eWellness: All about depression
Dr KK Aggarwal, 11 July 2019
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- Depression is a major public health problem and a leading predictor of functional disability and mortality.
- Optimal depression treatment improves outcome for most patients.
- Most adults with clinical significant depression never see a mental health professional but they often see a primary care physician.
- A non-psychiatric physician 50% of times misses the diagnosis of depression.
- All depressed patients must be enquired specifically about suicidal ideations.
- Suicidal ideation is a medical emergency.
- Risk factors for suicide are known psychiatric disorders, medical illness, prior history of suicidal attempts or family history of attempted suicide.
- The demographic reasons include older age, male gender, marital status (widowed or separated) and living alone.
- About 1 million people commit suicide every year globally.
- Around 79% of patients who commit suicide contact their primary care provider in the last one year before their death and only one-third contact their mental health service provider.
- Twice as many suicidal victims had contacted their primary care provider as against the mental health provider in the last month before suicide.
- Suicide is the 10th leading cause of death worldwide and accounts for 1.2% of all deaths.
- The suicide rate in the US is 10.5 per 100,000 people.
- In the US, suicide is increasing in middle aged adults.
- There are 10-40 non-fatal suicide attempts for every one completed suicide.
- The majority of suicides completed in US are accomplished with fire arm (57%), the second leading method of suicide in US is hanging for men and poisoning in women.
- Patients with prior history of attempted suicide are 5-6 times more likely to make another attempt.
- Fifty percent of successful victims have made prior attempts.
- One of every 100 suicidal attempt survivors will die by suicide within one year of the first attempt.
- The risk of suicide increases with increase in age; however, young adults and adolescents attempt suicide more than the older.
- Females attempt suicide more frequently than males but males are successful three times more often.
- The highest suicidal rate is amongst those individuals who are unmarried followed by those who are widowed, separated, divorced, married without children and married with children in descending order.
- Living alone increases the risk of suicide.
- Unemployed and unskilled patients are at higher risk of suicide than those who are employed.
- A recent sense of failure may lead to higher risk.
- Clinicians are at higher risk of suicide.
- The suicidal rate in male clinicians is 1.41 and in female clinicians, it is 2.27.
- Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts.
- The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration.
- Management of suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow-up.
- Major risk for suicidal attempts is in psychiatric disorder, hopelessness and prior suicidal attempts or threats.
- High impulsivity or alcohol or other substance abuse increase the risk.