Two Takes on Depression

Treating the very condition you live with––A clinician's dual perspective

Late in Life Suicide: A Concerning Trend

Studies show that middle aged women have the highest death by suicide rate

Though suicide is the most preventable kind of death, more than 3,000 people die by suicide each day. Another way to look at this is how Dr. Catherine Le Galès-Camus, from the World Health Organization, describes the rate of suicide each year:

"Worldwide, more people die from suicide than from all homicides and wars combined."

What research is showing is that the largest growing number of completed suicides is occurring in later life, more specifically with women aged 50 and older. Clinical studies have shown a staggering 49% rise in emergency room visits for drug-related suicide attempts by females of this age population. The lethal drugs of choice are narcotic pain relievers hydrocodone and oxycodone. Studies by The Center for Disease Control concurs that suicide rates for middle aged adults has significantly increased. These findings make the case that late in life suicide is a cause for great concern that warrants ongoing attention from researchers, health care providers, policy makers, and society at large.

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Related Facts

Suicide is a significant risk for anyone with a mental illness, but is exponentially higher for people with depression. Women attempt suicide more than men, and the steep rise in abuse of narcotic pain relievers by women is now considered a public health crisis.

Data shows that prescriptions for anti-anxiety medication and antidepressant medication have tripled over the last decade, while the seeking of psychotherapy has significantly reduced. This trend suggests that more adults are using medication as a means to manage mental health than learning how to use therapeutic skills to manage life stressors. And with narcotic pain reliever prescriptions tipping the scales, it appears that baby boomers are vulnerable to depression – and suicide.

10 Tips to offset this trend

1) Know the risks for suicide. Awareness can help identify at-risk adults, which include:

• Previous suicide attempt(s)

• History of depression or other mental illness

• Alcohol or drug abuse

• Family history of suicide or violence

• Physical illness

• Sudden loss or significant change

• Feeling alone

2) Understand what depression REALLY is. It’s essential to understand that depression is not just a disorder of mood. It is a disorder of thinking which infects the clarity of the mind like a virus attacks the body. It weakens your defenses, cripples your resolve, and leaves you vulnerable to corrosive thoughts. If you think someone is depressed, don’t rely on them reaching out to you. Instead, be proactive. Call them. Check in. Visit in person. And if you feel worried about them, don’t hesitate to call for help (Police, Fire Department, Family/Friends or call 1.800.273.TALK for guidance),

3) Primary care physicians and other health providers need to recognize that physical pain is often a symptom of depression. Better detection, diagnosis and follow up care are needed. In addition, professionals who prescribe narcotics, or any kind of medication, should monitor the frequency of requested refills. Family members should also be aware. This helps to sequester the lethality of the drugs.

4) The mental and physical health needs of women vary across the life span. We need to teach women what to expect when these changes occur. For example, low levels of estrogen have been linked to suicidal behavior in women. As women age, many go through the emotional process of a life review (measuring what they’ve done in their life as mortality approaches), which can heighten sadness. Social connections can wane with age, so isolation is a common experience in later life. It’s vital to encourage women to take an active role in monitoring their own health, so if confronted with these developmental experiences, alternatives can be explored.

5) Interpersonal stress is a risk factor for suicide. Illness, job loss, or any kind of adversity can shake one’s feeling of hope and resolve. It’s important for women to keep a healthy diet and get plenty of sleep. Getting a good 30 minutes a day of natural sunshine boosts melatonin – and exercise releases mood pleasing endorphins. If you notice that someone you love is under stress and not tending to self-care, consider this a significant setback and risk factor.

6) Evaluate feelings of security. A loss of personal control is another issue related to suicidal thinking in older females. For example, women who no longer feel important or necessary to family and/or children, or who no longer feel useful can lapse into self-destructive thoughts. A central way to combat this is to reinvest socially with others. Be it volunteering, finding a low-stress part time job, joining a book club, the goal here is to form new connections and feelings of self worth.

7) Pills are not skills. We need to return to recommending psychotherapy for skill building and problem solving when it comes to mental illness. We live in a disposable society, where medication is seen the quick fix. Medication is a tremendous tool for dealing with suicide and depression, but it’s not sufficient enough to help women navigate the challenges that present in later-life.

8) Choose life affirming experiences. Make sure to activate your senses. Touch. See. Smell. Taste. Listen. Re-engage to the world and it will refuel you. The goal here is to redirect negative thinking to more positive kinds of experiences.

9) Stay away from alcohol and drugs – recreational, over the counter and prescriptive. They can blur your thinking and loosen inhibition.

10) Have a safety plan at-the-ready. Knowing what to do if suicidal thinking occurs can reduce death by suicide. Identify triggers that may lead to a suicidal crisis, such as an anniversary of a loss, stress from work, or a love relationship. Also include contact numbers for the person's doctor or therapist, as well as friends and family members who will help in an emergency. It’s also a good idea to share this safety plan with others.

References

Center for Disease Control (May, 3, 2013). Suicide Among Adults Aged 35–64 Years — United States, 1999–2010.Morbidity and Mortality Weekly Report, 62(17):321-325.

Substance Abuse and Mental Health Services Administration (2011). DAWN report: Trends in emergency department visits for drug-related suicide attempts among females: 2005 and 2009. Center for Behavioral Health Statistics and Quality, (12):1-6.

World Health Organization. “Suicide Huge but Preventable Public Health Problem.” September 8, 2004. Retrieved September 9, 2013 at http://www.who.int/mediacentre/news/releases/2004/pr61/en/index.html


 

Dr. Deborah Serani is an award-winning author. Her books"Depression and Your Child: A Guide for Parents and Caregivers" and "Living with Depression" are published by Rowman & LIttlefield.

 

 

 

 

 

Deborah Serani, Psy.D., is a psychologist and psychoanalyst who lives with depression and specializes in its diagnosis and treatment.

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