Showing posts with label risk factors. Show all posts
Showing posts with label risk factors. Show all posts

Male Suicide - Gender Factor in Suicide

Statistics
  • More men than women die by suicide. The gender ratio is 4:1.

  • 72% of all suicides are committed by white men.

  • 80% of all firearm suicides are committed by white men.

  • Among the highest rates (when categorized by gender and race) are suicide deaths for white men over 85, who had a rate of 59/100,000.

Suicide and men


Suicide accounts for 1 in 100 deaths. The majority of those who die in this way are men.


A worrying recent trend is the increasing rate of suicide among younger men (a trend not seen among young women). The majority of these men have not asked for help before their deaths.


The suicide rate in men also increases in those aged between 65 and 75 years. In contrast, the suicide rate in women varies less with age.


The higher suicide rate among men is a worldwide phenomenon. A few exceptions to the general rule exist, for example, among elderly women in Hungary and in some Asian countries. The reasons why men are more likely to kill themselves than women are complex and ill-understood. However, several pointers help our understanding.


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Risk factors for suicide


As well as being male, several other risk factors for suicide have been identified.


  • Age: suicide in men peaks in the 20s and again in the 60s and 70s.

  • Unemployment: the suicide rate has been shown to rise and fall with the unemployment rate in a number of countries – half of the record 33,000 people who committed suicide in Japan in 1999 were unemployed.

  • Social isolation: those who kill themselves often live alone and have little contact with others. They may have been recently widowed or have never married. They usually are not being able to form or sustain meaningful relationships.

  • Chronic illness: any chronic illness increases the risk of suicide.

  • Certain occupations: people with certain occupations are more likely to die by suicide, for example farmers (who usually work alone, may be unmarried and have access to the means of suicide, such as a shotgun or poisonous weedkiller).

  • Drug abuse: using drugs and/or alcohol to help cope with emotions, relationships, pressure of work etc.

  • A history of physical and sexual abuse.

  • Imprisonment.

  • Subject of bullying: being bullied at school/college/work.

Many of the above risk factors affect men more than women. It is important to remember that many people are subject to these factors, but only a tiny minority of them will end their own lives.


Other factors are also significant. The most important risk factor is the presence of a mental illness. The most important protective factor is the presence of good support from family or friends.


Mental illness


Research has shown that the vast majority of those who kill themselves are mentally ill at the time of their death. Two thirds are troubled by a depressive illness and 20 per cent by alcoholism.


Of people with severe depressive illnesses, 10 to 15 per cent will commit suicide.


Paradoxically, as mentioned above, depressive illnesses are more common in women, but suicide is more common in men.


Several possible explanations exist for this apparent discrepancy.
  • The more severe the depression is, the more likely it is to lead to suicide. So one possibility is that more severe forms of depressive illness are equally common in men and women. In addition, once men are depressed, they are more likely to end their lives. They are also more likely to choose especially lethal methods when they attempt suicide, for example, hanging or shooting. Depressive illness among people under 25 years of age is probably much more common now than it was 50 years ago, which may be one reason why the suicide rate is increasing in young men.

  • Alcoholism leads to suicide in 10 per cent of affected people. Alcoholism is much more common in men (though it is increasing rapidly among women).

  • Schizophrenia (a relatively uncommon condition affecting 1 in 100 of the population) leads to suicide in 10 per cent of affected people.

 Why is the male suicide rate rising?


The reasons why the number of men taking their own lives has risen in recent years are far from clear. All of the proposed explanations share a common feature – the changing role of men in society.
  • Adolescence has been prolonged, with adulthood and independence reached at a much later age than previously. Two generations ago, work began at the age of 14; one generation ago at 16 years for most; now many men only achieve financial independence in their mid 20s.

  • Men have a more stressful time in achieving educational goals than in the past and are now less successful in this regard than women.

  • Work is much less secure now and periods of unemployment are the norm for many (psychologically the threat of unemployment is at least as harmful as unemployment itself).

  • Alcohol use, and abuse, has increase markedly since the Second World War. Such use is often an attempt to cope with stress and to self-medicate symptoms.

  • Illegal drug abuse has become much more common (a correlation between the youth suicide rate and the rate of convictions for drug offences has been demonstrated in some countries).

  • Changes that are assumed to be symptoms of the 'breakdown of society' are associated with a rising suicide rate (examples include the rising divorce rate and falling church attendances).



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Boys don't cry


In many societies, expressing emotions, for example sadness, fear, disappointment or regret, is seen as being less acceptable for boys than girls.


This cultural stereotype is very difficult to shake off, though the advent of 'new men' in the 1990s, and 'metrosexual' men in this century, have made it more acceptable for men to open up to others.


If a man, particularly an older man, does cry openly, this is often a sign of severe depression and is taken very seriously indeed by health professionals.


Deliberate self-harm


Some of those who 'attempt' suicide, do not actually intend to kill themselves. They mimic the act of suicide by taking an overdose or cutting themselves.


They do so in an attempt to change an intolerable situation or gain attention from significant other people in their lives. This process is known as deliberate self-harm or parasuicide.


Such people can get considerable relief of tension and anxiety from these acts.


Deliberate self-harm is more common in women, though the proportion of men who self-harm is increasing.


Some 10 to 15 per cent of those who attempt suicide go on to complete suicide. Of course this means that 85 to 90 per cent do not.


Is Suicide Preventable?


Not all suicide attempts succeed and many people who set out with the clear intention of ending their own lives find that with good emotional and practical support they are able to adjust their circumstances to live a complete and fruitful life. The warning signs listed above do not inevitably lead to suicide attempts although where suicide is attempted and fails that person is much more likely to try again and be successful. People who feel suicidal often report a certain kind of tunnel vision, of being unable to see the broader picture and thinking only in terms of black and white. In such circumstances that individual may not be motivated to seek out help for themselves and it falls on others to offer support by listening, offering encouragement and sometimes even challenging the preconceptions that people hold about themselves such as their abilities and their worth to society.


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How does suicide affect others?


It's not true that suicide hurts no one except the person who takes his or her life.


Those who are left behind will typically go through a number of stages as they grieve – denial, anger, guilt, confusion, a protective wish to prove death was accidental, and, perhaps, depression and anxiety.


Barriers to effective treatment of depression in men


  • Men are less likely to recognize that they are under stress or unhappy, let alone ill.

  • Men are less likely to consult their doctor when distressed.

  • If they do consult their doctor, they are more likely to complain of physical symptoms (for example, stomach ache) or vague ill-health.

  • Health professionals are often less likely to consider a diagnosis of mental illness in men.

  • Some of the young men who kill themselves without ever seeking help seem to not have an identifiable mental illness. Rather, they are troubled by a philosophical dilemma, a disease of the soul, for which suicide seems the solution.



Sources and Additional Information:




Post Partum Depression for New Moms and Dads

The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect — depression.


Many new moms experience the baby blues after childbirth, which commonly include mood swings and crying spells and fade quickly. But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Rarely, an extreme form of postpartum depression known as postpartum psychosis develops after childbirth.


Postpartum depression isn't a character flaw or a weakness. Sometimes postpartum depression is simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms — and enjoy your baby.


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Symptoms


Signs and symptoms of depression after childbirth vary depending on the type of depression.


Baby blues symptoms

Signs and symptoms of the baby blues — which last only a few days or weeks — may include:
  • Mood swings

  • Anxiety

  • Sadness

  • Irritability

  • Crying

  • Decreased concentration

  • Trouble sleeping

Postpartum depression symptoms

Postpartum depression may appear to be the baby blues at first — but the signs and symptoms are more intense and longer lasting, eventually interfering with your ability to care for your baby and handle other daily tasks. Postpartum depression symptoms may include:
  • Loss of appetite

  • Insomnia

  • Intense irritability and anger

  • Overwhelming fatigue

  • Loss of interest in sex

  • Lack of joy in life

  • Feelings of shame, guilt or inadequacy

  • Severe mood swing

  • Difficulty bonding with the baby

  • Withdrawal from family and friends

  • Thoughts of harming yourself or the baby

Untreated, postpartum depression may last for a year or more.


Postpartum psychosis

With postpartum psychosis — a rare condition that typically develops within the first two weeks after delivery — the signs and symptoms are even more severe. Signs and symptoms of postpartum psychosis may include:
  • Confusion and disorientation

  • Hallucinations and delusions

  • Paranoia

  • Attempts to harm yourself or the baby

When to see a doctor


If you're feeling depressed after your baby's birth, you may be reluctant or embarrassed to admit it. But it's important to call your doctor if the signs and symptoms of depression:
  • Don't fade after two weeks

  • Are getting worse

  • Make it hard for you to care for your baby

  • Make it hard to complete everyday tasks

  • Include thoughts of harming yourself or your baby

Getting early treatment for postpartum depression can speed your recovery.


If you suspect that you're developing postpartum psychosis, seek medical attention immediately. Don't wait and hope for improvement. Postpartum psychosis may lead to life-threatening thoughts or behaviors.


Causes


There's no single cause for postpartum depression. Physical, emotional and lifestyle factors may all play a role.


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Physical changes
The postpartum period is a time of great changes in the body. These changes can affect a woman’s mood and behavior for days or weeks.


Levels of the hormones estrogen and progesterone decrease sharply in the hours after childbirth. This change may trigger depression in the same way that much smaller changes in hormone levels can trigger mood swings and tension before menstrual periods. Some women are more bothered by these changes than others. They may be more likely to have postpartum blues or depression.


Hormone levels produced by the thyroid gland also may decrease sharply after birth. If these levels are too low, the new mother may have depression-like symptoms, such as mood swings, nervousness, fatigue, trouble sleeping, and tension.


Many women feel very tired after giving birth. It can take weeks for a woman to regain her normal strength. Some women have their babies by cesarean birth. Because this is major surgery, it will take them longer to feel strong again.


Also, new mothers seldom get the rest they need. In the hospital, sleep is disturbed by visitors, hospital routine, and the baby’s feedings. At home, the baby’s feedings and care must be done around the clock, along with household tasks. Fatigue and lack of sleep can go on for months. They can be a major reason for depression.


Emotional factors
Many emotional factors can affect a woman’s self-esteem and the way she deals with stress. This can add to postpartum depression.


Feelings of doubt about the pregnancy are common. The pregnancy may not have been planned. Even when a pregnancy is planned, 40 weeks may not be enough time for a couple to adjust to the extra effort of caring for a baby.


The baby may be born early. This can cause changes in home and work routines that the parents did not expect. If the baby is born with a birth defect, it may be even harder for the parents to adjust.


Having a baby who must stay in the hospital after birth can cause sadness and guilt. A woman may feel guilty that she did something wrong during pregnancy. Sadness about coming home without the baby is very common.


Mixed feelings sometimes arise from a woman’s past. She may have lost her own mother early or had a poor relationship with her. This might cause her to be unsure about her feelings toward her new baby. She may fear that caring for the child will lead to pain, disappointment, or loss.


Feelings of loss are common after having a baby. This can add to depression. The loss can take many forms:
  • Loss of freedom. This can include feelings of being trapped and tied down.

  • Loss of an old identity. The mother may be used to someone else taking care of her or of being in control.

  • Loss of prepregnancy shape and feelings of having sex appeal.

Lifestyle influences
A major factor in postpartum depression is lack of support from others. The steady support of a new mother’s partner, other family members, or friends is a comfort during pregnancy and after the birth. It helps when others can assume household chores and share in child care. If a woman lives alone or far away from her family, support may be lacking.


Breast-feeding problems can make a new mother feel depressed. New mothers need not feel guilty if they cannot breast-feed or if they decide to stop. The baby can be well nourished with formula. Your partner or other supportive person can help with some of the feedings, giving you more time for yourself or for rest.


The Role of Myths
Women who have an idea of the “perfect mother” are more likely to feel let down and depressed when faced with the needs of day–to–day mothering. Three myths about being a mother are common:


Myth No. 1: Motherhood Is Instinctive. First-time mothers often believe that they should just know how to care for a newborn. In fact, new mothers need to learn mothering skills just as they learn any other life skill. It takes time and patience. It takes reading child care books, watching skilled child caregivers, and talking with other mothers. As a mother’s skills grow, she will become more sure of herself.


Mothers also may believe that they must feel a certain way toward their newborns or they are not “maternal.” In fact, some women feel very little for their infants at first. Mother love, like mothering skills, does not just happen. Bonding often takes days or even weeks. When the special feelings of motherhood begin to emerge, they should be nurtured.


Myth No. 2: The Perfect Baby. Most women dream about what their newborns will look like. When the baby arrives, it may not match the baby of their dreams.


Also, babies have distinct personalities right from birth. Some infants are easier to care for. Others are fussy, have upset stomachs, and are not easy to comfort. A new mother may find it hard to adjust to the baby.


Myth No. 3: The Perfect Mother. For some women, being perfect is a never-ending goal. A mother may think she is not living up to the ideal. She may feel that she is a failure.


Of course, no mother is perfect. It is not true that every woman can “have it all.” Most women have trouble finding a balance between caring for a new baby and keeping up with household duties, other children, and a job. They often feel this way even with a lot of support.


Risk factors


Postpartum depression can develop after the birth of any child, not just the first. The risk increases if:
  • You have a history of depression, either during pregnancy or at other times

  • You had postpartum depression after a previous pregnancy

  • You've experienced stressful events during the past year, including illness, job loss or pregnancy complications

  • You're having problems in your relationship with your spouse or significant other

  • You have a weak support system

  • You have financial problems

  • The pregnancy was unplanned or unwanted

The risk of postpartum psychosis is higher for women who have bipolar disorder.


Complications


Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems. Children of mothers who have untreated postpartum depression are more likely to have behavioral problems, such as sleeping and eating difficulties, temper tantrums and hyperactivity. Delays in language development are more common as well.


Untreated postpartum depression can last up to a year or longer. Sometimes untreated postpartum depression becomes a chronic depressive disorder. Even when treated, postpartum depression increases a woman's risk of future episodes of major depression.


Treatments and drugs


Treatment and recovery time vary, depending on the severity of your depression and your individual needs.


Baby blues

The baby blues usually fade on their own within a few days to weeks. In the meantime, get as much rest as you can. Accept help from family and friends. Connect with other new moms. Avoid alcohol, which can make mood swings worse. If you have an underactive thyroid, your doctor may prescribe thyroid medication.


Postpartum depression

Postpartum depression is often treated with counseling and medication.
  • Counseling. It may help to talk through your concerns with a psychiatrist, psychologist or other mental health professional. Through counseling, you can find better ways to cope with your feelings, solve problems and set realistic goals. Sometimes, family or relationship therapy also is helpful.

  • Antidepressants. Antidepressants are a proven treatment for postpartum depression. If you're breast-feeding, it's important to know that any medication you take will enter your breast milk. However, some antidepressants can be used during breast-feeding with little risk of side effects for your baby. Work with your doctor to weigh the potential risks and benefits of specific antidepressants.

  • Hormone therapy. Estrogen replacement may help counteract the rapid drop in estrogen that accompanies childbirth, which may ease the signs and symptoms of postpartum depression in some women. Research on the effectiveness of hormone therapy for postpartum depression is limited, however. As with antidepressants, weigh the potential risks and benefits of hormone therapy with your doctor.

With appropriate treatment, postpartum depression usually goes away within a few months. In some cases, postpartum depression lasts up to a year. It's important to continue treatment after you begin to feel better, however. Stopping treatment too early may only lead to a relapse.


Postpartum psychosis

Postpartum psychosis requires immediate treatment, often in the hospital.


When your safety is assured, a combination of medications — such as antidepressants, antipsychotic medications and mood stabilizers — may be used to control your signs and symptoms. Sometimes electroconvulsive therapy (ECT) is recommended as well. During ECT, a small amount of electrical current is applied to your brain to produce brain waves similar to those that occur during a seizure. The chemical changes triggered by the electrical currents can reduce the symptoms of depression, especially when other treatments have failed or when you need immediate results.


Treatment for postpartum psychosis can challenge a mother's ability to breast-feed. Separation from the baby makes breast-feeding difficult, and some medications used to treat postpartum psychosis aren't recommended for women who are breast-feeding. If you're experiencing postpartum psychosis, a team of health care providers will help you work through these challenges.


Lifestyle and home remedies


Postpartum depression isn't generally a condition that you can treat on your own — but you can do some things for yourself that build on your treatment plan. In fact, taking good care of yourself can help speed your recovery.


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  • Make healthy lifestyle choices. Include physical activity, such as a walk with your baby, in your daily routine. Eat healthy foods, and avoid alcohol.

  • Focus on little things to look forward to during the day. This might be a hot shower, relaxing bath, walk around the block, or visit with a friend.

  • Read something uplifting. Since depression may make it difficult to concentrate, choose something light and positive that can be read a bit at a time.

  • Indulge in other simple pleasures. Page through a magazine, listen to music you enjoy, sip a cup of tea.

  • Rest. Give your child a quiet place to sleep, and try to rest when the baby does.

  • Set realistic expectations. Don't pressure yourself to do everything. Scale back your expectations for the perfect household. Do what you can and leave the rest. Ask for help when you need it.

  • Make time for yourself. If you feel like the world is coming down around you, take some time for yourself. Get dressed, leave the house, and visit a friend or run an errand. Or schedule some time alone with your partner.

  • Avoid isolation. Talk with your partner, family and friends about how you're feeling. Ask other mothers about their experiences. Ask your doctor about local support groups for new moms or women who have postpartum depression.

  • Be patient. Know that it may take time to feel better and take one day at a time.

  • Be optimistic. Try to think of small things you're grateful for.

Remember, the best way to take care of your baby is to take care of yourself.


Prevention


If you have a history of depression — especially postpartum depression — mention it to your doctor as soon as you find out you're pregnant. Your doctor will monitor you closely for signs and symptoms of depression. Sometimes mild depression can be managed with support groups, counseling or other therapies. In other cases, antidepressants are recommended — even during pregnancy.



After your baby is born, your doctor may recommend an early postpartum checkup to screen for signs and symptoms of postpartum depression. The earlier postpartum depression is detected, the earlier treatment can begin. If you have a history of postpartum depression, your doctor may recommend antidepressant treatment immediately after delivery.


Post Partum Depression for Male


Although many people know that new moms are at increased risk of depression following the birth of a child, new research suggests that about 10 percent of new dads experience the "baby blues," too.


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What's more, the researchers found that if the mother experiences postpartum depression, the father is more apt to be depressed also, which puts the baby at a significantly greater risk of developing emotional, behavioral and developmental problems later on, according to the study.



"Pre- and postnatal depression in men is real. The overall rate of depression in fathers was 10.4 percent in our analysis, about twice what we would expect in the general population of men," said the study's lead author, James Paulson, an associate professor and clinical psychologist at Eastern Virginia Medical School in Norfolk.


Sources and Additional Information:

Suicide in the Elderly Population

Statistics


The elderly (defined as those over 65 years old) have, historically and currently, the highest suicide rates in most, but certainly not all, countries of the world.


The death rate in adolescent suicide attempts is roughly 2%; among men over 45 years old, R. W. Maris found 88% of first-time attempts are fatal. Other estimates are lower, but still on the order of 25-50%, though psychiatrist Herbert Hendin, questioning these numbers, points out that there seem to be many more elderly survivors of suicide attempts than there are suicide deaths in this age group.


Despite recent decreases in old-age suicide frequency and increases in youth suicide, the suicide rate for the elderly in the U.S. is still more than 50% higher than that of 15-24 year-olds.


26 percent of the population is over 50 years old; 39% of suicides are from this group, a rate 1.5 times the national average. White males over 50 years old are about 10 percent of the population, but 33 percent of the suicides in the U.S. Elderly white males have a suicide rate 5 times the national average.


Among people over 65 years old (12% of the population), the suicide rate was about 22 per 100,000 (21% of suicides) in 1986, or almost twice the national average. The actual rate for the elderly is probably a good deal higher, since, "Many deaths from suicide are never investigated and are reported mistakenly as accidents or deaths from natural causes, particularly when the victim was old."


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The annual suicide rate for elderly women (6.7/100,000) is lower than that for middle-aged women (7.9/100,000), and about one sixth that of elderly men (around 40/100,000); however the rate for women is relatively under-reported, since they tend to use methods (e.g. overdose) that leave room for other verdicts. Since American men most often use guns, these deaths are harder to attribute to "natural causes".


Nevertheless, the fact that American male suicide rates peak in old age while female rates are at their maximum during middle age is difficult to explain. The unpleasant realities of old age, increasingly poor health, death of a husband or wife, relegation to a nursing home, fall more frequently on women than men, due to the former's greater longevity.


On the other hand, women are generally better than men at maintaining social and family contacts. And men, due to the higher status and more competitive nature of their activities (e.g., business, sports, war) lose more social standing to the infirmities of old age than do women, who generally have lower rank and thus less distance to fall.


Reasons for these high rates seem to include:
(1) Social isolation and loneliness, especially among widowers.
(2) Physical isolation: because many old people live alone, a suicide attempt may not be discovered soon enough to survive it.
(3) The accumulation of losses, such as friends, physical and mental abilities, social status, and health.
(4) The elderly use more lethal methods than do younger people.
(5) Old people are less likely to survive any given level of injury than are younger, healthier, ones.


Some specific reasons were identified among elderly suicides from the Miami area. The single most-cited cause was "physical health concerns", which were more frequent than the next two reasons ("depression" and "unknown") combined.


Such health concerns are not necessarily accurate. In one study of 248 suicides, more people (8) killed themselves in the mistaken belief that they had cancer than the number of suicides who, in fact, had terminal cancer.


The real rates are probably a good deal higher than the official ones. This is because many drug overdoses have no witnesses, no wounds, and look like a natural death. Since serious pre-existing illness is common in the elderly, such deaths are particularly likely to be misdiagnosed as "natural." In one study, 15,000 autopsies in apparently-natural deaths were reviewed. 764 (5.1%) bodies contained enough poison to account for death.


About half of the elderly who commit suicide are "depressed", but depression is common amongst old people. Both psychiatric and physical illness are more common in elderly suicides than in younger ones, whose deaths are more often precipitated by relationship, school, job, or jail problems. Between 60 and 85 percent of elderly suicides had significant health problems and in four out of every five cases this was a contributing factor to their decision. On the other hand, non-suicidal elderly had similar rates of physical illness as the suicidal.


Does depression affect willingness to accept treatment for other medical problems? In one study, depressed patients were less inclined than non-depressed ones to want medical treatment when the likelihood for improvement in some physical disease was good, but there was no difference between the two groups when the prognosis was poor. It seems that both groups were equally realistic about a poor prognosis, but that the lower quality-of-life and hopes-for-the-future among depressed patients decreased their willingness to seek or accept help when the probability of improvement was good.


This is consistent with other data. For example, a survey of elderly (60-100 years-old) visitors to senior centers in Indiana found that depression, low self-esteem, and loneliness were not associated with a decision to end their lives if faced with terminal, or debilitating chronic, illness. Again, both the depressed and non-depressed elderly were similarly pragmatic about their options under these circumstances.


However, when the severity of the depression is taken into account, differences appear. Elderly patients who were hospitalized for major depression were asked, before and after anti-depressant medication, whether they wanted life-sustaining treatment for their current physical health problems and for two hypothetical physical illnesses.


In the relatively "mild" to "moderate" cases, remission of their depression did not increase their willingness to accept medical intervention; however in the most severely depressed people, it did. This suggests that people in the midst of severe depression should probably not make life-and-death decisions, because their views are likely to change after anti-depressant treatment.


Poverty is not a good suicide predictor. Sweden and Denmark both have high per-capita income as well as comprehensive social welfare for the aged. They also both have high suicide rates among the elderly, as well as in the general population. Greece and Mexico, which have a far lower (economic) standard-of-living than Sweden and Denmark, have particularly low rates, though higher in the elderly than in the general population.


Interestingly, during times of economic prosperity, the elderly suicide rate goes down while the suicide rate of younger adults goes up in the U.S.


A final observation: suicide notes left by the elderly tend to show a desire to end their suffering, rather than dwell on interpersonal relationships, introspection, or punishing themselves or others, which are common themes in younger suicides.


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Risk Factors for Elderly Suicide


Suicide can happen in any family. However, life events commonly associated with elderly suicide are: the death of a loved one; physical illness; uncontrollable pain; fear of dying a prolonged death that damages family members emotionally and economically; social isolation and loneliness; and major changes in social roles, such as retirement.


Among the elderly, white men are the most likely to die by suicide, especially if they are socially isolated or live along. The widowed, divorced, and recently bereaved are at high risk. Others at high risk include depressed individuals and those who abuse alcohol or drugs.


Contributing Factors of Elderly Suicide



Suicide is typically an outcome that can be attributed to any combination of acute factors. Where suicide is considered an impulsive act at any age, elder suicide is often a grim outcome derived from the manifestation of tendencies experienced over an extended period of time. In the United States, suicide is the eleventh leading cause of death in the nation. What is more alarming is that eleven deaths per 100.000 Americans are suicides carried out by white males aged 65 and older, almost triple that of the national average.



Loss and mourning
Life events can trigger suicidal thoughts and often involve the loss of a loved one and/or pet. In these situations, bereavement can last up to two years. It is during this period; elderly persons are most susceptible to suicide.



Irreversible changes in lifestyle

Changes in retirement, a move from one's home to a nursing facility or loss in mobility are it sudden or gradual, mechanical or physical, can also become a trigger for elderly suicide. In a broadcast for Northern Irelands BICNews 6 in December of 1997, Dr. Ivan Boksay stressed the importance of noticing early warning signs that may indicate suicidal tendencies in an elderly subject. Boksay further emphasized the heightened degree of risk elderly subjects were faced with given prior suicide attempts.



Sleep disturbances

Recent research has indicated an intrinsic link between elderly suicide and sleep deprivation. Excessive loss in sleep can result in the manifestation of several problems. Older adults who suffer sleep loss are more likely to suffer from depression, memory loss, problems concentrating excessive daytime drowsiness, more injuries accrued during evening hours and the abuse of over-the-counter sleeping aids. This of course results in a poorer quality of life. Insomnia is among the highest of sleep complaints from persons aged 60 and older.


Clues to Look For


There are common clues to possible suicidal thoughts and actions in the elderly that must be taken seriously. Knowing and acting on these clues may provide you the opportunity to save a life. In addition to identifying risk factors, look for clues in someone's words and/or actions.


It is important to remember that any of these signs alone is not indicative of a suicidal person. Bur several signs together may be very important. The signs are even more significant if there is a history of previous suicide attempts.
A suicidal person may show signs of depression, such as:
  • changes in eating or sleeping habits

  • unexplained fatigue or apathy

  • trouble concentrating or being indecisive

  • crying for no apparent reason

  • inability to feel good about themselves or unable to express joy

  • behavior changes or are just "not themselves"

  • withdrawal from family, friends or social activities

  • loss of interest in hobbies, work, etc.

  • loss of interest in personal appearance

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A suicidal person also may:
  • talk about or seem preoccupied with death

  • give away prized possessions

  • take unnecessary risks

  • have had a recent loss or expect one

  • increase their use of alcohol, drugs or other medications

  • fail to take prescribed medicines or follow required diets

  • acquire a weapon.



Immediate Action Is Needed If The Person Is Threatening Or Talking About Suicide If you have contact with older adults, look for these clues to a potentially suicidal person. Your observing, caring about, and a suicidal older adult the difference between life and death.


You See the Warning Signs of Suicide. What Now?


Some DOs and DON'Ts include:
  1. DO learn the clues to a potential suicide and take them seriously.

  2. DO ask directly if he or she is thinking about suicide. Don't be afraid to ask. It will not cause someone to be suicidal or commit suicide. You will usually get an honest answer. But don't act shocked, since this will put distance between you. (Some people may deny feeling suicidal but may still be very depressed and need help. You can encourage them to seek professional help for their depression. It's treatable.)

  3. DO get involved. Become available. Show interest and support.

  4. DON'T taunt or dare him or her to do it. This "common remedy" could have fatal results.

  5. DO be non-judgmental. Don't debate whether suicide is right or wrong, or feelings are good or bad. Don't lecture on the value of life.

  6. DON'T be sworn to secrecy. Seek support. Get help from persons or agencies that specialize in crisis intervention and suicide prevention. Also seek the help of the older person's social support network: his or her family, friends, physician, clergy, etc.

  7. DO offer hope that alternatives are available but do not offer glib reassurance. It may make the person feel as if you don't understand.

  8. DO take action. Remove easy methods they might use to kill themselves. Seek help.



Sources and additional information:




Bipolar Disorder

Overview



Bipolar disorder involves periods of excitability (mania) alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.



Statistics



About 5.7 million Americans, or 2.6% of the American population over the age of 18, have bipolar disorder.



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Symptoms



The manic phase may last from days to months and can include the following symptoms:
  • Agitation or irritation

  • Elevated mood


    • Hyperactivity

    • Increased energy

    • Lack of self-control

    • Racing thoughts


  • Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)

  • Little need for sleep

  • Over-involvement in activities

  • Poor temper control

  • Reckless behavior


    • Binge eating, drinking, and/or drug use

    • Impaired judgment

    • Sexual promiscuity

    • Spending sprees


  • Tendency to be easily distracted

These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.



The depressed phase of both types of bipolar disorder involves very serious symptoms of major depression:
  • Difficulty concentrating, remembering, or making decisions

  • Eating disturbances


    • Loss of appetite and weight loss

    • Overeating and weight gain


  • Fatigue or listlessness

  • Feelings of worthlessness, hopelessness and/or guilt

  • Loss of self-esteem

  • Persistent sadness

  • Persistent thoughts of death

  • Sleep disturbances


    • Excessive sleepiness

    • Inability to sleep


  • Suicidal thoughts

  • Withdrawal from activities that were once enjoyed

  • Withdrawal from friends

There is a high risk of suicide with bipolar disorder. While in either phase, patients may abuse alcohol or other substances, which can worsen the symptoms.



Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur simultaneously or in quick succession in what is called a mixed state.



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How does bipolar disorder affect someone over time?



Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.



Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:
  1. Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior.

  2. Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.

  3. Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.

  4. Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.  Some people experience more than one episode in a week, or even within one day. Rapid cycling seems to be more common in people who have severe bipolar disorder and may be more common in people who have their first episode at a younger age. One study found that people with rapid cycling had their first episode about four years earlier, during mid to late teen years, than people without rapid cycling bipolar disorder.  Rapid cycling affects more women than men.



Bipolar disorder tends to worsen if it is not treated. Over time, a person may suffer more frequent and more severe episodes than when the illness first appeared.  Also, delays in getting the correct diagnosis and treatment make a person more likely to experience personal, social, and work-related problems.



Proper diagnosis and treatment helps people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.


Treatment



For the manic phase of bipolar disorder, antipsychotic medications, lithium, and mood stabilizers are typically used. For the depressive phase, antidepressants are sometimes used, with or without the manic phase treatment.



There is very little long-term evidence suggesting that any medication has great success in the maintenance phase. However, in studies that followed patients for 2 years, lithium and some antipsychotics were found to be moderately successful.



Antipsychotic drugs can help a person who has lost touch with reality. Anti-anxiety drugs, such as benzodiazepines, may also help. The patient may need to stay in a hospital until his or her mood has stabilized and symptoms are under control.



Electroconvulsive therapy (ECT) may be used to treat bipolar disorder. ECT is a psychiatric treatment that uses an electrical current to cause a brief seizure of the central nervous system while the patient is under anesthesia. Studies have repeatedly found that ECT is the most effective treatment for depression that is not relieved with medications.



Getting enough sleep helps keep a stable mood in some patients. Psychotherapy may be a useful option during the depressive phase. Joining a support group may be particularly helpful for bipolar disorder patients and their loved ones.



Risk factors for bipolar disorder



Scientists are learning about the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.




Genetics



Bipolar disorder tends to run in families, so researchers are looking for genes that may increase a person's chance of developing the illness. Genes are the "building blocks" of heredity. They help control how the body and brain work and grow. Genes are contained inside a person's cells that are passed down from parents to children.



Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.



Genetic research on bipolar disorder is being helped by advances in technology. This type of research is now much quicker and more far-reaching than in the past. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Using the database, scientists will be able to link visible signs of the disorder with the genes that may influence them. So far, researchers using this database found that most people with bipolar disorder had:
  • Missed work because of their illness

  • Other illnesses at the same time, especially alcohol and/or substance abuse and panic disorders

  • Been treated or hospitalized for bipolar disorder.

The researchers also identified certain traits that appeared to run in families, including:
  • History of psychiatric hospitalization

  • Co-occurring obsessive-compulsive disorder (OCD)

  • Age at first manic episode

  • Number and frequency of manic episodes.

Scientists continue to study these traits, which may help them find the genes that cause bipolar disorder some day.



But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder. This is important because identical twins share all of the same genes. The study results suggest factors besides genes are also at work. Rather, it is likely that many different genes and a person's environment are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.



Brain structure and functioning



Brain-imaging studies are helping scientists learn what happens in the brain of a person with bipolar disorder.  Newer brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain's structure and activity.



Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. For example, one study using MRI found that the pattern of brain development in children with bipolar disorder was similar to that in children with "multi-dimensional impairment," a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia.  This suggests that the common pattern of brain development may be linked to general risk for unstable moods.



Learning more about these differences, along with information gained from genetic studies, helps scientists better understand bipolar disorder. Someday scientists may be able to predict which types of treatment will work most effectively. They may even find ways to prevent bipolar disorder.



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Tests & diagnosis



A diagnosis of bipolar disorder involves consideration of many factors. The health care provider may do some or all of the following:
  • Ask about your family medical history, particularly whether anyone has or had bipolar disorder

  • Ask about your recent mood swings and for how long you've experienced them

  • Observe your behavior and mood

  • Perform a thorough examination to identify or rule out physical causes for the symptoms

  • Request laboratory tests to check for thyroid problems or drug levels

  • Speak with your family members to discuss their observations about your behavior

  • Take a medical history, including any medical problems you have and any medications you take

Note: Use of recreational drugs may be responsible for some symptoms, though this does not rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.



Prognosis



Mood-stabilizing medication can help control the symptoms of bipolar disorder. However, patients often need help and support to take medicine properly and to ensure that any episodes of mania and depression are treated as early as possible.



Some people stop taking the medication as soon as they feel better or because they want to experience the productivity and creativity associated with mania. Although these early manic states may feel good, discontinuing medication may have very negative consequences.



Suicide is a very real risk during both mania and depression. Suicidal thoughts, ideas, and gestures in people with bipolar affective disorder require immediate emergency attention.



Complications



Stopping or improperly taking medication can cause your symptoms to come back, and lead to the following complications:
  • Alcohol and/or drug abuse as a strategy to "self-medicate"

  • Personal relationships, work, and finances suffer

  • Suicidal thoughts and behaviors

This illness is challenging to treat. Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder.



When to contact a doctor



Call your health provider or an emergency number right way if:
  • You are having thoughts of death or suicide

  • You are experiencing severe symptoms of depression or mania

  • You have been diagnosed with bipolar disorder and your symptoms have returned or you are having any new symptoms

If you have suicidal thoughts



Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:
  • Contact a family member or friend.

  • Seek help from your doctor, a mental health provider or other health care professional.

  • Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.

  • Contact a minister, spiritual leader or someone in your faith community.



Sources and Additional Information:


Depression and Suicide: Background and Statistics

We, the Depressed, in our darkest hours have
No energy to move
No reason to live
No will to survive
No hope in a cure
No reason to try.
We roam the earth as the living dead
Wanting only to extinguish
That persistent heart that beats,
That ceaseless breath that enters,
That pain that never relents.
 
Every cell of our being wants to die,
Yet Do We Live.






Background
Throughout the world, about 2000 people kill themselves each day. That's about 80 per hour, three quarters of a million a year. In the U.S., there are more than 80 deaths from suicide every day, 30,000 every year. This is the equivalent of a fully loaded jumbo jet crash every fifth day. From another perspective, you are more likely to kill yourself than be killed by someone else.



Another estimated 300,000 (or more) Americans a year survive a suicide attempt. A majority have injuries minor enough to need no more than emergency room treatment. However, about 116,000 are hospitalized, of whom 110,000 are eventually discharged alive. Their average hospital stay is 10 days; the average cost is $15,000.



"...without knowledge of proper dosages and methods, suicide attempts are often bungled, leaving the victim worse off than before. Many intended suicides by gunshot leave the person alive but brain-damaged; drug overdoses that are not fatal may have the same effect. One eighty-three-year-old woman obtained an insufficient number of pills and lost consciousness but did not die; her daughter ended up smothering her with a plastic bag."



Seventeen percent, some 19,000, of these people are permanently disabled, restricted in their ability to work, each year, at a cost of $127,000 per person. Such injury is tragic, either if someone were trying to kill herself and failed, or, perhaps even sadder, if the suicide attempt was intended as a "cry for help".



About 1.4% of Americans end their lives by suicide. This is the eighth leading cause of death in the U.S., and ranks fourth in years of lost life. The largest increase in the last 30 years has been among people between 15-24 years old, but the highest rates are still among the elderly. Men kill themselves at about four times the rate for women (19.8/100,000 vs 4.5/100,000 in 1994). Around 3% of adults make one or more suicide attempts.



There are more suicides than the official numbers show, but there is no general agreement as to how many more. Estimates of under-reporting range from around 1% to 300%...



Reasons for under-reporting include:
(1) Families or family physicians may hide evidence due to the stigma of suicide. For example, "Physicians and surviving relatives have told me in confidence of many deaths which were suicides, but which had been certified as natural or accidental deaths by a physician, either through error, misinformation, or deliberate falsehood....My own estimate is that there were an additional 10,000 deaths yearly [in the U.S.] which would have been certified as suicides if there had been complete and impartial investigations."
(2) The determination of cause-of-death is judged by local standards, which vary widely. In one egregious instance, a coroner would cite suicide only in deaths where a suicide note was found, and suicide notes are only found in around one quarter of known suicides.
(3) There are lots of ambiguous situations, some of which are suicides, but which almost always end up classified as "accidental" or "undetermined" the single-car "accident" with no skid marks; the "fall" off the night ferry; the "stumble" in front of the train; the "inadvertent" overdose; the gun-cleaning "mishap".
(4) Compared to the "accidental" or "undetermined" motive categories, there is a much larger number of deaths officially classified as "ill-defined and unknown causes of mortality," where even the actual cause of death is uncertain, and some of which are undoubtedly suicides.
(5) The frequency of physician-assisted suicide for the terminally ill is unknown, but, based on anecdotal evidence, is probably both substantial and increasing.



On the other side of the ledger, some doubtful cases may be classified as suicides as well. These usually occur in institutions, such as prisons, hospitals, religious orders, and the military, which control their population more-or-less completely.



For such institutions a verdict of suicide is likely to be the least embarrassing (after "natural") cause of death: homicides must be investigated and a murderer sought; accidents may be the basis of negligence lawsuits.
The number of suicide attempts is also subject to dispute. Based on a range of studies, there are probably between 10-20 attempts for every suicide, or roughly 300,000-600,000 attempts per year in the U.S. Yet more than half of suiciders kill themselves on their first try.









Race
Suicide rates among American Indian and Alaskan natives between 15 and 34 years are almost twice the national average for this age range. Hispanic females make significantly more suicide attempts than their male or non-Hispanic counterparts.



The risk of suicide is increased by concurrent alcohol and drug abuse, access to lethal means, hopelessness, pessimism, and impulsivity, and is reduced by help-seeking behavior, access to psychiatric treatment, and availability of family and other social supports.



Sex
More women than men seek treatment for depression, but this is not necessarily reflective of the true incidence of the disease.
  • Although depression is more often diagnosed in women, more men than women die from suicide by a factor of 4.5:1. White men complete more than 78% of all suicides, and 56% of suicide deaths in males involve firearms. Poisoning is the predominant method among females.

  • An estimated 8-25 attempted suicides occur for every completion. Many of these are never discovered or never reported. It is important to understand that the majority of suicide attempts are expressions of extreme distress, not merely bids for attention.

Age
The highest suicide rates are found in men older than 75 years. However, suicide is also a selective killer of youth. It is the third leading cause of death among people aged 15-24 years, after unintentional injuries and homicide, and the second leading cause of death in college students. The mean age for successful completed suicides is 40 years.



For adolescents, the attempt-to-fatality ratio may be 50:1; but this average masks the fact that the death rate for boys is a hundred times higher than for girls: around 10 percent and 0.1 percent, respectively. About 11% of high school students have made at least one suicide attempt. Ninety percent of adolescents' suicide attempts occur at home, and parents are home 70% of the time.



Risk Factors
Risk factors for thoughts of suicide can vary with age, gender, and ethnic group. And risk factors often occur in combinations.



Over 90% of people who die by suicide have clinical depression or another diagnosable mental disorder. Many times, people who die by suicide have a substance abuse problem. Often they have that problem in combination with other mental disorders.



Adverse or traumatic life events in combination with other risk factors, such as clinical depression, may lead to suicide. But suicide and suicidal behavior are never normal responses to stress.



Other risk factors for suicide include:
  • One or more prior suicide attempts.

  • Family history of mental disorder or substance abuse.

  • Family history of suicide.

  • Family violence.

  • Physical or sexual abuse.

  • Keeping firearms in the home.

  • Incarceration.

  • Exposure to the suicidal behavior of others.





Sources and Additional Information:
 
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