Mood Disorders and Suicide
BPSY 80: Abnormal Psychology
BSP 2-1 | A.Y. 2023-2024
MOOD DISORDERS
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Mood is a pervasive and sustained
emotional
tone
that influences
behaviors and thoughts.
Disorders of mood, also called
affective disorders, are common
among the general population. They
include depressive disorder, bipolar
disorder, and other disorders.
Patients with only major depressive
episodes are said to have major
depressive disorder or unipolar
depression.
BIPOLAR DISORDER
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DSM IV-TR
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MOOD DISORDERS: HISTORY
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The story of King Saul as depicted
by The Old Testament describes a
depressive syndrome: Saul was at
times possessed by an “evil spirit”
which “tormented him”. He had
several symptoms such as insomnia,
feelings
of
worthlessness,
indecisiveness and even paranoia
and irritability. He may have
committed suicide during a battle.
About 400 BC, Hippocrates used the
terms mania and melancholia to
describe mental disturbances.
Around 30 AD, Celsus described
melancholia (from Greek melan
“black” and chole “bile”) as a
depression caused by black bile.
In 1854, Jules Falret described a
condition called folie circulaire, in
which patients experience alternating
moods of depression and mania.
In 1882, the German psychiatrist Karl
Kahlbaum,
using
the
term
cyclothymia, described mania and
depression as stages of the same
illness.
In 1899, Emil Kraepelin described
manic-depressive psychosis using
most of the criteria that psychiatrists
now use to establish a diagnosis of
bipolar I disorder.
According to Kraepelin, the absence
of a dementing and deteriorating
course in manic-depressive psychosis
differentiated it from dementia precox
(as schizophrenia was then called).
also known as manic-depressive
illness
a brain disorder that causes unusual
shifts in mood, energy, activity levels,
and the ability to carry out day-to-day
tasks
MOOD DISORDER
○ Major Depression - a person
experience profound sadness as
well as related problems such as
sleep and appetite disturbances
and loss of energy and self-esteem
○ Bipolar Disorder - characterized
by periods of elevated mood and
periods of depression
DSM 5
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Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Substance/Medication-Induced
Bipolar and Related Disorder
Bipolar and Related Disorders due to
another Medical Condition
Other Specified Bipolar and Related
Disorders
Unspecified Bipolar and Related
Disorders
THE DSM-5 CLASSIFICATION OF
MOOD DISORDERS
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●
Section II, Chapter 3 (pp. 123-154):
Bipolar and Related Disorders
Section II, Chapter 4 (pp. 155-188):
Depressive Disorders
BIPOLAR I DISORDER
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characterized by the occurrence of at
least one manic or mixed episode
1
MANIC EPISODE
HYPOMANIC EPISODE
A. A distinct period of abnormally and
persistently elevated, expansive, or
irritable mood and abnormally and
persistently increased goal-directed
activity or energy, lasting at least 1
week and present most of the day,
nearly every day (or any duration if
hospitalization is necessary).
B. During
the
period
of
mood
disturbance and increased energy or
activity, three or more of the following
symptoms (four if the mood is only
irritable) are present to a significant
degree and represent a noticeable
change from usual behavior:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g.,
feels rested after only 3 hours of
sleep).
3. More talkative than usual or
pressure to keep talking.
4. Flight of ideas or subjective
experience that thoughts are
racing.
5. Distractibility (i.e., attention too
easily drawn to unimportant or
irrelevant external stimuli), as
reported or observed.
6. Increase in goal-directed activity
(either socially, at work or school,
or sexually) or psychomotor
agitation
(i.e.,
purposeless
non-goal-directed activity).
7. Excessive involvement in activities
that have a high potential for
painful
consequences
(e.g.,
engaging in unrestrained buying
sprees, sexual indiscretions, or
foolish business investments)
C. The mood disturbance is sufficiently
severe to cause marked impairment
in social or occupational functioning
or to necessitate hospitalization to
prevent harm to self or others, or
there are psychotic features.
D. The episode is not attributable to the
physiological effects of a substance or
to another medical condition.
A. A distinct period of abnormally and
persistently elevated, expansive, or
irritable mood and abnormally and
persistently increased activity or
energy, lasting at least 4 consecutive
days and present most of the day,
nearly every day.
B. During
the
period
of
mood
disturbance and increased energy
and activity, three (or more) of the
following symptoms (four if the mood
is only irritable) have persisted,
represent a noticeable change from
usual behavior, and have been
present to a significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep.
3. More talkative than usual or
pressure to keep talking.
4. Flight of ideas or subjective
experience that thoughts are
racing.
5. Distractibility, as reported or
observed.
6. Increase in goal-directed activity
(either socially, at work or school,
or sexually) or psychomotor
agitation.
7. Excessive involvement in activities
that have a high potential for
painful consequences.
Gaby’s note: Check Criterion B of Manic Episode for
elaboration of points 1-7 (kasi same lang naman sila).
C. The episode is associated with an
unequivocal change in functioning
that is uncharacteristic of the
individual when not symptomatic.
D. The disturbance in mood and the
change in functioning are observable
by others.
E. The episode is not severe enough to
cause marked impairment in social or
occupational
functioning
or
to
necessitate hospitalization. If there
are psychotic features, the episode is,
by definition, manic.
F. The episode is not attributable to the
physiological effects of a substance
(e.g., a drug of abuse, a medication,
other treatment).
2
MAJOR DEPRESSIVE EPISODE
A. Five (or more) of the following
symptoms have been present during
the same 2-week period and
represent a change from previous
functioning; at least one of the
symptoms is either (1) depressed
mood or (2) loss of interest or
pleasure:
1. Depressed mood most of the day,
nearly every day, as indicated by
either subjective report (e.g., feels
sad, empty, or hopeless) or
observation made by others (e.g.,
appears tearful).
2. Markedly diminished interest or
pleasure in all, or almost all,
activities most of the day, nearly
every day (as indicated by either
subjective account or observation).
3. Significant weight loss when not
dieting or weight gain (e.g., a
change of more than 5% of body
weight in a month), or decrease or
increase in appetite nearly every
day. (Note: In children, consider
failure to make expected weight
gain.)
4. Insomnia or hypersomnia nearly
every day.
5. Psychomotor
agitation
or
retardation nearly every day
(observable by others; not merely
subjective feelings of restlessness
or being slowed down).
6. Fatigue or loss of energy nearly
every day.
7. Feelings of worthlessness or
excessive or inappropriate guilt
(which may be delusional) nearly
every
day
(not
merely
self-reproach or guilt about being
sick).
8. Diminished ability to think or
concentrate, or indecisiveness,
nearly every day (either by
subjective account or as observed
by others).
9. Recurrent thoughts of death (not
just fear of dying), recurrent
suicidal ideation without a specific
plan, or a suicide attempt or a
specific plan for commit.ting
suicide.
B. The symptoms cause clinically
significant distress or impairment in
social,
occupational,
or
other
important areas of functioning.
C. The episode is not attributable to the
physiological effects of a substance or
another medical condition.
BIPOLAR II DISORDER
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like Bipolar I Disorder, with moods
cycling between high and low over
time
same depression as in major
depressive
disorder,
but
they
experience hypomania (literally lesser
manias)
at least one hypomanic episode and
at least one major depressive episode
never had a manic episode
diagnostic criteria include hypomanic
and major depressive episodes
Gaby’s note: Check Hypomanic Episode and Major
Depressive Episode of Bipolar I Disorder for the criteria
(kasi similar naman sila, only no manic episode).
CYCLOTHYMIC DISORDER
●
a
chronic
fluctuating
mood
disturbance
involving
numerous
periods of hypomanic symptoms and
periods of depressive symptoms that
are distinct from each other
DIAGNOSTIC CRITERIA
A. For at least 2 years (at least 1 year in
children and adolescents) there have
been
numerous
periods
with
hypomanic symptoms that do not
meet criteria for a hypomanic episode
and
numerous
periods
with
depressive symptoms that do not
meet criteria for a major depressive
episode.
B. During the above 2-year period (1
year in children and adolescents), the
hypomanic and depressive periods
have been present for at least half the
time and the individual has not been
without the symptoms for more than 2
months at a time.
C. Criteria for a major depressive, manic,
or hypomanic episode have never
been met.
3
D. The symptoms in Criterion A are not
better explained by schizoaffective
disorder,
schizophrenia,
schizophreniform disorder, delusional
disorder, or other specified or
unspecified schizophrenia spectrum
and other psychotic disorder.
SUBSTANCE/MEDICATION-INDUCED
BIPOLAR AND RELATED DISORDER
A. A
prominent
and
persistent
disturbance
in
mood
that
predominates in the clinical picture
and is characterized by elevated,
expansive, or irritable mood, with or
without depressed mood, or markedly
diminished interest or pleasure in all,
or almost all, activities.
B. There is evidence from the history,
physical examination, or laboratory
findings of both (1) and (2):
1. The symptoms in Criterion A
developed during or soon after
substance
intoxication
or
withdrawal or after exposure to a
medication.
2. The involved substance/medication
is capable of producing the
symptoms in Criterion A.
C. The disturbance is not better
explained by a bipolar or related
disorder
that
is
not
substance/medication-induced.
E. The symptoms are not attributable to
the physiological effects of a
substance (e.g., a drug of abuse, a
medication) or another medical
condition.
F. The symptoms cause clinically
significant distress or impairment in
social,
occupational,
or
other
important areas of functioning.
D. The disturbance does not occur
exclusively during the course of a
delirium.
E. The disturbance causes clinically
significant distress or impairment in
social,
occupational,
or
other
important areas of functioning.
BIPOLAR AND RELATED DISORDER
DUE TO ANOTHER MEDICAL
CONDITION
A. A prominent and persistent period of
abnormally elevated, expansive, or
irritable
mood
and
abnormally
increased activity or energy that
predominates in the clinical picture.
B. There is evidence from the history,
physical examination, or laboratory
findings that the disturbance is the
direct
pathophysiological
consequence of another medical
condition.
C. The disturbance is not better
explained by another mental disorder.
4
D. The disturbance does not occur
exclusively during the course of a
delirium.
E. The disturbance causes clinically
significant distress or impairment in
social,
occupational,
or
other
important areas of functioning, or
necessitates hospitalization to prevent
harm to self or others, or there are
psychotic features.
OTHER SPECIFIED BIPOLAR AND
RELATED DISORDER
1. Short-duration hypomanic episodes
(2-3 days) and major depressive
episodes
2. Hypomanic episodes with insufficient
symptoms and major depressive
episodes
3. Hypomanic episode without prior
major depressive episode
4. Short-duration cyclothymia (less than
24 months)
UNSPECIFIED BIPOLAR AND
RELATED DISORDER
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applies to presentations in which
symptoms characteristic of a bipolar
and related disorder that cause
clinically
significant distress or
impairment in social, occupational, or
other important areas of functioning
predominate but do not meet the full
criteria for any of the disorders in the
bipolar
and
related
disorders
diagnostic class
used in situations in which the
clinician chooses not to specify the
reason that the criteria are not met for
a specific bipolar and related disorder
and includes presentations in which
there is insufficient information to
make a more specific diagnosis (e.g.,
in emergency room settings)
THE DSM-5 CLASSIFICATION OF
DEPRESSIVE DISORDERS
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Disruptive Mood Dysregulation Disorder
Major Depressive Disorder
Persistent Depressive Disorder
Premenstrual Dysphoric Disorder
Substance/Medication-Induced Depressive
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Disorder
Depressive Disorder Due to Another Medical
Condition
Other Specified Depressive Disorder
Unspecified Depressive Disorder
DISRUPTIVE MOOD
DYSREGULATION DISORDER
(DMDD)
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a new addition to the DSM
characterized
by
severe,
developmentally inappropriate, and
recurrent temper outbursts at least
three times per week, along with a
persistently irritable or angry mood
between temper outbursts
symptoms must be present for at
least a year, and onset must be by
age 10
Studies suggest that youth with
chronic irritability and severe mood
dysregulation are at higher risk for
future unipolar depressive disorders
and anxiety disorders.
DIAGNOSTIC CRITERIA
A. Severe recurrent temper outbursts
manifested verbally (e.g., verbal
rages) and/or behaviorally (e.g.,
physical aggression toward people or
property) that are grossly out of
proportion in intensity or duration to
the situation or provocation.
B. The temper outbursts are inconsistent
with developmental level.
C. The temper outbursts occur, on
average, three or more times per
week.
D. The mood between temper outbursts
is persistently irritable or angry most
of the day, nearly every day, and is
observable by others (e.g., parents,
teachers, peers).
E. Criteria A–D have been present for 12
or more months. Throughout that
time, the individual has not had a
period lasting 3 or more consecutive
months without all of the symptoms in
Criteria A–D.
F. Criteria A and D are present in at
least two of three settings (i.e., at
home, at school, with peers) and are
severe in at least one of these.
5
G. The diagnosis should not be made for
the first time before age 6 years or
after age 18 years.
H. By history or observation, the age at
onset of Criteria A–E is before 10
years.
I. There has never been a distinct
period lasting more than 1 day during
which the full symptom criteria, except
duration, for a manic or hypomanic
episode have been met. Note:
FUNCTIONAL CONSEQUENCES
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Developmentally
appropriate
mood
elevation, such as occurs in the context of
a highly positive event or its anticipation,
should not be considered as a symptom
of mania or hypomania.
J. The
behaviors
do not occur
exclusively during an episode of
major depressive disorder and are not
better explained by another mental
disorder (e.g., autism spectrum
disorder,
posttraumatic
stress
disorder, separation anxiety disorder,
persistent depressive disorder). Note:
This diagnosis cannot coexist with
oppositional defiant disorder, intermittent
explosive disorder, or bipolar disorder,
though it can coexist with others,
including major depressive disorder,
attention-deficit/hyperactivity
disorder,
conduct disorder, and substance use
disorders.
K. The symptoms are not attributable to
the physiological effects of a
substance or to another medical or
neurological condition.
COMORBIDITY
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DMDD is common among children
presenting to mental health clinics.
Prevalence
estimates
in
the
community are unclear. Overall 1-year
prevalence
in
children
and
adolescents is probably 2%-5%.
Rates are expected to be higher in
males than in females, and in children
compared to adolescents.
DEVELOPMENT & COURSE
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Rates of conversion to bipolar
disorder are very low.
Children with chronic irritability are at
risk to develop unipolar depression
and/or anxiety disorders in adulthood.
Rates of comorbidity in DMDD are
very high.
The strongest overlap occurs with
oppositional defiant disorder (ODD).
ADHD is also very frequently
comorbid with DMDD.
Children with DMDD present to
clinical attention with a wide range of
disruptive behavior, mood, anxiety,
and even autism spectrum diagnoses.
MAJOR DEPRESSIVE DISORDER
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PREVALENCE
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There is marked disruption in a child’s
family and peer relationships, as well
as in school performance.
Because of their low frustration
tolerance, such children have difficulty
succeeding in school and sustaining
friendships.
Levels of dysfunction in children with
bipolar disorder and DMDD are
generally
comparable.
Also,
dangerous behaviors and psychiatric
hospitalizations are common.
a period of at least 2 weeks during
which there is either depressed mood
or the loss of interest or pleasure in
nearly all activities
also called unipolar depression
DIAGNOSTIC CRITERIA
Criteria A-C represent a major depressive
episode.
Gaby’s note: Check BP-I Disorder for the episode criteria.
D.
The occurrence of the major
depressive episode is not better
explained by schizoaffective disorder,
schizophrenia,
schizophreniform
disorder, delusional disorder, or other
specified
and
unspecified
schizophrenia spectrum and other
psychotic disorders.
E. There has never been a manic
episode or a hypomanic episode.
Note: This exclusion does not apply if all
of the manic-like or hypomanic-like
episodes are substance-induced or are
attributable to the physiological effects of
another medical condition.
6
PERSISTENT DEPRESSIVE
DISORDER (DYSTHYMIA)
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a depressed mood that occurs for
most of the day, for more days than
not, for at least 2 years (or at least 1
year for children and adolescents)
Individuals whose symptoms meet
major depressive disorder criteria for
2 years should be given a diagnosis
of persistent depressive disorder
(PDD) as well as major depressive
disorder (MDD).
Because these symptoms have
become part of the individual’s
day-to-day experience, they may not
be reported unless the individual is
directly prompted.
DIAGNOSTIC CRITERIA
G. The symptoms are not attributable to
the physiological effects of a
substance
or
another
medical
condition.
H. The symptoms cause clinically
significant distress or impairment in
social,
occupational,
or
other
important areas of functioning.
PREVALENCE
●
DEVELOPMENT & COURSE
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A. Depressed mood for most of the day,
for more days than not, as indicated
by either subjective account or
observation by others, for at least 2
years. Note: In children and adolescents,
mood can be irritable and duration must
be at least 1 year.
B. Presence, while depressed, of two (or
more) of the following:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty
making decisions
6. Feelings of hopelessness
C. During the 2-year period (1 year for
children or adolescents) of the
disturbance, the individual has never
been without the symptoms in Criteria
A and B for more than 2 months at a
time.
D. Criteria for a major depressive
disorder may be continuously present
for 2 years.
E. There has never been a manic
episode or a hypomanic episode.
F. The disturbance is not better
explained
by
a
persistent
schizoaffective
disorder,
schizophrenia, delusional disorder, or
other
specified
or
unspecified
schizophrenia spectrum and other
psychotic disorder.
The 12-month prevalence in the US is
approximately 0.5% for PDD and
1.5% for chronic MDD.
PDD often has an early and insidious
onset and, by definition, a chronic
course.
Early onset (i.e., before age 21 years)
is associated with a higher likelihood
of comorbid personality disorders and
substance use disorders.
COMORBIDITY
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Compared to patients with MDD,
individuals with PDD are at a higher
risk for psychiatric comorbidity in
general, and for anxiety disorders and
substance use disorders in particular.
Early-onset
PDD
is
strongly
associated with Cluster B and C
personality disorders.
TREATMENT
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Recent data offer the most objective
support
for
cognitive
therapy,
behavior
therapy
and
pharmacotherapy.
The combination of pharmacotherapy
and some form of psychotherapy may
be the most effective treatment for the
disorder.
DOUBLE DEPRESSION
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An estimated 40% of patients with
major depressive disorder also meet
the
criteria
for
dysthymia,
a
combination often referred to as
double depression.
7
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Double depression has a poorer
prognosis than only major depressive
disorder.
The treatment of patients with double
depression
should
target
both
disorders because the resolution of
the symptoms of major depressive
episode still leaves these patients
with
significant
psychiatric
impairment.
PREMENSTRUAL DYSPHORIC
DISORDER
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triggered by changing levels of sex
hormones that accompany the
menstrual cycle
occurs about 1 week before the onset
of menses and is characterized by
irritability,
emotional
lability,
headache, anxiety, and depression
somatic symptoms include edema,
weight gain, breast tenderness,
syncope, and paresthesias
affects approximately 5% of women
are affected
Treatment
is symptomatic and
includes analgesics and sedatives.
Some patients respond to short
courses of SSRIs. Fluid retention is
relieved with diuretics.
DIAGNOSTIC CRITERIA
A. In the majority of menstrual cycles, at
least five symptoms must be present
in the final week before the onset of
menses, start to improve within a few
days after the onset of menses, and
become minimal or absent in the
week postmenses.
B. One (or more) of the following
symptoms must be present:
C. One (or more) of the following
symptoms must additionally be
present, to reach a total of five
symptoms when combined with
symptoms from Criterion B above.
D. The symptoms are associated with
clinically
significant distress or
interference with work, school, usual
social activities, or relationships with
others (e.g., avoidance of social
activities; decreased productivity and
efficiency at work, school, or home).
E. The disturbance is not merely an
exacerbation of the symptoms of
another disorder, such as major
depressive disorder, panic disorder,
persistent depressive disorder, or a
personality disorder (although it may
co-occur with any of these disorders).
F. Criterion A should be confirmed by
prospective daily ratings during at
least two symptomatic cycles. (Note:
The diagnosis may be made provisionally
prior to this confirmation.)
G. The symptoms are not attributable to
the physiological effects of a
substance
or
another
medical
condition.
DIAGNOSTIC FEATURES
●
The generally recognized syndrome
involves
○ mood symptoms (e.g., lability,
irritability)
○ behavior symptoms (e.g., changes
in eating patterns, insomnia)
○ physical symptoms (e.g., breast
tenderness,
edema,
and
headaches)
● These symptoms occur at a specific
time during the menstrual cycle, and
resolve between menstrual cycles.
● The hormonal changes that occur
during the menstrual cycle are
thought to cause the symptoms,
although the exact etiology is
unknown.
EPIDEMIOLOGY
●
●
●
The prevalence is unclear.
Up to 80% of all women experience
some alteration in mood or sleep and
some somatic symptoms during the
premenstrual period, and about 40%
of them have premenstrual symptoms
that prompt them to seek medical
advice.
Only 3 to 7% of women have
symptoms that meet the full
diagnostic criteria for PMDD.
COURSE & PROGNOSIS
●
Treatment includes support
recognition of the symptoms.
and
8
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●
SSRIs
(e.g.,
fluoxetine)
and
benzodiazepine (e.g., alprazolam)
have been reported to be effective.
If symptoms are present throughout
the menstrual cycle, clinicians should
consider one of the non-menstrual
cycle- related mood and anxiety
disorders.
The presence of especially severe
symptoms should prompt clinicians to
consider other mood and anxiety
disorders. A thorough medical workup
is necessary to rule out medical or
surgical conditions that may account
for symptoms (e.g., endometriosis).
●
OTHER SPECIFIED DEPRESSIVE
DISORDER
●
SUBSTANCE/MEDICATION-INDUCED
DEPRESSIVE DISORDER
Depressed
mood
or
markedly
diminished interest or pleasure in all,
or almost all, activities
● There is evidence that:
○ The symptoms developed during
or
soon
after
substance
intoxication or withdrawal or after
exposure to a medication.
○ The involved substance/medication
is capable of producing the
symptoms.
○ The symptoms are not better
explained by a depression that is
not substance-induced.
● Lifetime-prevalence in the US: 0.26%
● Examples of culprit-agents: efavirenz,
clonidine, isotretinoin, corticosteroids,
oral contraceptives, interferon
●
DEPRESSIVE DISORDER DUE TO
ANOTHER MEDICAL CONDITION
●
●
●
●
Depressed
mood
or
markedly
diminished interest or pleasure in all,
or almost all, activities.
There
is
evidence
that
the
disturbance
is
the
direct
pathophysiological consequence of
another medical condition.
The disturbance is not better
explained by another mental disorder
(e.g., adjustment disorder in which the
stressor is a serious medical
condition).
There are clear associations with
stroke,
Huntington’s
disease,
Parkinson’s disease, and traumatic
brain injury.
Several
other
conditions
are
associated with depression, including
Cushing’s disease, hypothyroidism
and multiple sclerosis.
This
category
applies
when
symptoms of depression predominate
but do not meet the full criteria for any
of the disorders in the depressive
disorders diagnostic class.
1. Recurrent
brief
depression:
Concurrent presence of depressed
mood and at least 4 other
symptoms of depression for 2-13
days at least once per month for at
least 12 consecutive months.
2. Short-duration
depressive
episode (4-13 days)
3. Depressive
episode
with
insufficient
symptoms:
Depressed affect and at least one
of the other symptoms of
depression that persist for at least
2 weeks
UNSPECIFIED DEPRESSIVE
DISORDER
●
●
This category applies to presentations
in which symptoms of depression
predominate but do not meet criteria
for any of the disorders in the
depressive disorders diagnostic class.
used in situations in which the
clinician chooses not to specify the
reason that the criteria are not met for
a specific depressive disorder, and
includes presentations for which there
is insufficient information to make a
more specific diagnosis (e.g., in
emergency room settings)
SUICIDALITY
●
●
suicide ideation - thoughts of killing
oneself
suicide attempt - behavior intended
to kill oneself
9
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●
suicide - death from deliberate
self-injury
non-suicidal self-injury - behaviors
intended to injure oneself without
intent to kill oneself
EPIDEMIOLOGY OF SUICIDE AND
SUICIDE ATTEMPTS
●
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Suicide rate in US is 1 per 10,000 in a
given year.
Worldwide,
9%
report
suicidal
ideation at least once in their lives,
and 2.5% have made at least one
suicide attempt.
Men are four times more likely than
women to kill themselves; women are
more likely than men are to make
suicide attempts that do not result in
death.
Guns are by far the most common
means of suicide in the United States
(60%); men usually shoot or hang
themselves; women more likely to use
pills.
The suicide rate increases in old age.
The highest rates of suicide in the
United States are for white males
over age 50.
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The rates of suicide for adolescents
and children in the United States are
increasing dramatically.
Being divorced or widowed elevates
suicide risk four- or fivefold.
RISK FACTORS FOR SUICIDE
●
Psychological Disorders
○ Half of suicide attempts are
depressed at the time of the act.
● Neurobiological Models
○ heritability of 48% for suicide
attempts
○ low levels of serotonin
○ overly reactive HPA system
● Social Factors
○ economic recessions
○ media reports of suicide
○ social isolation and a lack of social
belonging
● Psychological Models
○ problem-solving deficit
○ hopelessness
○ life satisfaction
○ impulsivity
ANNUAL DEATHS DUE TO SUICIDE PER 100,000
PEOPLE
PREVENTING SUICIDE
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Talk about suicide openly and
matter-of-factly.
Most people are ambivalent about
their suicidal intentions.
Treat the associated mental disorder.
Treat suicidality directly.
Suicide prevention centers
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