Dr KK Aggarwal
Padma Shri and Dr B C Roy National Awardee
President, Heart Care Foundation of India
Depression is a major public health problem as 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–psychiatrist physician misses the diagnosis of the depression 50% of times.
All depressed patients must be enquired specifically about suicidal ideations.
Suicidal ideation is a medical emergency
Risk factors for suicide are psychiatric known disorders, medical illness, prior history of suicidal attempts, or family history of attempted suicide.
Demographic reasons include older age, male gender, marital status (widowed or separated) and living alone.
World over about 1 million people commit suicide every year.
Seventy–nine percent 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 with 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 account for 1.2% of all deaths.
In US suicidal rate is 10.5 per 100,000 people.
In America 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, younger 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 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 disorders, hopelessness and prior suicidal attempts or threats.
High impulsivity or alcohol or other substance abuse increase the risk.