21 Nov Depression and Suicide: A Very Dark Place
On August 11th Robin Williams committed suicide and the public was shocked. Friends were quoted as saying he had long “struggled with demons” and “lived in a dark place”. Known as a comedian and actor and therefore wealthy and having access to resources, why did he not get help that he needed? Although it was reported by the media that he had long suffered from depression , complicated by intermittent alcohol and drug abuse which are the two greatest risk factors associated with suicide.
The World Health Organization (WHO) estimates that 450 million people in the world suffer from some form of mental illness with over 60 million in the USA. The an:nual cost of caring for mental illness is estimated to be $2.5 trillion ($300 billion in the USA). Psychiatric illness are ranked by WHO as being third most costly diseases following cardiovascular and infectious diseases and by 2030 depression will be the most costly disease to society.
Each year 39,000 Americans die by suicide, giving us a rate of 12.4 deaths per 100,00 individuals. This rate has remained constant even though medical science is making advanced every day in how to diagnose, treat, and prevent suicide deaths. Suicide is contagious as is seen when a celebrity commits suicide and we see a spike in the incidence rate.
The suicide rate increased by 10% after Marilyn Monroe took her own life in 1962 by a fatal overdose. Conversely in some populations the suicide rate falls after a suicide, as in Curt Cobain’s death in 1994 by a self-inflicted gunshot wound. In this case the suicide rate fell while the number of calls to suicide prevention hotlines rose.
The interim action, a stopgap if you might call it, is a call to a suicide prevention hotline. What happens on such a call? It is about establishing rapport establishing safety measures and implementing actions that will make callers feel safe. What alternatives are there to suicidal actions? How can we implement them and if we cannot who do we need to get involved? Is it a friend, a family member, is it EMS, is it 911, is it your clinician, who? The goal is get through the crisis moment, the moment of despair and then have time to work on clinical treatment over the long haul.
Depression is a factor in suicide, but not always the only reason for a suicide or a suicide attempt. If the suicide prevention hotline is the crisis management system, then adequate care including a thorough diagnostic assessment, treatment, and follow-up is the long haul approach. Medical science is working each and every day to identify new and better treatments for patients with depression.
Medical research is one option for patients that are not satisfied with their current treatment or have doubts or questions and are seeking a research level diagnostic evaluation.