Depression and Suicide
Suicide rates have been falling globally but rising in the U.S. since the turn of the millennium, and now stand at 14.2 deaths per 100,000 population. Since 1999, the suicide rate his risen 35 percent. And since 2006, the rate of increase in suicide deaths has been accelerating. The U.S. National Center for Health Statistics reports that for females, suicide is most likely to occur between ages 45 and 64; among males, the peak age is 75 and above. For both men and women, the rate of suicide is significantly higher in rural areas than in urban ones.
Most suicides are linked to some form of psychiatric illness, particularly depression, and the more severe the depression, the greater the risk. Still, most people with major depression do not die by their own hand. Studies show that about 5 percent of depressed persons may have thoughts about suicide—suicidal ideation. Only a small percentage of them actively make plans to end their lives.
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Many people have fleeting thoughts of suicide at some, usually difficult, time in their life. But they typically counter that with thoughts about all that they, or their loved ones, would lose. Depression, by its very nature, impairs such cognitive flexibility. It changes patterns of thinking and feeling so that those suffering cannot see a way out their current state of mind or envision a future possibility of feeling better.
Those with depression brood over not just their current situation but all setbacks they’ve encountered, all losses and relationship failures, all adverse childhood experiences, and are weighed down even further by all the negativity. In addition, depression magnifies the perception of pain. Those with depression are especially likely to see suicide as the only way to escape the suffering and psychic pain.
According to the U.S. Department of Health and Human Services, 2 percent of people ever treated for depression in an outpatient setting take their own life. Among those ever hospitalized for treatment of depression, the rate of death by suicide is twice as high (4 percent).
Among those hospitalized for depression because of suicidal ideation or suicide attempt, 6 percent eventually take their own life. About 60 percent of people who kill themselves have a mood disorder that s potentially treatable; younger persons who kill themselves often have a substance abuse disorder as well. Life events involving loss—a job, a relationship, one’s health—play a role, too.
Suicide, some observers believe, is less an attempt to end one’s own life than to escape the mental pain of endless negative thoughts, reliving life’s failures and defeats, enduring constant self-recrimination, and envisioning only bleakness ahead, which are the hallmarks of depression.
Rejection of any kind—relationship breakup, the silence of a friend, social shunning— is one of the harshest experiences a human can endure and can create so much emotional agony that it is increasingly linked to suicide attempts among young adults. Studies show that the same areas of the brain that are activated by physical pain are activated when we experience rejection. But unlike with physical pain, psychological pain can endlessly loop through the brain; every time such experiences are recalled, the pain is re-experienced in all its acute emotional intensity.
Just as depression can run in families, so can suicide. Depressed people with a family member who died by suicide are themselves at elevated risk for taking their own life. People who have PTSD as well as depression are at increased risk of suicidal ideation and suicide attempts. A history of trauma also raises the risk of suicide among those who suffer depression. Substance use, by itself, is a major risk factor for suicide, and when it accompanies depression, it adds to the risk of taking one’s life.
Loneliness is a significant contributing factor to depression, and people who are socially isolated are at higher risk of suicide than those who are not. Because the brain makes no distinction between physical and psychological pain, people who have chronic pain along with depression—or any chronic illness—are at elevated risk of suicide. Most of those who complete suicide are men, but women are four times more likely than men to make a suicide attempt..
The clearest warning sign of suicide is talk about wanting to die. And the best way to determine whether suicide is a risk is to ask. It is popularly believed that asking someone directly if they’re thinking about suicide will put the idea in their head, but that is not the case. The person is likely to be relieved; they want to feel better but don’t know how.
People in the depths of hopelessness give clues to suicide risk in the way they talk. They talk about having no purpose, feeling trapped, being a burden to others, or feeling unbearable pain. There are behaviors that signal risk, too—isolating themselves, searching online for ways of ending their life, calling or visiting people to say goodbye, giving away possessions. Sometimes a very sudden improvement in mood can signal suicide.
Anti-suicide pacts have long existed between therapists and patients as a way to prevent suicide. The contract may be written or verbal but, either way, patients at risk agree to commit no self-harm and to call the therapist if they ever have thoughts of ending their life, or to call an emergency number such as 911. Anti-suicide pacts are not legally binding contracts.
Nevertheless, they are common among groups of EMS technicians and other first responders, a line of work linked to particularly high rates of suicide, and they are becoming increasingly common among family members and friends of anyone who has been suicidal.
Effective suicide contracts—written, signed and dated, with a copy given to each party and kept in an accessible location—are concrete and help a person take action. They don’t just specify that the person will not die by suicide but also list numbers to call when the person is in immediate danger—911, helplines, and the therapist, family member, or friend.