What is the risk of suicide when someone is diagnosed with depression?

Most depressed persons do not attempt suicide, but the majority of suicide attempters have depression. Suicide is the most significant risk of untreated depression. Typically, suicide is not a sudden thought and action; rather, it undergoes development over time. There may initially be only fleeting thoughts of death or wishes of dying. These thoughts can progress to fantasies of methods of killing oneself and later to stages of planning actual self-harm. The time frame of this progression can take as long as weeks to months to as little as within minutes. Someone with poor impulse control may be more apt to attempt suicide within the shorter time period. Anyone with plans to kill oneself or who has made an attempt requires emergency psychiatric evaluation. In some situations a family member may not take one who has attempted suicide to the emergency room because he or she ensures the family member that it was a mistake and that he or she will be okay. It is best, however, if a professional evaluates the situation to determine the most appropriate course of action.

Suicide is the most serious risk of depression. Clinicians assess suicide risk based on many factors, including the patient's current mental status, personal history, family history, use of substances, and more. As stated, suicidal thinking tends to fall on a continuum from morbid thoughts of death to passive thoughts of wishing to be dead to an actual plan to carry out the suicide, a continuum that is assessed by the clinician. Clinicians will ask direct questions about suicidal thoughts. Direct questions do not put ideas in a person's mind; rather, they invite the individual to speak openly about the issue. Most patients want help and want to let someone know how they are feeling. Also in this light, if you have reason to believe a family member is contemplating suicide, it is best to speak openly and frankly about your concerns. Doing so will not put new thoughts of suicide into the person's mind; instead, it will give an opportunity to help him or her get the treatment that may be needed.

A family member committed suicide. Did I miss something?

Anne's comment:

Sadly, we experienced the loss of my husband's mother to suicide when our children were very young. That traumatic event has made us vigilant in getting professional help for us and for our children when the need arises. Although there is sometimes a possibility that a patient will commit suicide despite the best care and treatment, it is helpful to focus on the greater likelihood that treatment will prevent such a traumatic end to a loved one's suffering and will restore the depressed person to a state of well-being.

Suicide is the single most tragic outcome of patients suffering from mental illness. No matter how prepared someone believes he or she is that a family member may eventually commit suicide because of his or her pain and suffering, it always feels unexpected and comes as a complete surprise. When it happens, everyone, including family, friends, and caregivers, feels shocked. Some are completely devastated with guilt about the loss. Small, seemingly insignificant events leading up to the person's death, appearing at the time to be normal, take on a new and painful meaning in retrospect. These events evolve into clear signs of the person's commitment to the inevitable last act, thus heightening the feelings of guilt. A sense of having let the person down, of saying the wrong thing, or of not being there when he or she needed you most may be present. When looked at in retrospect, everyone asks himself or herself, "How could I have missed that?" These are normal feelings.

An exact science of predicting suicide is not presently established and probably never will be established. Some people live their lives with chronic suicidal ideation and never act on their thoughts. Some people engage in countless acts of cutting and overdosing without any significant physical harm to themselves. Alternatively, other people have never thought of suicide their entire lives until the moment they commit suicide. Despite the advances psychiatry has made in assessing and treating mental illness, it is only one of many risk factors that contribute to suicide. Epidemiologists develop risk factors by looking at population aggregates of people who attempt or complete suicide and establishing the frequency that various factors correlate with suicide; however, correlation does not mean causation. Although risk factors can help to assess someone who is at risk for suicide, they play little role in helping to predict whether and when a person at risk will attempt or complete suicide. As a result, psychiatry is an inexact science at best, and the ability to predict suicide is worse than forecasting the weather. One can never underestimate the power of free will. Although guilt is a feeling one cannot control and is often a normal expected response under such circumstances, one is rarely guilty for another's actions.

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