Depression and Suicide _______________________________________________________________________
clinicians to defuse a suicide crisis by support at an impulsive moment. Rigidity constricts patient thinking, mood, and moti- vation; perception of problems and outlook is dichotomized into black-and-white reasoning. With gentle reasoning, clini- cians may help the patient understand and consider alternative
and there is no timeframe for grief. Survivors should not expect their lives to return to their previous state and should strive to adjust to life without their loved one. The initial emotional response may be overwhelming, and crying is a natural reaction and an expression of sadness following the loss of a loved one [481]. Survivors may struggle to comprehend why the suicide occurred and how they could have intervened, and the guilt over perceiving missed opportunities with hindsight can be agonizing. Relief may be felt if the loved one was prone to difficult mood or temperament. The stigma and shame sur- rounding suicide may inhibit family members and friends from contacting survivors and can prevent survivors from reaching out for help. Ongoing support remains important to maintain family and relationships during the grieving process [481]. Many survivors find support groups for suicide loss survivors the most beneficial means to feel supported and understood. The shared experience of group members enables survivors to openly discuss their story and feelings without pressure, fear of judgment, or shame [481]. The American Foundation for Suicide Prevention maintains an international directory of suicide bereavement support groups on their website at https://afsp.org/find-support. CONCLUSION Depression is a debilitating and potentially life-threatening mood disorder that afflicts millions of Americans. Depressed persons are more likely to develop chronic medical conditions, including type 2 diabetes and cardiovascular disease, and depression is projected to be the leading cause of disability over the next 20 years. Furthermore, suicide is a major preventable public health problem and cause of mortality. Depression, especially with comorbid substance abuse, represents a signifi- cant risk factor for suicide. Depression causes enormous pain and suffering to the afflicted and substantial economic cost to society, and the emotional impact on survivors of a depressed person who has died by suicide is often devastating. Many per- sons with depression do not seek treatment; among those who do, only a fraction receive treatment consistent with current practice guidelines. Primary care contact may represent the last opportunity for intervention in the severely depressed suicidal patient, making the thorough comprehension of identification and treatment of depression and suicide risk imperative.
options to death [469; 470]. Acute Anxious Agitation
Treat patients with anxious agitated distress states aggressively with benzodiazepines and/or antipsychotics, considering age and past/current medication exposure. Frequently monitor these patients for efficacy and side effects, and strongly consider emergency evaluation [368; 496]. Safety Precautions In all clinical settings, scrutinize patient belongings and nearby medical equipment, such as intravenous tubing, for use in self- harm. Decline family or friends’ insistence on driving patients to treatment; transfer patients for emergency evaluation or hospitalization safely by ambulance with trained personnel following standard protocols. During hospital or emergency department discharge or outpatient visits, recommend that close others secure or remove firearms, large quantities of medication, and other obvious means of self-harm. Make an effort to involve family and significant others in crisis planning and treatment [368]. Suicide Prevention Contracts Written and verbal “no harm” and “no-suicide” contracts do not prevent suicide and tend to give clinicians a false sense of safety that decreases vigilance and may communicate an uncaring “brush-off” to patients, especially in busy clinics and emergency departments. In one study, approximately 50% of inpatients who died by suicide had a prevention contract in place. It is recommended that suicide prevention contracts not be used [366; 493; 497; 498; 499]. SUICIDE LOSS SURVIVORS Suicide loss survivors are those family members and friends affected by the death of a loved one through suicide. Estimates suggest that each suicide death exposes 147 people, of whom 6 or more experience a major life disruption. With 948,090 suicide deaths in the United States between 1997 and 2021, there are more than 5.69 million suicide loss survivors [374]. The death of a loved one by suicide can be shocking, painful, and unexpected for survivors, with significant impact on health and mental health. A Danish study found that within five years of the loss, spouses bereaved by a partner’s suicide had higher risks for mental disorders, suicidal behaviors and mortality, use of public assistance, and mental health care utilization than spouses bereaved by other manners of death [500]. The ensuing grief can be intense, complex, chronic, and nonlinear. Working through grief is a highly individual and unique pro- cess that survivors experience in their own way and at their own pace. Grief does not always move in a forward direction,
WORKS CITED https://qr2.mobi/depression-suicide
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EliteLearning.com/Psychology
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