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Suicide
When left untreated, severe depression can result in a suicide attempt, which in 30,535 cases each year is, tragically, successful. About 15 percent of those who are clinically depressed will die by suicide.
The highest rate of suicide is among white men who are over the age of 85. But teenagers and adults in their early 20s are at the highest risk for suicide since so many contemplate and even attempt it, though far fewer successfully complete the act. Each year, about 20 percent of adolescents contemplate suicide; by the end of high school, 1 in 10 will have attempted it, with almost 2,000 succeeding each year. About half of those who die suffer from major clinical depression.
In both depression and suicide, levels of a key neurochemical called serotonin are abnormally low. Advocates for the use of antidepressants point out that the teen suicide rate increased from 5.9 to 11.1 per 100,000 between 1970 and 1994 but declined to 7.4 per 100,000 in 2002, just when the drugs were increasingly being prescribed for children.Modern antidepressants that boost serotonin levels are also credited with the small but real decline in the overall suicide rates internationally. But occasionally these drugs energize a depressed person before actually lifting the depression. Thus, in those rare cases, the risk of suicide can increase after a person begins taking medications. In addition, the Food and Drug Administration has cautioned that some of these drugs, when used in those under 18, might increase suicidal behavior.
A universal and perplexing reality is suicide's maleness. More than four times as many men as women die by suicide (although more women report making the attempt). Boys kill themselves six times as often as girls do. In 2000, the United States had 4,294 recorded suicides in the 10-to-24-year-old age group; only 632 of them were girls--this despite the fact that females are diagnosed with depression more often and make many more suicide attempts. A closer look suggests that males often experience and express their illness differently--more aggression, anger, irritability, and impulsiveness and less of the overt hopelessness, helplessness, and sadness common in suicidal females.
These numbers reveal not only the scope of the problem but also the vast difference between the state of contemplating suicide--also called suicidal ideation--a suicide attempt, and an actual suicide. Ideation, it seems, is part of adolescence for 1 in every 5 kids in a high school classroom. A suicide attempt, however, becomes murkier in terms of reporting: Is cutting oneself on the wrist, say, a suicide attempt or a way of relieving tension? Of course, it depends on the patient. If someone is cutting herself, this self-mutilation is often serious and scarring, according to psychiatrists, but still is not attempted suicide. Researchers have found that those who cut themselves have no wish to die, no matter how difficult that may be to understand. They find that cutting relieves unbearable anxiety, somehow, or channels anger.
What is most important, however, is the link between depression and suicide. The suicide prevention programs that are the most likely to succeed are those that focus on the identification and treatment of depression and substance abuse and that teach people how to cope with stress and manage their aggressive behaviors and feelings.
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