Saturday, August 16, 2014

To Know Suicide: Depression Can Be Treated, but It Takes Competence - By KAY REDFIELD JAMISON - AUG. 15, 2014 - NYT

» Depression is a disease of loneliness
16/08/14 03:00 from Comment is free | theguardian.com
A lack of friends can suck someone into solitude sharing the language of affection could help to ease the pain Continue reading...


» To Know Suicide
16/08/14 01:00 from NYT > Contributors
Depression may be a deadly illness, but we can help people back to life.

BALTIMORE — WHEN the American artist Ralph Barton killed himself in 1931 he left behind a suicide note explaining why, in the midst of a seemingly good and full life, he had chosen to die.
“Everyone who has known me and who hears of this,” he wrote, “will have a different hypothesis to offer to explain why I did it.”
Most of the explanations, about problems in his life, would be completely wrong, he predicted. “I have had few real difficulties,” he said, and “more than my share of affection and appreciation.” Yet his work had become torture, and he had become, he felt, a cause of unhappiness to others. “I have run from wife to wife, from house to house, and from country to country, in a ridiculous effort to escape from myself,” he wrote. The reason he gave for his suicide was a lifelong “melancholia” worsening into “definite symptoms of manic-depressive insanity.”
Barton was correct about the reactions of others. It is often easier to account for a suicide by external causes like marital or work problems, physical illness, financial stress or trouble with the law than it is to attribute it to mental illness.
Certainly, stress is important and often interacts dangerously withdepression. But the most important risk factor for suicide is mental illness, especially depression or bipolar disorder (also known as manic-depressive illness). When depression is accompanied by alcohol or drug abuse, which it commonly is, the risk of suicide increases perilously.
Suicidal depression involves a kind of pain and hopelessness that is impossible to describe — and I have tried. I teach in psychiatry and have written about my bipolar illness, but words struggle to do justice to it. How can you say what it feels like to go from being someone who loves life to wishing only to die?
Suicidal depression is a state of cold, agitated horror and relentless despair. The things that you most love in life leach away. Everything is an effort, all day and throughout the night. There is no hope, no point, no nothing.
The burden you know yourself to be to others is intolerable. So, too, is theagitation from the mania that may simmer within a depression. There is no way out and an endless road ahead. When someone is in this state, suicide can seem a bad choice but the only one.
It has been a long time since I have known suicidal depression. I am one of millions who have been treated for depression and gotten well; I was lucky enough to have a psychiatrist well versed in using lithium and knowledgeable about my illness, and who was also an excellent psychotherapist.
This is not, unfortunately, everyone’s experience. Many different professionals treat depression, including family practitioners, internists and gynecologists, as well as psychiatrists, psychologists, nurses and social workers. This results in wildly different levels of competence. Many who treat depression are not well trained in the distinction among types of depression. There is no common standard for education about diagnosis.
Distinguishing between bipolar depression and major depressive disorder, for example, can be difficult, and mistakes are common. Misdiagnosis can be lethal. Medications that work well for some forms of depression induce agitation in others. We expect well-informed treatment for cancer or heart disease; it matters no less for depression.



We know, for instance, that lithium greatly decreases the risk of suicide in patients with mood disorders like bipolar illness, yet it is too often a drug of last resort. We know, too, that medication combined with psychotherapy is generally more effective for moderate to severe depression than either treatment alone. Yet many clinicians continue to pitch their tents exclusively in either the psychopharmacology or the psychotherapy camp. And we know that many people who have suicidal depression will respond well toelectroconvulsive therapy (ECT), yet prejudice against the treatment, rather than science, holds sway in many hospitals and clinical practices.
Severely depressed patients, and their family members when possible, should be involved in discussions about suicide. Depression usually dulls the ability to think and remember, so patients should be given written information about their illness and treatment, and about symptoms of particular concern for suicide risk — like agitation, sleeplessness and impulsiveness. Once a suicidally depressed patient has recovered, it is valuable for the doctor, patient and family members to discuss what was helpful in the treatment and what should be done if the person becomes suicidal again.

People who are depressed are not always easy to be with, or to communicate with — depression, irritability and hopelessness can be contagious — so making plans when a patient is well is best. An advance directive that specifies wishes for future treatment and legal arrangements can be helpful. I have one, which specifies, for instance, that I consent to ECT if my doctor and my husband, who is also a physician, think that is the best course of treatment.
Because I teach and write about depression and bipolar illness, I am often asked what is the most important factor in treating bipolar disorder. My answer is competence. Empathy is important, but competence is essential.
I was fortunate that my psychiatrist had both. It was a long trip back to life after nearly dying from a suicide attempt, but he was with me, indeed ahead of me, every slow step of the way.


Saturday, April 26, 2014

The Pentagon released a report Friday that provided final data for 2012 suicides and some preliminary numbers for 2013: Suicides among Army National Guard and Reserve members increased last year, even as the number of active-duty troops across the military who took their own lives dropped by more than 15 percent, according to new data - AP




Military Suicides Dropped 15 Percent Last Year; Army National Guard Deaths Rose

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WASHINGTON (AP) — Suicides among Army National Guard and Reserve members increased last year, even as the number of active-duty troops across the military who took their own lives dropped by more than 15 percent, according to new data.
The overall totals provided by the Army, Navy, Air Force and Marine Corps give some hope that prevention programs and increased efforts to identify troops at risk may be taking hold after several years of escalating suicide rates. But the increase among Army National Guard and Reserve members raises questions about whether those programs are getting to the citizen soldiers who may not have the same access to support networks and help that their active duty comrades receive.
Not only did suicides among Army National Guard and Reserve members increase from 140 in 2012 to 152 last year, but the 2013 total exceeded the number of active-duty soldiers who took their own lives, according to the Army. There were 151 active duty soldier suicides last year, compared with 185 in 2012, Army officials said.
The Pentagon released a report Friday that provided final data for 2012 suicides and some preliminary numbers for 2013. But the department data differs a bit from the totals provided by the services because of complicated accounting changes in how the department counts suicides by reservists. Some of the Pentagon numbers were finalized a year ago, while the services have more recently updated totals that reflect the results of some death investigations.
According to the four military services, there were 289 suicides among active duty troops in 2013, down from 343 in 2012. The vast majority were in the Army, the nation's largest military service. The Navy saw a 25 percent decline, from 59 in 2012 to 44 in 2013. The Marines went from 48 to 45, while the Air Force went from 51 to 49.
Due to the accounting changes and other updates, the Pentagon numbers are generally a bit lower and reflect a larger decline in overall active-duty suicides of about 18 percent from 2012 to 2013. In some cases, the services are counting Guard and Reserve members who have been called to active duty as part of the active duty total, while the Pentagon did not.
Both sets of numbers, however, show the same trends: fewer active duty suicides across all four services and slightly more deaths among the Army National Guard and Reserve.
The Pentagon also released detailed demographic data on the 2012 suicides, showing that more often they involve young, white men using a non-military issued gun. They also frequently had reported family or relationship stress.
Military leaders say it's too soon to declare success in the battle against suicides, but they say that some programs appear to be working.
"I think we've changed the cultural mindset — that it's OK for a sailor or a soldier or an airman or Marine to come forward and ask for help," said Rear Adm. Sean Buck, the Navy's officer in charge of suicide prevention and resilience programs. "We're trying to reduce the stigma that used to exist."
Buck said the Navy has focused on doing more programs designed to reduce stress, including teaching sailors coping mechanisms and stress management tools.
For example, he said, Navy leaders noticed a spike in suicides by medical specialists, including doctors and nurses, reaching a total of 22 for 2011 and 2012 combined. The Navy surgeon general started a program that found that there seemed to be a lot of transitions during that time involving the sailors' jobs or base locations.
Buck said that due to the frequent moves, sailors could sometimes find themselves unconnected to their families or units or higher command. "In many instances, if you find yourself in time of need and you're not in a permanent command, you may not know who to turn to," he said.
In response, Navy leaders were told to reach out to communicate with their medical specialists on a daily basis, checking with them to see how they were doing and if there were any problems.
Last year, Buck said, there was a sharp decline in suicides among the medical community, with six in 2013.
Lack of consistent contact with leaders or units could also be a factor for reservists.
Scattered across the United States, often in small or remote rural communities, many members of the Army National Guard and Reserve report for training about one weekend a month and two weeks in the summer. And they often don't have quick access to military medical or mental health services that may be on bases far from their homes. That means the outreach effort by the armed services to address the increase in suicides may not always get to reservists in need — particularly those who don't actively seek help.
According to the Army data, more than half of the reservists who committed suicide in 2012 and 2013 had served in Iraq and Afghanistan. Officials, however, have not been able to establish a strong link between military service on the warfront and suicide.
Army spokeswoman Lt. Col. Sunset Belinsky said the Army set up several programs to deal with the problem, including a 24-hour suicide prevention phone line. The Army Reserve set up six Army Strong Community Centers in New York, North Carolina, Pennsylvania, Oregon, Connecticut and Michigan.
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For help: http://www.veteranscrisisline.net/ActiveDuty.aspx
Crisis phone line: 1-800-273-8255


Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.
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Suicides down for active-duty troops. What about veterans?

By Josh Hicks Updated: April 25 at 3:49 pm

A new Pentagon report shows that suicides among active-duty troops declined by 15 percent last year, offering hope that the military’s suicide-prevention programs may be working.
But at least one veterans group, the Iraq and Afghanistan Veterans of America, says a similar focus on prevention is needed to lower the rate among former service members. An estimated 22 veterans killed themselves each day in 2010, compared with 18 per day in 2007, according to the latest figures available from the Department of Veterans Affairs.
The IAVA said troops can struggle more as they transition into the civilian world and away from the military’s suicide-prevention programs. The group is advocating for a more robust network of care to assist service members throughout their lives.
“The Department of Defense, the Department of Veterans Affairs, the White House and the entire nation need to strengthen our efforts to support our military community in this effort,” IAVA chief executive Paul Rieckhoff said in a statement. “Our service members and veterans fought for our nation, and now is the time for us to fight for them.”
The VA has taken steps in recent years to address the suicide epidemic among veterans, including setting up a toll-free crisis hotline, placing suicide-prevention specialists in all of the agency’s 151 medical centers and integrating mental health services with primary care. The suicide rate among veterans who use the VA health system has not risen like it has for veterans overall, according to the agency’s numbers. VA officials take that as a sign that the department’s suicide-prevention programs are making an impact.
“We have made strong progress, but we must do more,” the VA said in a statement on Friday. “Every veteran suicide is a tragic outcome, and regardless of numbers or rates, even one veteran suicide is too many.”
The Pentagon report Friday also showed that suicides among reservists and National Guard troops actually increased by 8 percent last year. Overall, 289 active-duty troops committed suicide last year, compared with 343 in 2012. Among reservists and National Guard personnel, the number rose from 140 to 152 over the same period.
The American Legion said Friday that the Defense Department and VA need more proactive programs to address suicide risks before current and former troops reach the crisis stage. The group called for better risk-recognition and intervention strategies, such as targeted outreach for high-risk veterans and education to help families identify the signs of a suicidal service member.
“It’s not the ones calling the military crisis line, who are currently being treated or flagged for suicide ideation, that we are worried about, but the ones who fall through the cracks,” said Legion official John Stovall. “We as friends and neighbors have to do a better job identifying those in distress.”
Follow Josh Hicks on TwitterFacebook or Google+. Connect by e-mail at  josh.hicks(at)washpost.comVisit The Federal Eye, and The Fed Page for more federal news. Submit news tips and suggestions to federalworker@washpost.com.
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See more: 

Military Suicide Studies Review


Wednesday, April 9, 2014

Psychiatry Playlist on YouTube: The Superpredator Scare | Retro Report | The New York Times



Psychiatry Playlist on YouTube - by Mike Nova


The Superpredator Scare | Retro Report | The New York Times

Published on Apr 8, 2014
After a surge of teen violence in the early 1990s, some social scientists predicted the future was going to be a whole lot worse. Reality proved otherwise.
Read the story here: http://nyti.ms/1swJRQR 

Watch also: Breivik  Playlist on YouTube

Sunday, April 6, 2014

Fort Hood shooting raises questions over high suicide rate among veterans - The Guardian: "One highly respected institution, in spite of intensive research, had to admit this year that the root causes of military suicides remained unknown."

The Guardian
The statistics for the US military on mental illness, alcoholism and suicidewere already damning before the Fort Hood shooting, with more militarypersonnel killed on home ground than in combat. No one yet knows why the suspect, Ivan Lopez, carried ...

Fort Hood shooting raises questions over high suicide rate among veterans

Statistics on mental illness, alcoholism and suicide in US military were damning before and are proving hard to explain
Lieutenant General Mark Milley
Lieutenant General Mark Milley says Ivan Lopez was known to have behavioural and mental health issues and was being treated. Photograph: Ashley Landis/EPA
The statistics for the US military on mental illness, alcoholism and suicide were already damning before the Fort Hood shooting, with more military personnel killed on home ground than in combat.
No one yet knows why the suspect, Ivan Lopez, carried out the shooting spree at Fort Hood, Texas, before turning the gun on himself, but he was taking medication and undergoing diagnosis to determine whether he was suffering from post-traumatic stress disorder (PTSD). He had served in Iraq for four months in 2011.
Lieutenant General Mark Milley, head of the army's 111 corps at Fort Hood, said: "We do know that this soldier had behavioural health andmental health issues and was being treated for that." He said Lopez had diagnosed himself as suffering from a traumatic brain injury but Milley added that the shooter, who had been engaged in logistical support, had not been wounded in action.
The oft-quoted statistic is that, going back to at least 2008 and in other years since, more American soldiers have committed suicide than have been killed in combat. Last year the US department of veterans affairs issued the startling figure that 22 veterans killed themselves every day.
There is no consensus on why. Many intensive and costly studies have reached different conclusions or have even avoided an explanation when presented with glaring contradictions.
One highly respected institution, in spite of intensive research, had to admit this year that the root causes of military suicides remained unknown. There have been several attempts to debunk the notion of the "dangerous veteran". In a 2007 report on veterans in state and federal prisons, researchers at the Bureau of Justice Statistics found that during the past three decades, the number of veterans in US penitentiaries had declined.
But undoubtedly the US army has suffered over the past decade from what its commanders routinely refer to as overstretch – too few soldiers to fight two wars simultaneously in Iraq and Afghanistan. Tours of duty became longer and more frequent. That seems an obvious explanation for why suicides have been rising. But it is not as simple as that.
One of the largest studies of military suicides, published in March this year, showed that suicide rates among soldiers who had served in either Iraq or Afghanistan had roughly doubled from 2004 to 2009, to more than 30 suicides per 100,000.
The studies were carried out by the National Institute of Mental Health (NIMH), which looked at the records of about 1 million soldiers. The findings would seem to support the idea of combat stress. But the study found that while the number of suicides had roughly doubled among Iraq and Afghanistan veterans, the numbers had trebled among military personnel who had never been deployed. No explanation for the discrepancy is offered.
The military is struggling veterans' not only with PTSD but a host of other problems, not least alcohol and substance abuse, domestic violence, personal financial problems and inability to find jobs at home. One explanation is that, faced with fighting two wars, the military relaxed its recruitment criteria.
According to the NIMH, about one in five US soldiers suffered from depression, panic disorder and other mental illness before enlisting. But with the end of the American military role in Iraq and its winding-down in Afghanistan, the US army has been shrinking – and screening of recruits has become much tougher.
In theory, given the more selective nature of the recruitment, the easy access to healthcare and the high standards of fitness, the military should have lower suicide rates than civilians, or at least be on par with them. Before Iraq and Afghanistan this was the case, but not since.
One of the problems in the US is that the military will fund treatment for PTSD but is less enthusiastic about investing in treatment of other mental illnesses. Doctors sympathetic to the troops will often place those being treated in the PTSD category so they will be entitled to have medical bills paid. The downside is that this inflates the percentage of those judged to be suffering from PTSD.
There are similar problems in Europe from soldiers returning from duty in Iraq and Afghanistan but fewer of the shootings seen in the US. One explanation is the easier access to guns. Lopez, according to Milley, bought the semi-automatic locally and did not register it with the base.

See also:
The Epoch Times
Let us fast forward to current military sacrifices. Compounding the sacrifices that have been made on the battlefield, there is a staggering rise in military suicides. According to a Department of Veterans Affairs report, an average of 22 veterans ...

Monday, January 13, 2014

Young veterans are committing suicide at an alarmingly high rate -- nearly three times that of active-duty troops

» Suicide Among Young Veterans Rising At Alarming Rate
10/01/14 20:02 from Crime on HuffingtonPost.com
Upon returning to civilian life, young veterans are committing suicide at an alarmingly high rate -- nearly three times that of active-duty troops. According to new data released by the Department of Veterans Affairs (VA) on Thursday and...