A recent study by Dr K J Bender, reported in Psychiatric Times, 16 February, Vol 43/2 noted that “adjunctive lithium treatment significantly reduces clinical recurrence, suicidal ideation, and suicide attempts in Bipolar Disorder and Major Depressive Disorder patients.”
He also flagged the concept of “mental pain” (“I cannot go on…”) as a very important indication of raised suicidal ideation. It is a timely reminder for us all as we approach the winter here in New Zealand, with darker skies and increased depressed mood for many, that we need to have our focus on that aspect of assessment with our clients.
Earlier in January, in Vol 43/1 of Psychiatric Times an article by Alkarra, Thomas,and Moukaddam appeared that challenged us all to think deeper about suicidality in association with trauma, where the trauma injury can mask what they called “the disguised suicidal ideation” and we can miss it, being too focused on the trauma treatment.
They noted, “The progression from suicidal ideation to attempt is non-linear, influenced by psychiatric disorders, substance use and environmental factors.” In the USA, “most individuals who commit suicide have not made a previous attempt and are unlikely to be receiving psychological care.” 60% of suicides there are first attempts.
While the stats may differ with the latest New Zealand Data from the Coroner’s Office (due around May this year again) the “red lights” are constant across cultures and countries.
- Substance use is the top “red-light”.
- Alcohol use is the second major risk factor (3 x more likely than non-drinkers).
- Mood disorder – untreated or unresponsive.
- Environmental factors – especially criminality, access to lethal means, parental death by suicide…
- “Thwarted belongingness” – back to our “loneliness” theme of Human needs from a few weeks ago.
Our challenge as clinicians, always the same, is to build hope in the patient that “I can win here…, there is a way through…there are people I can help (altruism), there are people who care for me or I can connect to for belonging and meaning,…there are self-destructive behaviours I can change…”
Keeping Hope alive is always a ‘core value” of our work, but it must be real hope and able to be advanced towards.
Dr John C McEwan
At Monarch Psychology Rooms, Greenlane