Professional Documents
Culture Documents
Mortality/Morbidity:
In 1994, 1.4% of all deaths were attributed to suicide. It is reported that more than
30,000 Americans commit suicide each year. The real number is unknown since
Almost all people who kill themselves intentionally have a diagnosable mental
disorder with or without substance abuse, which is often a result of attempted selftreatment for the symptoms of depression.
Although depression is more often diagnosed in women, more men than women
die from suicide by a factor of 4.5:1. White men commit over 72% of all suicides,
and 78% of suicides use firearms.
It is estimated that 8-25 attempted suicides occur for every completion. Many of
these are never discovered, or never reported. It is important to understand that
the majority of suicide attempts are expressions of extreme distress, not merely
bids for attention.
Age: The highest suicide rates are found in persons older than 85 years. However, suicide
is also a selective killer of youth. It is the third leading cause of death among people aged
15-24 years, after unintentional injuries and homicide, and the second leading cause of
death in college students. The mean age for successful completed suicides is 40 years.
History:
Restlessness, irritability
Sleep disturbances
To establish the diagnosis of major depression, a patient must express one of the
first 2 and at least 5 of the other symptoms listed above. Such disturbances must
be present nearly daily for at least 2 weeks. Symptoms can last for months or
years.
Symptoms can cause significant personality changes and changes in work habits,
making it difficult for others to empathize with the depressed individual. Some
symptoms are so disabling that they interfere significantly with the patient's
ability to function. In very severe cases, people with depression may be unable to
eat or even to get out of bed.
Appearance of preoccupation
Lab Studies:
Depression is a clinical diagnosis. Laboratory tests are primarily used to rule out
other diagnoses. Consider the following laboratory tests:
o
Calcium
Imaging Studies:
Other Tests:
Electroencephalogram (EEG)
Although primary at-risk populations include young adults and elderly persons,
depression and suicidality can occur in any age group, including children.
Transfer:
Complications:
Suicide
Failure to improve
Drug reaction
Prognosis:
The ED can sometimes be the last opportunity for intervention in the downward
spiral of depression, which leads to death for a significant number of those
affected. Although the clinician may never see the results of protective
intervention, this is an opportunity to really make a difference. There are few
diseases as lethal yet so reversible as depression. Lives can be and are saved every
day as the result of the timely efforts and empathic interventions of skilled and
compassionate emergency physicians.
Patient Education:
Carefully inform patients about the critical importance of taking any medications
that are prescribed, as well as likely adverse effects and their management.
Medical/Legal Pitfalls:
Failure to warn others of any threat made concerning them by a patient who is not
to be admitted to protective custody.
Failure to warn patient and significant others about potential signs of deterioration
and suicidality and what to do about them.