represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure (known clinically as anhedonia). Other symptoms of depression include: ● Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., patient feels sad, empty, hopeless) or observation made by others. ( Note : In children and adolescents, this can be irritable mood.) ● Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation) ● Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month) or significant change in appetite nearly every day. ( Note : In children, consider failure to make expected weight gain.) ● Insomnia or hypersomnia nearly every day. ● Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). ● Fatigue or loss of energy nearly every day. ● Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self- reproach or guilt about being sick). ● Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). ● Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. The symptoms of depression must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Of course, not everyone with a diagnosis of depression thinks about suicide attempts and not everyone who is suffering from depression is clinically diagnosed. Symptoms that are clearly attributable to another medical condition should not be included in diagnosis. Another often-overlooked psychiatric symptom associated with suicidal behavior is sleep disturbance, such as insomnia at bedtime or early morning awakening (Tae, Jeong, & Chae, 2019). Depression has an enormous impact on public health, as highlighted by the following statistics: ● 25 million Americans suffer from depression each year. ● Over 50% of all people who die by suicide suffer from major depression. ● If data is included for alcoholics who are depressed, this figure increases to over 75%. ● Depression affects nearly 5 to 8% of Americans ages 18 and over in a given year. ● More Americans suffer from depression than coronary heart disease, cancer, and HIV/AIDS. ● Depression is among the most treatable of psychiatric illnesses. Between 80 and 90% of people with depression Bipolar and related disorders The DSM-5 separates bipolar and related disorders from the depressive disorders and places them between the chapters on schizophrenia spectrum and other psychotic disorders and depressive disorders, in recognition of their place as a bridge between the two diagnostic classes in terms of symptomatology, family history, and genetics (APA, 2017). The diagnoses included in this classification are bipolar I disorder, bipolar II disorder, cyclothymic disorder, substance/medication-induced bipolar and related disorder, bipolar and related disorder due to another medical condition, other specified bipolar and related disorder, and unspecified bipolar and related disorder. About 34% of people with bipolar disorder only have suicidal ideation, but 25% of people with bipolar disorder die by suicide, which is 20 times the rate of the general population (LaBouff, 2016). Impulsivity is one characteristic of the disorder that may cause someone to make a quick decision to attempt suicide.
respond positively to treatment, and almost all patients gain some relief from their symptoms. But first, depression must be recognized. (AFSP, 2018) Numbers for depression vary; the National Institute of Mental Health’s figure is 1.5 million children and adolescents, while the American Academy of Child and Adolescent Psychiatry estimates 3 million (UCLA, 2016). Depression does not always exist in isolation. Most studies on the epidemiology of depression have shown that depression commonly coexists with other common mental health disorders, such as general anxiety and even suicidal ideation. Any tools designed to screen for depression must recognize and assess for coexisting psychological symptoms, including suicidal ideation and suicidal behavior (Littlewood et al., 2016). Individuals with depression who have attempted suicide more than once are an extremely high-risk type. A 2017 study conducted by Sher et al. reviewed cases to determine clinical characteristics surrounding multiple attempts. The study compared the demographic and clinical characteristics of three patient groups: depressed patients without a history of suicide attempts (non-attempters), depressed patients with a history of one to three suicide attempts (attempters), and depressed patients with a history of four or more suicide attempts (multiple attempters). The study recorded a lifetime history of all suicide attempts, including number of attempts and the method of the attempt. Researchers observed that attempters and multiple attempters had higher levels of depression, hopelessness, aggression, hostility, and impulsivity and were more likely to have borderline personality disorder and family history of major depression or alcohol use disorder compared with non- attempters but did not differ between each other on these measures. However, multiple attempters had greater suicidal ideation at study entry and were more likely to have family history of suicide attempt compared with attempters. Multiple attempters also had greater suicide intent and more serious medical consequences at the time of the most medically-serious suicide attempt in comparison with attempters. The study indicated that depressed patients with a history of four or more suicide attempts display features that suggest a higher risk of completing suicide compared with depressed patients with a history of three or fewer suicide attempts or with non-attempters. The fact that that most attempters do not later die by suicide should not, however, distract clinicians, educators, psychiatrists, and other medical professionals from the considerable increase in future risk associated with a survived suicide attempt, and, especially, with multiple suicide attempts. Mental and non-mental health professionals should not be misled by the adage “those who try rarely die.” For a diagnosis of bipolar I disorder, it is necessary for the patient to meet the criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes. One of the criteria for a manic disorder is that “the mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features” (APA, 2013). Criteria for a major depressive episode includes “recurrent thoughts of death, not just fear of dying, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide” (APA, 2013). The depressive component of mixed states in patients with bipolar disorder was found to be associated with a high risk for suicidal behavior, according to recent research (Martin, 2017). Researchers prospectively followed 429 participants with bipolar disorder for an average follow-up of 18 years (mean age: 36
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