Depression is a major public health problem as a leading predictor of functional disability and mortality.
• Optimal depression treatment improves outcome for most patients.
• Most adults with clinical significant depression never see a mental health professional but they often see a primary care physician.
• A non–psychiatric physician 50% of times misses the diagnosis of the depression.
• All depressed patients must be enquired specifically about suicidal ideations.
• Suicidal ideation is a medical emergency
• Risk factors for suicide are psychiatric known disorders, medical illness, prior history of suicidal attempts or family history of attempted suicide.
• The demographic reasons include older age, male gender, marital status (widowed or separated) and living alone.
• About 1 million people commit suicide every year globally.
• Around 79% of patients who commit suicide contact their primary care provider in the last one year before their death and only one-third contact their mental health service provider.
• Twice as many suicidal victims had contacted their primary care provider as against the mental health provider in the last month before suicide.
• Suicide is the 10th leading cause of death worldwide and accounts for 1.2% of all deaths.
• The suicide rate in the US is 10.5 per 100,000 people.
• In the US, suicide is increasing in middle aged adults.
• There are 10–40 non–fatal suicide attempts for every one completed suicide.
• The majority of suicides completed in US are accomplished with fire arm (57%), the second leading method of suicide in US is hanging for men and poisoning in women.
• Patients with prior history of attempted suicide are 5–6 times more likely to make another attempt.
• Fifty percent of successful victims have made prior attempts.
• One of every 100 suicidal attempt survivors will die by suicide within one year of the first attempt.
• The risk of suicide increases with increase in age; however, young adults and adolescents attempt suicide more than the older.
• Females attempt suicide more frequently than males but males are successful three times more often.
• The highest suicidal rate is amongst those individuals who are unmarried followed by those who are widowed, separated, divorced, married without children and married with children in descending order.
• Living alone increases the risk of suicide.
• Unemployed and unskilled patients are at higher risk of suicide than those who are employed.
• A recent sense of failure may lead to higher risk.
• Clinicians are at higher risk of suicide.
• The suicidal rate in male clinicians is 1.41 and in female clinicians it is 2.27.
• Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts.
• The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration.
• Management of suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow up.
• Major risk for suicidal attempts is in psychiatric disorder, hopelessness and prior suicidal attempts or threats.
• High impulsivity or alcohol or other substance abuse increase the risk.