Is there always a risk of suicide in depression? My spouse has struggled with depression on and off for years. She has a prescription for medication, but she doesn't always take it faithfully. Sometimes she seems so low that I begin to worry that she may harm herself in some way. Do you think I'm over-exaggerating the seriousness of the situation?
Not at all. As a matter of fact, your concerns are right on target. Caregivers, as well as primary care physicians and nurse practitioners, must constantly be on the lookout for signs of suicide in those who are depressed. What's more, if such signs appear, they should be prepared to act quickly. While individuals who are absolutely determined to take their lives will not tell others because they do not want anyone to interfere with their plan, most people who kill themselves send messages of their intentions before the fact. The attentive spouse, parent, or friend is often in the best position to detect these early signs that a loved one may be contemplating suicide.
All depressed persons need to be assessed for their risk of suicide. It is better to be safe than sorry. The best way to do this is to bring the topic right out in the open. Talk about it frankly with your spouse. As part of the discussion, reassure her that thoughts of death are not uncommon when one is depressed. When people talk this way, it's not a sign that they are crazy, nor does it necessarily mean that they are serious about it. Sometimes, just this reassurance is enough to remove the risk. This would also be a good time to emphasize the importance of staying current with medications.
If your spouse talks about or hints at specific suicide plans, consult a mental health specialist immediately. He or she will tell you what to do. Do not leave the depressed person alone at any time until you can get help.
You should also keep in mind that there is a heightened risk of suicide in cases where any of the following factors are present: prior suicide attempts; a family history of suicide; a history of substance abuse; psychosis; general or severe medical illness; advanced age; or a profound sense of helplessness or hopelessness.
It's worth adding that older Caucasian males who live alone are at greatest risk. In fact, eighty percent of older people who kill themselves are white men, and most of them use guns. The implication should be obvious: all access to firearms should be removed from anyone who is at risk. If you cannot remove the guns, then hide the ammunition.
Older women are three times as likely as younger women to attempt suicide – usually by overdosing themselves – but they tend to be less successful than men. All medications should be removed from any older woman at risk.
You should also be on the lookout for certain specific signs that your spouse might be contemplating suicide. Watch for any noticeable change in behavior. Take special note if your spouse suddenly becomes less interested in family, friends, hobbies, or church attendance. Some suicidal persons start drinking more. Others become more secretive and withdrawn. They may also become more careless about their personal appearance. Some have been known to give things and money away, to buy a gun, or to start stockpiling pills.
Along with major changes in behavior, keep an eye out for evidence of altered feelings. Suicidal people can become more lethargic, lose their appetite, or express more anger. They're also likely to say things such as "You'd be better off if I was dead," "I won't be around much longer," or "Life isn't all it's cracked up to be." You should also be very careful if your spouse experiences a major loss of any kind and expresses intense anger about it. When these two ingredients are combined – loss and anger – there is a very high risk of suicide occurring. Conversely, sometimes when seriously depressed individuals makes the decision to end their lives shortly they exhibit a surprising and unexplained improvement in mood. This is because they anticipate being out of their emotional pain soon. This sudden upturn in mood may seem like a wonderful thing, but should raise suspicions for loved ones and caregivers.
If you think it's time to enlist the help of a psychologist or trained therapist, call us. Focus on the Family's Counseling department can provide you with referrals to specialists practicing in your area. Our staff counselors would also be more than happy to discuss your concerns with you at length over the phone.