIN HOPEFUL ABOUT THE FINAL
  OUTCOME!

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Why Now Questions

• Things have been bad for a long time, whats
  happened recently?
• Whats changed so much that youre now thinking
  about suicide?
• Why now? Why are you thinking about killing
  yourself today?

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WITH WHAT?

• Elicits methods of suicide under
  consideration
• Only so many ways to die
• How? (name them)
• Access to means?
• More than one method?
• Degree of lethal planning?
• Backup plan?

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Whos Involved Sample Questions

• Whos important to you?
• Who else knows youre in this much pain?
• Who is your main support?
• Who could help right now?
• Who needs to know about your troubles?
• Who have you told about your suicidal thinking?

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Whos involved?Elicits social psychological
context

• It usually takes two
• Who wont/cant help?
• Who can make it worse?
• Who cares and can make it better?
• Professionals involved?
• Double suicide pact?
• Murder-suicide?

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When and With What in the Past?Elicits important
suicide history

• Past attempts?
• Past suicidal ideation?
• Rescue sought or avoided?
• Timing of attempt?
• Social response to attempt?
• What saved them?
• New method vs. old method?

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Why Not Now?Elicits protective factors

• Reasons for living?
• Spiritual or religious prohibitions?
• Duties to others/pets?
• Tidying up or to list before dying?
• Fear of death?
• More reasons is good, none is bad
• Low risk does not equal no risk

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Sample Why Not Now Questions

• Give me some reasons why you may want to live?
• You given me reasons why you want to die, can you
  tell me why you still want to live?
• Give me three reasons to keep on going?

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• Thank you!

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• NOPCAS,Inc
• P.O. 75571
• Washington, DC 20013
• www.nopcas.org
• 202-549-6039