depression in girls, women

Girls under 14 more stressed, suicide-prone
Bhavya Dore, Hindustan Times
Mumbai, August 27, 2011
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First Published: 01:28 IST(27/8/2011)
Last Updated: 01:32 IST(27/8/2011)
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Some indicative figures;

under 14 age group
year boys Girls
2009 5 9
2008 3 7
2007 4 9
2006
2005 4 10




above 14 years

Year Girls Boys Total
2009 243 263 506
2008 253 275 528
2007 244 273 517
2006
2005 280 307 567


A study conducted by the Tata Institute of Social Sciences (Tiss) on stress among city students has found that among children below 14 years, girls are more vulnerable to suicides. The report’s analysis of recent suicide statistics (from the National Crime Records Bureau) suggests that
while men have a higher rate of suicide compared to women, in the under 14 years age group, more girls compared to boys have committed suicide.

For instance, in 2009, in Maharashtra in the 15 to 29 years age group, 2,387 girls committed suicide compared to 2,901 boys. However, in the younger age group (under 14 years) 55 girls committed suicide compared to 48 boys in the same year.

“This indicates that young girls under the age of 14 years are either highly stressed in comparison to their male counterparts or are unable to cope with the stress,” said the report, while suggesting that further research was required in the area.

“Boys just have that chilled out attitude, it just happens, girls just don’t have it,” said Dristi Jain, 15, a college student.

The study report, which was submitted to the government last week, has recommended that the state government should develop a policy to prevent student suicides and make it mandatory for all schools to adopt it.

It recommends that all schools should have counsellors whom students can approach for their problems. “It is expensive for a school to have a full-time counsellor, but it is important to have someone for students to talk to,” said Katy Gandevia, a professor at Tiss Centre for Health and Mental Health.

“Children felt burdened under the expectations of their parents,” said the report. “During the interviews with the stakeholders, many identified family as the key source of stress. The stress from family might not be direct, but it can indirectly also cause a lot of friction in a student’s life.”

To combat student suicides the report recommends ;

Training teachers to identify warning signs and risk factors

Improving the student-teacher ratio in class


Training Peer cousellors

Full-time counsellors in all schools

mentorship programs


parent-teacher interactions on a regular basis should not be only about academics but also behaviour and attitudes

Hobby classes and recreational courses

Open discussions on depression, stress, tension and suicide


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Depression in Women
Causes, Symptoms, and Treatment
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Depression in Women: Causes, Symptoms, and Treatment

Depression is not "one size fits all," particularly when it comes to the genders. Not only are women more prone to depression than men, but the causes of female depression and even the pattern of symptoms are often different.

Many factors contribute to the unique picture of depression in women—from reproductive hormones to social pressures to the female response to stress. Learning about these factors can help you minimize your risk of depression and treat it more effectively.
In This Article:

Understanding depression in women
Causes of depression in women
Risks factors for depression in women
Treating depression in women
Premenstrual dysphoric disorder
Related links for depression in women

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Understanding depression in women

Depression is a serious condition that can impact every area of your life. It can affect your social life, your family relationships, your career, and your sense of self-worth and purpose. And for women in particular, depression is common.

If you’re feeling sad, guilty, tired, and just generally “down in the dumps,” you may be suffering from major depression. But the good news is that depression is treatable, and the more you understand about depression’s particular implications for and impact on women, the more equipped you will be to tackle the condition head on.
According to the National Mental Health Association:

Approximately 12 million women in the United States experience clinical depression each year.
About one in every eight women can expect to develop clinical depression during their lifetime.

Signs and symptoms of depression in women

The symptoms of depression in women are the same as those for major depression. Common complaints include:

Depressed mood
Loss of interest or pleasure in activities you used to enjoy
Feelings of guilt, hopelessness and worthlessness
Suicidal thoughts or recurrent thoughts of death
Sleep disturbance (sleeping more or sleeping less)
Appetite and weight changes
Difficulty concentrating
Lack of energy and fatigue

For more, see Understanding Depression: Spotting the Signs and Symptoms and Getting Help.
Differences between male and female depression

Although the signs and symptoms of depression are the same for both men and women, women tend to experience certain symptoms more often than men. For example, seasonal affective disorder—depression in the winter months due to lower levels of sunlight—is more common in women. Also, women are more likely to experience the symptoms of atypical depression.

In atypical depression, rather than sleeping less, eating less, and losing weight, the opposite is seen: sleeping excessively, eating more (especially carbohydrates), and gaining weight. Feelings of guilt associated with depression are also more prevalent and pronounced in women. Women also have a higher incidence of thyroid problems. Since hypothyroidism can cause depression, this medical problem should always be ruled out by a physician in women who are depressed.
Causes of depression in women

Women are about twice as likely as men to suffer from depression. This two-to-one difference persists across racial, ethnic, and economic divides. In fact, this gender difference in rates of depression is found in most countries around the world. There are a number of theories which attempt to explain the higher incidence of depression in women. Many factors have been implicated, including biological, psychological, and social factors.
Biological causes of depression in women

Premenstrual problems - Hormonal fluctuations during the menstrual cycle can cause the familiar symptoms of premenstrual syndrome (PMS), such as bloating, irritability, fatigue, and emotional reactivity. For many women, PMS is mild. But for some women, symptoms are severe enough to disrupt their lives and a diagnosis of premenstrual dysphoric disorder (PMDD) is made.

Pregnancy and infertility - The many hormonal changes that occur during pregnancy can contribute to depression, particularly in women already at high risk. Other issues relating to pregnancy such as miscarriage, unwanted pregnancy, and infertility can also play a role in depression.

Postpartum depression - Many new mothers experience the “baby blues.” This is a normal reaction that tends to subside within a few weeks. However, some women experience severe, lasting depression. This condition is known as postpartum depression. Postpartum depression is believed to be influenced, at least in part, by hormonal fluctuations.

To learn more, see Postpartum Depression: Signs, Symptoms, and Help for New Moms.

Perimenopause and menopause - Women may be at increased risk for depression during perimenopause, the stage leading to menopause when reproductive hormones rapidly fluctuate. Women with past histories of depression are at an increased risk of depression during menopause as well.
Social and cultural causes of depression in women

Role strain - Women often suffer from role strain over conflicting and overwhelming responsibilities in their life. The more roles a woman is expected to play (mother, wife, working woman), the more vulnerable she is to role strain and subsequent stress and depression. Depression is more common in women who receive little help with housework and child care. Single mothers are particularly at risk. Research indicates that single mothers are three times more likely than married mothers to experience an episode of major depression.
Unequal power and status - Women’s relative lack of power and status in our society may lead to feelings of helplessness. This sense of helplessness puts women at greater risk for depression. These feelings may be provoked by discrimination in the workplace leading to underemployment or unemployment. Low socioeconomic status is a risk factor for major depression. Another contributing factor is society’s emphasis on youth, beauty, and thinness in women, traits which to a large extent are out of their control.
Sexual and physical abuse - Sexual and physical abuse may play a role in depression in women. Girls are much more likely to be sexually abused than boys, and researchers have found that sexual abuse in childhood puts one at increased risk for depression in adulthood. Higher rates of depression are also found among victims of rape, a crime almost exclusively committed against women. Other common forms of abuse, including physical abuse and sexual harassment, may also contribute to depression.
Relationship dissatisfaction - While rates of depression are lower for the married than for the single and divorced, the benefits of marriage and its general contribution to well-being are greater for men than for women. Furthermore, the benefits disappear entirely for women whose marital satisfaction is low. Lack of intimacy and marital strife are linked to depression in women.
Poverty - Poverty is more common among women than men. Single mothers have the highest rates of poverty across all demographic groups. Poverty is a severe, chronic stressor than can lead to depression.

Psychological causes of depression in women

Coping mechanisms - Women are more likely to ruminate when they are depressed. This includes crying to relieve emotional tension, trying to figure out why you’re depressed, and talking to your friends about your depression. However, rumination has been found to maintain depression and even make it worse. Men, on the other hand, tend to distract themselves when they are depressed. Unlike rumination, distraction can reduce depression.
Stress response - Some studies show that women are more likely than men to develop depression under lower levels of stress. Furthermore, the female physiological response to stress is different. Women produce more stress hormones than men do, and the female sex hormone progesterone prevents the stress hormone system from turning itself off as it does in men.
Puberty and body image - The gender difference in depression begins in adolescence. The emergence of sex differences during puberty likely plays a role. Some researchers point to body dissatisfaction, which increases in girls during the sexual development of puberty. Body image is closely linked to self-esteem in women, and low self-esteem is a risk factor for depression.

Risk factors for depression in women

There are a number of different, yet interrelated, risk factors for depression in women. Women of lower socioeconomic status are more likely to develop depression. This makes sense considering that the more sources of stress in a woman’s life, the more likely she is to develop depression. Women of low socioeconomic status are likely to struggle with financial problems, issues of unemployment or underemployment, discrimination, lack of education, and single parenthood. Additional risk factors include marital conflict and dissatisfaction, past sexual or physical abuse, and role strain.
Risk Factors for Depression in Women

Family history of mood disorders
Personal past history of mood disorders in early reproductive years
Loss of a parent before the age of 10 years
Childhood history of physical or sexual abuse
Use of an oral contraceptive, especially one with a high progesterone content



Use of gonadotropin stimulants as part of infertility treatment
Persistent psychosocial stressors (e.g., loss of job)
Loss of social support system or the threat of such a loss

Source: American Academy of Family Physicians
Treating depression in women

For the most part, women suffering from depression receive the same types of treatment as everyone else. The main treatment approaches are psychotherapy and antidepressant therapy. However, there are some special treatment considerations for depression in women.
Depression and the reproductive cycle

Hormone fluctuations related to the reproductive cycle can have a profound influence on a woman’s mood. In light of this possibility, you and your doctor should always look for connections between your depressive symptoms and the female reproductive cycle. Is your depression connected to your menstrual period and a possible effect of PMS? Are you pregnant and struggling with complications and concerns related to the vast changes you and your body are undergoing? Are you struggling with the baby blues after recently giving birth? Or are you approaching menopause and dealing with hormonal and emotional fluctuations? All of these milestones in the reproductive cycle can influence or trigger depression. It’s also important to consider mood-related side effects from birth control medication or hormone replacement therapy.
Relationship issues and role strain

Because of the special role that interpersonal issues and role strain plays in female depression, psychotherapy should address them directly. Interpersonal therapy and cognitive-behavior therapy are both effective in teaching new problem solving skills, improving interpersonal relationships, and reducing negative thinking and ineffective coping techniques.
Treatment modifications

Specific aspects of treatment must often be modified for women. Because of female biological differences, women should generally be started on lower doses of antidepressants than men. Women are also more likely to experience side effects, so any medication use should be closely monitored. Finally, women are more likely than men to require simultaneous treatment for other conditions such as anxiety disorders and eating disorders.
Premenstrual dysphoric disorder

Most women are all too familiar with premenstrual syndrome (PMS). Unwelcome symptoms of PMS such as bloating, moodiness, and fatigue appear and reappear each month at the same time in the menstrual cycle. For most women, these premenstrual symptoms are uncomfortable but not disabling. But for up to one out of ten women, symptoms are so distressing and disabling that they warrant a diagnosis of premenstrual dysphoric disorder (PMDD). PMDD is characterized by severe depression, irritability, and other mood disturbances. Symptoms begin about 10 to 14 days before your period and improve within a few days of its start.
Symptoms of Premenstrual Dysphoric Disorder

Feelings of sadness or hopelessness
Feelings of tension or anxiety
Panic attacks
Mood swings and tearfulness
Persistent irritability or anger
Disinterest in daily activities and relationships



Trouble concentrating
Fatigue or low energy
Food cravings or binge eating
Sleep disturbances
Feeling out of control
Physical symptoms (bloating, breast tenderness, headaches, muscle pain)

Self-help for PMDD

There are many steps you can take to improve PMDD symptoms. Many involve simple lifestyle adjustments.

Exercise - Regular aerobic exercise can reduce the symptoms of PMDD.
Dietary modifications - Changes to your diet may help reduce symptoms. Cutting back on salt, fatty foods, caffeine, and alcohol is recommended. Eating plenty of complex carbohydrates is also recommended.
Nutritional supplements - Vitamin B-6, calcium, magnesium, Vitamin E, and tryptophan have all been shown to benefit women suffering from PMDD.
Herbal remedies - Evening primrose oil and chaste tree berry are herbal supplements that have both been studied and found to be effective in the treatment of PMDD.
Stress reduction - Relaxation techniques and other strategies to reduce stress may help with PMDD symptoms. Yoga and meditation are particularly effective.

For more severe cases of PMDD, antidepressant therapy may be helpful. Serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil can alleviate the emotional symptoms of PMDD. The medication may be taken consistently, or in some cases, it is only taken during the two weeks leading up to the onset of menstruation.
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Postpartum DepressionPostpartum Depression and the Baby Blues
Symptoms, Treatment, and Support for New Moms

Postpartum Depression and the Baby Blues
Symptoms, Treatment, and Support for New Moms
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Postpartum Depression:

Having a baby is stressful—no matter how much you've looked forward to it or how much you love your child. Giving birth puts you through a physical and emotional wringer. But your exhaustion has to take a backseat to the needs of your newborn. Considering the sleep deprivation, new responsibilities, and lack of time for yourself, it's only natural that a lot of new moms feel like they're on an emotional rollercoaster.

The baby blues are perfectly normal, but if your symptoms don’t dissipate after a few weeks or they start getting worse, you may be suffering from postpartum depression. Postpartum depression can interfere with your ability to take care of yourself and your newborn child. But with treatment, the support of your family, and attention to your own needs, you can get back on the road to healthy and happy motherhood. Learn about the signs and symptoms and how you can help yourself or your partner.
In This Article:

The baby blues
Signs and symptoms of postpartum depression
Postpartum depression causes and risk factors
How postpartum depression affects the baby
Treatment and help for postpartum depression
Coping with postpartum depression
Postpartum psychosis
Related links

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The baby blues

You’ve just had a baby. You expected to be basking in new mom bliss. You expected to be celebrating the arrival of your little one with your friends and family. But instead of celebrating, you feel like crying. You were prepared for joy and excitement, not exhaustion, anxiety, and weepiness. You may not have been expecting it, but mild depression and mood swings are common in new mothers—so common, in fact, that it has its own name: the baby blues. The vast majority of new mothers experience at least some symptoms: moodiness, sadness, difficulty sleeping, irritability, appetite changes, concentration problems. Symptoms of the baby blues typically show up within a few days of giving birth and last from several days to a couple of weeks.

The baby blues are a normal part of new motherhood—probably caused by the hormonal changes that occur following birth. If you have them, there is no cause for undue worry. The baby blues usually don’t last very long and will go away on their own once your hormones level out. Aside from the support of your loved ones and plenty of rest, no treatment is necessary. However, if your symptoms don’t go away within two to three weeks, or they are severe (such as suicidal thoughts or an inability to care for your newborn), you may be suffering from a more serious condition known as postpartum depression.
Signs and symptoms of postpartum depression

In the beginning, postpartum depression can look like the normal baby blues. In fact, they share many symptoms, including mood swings, crying jags, sadness, insomnia, and irritability. However, in postpartum depression, these symptoms are either longer lasting or more severe. Anxiety is also more prominent in postpartum depression. If you have postpartum depression, you may worry to excess over your baby’s health and well-being. In addition to obsessing over the safety of your newborn, you may be troubled by intrusive thoughts about harming your baby.

Signs and Symptoms of Postpartum Depression

Lack of interest in your baby
Negative feelings towards your baby
Worrying about hurting your baby
Lack of concern for yourself
Loss of pleasure



Lack of energy and motivation
Feelings of worthlessness and guilt
Changes in appetite or weight
Sleeping more or less than usual
Recurrent thoughts of death or suicide

Postpartum depression usually sets in soon after childbirth and develops gradually over a period of several months. But postpartum depression can also come on suddenly, and in some women, the first signs don’t appear until months after they’ve given birth. Because of the possibility of delayed onset, if you have a depressive episode within six months of having a baby, postpartum depression should be considered.

The Edinburgh Postnatal Depression Scale (EPDS) is a screening tool designed to detect postpartum depression. Fill it out for a more complete look at your emotional state. If you believe you have postpartum depression, it can be helpful to bring the completed form to your doctor or therapist.
Postpartum depression causes and risk factors

The exact reasons why some new mothers develop postpartum depression and others don’t are unknown. But a number of interrelated causes and risk factors are believed to contribute to the problem.
Causes

The rapid hormonal changes that accompany pregnancy and delivery may trigger depression. After childbirth, women experience a big drop in estrogen and progesterone hormone levels. Thyroid levels can also drop, which leads to fatigue and depression. These hormone dips—along with the changes in blood pressure, immune system functioning, and metabolism that new mothers experience—can all play a part in postpartum depression. It has been theorized that women who are more sensitive to these hormone imbalances develop postpartum depression.

Women who have just given birth are also dealing with numerous changes, both physical and emotional. They may still be coping with physical pain from the pregnancy and delivery. They may also have difficulties losing the baby weight, leading to insecurities about their physical and sexual attractiveness. In addition to changes to their body, they are also dealing with lifestyle changes. The lifestyle adjustment can be particularly difficult for first time moms, who must get used to an entirely new identity. The stress of caring for a newborn can also take a toll. New mothers are often sleep deprived. In addition, they may feel overwhelmed and anxious about their ability to properly care for their baby. All of these factors can contribute to and trigger postpartum depression.
Risk factors

Women with a previous history of depression are at an increased risk of experiencing postpartum depression. Your risk is also elevated if you have a history of severe PMS or premenstrual dysphoric disorder, if the pregnancy was unplanned, or if you had postpartum depression following a previous pregnancy. According to the National Institute of Mental Health, women with a prior history of postpartum depression have a 50% chance of recurrence.

Stressful events during pregnancy or birth also increase the odds of developing postpartum depression. Stressful events might include a difficult delivery, prenatal problems, premature birth, or illness during pregnancy. Finally, research has shown that women with marital difficulties or a general lack of social support have a greater chance of developing postpartum depression.

If you’ve recently given birth and have one or more of these risk factors, it is especially important to be on the lookout for any signs or symptoms of postpartum depression.
How postpartum depression affects the baby

Postpartum depression can interfere with your ability to function, including your ability to take care of yourself and your child. If you have postpartum depression, it doesn’t mean that you’re a bad mother. However, when you’re consumed with symptoms of depression such as fatigue, irritability, apathy, and tearfulness, it is difficult—if not impossible—to properly look after your newborn’s needs. Your baby will be affected if the depression is left untreated.
The Impact of Postpartum Depression on Children

Behavioral problems


Children of depressed mothers are more likely to develop behavioral problems down the line, including sleep problems, temper tantrums, aggression, and hyperactivity.

Delays in cognitive development


Development is often delayed in babies and children who have depressed mothers. They may learn to walk and talk later than other children. They may also have many other learning difficulties, including problems with school.

Social problems


Children of depressed mothers have difficulty establishing secure relationships. They may find it hard to make friends in school. They may be socially withdrawn, or they may act out in destructive ways.

Emotional problems


Studies have show that children of depressed mothers have lower self-esteem, are more anxious and fearful, are more passive, and are less independent.

Depression


The risk of developing major depression early in life is particularly high for the children of mothers with postpartum depression.

If you’re suffering from postpartum depression, there is no reason to feel guilty or ashamed. The symptoms of postpartum depression are outside your control, and they don’t make you a bad person or a bad parent. However, the choice to get treatment is in your control. Considering the impact depression has on both you and your child, it’s important to seek help right away.
Postpartum depression and attachment
VIDEO

Creating Secure Infant Attachment

Creating Secure Infant Attachment

Research has shown that depressed mothers interact less with their babies. Women with postpartum depression are less likely to breastfeed, play with, and read to their children. They may also be inconsistent in the way they care for their newborns. Depressed mothers can be loving and attentive at times, but at other times they may react negatively or they may not respond at all. This inconsistency disrupts the bonding process between mother and child. This emotional bonding process, known as attachment, is the most important task of infancy.

A secure attachment is formed when the mother responds warmly and consistently to her baby’s physical and emotional needs. When the baby cries, the mother quickly soothes him or her. If the baby laughs or smiles, the mother responds in kind. In essence, the mother and child are in synch. They recognize and respond to each other’s signals. But a depressed mother is less likely to pick up on and respond to her baby’s cues. This sets the stage for an insecure attachment. A child who is insecurely attached is at risk for multiple developmental difficulties and delays, including behavioral, emotional, and social problems.

To learn more about attachment and its impact, see Parenting: Attachment, Bonding and Reactive Attachment Disorder.
Treatment and help for postpartum depression

If you have postpartum depression, you should seek professional treatment. Left untreated, postpartum depression can last for a significant length of time—even up to a year or more. Postpartum depression responds to the same types of treatment as regular depression. Therapy, medication, and support groups can all be helpful.

Psychotherapy – Individual therapy or group therapy can be very effective in the treatment of postpartum depression. Psychotherapy is often the treatment of choice because of concerns over taking medication while breastfeeding. Interpersonal therapy (IPT), which focuses on interpersonal relationships and issues, is believed to be particularly effective for postpartum depression.
Hormone therapy – Estrogen replacement therapy sometimes helps with postpartum depression. Estrogen is often used in combination with an antidepressant. There are risks that go along with hormone therapy, so be sure to talk to your doctor about what is best—and safest—for you.
Marriage counseling – If you are experiencing martial difficulties or are feeling unsupported at home, marriage counseling could be very beneficial.
Antidepressants – For severe cases of postpartum depression where the mother is unable to care for herself or her baby, antidepressants may be an option. However, medication use should be accompanied by therapy, as well as close monitoring by a physician.

To learn more, see Antidepressants: Understanding Depression Medication.
Taking antidepressants while breastfeeding

If you’re considering the use of antidepressants, it’s important to know that your medication can be passed to your baby through your breast milk. Research suggests that in the case of tricyclic antidepressants and SSRIs, the levels of medication that reach the baby through breastfeeding are either low or undetectable. However, there have been rare reports of adverse reactions in nursing infants. Furthermore, the long-term effects of exposure—even to trace amounts of the medication—are unknown.
Coping with postpartum depression

The best thing you can do if you have postpartum depression is to take care of yourself. Be sure to get enough rest, get out in the sunshine each day, and eat a healthy diet. Set aside quality time for yourself to relax and take a break from your mom duties.
Self-help for postpartum depression

Find someone you can talk to about your feelings.
Find people who can help you with child care, housework, and errands so you can get some much needed rest.
Make time for yourself every day, even if it’s only for 15 minutes. Do something relaxing or that makes you feel good about yourself.
Keep a daily diary of your emotions and thoughts. This is a good way to let everything out and to keep track of your progress as you begin to feel better.
Give yourself credit for the things you’re able to accomplish, even if you only get one thing done in a day. If you aren’t able to get anything done, don’t be hard on yourself.
Give yourself permission to feel overwhelmed.
Remember that no one expects you to be supermom.
Be honest about how much you can do and ask others for help.
Join a support group.

Source: American Academy of Family Physicians

It’s also important to stay connected to family and friends. Don’t keep your feelings to yourself. Share them with your significant other or a close friend. Let your loved ones know what you need and how you’d like to be supported.
Helping a loved one with postpartum depression

If your loved one is experiencing postpartum depression, the best thing you can do is to offer support. Give her a break from her childcare duties, provide a listening ear, and be patient and understanding.
You also need to take care of yourself. Dealing with the needs of a new baby is hard for fathers as well as mothers. And if your significant other is depressed, you are dealing with two major stressors.
Postpartum psychosis

Postpartum psychosis is a rare, but extremely serious disorder that can develop after childbirth. It is characterized by loss of contact with reality. Postpartum psychosis should be considered a medical emergency. Because of the high risk for suicide or infanticide, hospitalization is usually required to keep the mother and the baby safe.

Postpartum psychosis develops suddenly, usually within the first two weeks after delivery, and sometimes within 48 hours. Symptoms include:

Hallucinations (seeing things that aren’t real or hearing voices)
Delusions (paranoid and irrational beliefs)
Extreme agitation and anxiety
Confusion and disorientation
Rapid mood swings
Bizarre behavior
Inability or refusal to eat or sleep
Suicidal thoughts or actions
Thoughts of harming or killing the baby

Early warning signs of postpartum psychosis include an inability to sleep for several nights, agitation, euphoria or irritability, and avoidance of the baby. 
Women with a history of bipolar disorder are at an increased risk of developing postpartum psychosis. In fact, postpartum psychosis resembles a manic episode. Women who have previously had postpartum psychosis are also highly likely to develop it again if they have another child.

Parenting & AttachmentParenting & Attachment
Advice For Bonding With Your Baby

Helping a Depressed PersonHelping a Depressed Person
Taking Care of Yourself While Supporting a Loved One
More Helpguide articles:

Dealing with Depression: Self-Help and Coping Tips
Depression Treatment: Therapy, Medication, and Lifestyle Changes That Can Help
Feeling Suicidal? Coping with Suicidal Thoughts and Help to Get You Through

Related Links
General Information about postpartum depression

Depression During and After Pregnancy – Article discusses depression during pregnancy and after childbirth, including possible causes. (The National Women's Health Information Center)

More than the Baby Blues – Learn about postpartum depression and postpartum psychosis, including the signs, symptoms, and causes. (HealthyPlace)
Treatment and help for postpartum depression

Postpartum Major Depression: Detection and Treatment – Take a comprehensive look at the treatment options and considerations for postpartum depression. (American Academy of Family Physicians)

Antidepressants and Breastfeeding - Provides an overview of the benefits and potential risks of breastfeeding while on medication. (HealthyPlace)
Support for postpartum depression

The Online PPD Support Group – Online discussion forum for women suffering from postpartum depression. (PPD Support Page)
Information for fathers

Postpartum Dads – Guide to getting through a partner’s postpartum depression. Includes advice on dealing with rejection from your partner and tips for staying healthy and together. (PostpartumDads)
Postpartum psychosis

One Mother's Story: Postpartum Psychosis – A personal look at postpartum psychosis, including the signs and symptoms. (National Public Radio)

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Dealing with Depression



Dealing with Depression
SELF-HELP AND COPING TIPS
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Depression Self-Help: Living with Depression in Yourself and Others

Depression drains your energy, hope, and drive, making it difficult to do what you need to feel better. But while overcoming depression isn’t quick or easy, it’s far from impossible. You can’t beat it through sheer willpower, but you do have some control—even if your depression is severe and stubbornly persistent.

You can make a huge dent in your depression with simple lifestyle changes: exercising every day, avoiding the urge to isolate, challenging the negative voices in your head, eating healthy food instead of the junk you crave, and carving out time for rest and relaxation. Feeling better takes time, but you can get there if you make positive choices for yourself each day and draw on the support of others.
In This Article:

The road to recovery
Supportive relationships
Taking care of yourself
Exercise
Healthy diet
Negative thinking
Emotional Intelligence
Getting additional help
Related links

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The road to depression recovery

Recovering from depression requires action. But taking action when you’re depressed is hard. In fact, just thinking about the things you should do to feel better, like going for a walk or spending time with friends, can be exhausting.

It’s the Catch-22 of depression recovery. The things that help the most are the things that are most difficult to do. But there’s a difference between difficult and impossible.
Start small and stay focused

The key to depression recovery is to start with a few small goals and slowly build from there. Draw upon whatever resources you have. You may not have much energy, but you probably have enough to take a short walk around the block or pick up the phone to call a loved one.

Take things one day at a time and reward yourself for each accomplishment. The steps may seem small, but they’ll quickly add up. And for all the energy you put in to your depression recovery, you’ll get back much more in return.
Depression self-help tip 1: Cultivate supportive relationships
10 tips for reaching out and building relationships

Talk to one person about your feelings.
Help someone else by volunteering.
Have lunch or coffee with a friend.
Ask a loved one to check in with you regularly.
Accompany someone to the movies, a concert, or a small get-together.
Call or email an old friend.
Go for a walk with a workout buddy.
Schedule a weekly dinner date.
Meet new people by taking a class or joining a club.
Confide in a counselor, therapist, or clergy member.

Getting the support you need plays a big role in lifting the fog of depression and keeping it away. On your own, it can be difficult to maintain perspective and sustain the effort required to beat depression. But the very nature of depression makes it difficult to reach out for help. However, isolation and loneliness make depression even worse, so maintaining your close relationships and social activities are important.

The thought of reaching out to even close family members and friends can seem overwhelming. You may feel ashamed, too exhausted to talk, or guilty for neglecting the relationship. Remind yourself that this is the depression talking. You loved ones care about you and want to help.

Turn to trusted friends and family members. Share what you’re going through with the people you love and trust. Ask for the help and support you need. You may have retreated from your most treasured relationships, but they can get you through this tough time.
Try to keep up with social activities even if you don’t feel like it. When you’re depressed, it feels more comfortable to retreat into your shell. But being around other people will make you feel less depressed.
Join a support group for depression. Being with others who are dealing with depression can go a long way in reducing your sense of isolation. You can also encourage each other, give and receive advice on how to cope, and share your experiences. To locate a depression support group in your area, use the Depression and Bipolar Support Alliance's Support Group Locator.

Therapeutic Benefits of PetsHow pets can make you happier and healthier

While nothing can replace the human connection, pets can bring joy and companionship into your life and help you feel less isolated. Caring for a pet can also get you outside of yourself and you a sense of being needed—both powerful antidotes to depression. And the research backs it up. Studies show that pet owners are less likely to suffer from depression or get overwhelmed by stress.

Read: The Therapeutic Benefits of Pets: How Caring for a Pet Can Make You Happier and Healthier
Depression self-help tip 2: Take care of yourself

In order to overcome depression, you have to nurture yourself. This includes making time for things you enjoy, asking for help from others, setting limits on what you’re able to do, adopting healthy habits, and scheduling fun activities into your day.
Do things you enjoy (or used to)

While you can’t force yourself to have fun or experience pleasure, you can choose to do things that you used to enjoy. Pick up a former hobby or a sport you used to like. Express yourself creatively through music, art, or writing. Go out with friends. Take a day trip to a museum, the mountains, or the ballpark.
Develop a wellness toolbox

Come up with a list of things that you can do for a quick mood boost. Include any strategies, activities, or skills that have helped in the past. The more “tools” for coping with depression, the better. Try and implement a few of these ideas each day, even if you’re feeling good.

Spend some time in nature.
List what you like about yourself.
Read a good book.
Watch a funny movie or TV show.
Take a long, hot bath.



Listen to music.
Take care of a few small tasks.
Play with a pet.
Write in your journal.
Do something spontaneous.

Push yourself to do things, even when you don’t feel like it. You might be surprised at how much better you feel once you’re out in the world. Even if your depression doesn’t lift immediately, you’ll gradually feel more upbeat and energetic as you make time for fun activities.
Adopt healthy lifestyle habits

Aim for 8 hours of sleep. Depression typically involves sleep problems. Whether you’re sleeping too little or too much, your mood suffers. Get on a better sleep schedule by learning healthy sleep habits.
Expose yourself to a little sunlight every dayExpose yourself to a little sunlight every day. Lack of sunlight can make depression worse. Make sure you’re getting enough. Take a short walk outdoors, have your coffee outside, enjoy an al fresco meal, people-watch on a park bench, or sit out in the garden.
Practice relaxation techniques. A daily relaxation practice can help relieve symptoms of depression, reduce stress, and boost feelings of joy and well-being. Try yoga, deep breathing, progressive muscle relaxation, or meditation.

Fight depression by managing stress

Not only does stress prolong and worsen depression, but it can also trigger it. In order to get over depression and stay well, it’s essential to learn how to minimize and cope with stress.

Identify your stressors. Figure out all the things in your life that are stressing you out. Examples include: work overload, unsupportive relationships, substance abuse, taking on too much, or health problems. Once you’ve identified your stressors, you can make a plan to avoid them or minimize their impact.
Go easy on yourself. Many depressed people are perfectionists, holding themselves to impossibly high standards and then beating themselves up when they fail to meet them. Battle this source of self-imposed stress by challenging your negative ways of thinking.
Plan ahead. If you know your stress triggers and limits, you will be able to identify and avoid many landmines. If you sense trouble ahead, protect yourself by dipping into your wellness toolbox and saying “no” to added responsibility.

Depression self-help tip 3: Get regular exercise

Get regular exerciseWhen you’re depressed, exercising may be the last thing you feel like doing. But exercise is a powerful tool for dealing with depression. In fact, studies show that regular exercise can be as effective as antidepressant medication at increasing energy levels and decreasing feelings of fatigue.

Scientists haven’t figured out exactly why exercise is such a potent antidepressant, but evidence suggests that physical activity increases mood-enhancing neurotransmitters in the brain, raises endorphins, reduces stress, and relieves muscle tension – all things that can have a positive effect on depression.

To get the most benefit, aim for 30 minutes of exercise per day. But you can start small. Short 10-minute bursts of activity can have a positive effect on your mood. Here are a few easy ways to get moving:

Take the stairs rather than the elevator
Park your car in the farthest spot in the lot
Take your dog for a walk
Pair up with an exercise partner
Walk while you’re talking on the phone

As a next step, try incorporating walks or some other enjoyable, easy form of exercise into your daily routine. The key is to pick an activity you enjoy, so you’re more likely to keep up with it.
Exercise as an Antidepressant

The following exercise tips offer a powerful prescription for boosting mood:

Exercise now…and again. A 10-minute walk can improve your mood for two hours. The key to sustaining mood benefits is to exercise regularly.
Choose activities that are moderately intense. Aerobic exercise undoubtedly has mental health benefits, but you don't need to sweat strenuously to see results.
Find exercises that are continuous and rhythmic (rather than intermittent). Walking, swimming, dancing, stationery biking, and yoga are good choices.
Add a mind-body element. Activities such as yoga and tai chi rest your mind and pump up your energy. You can also add a meditative element to walking or swimming by repeating a mantra (a word or phrase) as you move.
Start slowly, and don't overdo it. More isn't better. Athletes who over train find their moods drop rather than lift.

Adapted from Johns Hopkins Health Alerts

For more exercise tips, read Exercise for Exercise Haters: Finding Ways to Tolerate (or Even Enjoy) Exercise.
Depression self-help tip 4: Eat a healthy, mood-boosting diet

Eat a healthy, mood-boosting dietWhat you eat has a direct impact on the way you feel. Aim for a balanced diet of protein, complex carbohydrates, fruits and vegetables.

Don’t neglect breakfast. A solid breakfast provides energy for the day.
Don’t skip meals. Going too long between meals can make you feel irritable and tired, so aim to eat something at least every 3-4 hours.
Minimize sugar and refined carbs. You may crave sugary snacks, baked goods, or comfort foods such as pasta or french fries. But these “feel-good” foods quickly lead to a crash in mood and energy.
Focus on complex carbohydrates. Foods such as baked potatoes, whole-wheat pasta, brown rice, oatmeal, whole grain breads, and bananas can boost serotonin levels without a crash.
Boost your B vitamins. Deficiencies in B vitamins such as folic acid and B-12 can trigger depression. To get more, take a B-complex vitamin supplement or eat more citrus fruit, leafy greens, beans, chicken, and eggs.
Consider taking a chromium supplement. Some depression studies show that chromium picolinate reduces carbohydrate cravings, eases mood swings, and boosts energy. Supplementing with chromium picolinate is especially effective for people who tend to overeat and oversleep when depressed.
Practice mindful eating. Slow down and pay attention to the full experience of eating. Enjoy the taste of your food

Omega-3 fatty acids play an essential role in stabilizing mood.

Foods rich in certain omega-3 fats called EPA and DHA can give your mood a big boost. The best sources are fatty fish such as salmon, herring, mackerel, anchovies, sardines, and some cold water fish oil supplements. Canned albacore tuna and lake trout can also be good sources, depending on how the fish were raised and processed.
You may hear a lot about getting your omega-3’s from foods rich in ALA fatty acids. Main sources are vegetable oils and nuts (especially walnuts), flax, soybeans, and tofu. Be aware that our bodies generally convert very little ALA into EPA and DHA, so you may not see as big of a benefit.
Some people avoid seafood because they worry about mercury or other possible toxins. But most experts agree that the benefits of eating 2 servings a week of cold water fatty fish outweigh the risks.

Depression self-help tip 5: Challenge negative thinking

Depression puts a negative spin on everything, including the way you see yourself, the situations you encounter, and your expectations for the future.

But you can’t break out of this pessimistic mind frame by “just thinking positive.” Happy thoughts or wishful thinking won’t cut it. Rather, the trick is to replace negative thoughts with more balanced thoughts.
Ways to challenge negative thinking:

Think outside yourself. Ask yourself if you’d say what you’re thinking about yourself to someone else. If not, stop being so hard on yourself. Think about less harsh statements that offer more realistic descriptions.
Keep a “negative thought log." Whenever you experience a negative thought, jot down the thought and what triggered it in a notebook. Review your log when you’re in a good mood. Consider if the negativity was truly warranted. For a second opinion, you can also ask a friend or therapist to go over your log with you.
Replace negatives with positives. Review your negative thought log. Then, for each negative thought, write down something positive. For instance, “My boss hates me. She gave me this difficult report to complete” could be replaced with, “My boss must have a lot of faith in me to give me so much responsibility.”
Socialize with positive people. Notice how people who always look on the bright side deal with challenges, even minor ones, like not being able to find a parking space. Then consider how you would react in the same situation. Even if you have to pretend, try to adopt their optimism and persistence in the face of difficulty.

Depression self-help tip 6: Raise your emotional intelligence

Emotions are powerful. They can override thoughts and profoundly influence behavior. But if you are emotionally intelligent, you can harness the power of your emotions.

Emotional intelligence isn’t a safety net that protects you from life’s tragedies, frustrations, or disappointments. We all go through disappointments, loss, and change. And while these are normal parts of life, they can still cause sadness, anxiety, and stress. But emotional intelligence gives you the ability to cope and bounce back from adversity, trauma, and loss. In other words, emotional intelligence makes you resilient.
Emotional intelligence gives you the ability to:

Remain hopeful during challenging and difficult times
Manage strong feelings and impulses
Quickly rebound from frustration and disappointment
Ask for and get support when needed
Solve problems in positive, creative ways

Learn how to raise your emotional intelligence

Emotional intelligence gives you the tools for coping with difficult situations and maintaining a positive outlook. It helps you stay focused, flexible, and creative in bad times as well as good. The capacity to recognize your emotions and express them appropriately helps you avoid getting stuck in depression, anxiety, or other negative mood states.

Read: Emotional Intelligence: The Five Key Skills


Depression self-help tip 7: Know when to get additional help

If you find your depression getting worse and worse, seek professional help. Needing additional help doesn’t mean you’re weak. Sometimes the negative thinking in depression can make you feel like you’re a lost cause, but depression can be treated and you can feel better!

There are many effective treatment options for depression. To learn about them, see Depression Treatment and Therapy.

Don’t forget about these self-help tips, though. Even if you’re receiving professional help, these tips can be part of your treatment plan, speeding your recovery and preventing depression from returning.

Relaxation Techniques for Stress ReliefRelaxation Techniques for Stress Relief
Relaxation Exercises to Reduce Stress, Anxiety, and Depression

Improving Emotional HealthImproving Emotional Health
Strategies and Tips for Good Mental Health
More Helpguide articles:

Depression Treatment: Therapy, Medication, and Lifestyle Changes That Can Help
Antidepressant Medications: What You Need to Know About Depression Medications
Feeling Suicidal? Coping with Suicidal Thoughts and Help to Get You Through
Helping a Depressed Person: Taking Care of Yourself While Supporting a Loved One

Need More Help?
Use your senses to keep stress in checkBring Your Life Into Balance Toolkit

Feeling depressed, overwhelmed, helpless, or hopeless? This toolkit can help you regain your emotional balance.

Go to Toolkit »
Related links for depression self-help and recovery
Depression self-help and coping tips

A Case of Catch 22 – Learn how to get around the Catch-22 of depression, in which the things a person needs to do to get well are the very things the illness makes it difficult to do. (Psychology Today)

Recovery - A series of articles on depression recovery, covering topics such as meditation, healthy eating, sleep, and exercise. (McMan’s Depression and Bipolar Web)
Support Groups

Find Support – To locate a depression support group in your area, visit the (Depression and Bipolar Alliance)
Depression self-help tools

Back from the Bluez – Self-help modules for coping with and recovering from depression. Features advice on increasing activity levels, thinking more positively, and maintaining treatment progress. (The Government of Western Australia Department of Health)

Self-Care Depression Program (PDF) – Comprehensive self-help guide to depression recovery from the University of British Columbia. (National Electronic Library for Health)

Wellness Toolbox – A selection of tools for depression recovery, including a therapy worksheet, symptom checklist, trigger tracker, and a personal wellness checklist. (Depression and Bipolar Support Alliance)
Challenging negative thoughts

Depression Doing the Thinking – Learn about common cognitive distortions and how to change them (Psychology Today)
Healthy lifestyle habits and depression

Depression and Exercise – Learn how exercise improves depression and find tips for getting started. (Better Health Channel)

Omega-3 for Depression and Bipolar – Gives an overview of the Omega-3 fatty acids and their role in boosting mood and relieving depression symptoms. (McMan's Depression and Bipolar Web)

Bedfellows: Insomnia and Depression – Discover the connection between sleep and mood, including how lack of sleep can trigger depression. (Psychology Today)

Healthy eating and depression (PDF) – Learn how to change your diet to improve your mood and relieve symptoms of depression. (Mental Health Foundation)
Delving deeper into dealing with depression

Coping with Depression – Psychologist Jon G. Allen reviews the key concepts of depression self-help and recovery, such as minimizing stress, thinking more flexibly, and maintaining supportive relationships. (The Menninger Clinic)

Authors: Melinda Smith, M.A., and Joanna Saisan, Robert Segal, M.A., and Jeanne Segal, Ph.D. Last updated: June 2011

Sangli woman ends life, claimed she was fed-up of corruption

Thirty two year old Shubangi Karande from Sangli allegedly committed suicide on Friday 26th august .A note pinned to her body claimed she was ending her life to protest against corruption.


Anoother incident of misguided fervor- A 27 year old woman, Senkodi, set herself on fire on Sunday 28th Aug 2011 in Kancheepuram, 120 km off Chennai demanding the release of former PM Rajiv Gandhi's Killers Perarivalan, Santhan and Murugan. Senkodi set herself on fire in front of a government office shouting pro-LTTE slogans.


After surgery, patient ends life

Homesick 30-yr-old Jalna farmer, whose heart valve was replaced, jumps off fifth floor window of JJ Hospital

Lata Mishra

Posted On Saturday, August 27, 2011 at 03:05:34 AM

A 30-year-old man, who was undergoing treatment at JJ Hospital in Byculla, allegedly committed suicide by jumping from a window on the fifth floor of the hospital building around 2 am on Friday. The window, unlike others in the ward, did not have a grille.

The deceased, Subhash Patole, a farmer from Jalna district, was fed up over the prolonged stay in hospital, said his relatives. A cardiac patient, he had been admitted on May 25, and underwent a valve replacement surgery on July 28 after which he was undergoing post-operative care. Patole was entitled to free treatment as he was covered under the central government’s Jivandaayi Yojana scheme.

A security guard and ward boy, who spotted Patole in the compound, took him to the casualty ward where he died.

This year, it’s the second patient suicide case at the state-run hospital. In March, a schizophrenic admitted to the psychiatry ward, hanged himself in the toilet as he could not watch the cricket World Cup final match.

Deepak Turbhekar
A relative points to the spot where the deceased, Subhash Patole, was found lying

Kids’ uncertain future

“My husband was fed up with hospital stay and kept asking when he could go home,” said his widow Sanjivani. The couple have two kids.

She said that all windows in the ward are grilled, and that her husband managed to find one without grilles.

“His surgery was successful, and everything was fine. We have no clue why he ended his life,” said Patole’s brother-in-law Sahebrao Kamble.

A post-mortem was conducted on Friday, after which the body was taken to Jalna for the last rites.

Missing window grille?

Dean of JJ Hospital, Dr T P Lahane, said the patient was to be discharged soon. “His relatives told me he was behaving strangely and had become aggressive since a couple of days.”

Dr Lahane said that similar suicide cases at the hospital made the authorities fence all windows with grilles. “The window from which Patole jumped was at the entrance of the ward. The patient’s cot was at the other side,” said Lahane.

A suicide case has been registered at JJ Marg police station, said Police Sub-Inspector Vishwanath Bhosale.

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6 more Vidharbha farmers suicide, Man in lock-up hangs himself,

Farmer Suicides in Vidharbha

2001- 52 deaths by suicide
2002- 104
2003-148
2004-447
2005-445
2006-1448
2007- 1246
2008- 1268
2009- 916
2010- 748
2011- 418( till Aug 26th ,2011)

6 more farmers commit suicide in Vidarbha in last 48 hours
Pradip Kumar Maitra, Hindustan Times
Nagpur, August 25, 2011
Email to Author

First Published: 20:09 IST(25/8/2011)
Last Updated: 20:10 IST(25/8/2011)

At a time when the Anna-tide has swept the people across the country against the anti-corruption campaign, sadly, the agrarian crisis continues to take a heavy toll on farmers in Vidarbha. Unable to put up with crop failure, crippling debts and not getting remunerative price for their
produce, six more distressed cotton-growers have committed suicide in Vidarbha over the last 48 hours.

Reports reaching Nagpur on Thursday said six cotton growers Kaniram Jadhav of Krishna Nagar (Yavatmal district), Pramod Gawande of Lotwada, Puroshottam Pakhan of Muradevi (both in Amravati), Nitin Fale, Masa (Akola), Sheikh Anwar, Pangarkhed (Buldhana) and Santosh Raut of Malegaon (Washim), ended their lives in the last two days.

With these, the farmers' suicide toll has risen to 44 this month while the figure was 52 in July. As many as 418 farmers have committed suicide because of agrarian crisis in Vidarbha since January 2011.

Talking to Hindustan Times, Shravan Hardikar, the district collector of Yavatmal, one of the worst hit districts in the region, admitted that the rate of farmers' suicide has increased this month in the district. "We are trying our best to prevent such thing in the district," he said.

The institutional banks have disbursed around Rs 650-crore crop loan in the current kharif season as against the target of over Rs 900-crore. "Some nationalised banks are not cooperating in this regard and have been issued a stern warning. These banks have been directed to meet the target of disbursing crop loan to needy farmers," Hardikar said.

He informed that there were reports of 25 farmers' suicide this month in Yavatmal. "We are verifying facts whether these cases were related with agrarian crisis or not," he said.

Kishore Tiwari of Vidarbha Janandolan Samiti said that the growing trend of farmers' suicide is alarming. However, nobody is listening it in the wake of Hazare's fast for Jan Lokpal bill. This sensitive issue was overshadowed by Anna's agitation across the country.

"It is pathetic that Anna, who has been fighting for a good cause of anti-corruption, but never bothered about the vital issue of farmers' suicide in Vidarbha where an average two farmers commit suicide every day," he said. The veteran Gandhian crusader did not even speak about on wanton corruption by government officials and politicians while implementing the Prime Minister and state government relief packages of over Rs 6000-crore to bailout the distressed farmers of Vidarbha, Tiwari said.

The vicious circle of loans and exploitation by moneylenders and the powers-that-be, doesn't seem to be addressed by Anna Hazare's anti-corruption campaign. The farmers at large, though see a ray of hope in Anna, but those deeply caught in this vicious circle, are unable to cope up with farm distress any more.

"We are insisting that at least the government should treat these distressed farmers as BPL families so that they can get the food grain benefit from the government under the public distribution system to help minimise the farmers' suicide," Tiwari said. However, the government is not doing anything in this regard, he rued.
=====================================================================
Man in lock-up hangs himself(DNA)


A youth detained by the police from Sativali village, committed suicide in Gorai Pada chowkie on Wednesday night.

Badal Kumar Shetty, 23, a resident of Velchi Pada at Sativali village, was detained by the Manikpur police on suspicion that he had kidnapped a 16-year-old girl from his locality.

According to the police, the girl’s parents had lodged a missing complaint and suspected that Shetty had kidnapped her because they were having an affair.

Shetty was brought to Gorai Pada police chowky for questioning and was put in a lock-up along with another criminal.

Before two police constables could start interrogating him, they got information of an accident and had to rush to the spot.

When the constables returned, the other criminal in Shetty’s lock-up told them that Shetty had locked himself in the toilet for a long time.
They broke open the toilet door and saw Shetty’s body hanging from the toilet window.Badal had committed suicide by hanging himself with his trousers.

“He was brought to the police chowkie at 8.25pm andwas found dead at 10.30pm,” said Chandrakant Jadhav, senior inspector of Manikpur police station.

“We have sent the body for post-mortem. Shetty might have committed suicide fearing police action against him as he was in love with a minor girl, who has gone missing. We have registered an accidental death case,” added Jadhav.


-----------------------------------------------------------------
Man hangs self in Babu's Mhada flat

A 33 year old man was found hanging from a fan in a Mhada housing colony flat in Pratiksha Nagar , Sion on thursday 25th aug 2011. Ankit Jain who was staying in Flat No H 18 might have committed suicide two days ago, according to sources. The flat belongs to anant Khalse, principal Secretary in the state legislature.

--------------------------------------------------------------------------
Orissa youth Arun Kumar Das ,fasting for Anna's Jan Lokpal Bill/anti-graft campaign, dies and Ahmedabad's Anna, 62 yr old Chandrakant Barot was admitted to Hospital. In yet another development Dinesh Yadav, an Anna Hazare fan tried self-immolation and is battling for his life in a hospital in Delhi.
--------------------------------------------------------------------------

Parasmuni who took the life-long vow of deeksha (monkhood) 40 years ago completed 2360 days( in seperate spells) of fasting and continues to survive.

Questions from SNDT college student for a project on NGO's answered by Johnson Thomas

sara bhoira wrote:
> TO,
> johnson thomas,
> director councellor,
> aasra foundation
> 104,sunrise
> arcade plot no 100
> sector 16
> navi mumbai 400709
>
> subject :-i) have attached the college letter
> ii) questionnaire related to high rate of suicide in women
>
> 1.) if a suicide paitent who have survived suicide instance and the paitent comes to you what therapy or advice do you give them?
The client needs counselling and long-term therapy so that, that suicidal instance is not repeated again. We offer them that support. We also have support group services fpeople who have attempted suicide so that they are able to talk about their experiences freely and feel supported by people who are similar to them.

> 2.)how many cases of women suicide have your organisation handled? if possible can you please give one case example please?
We have handled many cases where women have expressed their suicidal intent. Almost 60% of our callers are women who are in distress. We offer then unbiased, non-judgemental , non critical listening therapy(non directive counselling) which is very effective for crisis intervention for suicide prevention. It would not be ethical for me to divulge any details of cases we have handled.
>
> 3.)what are the various warning signs that one come to know that a suicide paitent is crying for help?

> Do go to our blog
http://aasrasuicideprevention.blogspot.com
for the warning signs/suicidal intent


> 4.)what is the best solution and best way to help women who are suicidal?
> answered in Question 2.

> 5.)what are the prevention measures your organisation does for prevention of suicide in women?
We have a 24x7 helpline(022-27546669/27546667). We also have face to face counselling service. We have support groups for women suffering from depression/metal illness/suicide attemptors andwe also conduct workshops in various educational institutions and workplaces to make women aware of our services which they could avail of when in distress.
>
> 6)if a suicide has taken place how does the family handle the case in terms what reaction do they get from the society?
> In India suicide and mental illness are still considered a stigma. Coupled with the law that punishes suicide attempt survivors it becomes doubly difficult for women or anyone to seek help when in need of it. They fear the society's negative reaction. People are even termed mad when thye are seen going to a psychiatrist or any mental health professional. The awareness of mental health issues is very limited in our society.

> 7)why are more women comitting suicide than men
Since our society is acutely patriachal, women hold a lowly place as compared to men. They are often subjugated, abused, controlled and harrassed by the men in their lives. The recent domestic violence act has made a small beginning in redressing that imbalance but it's still a long way off when women can feel completely secure in this man's world. It's also true that women are driven more by the heart than the head. They are far more emotional than men and that makes them far more vulnerable to distress.


> article on march 8 and april 16 reported that the women who comitted suicide first killed their children and then they comitted the act whats the link between the two case and whats the main cause? When women see no way out of their distressing predicament they choose death over life. Their children are part of their being and they believe that if they themselves were not being treated with respect and undertsanding they cannot expect that a part of their very being , their children, be treated with love, respect and understanding. hence they feel that ending their child's life alonghside theirs is justified.
>
> 8) what is the role of husband played to help his wife who is suicidal
> what impact does it have on husband after his wife has committed suicide?
Many women suffer from depression because of hormonal changes in their body. This happens post-delivery too. Husbands should be more involved and attentivie to their wives' needs. They must be supportive and understanding and must even help in taking care of the child/children so that their wives' can get the required rest needed to keep them calm and composed. It also prevents them from being overwhelmed by the responsibilities associated with bring up children.

When a wife commits suicide the husband is devastated emotionally. More often than not, He is also blamed for the death of his wife. He undergoes a lot of trauma and grief over the event and even has to face the distress of being questioned by the police and in some cases be imprisoned. It is a devastating experience for any man. he can also end up being suicidal himself. Depending on his mental framework, He might also become resentful about women.
>
>
> these are the types of questions please sir let me knw if the above question you can answer



--
JThomas

THE BELOW IS THE REPORT I HAVE INCLUDED IN MY REPORT I INTERVIWED VARIOUS OTHER ORGANIZATION LIKE MAJLIS LITIGATION CENTRE, FIDAI ACADEMY , CLINICAL PSHYCOLOGIST , SAHELI AND SOME OF THE STAFF FROM RCWS(RESEARCH CENTRE FOR WOMEN STUDIES)

"I interviwed one of the the quickest helpline that is aasra foundation I had taken an appointment to go to their organization but as they were free only at Sunday night and the organization aasra foundation is located in navi Mumbai so couldn’t go so I had sent my questionnaire through mail which was replied by Johnson Thomas Director of Aasra foundation helpline and I have attached the questionnaire. Aasra foundation is one of the quickest helpline from all the other organization I tried calling vabdrewala foundation and samaritians but both of the organization dint answer by call"

THANKS SIR FOR YOUR REPLY IM SORRY FOR BOTHERING YOU AS I HAD TO ARRANGE AND SUM UP MY DATA AND I DO UNDERSTAND THAT INSPITE OF YOUR BUSY SHEDULE YOU DID SPENT YOUR PRECIOUS TIME TO ANSWER MY QUESTIONNAIRE AN IM SO GRATEFUL THAT YOUR ORGANIZATION IS THE QUICKEST HELPLINE AND THAT IS WHAT I AM GOIN TO INCLUDE IN MY SEMINAR TOO

SARA BHOIRA
STUDENT
HUMAN DEVELOPMENT
SVT COLLEGE
SNDT UNIVERSITY
JUHU CAMPUS

Multiple sclerosis genes identified,chance of a cure?

Multiple sclerosis genes identified in largest-ever study of the disease

Most of the newly discovered multiple sclerosis (MS) gene variants are involved in the body's immune system



Alok Jha, science correspondent
guardian.co.uk, Wednesday 10 August 2011 19.00 BST
Article history

Computer-generated image of the DNA double helix
Computer-generated image of the DNA double helix. The study compared DNA from 9,772 people with MS with that from 17,376 healthy people. Photograph: Rex Features

Scientists have discovered 29 new gene variants that are implicated in multiple sclerosis, following the largest ever study of the genetics of the disease.

The genes are involved in controlling parts of the body's immune system, confirming research strategies and pointing to possible treatments for people who develop MS. The discoveries more than double the list of parts of the human genome that researchers believe contribute to the disease.

MS is one of the most common diseases of the nervous system, affecting more than 2.5 million people around the world. It is caused by damage to the protective insulation around nerve fibres, called the myelin sheath, preventing the nerves from working properly. This can affect everyday activities including sight, walking, thinking and control of organs.

In the latest study, led by Alastair Compston from the University of Cambridge, scientists looked at 600,000 locations in the DNA from 9,772 people with MS and compared it with those of 17,376 unrelated healthy people.

It is the largest-ever study into the disease, involving 250 researchers in the International Multiple Sclerosis Genetics Consortium and the Wellcome Trust Case Control Consortium. The results were published on Wednesday in Nature.

The first gene to be linked to MS, called HLA, was found in the early 1970s. Since then, several more genes have been implicated. In the Nature paper, researchers confirmed the involvement of 23 previously suspected gene variants and found 29 new variants. A further five variants were identified as strong candidates for future studies of the disease.

"The genes implicated by these 57 regions tell a very coherent story," said Compston. "There is a narrative that goes across these which is extremely informative – the story is immunological – 80% of the genes within the regions implicated are intimately involved in the workings of the immune response. This puts immunology right at the front end of the disease, unambiguously."

Many of the genes identified by Compston's team are involved in the function of T-cells, a type of immune cell that is responsible for destroying foreign invaders. Of the new gene variants found for MS, around a third have already been linked to a range of autoimmune conditions, where the T-cells malfunction and start attacking the body's own cells, such as Crohn's disease and Type 1 diabetes.

The findings also confirm some of the research scientists had already been pursuing. Four of the gene variants for MS are directly associated with drugs that are either already licensed or in clinical trials.

Peter Donnelly, a co-author of the research and head of the Wellcome Trust Centre for Human Genetics at Oxford University, said the study still did not reveal the complete picture for MS. "Our best guess at this is that, collectively, now the variants explain about 20% of the heritability," he said. "The rest will be down to a multitude of as-yet-undiscovered gene variants, each adding a tiny percentage to the overall risk of developing the disease."

Simon Gillespie, chief executive of the MS Society said: "By identifying which genes may trigger the development of MS, we can identify potential 'risk factors' and look at new ways of treating, or even preventing, the condition in the future. The MS Society is delighted to have helped fund this groundbreaking research."

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16 Jan 2003

New treatment found for delayed asthma attacks

New treatment for delayed asthma attacks found?
Aug 14, 2011 |

PTI

|

London


NEWSM.jpg

Scientists claim they probably found a potential new treatment for delayed asthma attacks which can occur several hours after exposure to allergens.
A team from Imperial College London found that blocking sensory nerve functions stopped a “late asthmatic response” in mice and rats, the Thorax journal reported.
The researchers say the late asthmatic response happens because the allergen triggers sensory nerves in the airways.
These nerves then set off a chain reaction which causes the release of neurotransmitter acetylcholine, which causes the airways to narrow.
If these findings translate to humans, it will mean that drugs which block acetylcholine could be used to treat asthma patients who suffer from delayed attacks.
Around half of people with asthma experience delayed symptoms.
These attacks can often happen at night, three to eight hours after the sufferer comes into contact with grass pollen or house-dust mites, for example.
Prof. Maria Belvisi, who led the team, said they realised the importance of sensory nerves in triggering symptoms by chance. “We wanted to do the research on anaesthetised rats, but we couldn’t because the late response had been blocked by anaesthetising them.
“We stumbled upon it. Now we want to work out how allergens trigger these nerves, because we don’t know the exact connections,” he was quoted by the BBC as saying.
The data produced by the study suggests that anti- cholinergic therapy may be effective in patients that observe a late phase response to allergen.
The study was funded by the Medical Research Council.

chronic ailments,diabetes

Garlic Benefits and Type 2 Diabetes

Oct 11, 2010 by Emilia

Garlic benefits

Knowledge of garlic benefits goes back to immemorial times. People have used garlic for thousands of years not only to ward off vampires, but also as food and medicine. And while it is true that modern research has not confirmed yet that rubbing garlic on doorknobs and window frames can protect us against vampires or evil spirits, it has confirmed what our ancestors believed about the garlic: that its consumption can protect us from many ailments.

Unfortunately, for several decades, the widespread use of antibiotics has ignored the medical properties of garlic. Lately, however, interest in garlic has escalated and nowadays research is focusing on the role garlic plays in the prevention and control of heart disease, a major risk factor for diabetics. Garlic can help people with diabetes through the following mechanisms:

Lower high blood pressure
High blood pressureis one of the health conditions where garlic treatment brings the fastest results. Studies suggest that garlic dilates blood vessel walls, increasing the diameter of the arteries. Garlic also helps prevent high blood pressure by stopping blood cells from sticking together.In a clinical trial, the subjects ingested standardized garlic powder capsules for four years.The results showed a 9 to 18 percent reduction in plaque volume and a 7 percent decrease in blood pressure.This resulted in an increase in the diameter of the arteries by 4 percent, which is associated with an 18 percent improvement of blood flow. These effects of garlic resulted in a risk reduction for heart attacks and strokes by more than 50 percent.
Lower LDL cholesterol levels
Studies indicate that the populations that eat garlic consistently have the lowest level of blood cholesterol. Pennsylvania State University showed that men with high total blood cholesterol were able to lower its concentration by 7 percent and LDL, the bad cholesterol, by 10 percent when taking garlic supplements.The study indicated that the sulfur compounds in garlic were responsible for the results, especially S-allylcysteine, which prevents the formation of cholesterol by the liver.
Lower blood platelets
Platelets are tiny cells in the blood that, when arteries get damaged, rush to the lesion site to repair them. They become sticky and form a clot. Unfortunately, although platelets’ intentions are good, these clots are the first step toward the formation of a thrombus, an accumulation of platelets and protein.A thrombus may in time obstruct the flow of blood in the blood vessels. Studies have shown that small doses of garlic can prevent platelets from becoming sticky and piling up together. In a study carried out by Liverpool John Moores University, the subjects experienced a reduction of platelet stickiness after ingesting 5 milliliters of garlic extract per day for 13 weeks.
Reduce plaque in the arteries
Plaque starts to form when arteries are damaged. It is made up of mounds of fat and debris deposited in the wall of the arteries that reduce the space available for blood to circulate. Plaque keeps growing and with time may block the flow of blood in the arteries.One study showed that continuous intake of high doses of garlic powder capsules for four years reduced the plaque volume by 5 to 18 percent.It is also a fact that most people between 50 and 80 years of age have an increase in the amount of plaque.During the four years this study lasted, the volume of plaque remained constant in people within this age frame demonstrating that garlic has a preventive as well as a curative role in heart disease.
Garlic is an antioxidant
Garlic has been shown to protect blood vessels from the destructive effects of free radicals. Ankara University of Turkey conducted a study to investigate the effects of garlic extract on the oxidation of red blood cells.For six months, 11 patients with atherosclerosis ingested a daily dose of 1 milliliter of garlic extract per kilogram of body weight. The study showed a reduction on the level of oxidation of red blood cells in the patients.

How to get the medicinal properties out of garlic

To get the medicinal properties of fresh garlic, however, you must follow several steps, a “protocol” as I call it before consuming it. Here is what you need to do:

- Peel the cloves

- Cut them in small pieces

- Crush them in a mortar.

- After you have crushed the garlic, let it sit uncovered in the mortar for 10 or 15 minutes before you put it in the food. This allows the formation of allicin, a compound necessary to unleash the medicinal properties of garlic.
Final thoughts

Let us remember that people around the world, especially those who enjoy few chronic diseases, are aware of garlic benefits and use this herb extensively in their daily diets. A truly wonder of nature with more than 200 chemical compounds, garlic has been a crucial contributor to the curative effects of the Mediterranean diet. So, how about going back to the basics and put some garlic in your life as a preventive measure?

To your heart health!

Emilia Klapp, R.D., B.S
www.TheDiabetesClub.com

teen ends life in chembur over failed affair

Mumbai teen ends life over 'failed affair'
Nitasha Natu, TNN | Aug 16, 2011, 06.46AM IST

MUMBAI: A 15-year-old schoolgirl hanged herself at her Chembur residence on Sunday night, allegedly over a failed love affair.

The deceased, Varlakshmi Gowda, lived with her parents and three-year-old sister at Tata Colony.

Her parents work as daily wage labourers. "When Gowda's parents returned home around 9.30 pm, they found her hanging by a sari from a hook in the ceiling. The couple, with the help of neighbours and patrolling policemen, rushed the girl to a local dispensary where she was declared dead on arrival," said an officer.

Officials suspect Gowda, a class VIII student, was in a relationship with a boy residing in her colony. "We found a suicide note written by Gowda in Kannada. The only English words in it were 'I love you' addressed to a boy. The note has been sent for translation," said senior inspector Shirish Shelke.

The police are trying to trace the boy to find out whether they had a fight. "We believe the suicide is linked to her affair," an officer said. Officers have also written a letter to the school where Gowda studied. The body has been sent to Rajawadi post-mortem centre for an autopsy. A case of accidental death has been registered.

Suicide and children,adolescents, youth and the Elderly

SUICIDE OVER THE LIFE SPAN


ADOLESCENTS AND YOUTHS Brian L. Mishara

CHILDREN Brian L. Mishara

THE ELDERLY Diego De Leo


ADOLESCENTS AND YOUTHS



Suicides of the young, those who have most of life's highlights to experience, are profoundly challenging to cultural systems. Considerable soul searching was triggered in the United States when, between the mid-1960s and mid-1980s, the suicide rates of its ten- to fourteen-year-olds nearly tripled while doubling among those aged fifteen to nineteen. Although the suicide rates for adolescents in the United States and Canada are lower than for other age groups because adolescents die infrequently from physical illnesses, by the end of the twentieth century suicide was the second greatest cause of death in adolescence, after (mainly automobile-related) accidents.

The term youth is often considered to end several years after adolescence, with twenty-first-century tendencies setting the upper limit for "youth" at age twenty-five or older. In the United States, males aged fifteen to twenty-five commit suicide at least five times as often as females, although females are much more likely to attempt suicide. This difference has been explained in different ways, including male preferences for more violent and more lethal methods; male tendencies to keep problems to themselves and not confide in others nor use health and mental health services as frequently; increased male vulnerability to mental health problems; socialization into male stereotypes and "macho" role expectations. During the 1990s suicide rates began to decrease among those aged fifteen to nineteen except among African Americans. The decrease may be attributed to better identification and treatment of mental disorders in youth, increased awareness of suicide and access to suicide prevention resources, or other sociocultural changes in American society.
Risk Factors Related to Adolescent and Youth Suicide

Mental health professionals have identified those factors that pose the greatest risk to adolescents and youth suicides. Youths who attempt and commit suicide generally have several risk factors, which are combined with the ready availability of a lethal means and the lack of suitable sources of help.

Social and economic environments. The family is one of the earliest and most significant influences in a young person's development. There have been numerous studies of family troubles associated with youth suicidal behavior, including early parental loss, parental mental health problems, parental abuse and neglect, and a family history of suicide. In addition to chronic family troubles, there are usually precipitant events closer in time to a suicide attempt, many of which involve the family. These precipitants include serious conflicts with family members or divorce of parents, perceived rejection by one's family, and failure of family members to take an adolescent's talk about suicide seriously.

The school constitutes an important influence on youth. It is therefore not surprising that a history of school problems and the stress of disruptive transitions in school are potential risk conditions for youth suicidal risk behavior, as well as failure, expulsion, and overwhelming pressure to succeed.

The influence of peers on young people's behavior can sometimes be greater than that of family and school. There is a risk of copycat suicidal behavior in adolescents who have been exposed to a peer's suicide. This contagion effect is most pronounced for vulnerable youths who tend to identify strongly with someone who has committed suicide in their environments or in mass media. Common precipitating events in youth suicidal behavior include rejection from peers, the breakup of a significant relationship, or the loss of a confidant. Furthermore, adolescents and young people who fail to act when confronted with a suicidal peer, by dismissing it as insignificant or failing to inform an adult, can increase the risk of suicide.

Poverty in children and youth heightens the risk conditions for suicide, including school problems and failures, psychiatric disorders, low self-esteem, and substance abuse, all of which can increase vulnerability to suicide and suicidal behavior.

Physical environment. Having immediate and easy access to lethal means to kill oneself increases the risk that a suicide will occur. Firearms are common methods of male suicides in the United States, and young women are increasingly using guns to kill themselves. Having such an instantly lethal method available increases the risk that vulnerable young people may kill themselves impulsively.

Additional risk factors. The researcher Jerome Motto suggested that the increased use of alcohol and drugs might have been a significant factor related to the rise of youth suicide since the 1970s. According to David Brent, at least one-third of adolescents who kill themselves are intoxicated at the time of their suicide and many more are likely to be under the influence of drugs.

A history of previous suicide attempts and the presence of a psychiatric disorder are among the most important and well-established risk factors for youth suicidal behavior. As many as 10 percent of suicide attempters eventually die in a later suicide attempt. Depression is a major mental health problem associated with suicide. In addition, impulsive behavior, poor problem-solving and coping skills, alcoholism, and homosexual orientation also increase the likelihood of suicidal behavior.
Prevention

No single risk factor alone is sufficient to result in a suicide. Youths who attempt and commit suicide generally have several risk factors that are combined with the ready availability of a lethal means and the lack of suitable sources of help.

Primary prevention. Primary prevention consists of actions to prevent suicidal behavior before people develop a high-risk or a suicidal crisis. Most youth and adolescent suicide prevention programs have focused on school-based activities where adolescents receive training in identifying signs of suicide risks and how to best react to suicidal peers. Some programs also identify resources to help with suicide and encourage young people to talk with adults if they feel that they or their friends are feeling suicidal. Young people are specifically encouraged not to keep a "secret" confession of suicidal intentions to themselves. Controversy surrounds the usefulness and effects of school-based suicide prevention programs. Few programs have been the subject of rigorous evaluations and not all programs have had positive results. Research indicates that programs that provide a variety of resources within the school and community, including specially trained teachers, mental health services and counselors, and information and training for parents, may be of more benefit in preventing suicidal behavior.

In addition to school-based programs, many primary prevention approaches have focused on key persons who may come in contact with potentially suicidal youth. These persons, called "gatekeepers," include school staff, child welfare workers, community volunteers, coaches, police, family doctors, and clergy members. Training usually involves information on taking suicide threats seriously and asking specific questions to assess suicide risk, identifying behavior changes that may indicate increased suicide risk, better identification and treatment of depression and other mental health problems, and providing information about resources to help with suicide and other community youth problems.
Intervention

Given their higher risk of suicide, particular treatment should be given to persons who attempt suicide. Unfortunately, many young suicide attempters do not receive adequate follow-up after they are discharged from the hospital. Successful programs for young people who are hospitalized for suicide attempts involve treatment in the community by counseling, therapy, and/or medication after their discharge. The most effective programs treat more than just the suicidal individual but also involve the person's family in developing a long-term strategy to reduce the factors associated with suicidal behavior. Very often, young people do not want to continue with treatment after an attempt and they may tell others that they are better or that they want to move on in their life and ignore the "mistake" they have made. Despite this, it is important to ensure that there is regular long-term follow-up after any suicide attempt in order to treat the underlying problems and reduce the likelihood of a subsequent attempt.

After a suicide occurs in a school setting, it is important that the school react in an appropriate manner to the suicidal death in order to allow other students to grieve the death and prevent a contagion effect of others imitating the suicidal behavior. Many schools have established protocols for "postvention" which often use a "critical debriefing" model to mobilize members of the community following a tragic event, including a suicide by a student. These protocols define who will act as a spokesperson for the school, how to identify students and family members who are particularly vulnerable or traumatized by the event, and how best to help them, as well as general activities in the school to allow for appropriate mourning and discussions in order to understand what has occurred. Each suicidal event is unique and any general protocol must be adapted to the specific circumstances and the school environment. After a suicide schools should provide information and help facilitate access to skilled individuals who may help those troubled by the event. However, it is also important for those in authority not to glorify the suicide by having long extended commemorative activities that may communicate to some vulnerable suicidal students that committing suicide is an effective means of having the entire school understand their grief or problems. It is important that commemorative events emphasize that suicide is a tragic event, that no one is better off for this having happened, that help is readily available, and that most suicides can be prevented.

See also: S UICIDE I NFLUENCES AND F ACTORS : G ENDER , M EDIA E FFECTS , R OCK M USIC ; S UICIDE OVER THE L IFE S PAN : C HILDREN ; S UICIDE T YPES : S UICIDE P ACTS
Bibliography

Brent, David. "Age and Sex-Related Risk Factors for Adolescent Suicides." Journal of the American Academy of Child and Adolescent Psychiatry 38, no. 12 (1999):1497–1505.

Brent, David, et al. "Psychiatric Sequelae to the Loss of an Adolescent Peer to Suicide." Journal of the American Academy of Child and Adolescent Psychiatry 32, no. 3 (1993):509–517.

Brent, David, et al. "Risk Factors for Adolescent Suicide." Archives of General Psychiatry 45 (1988):581–588.

Dyck, Ronald J., Brian L. Mishara, and Jennifer White. "Suicide in Children, Adolescents and Seniors: Key Findings and Policy Implications." In National Forum on Health Determinants of Health, Vol. 3: Settings and Issues. Ottawa: Health Canada, 1998.

Gould, Madeline, et al. "Suicide Clusters: An Examination of Age-Specific Effects." American Journal of Public Health 80, no. 2 (1990):211–212.

Groholt, Berit, et al. "Youth Suicide in Norway, 1990–1992: A Comparison between Children and Adolescents Completing Suicide and Age- and Gender-Matched Controls." Suicide and Life-Threatening Behavior 27, no. 3 (1997):250–263.

Motto, Jerome. "Suicide Risk Factors in Alcohol Abuse." Suicide and Life-Threatening Behavior 10 (1980):230–238.

Pfeffer, Cynthia, et al. "Suicidal Children Grow Up: Demographic and Clinical Risk Factors for Adolescent Suicide Attempts." Journal of the American Academy of Child and Adolescent Psychiatry 30, no. 4 (1991):609–616.

Shaffer, David, and Madeline Gould. "Suicide Prevention in Schools." In Keith Hawton and Kees van Heeringen eds., The International Handbook of Suicide and Attempted Suicide. Chichester: John Wiley & Sons, 2000.

Spirito, Anthony, et al. "Attempted Suicide in Adolescence: A Review and Critique of the Literature." Clinical Psychology Review 9 (1989):335–363.

BRIAN L. MISHARA
CHILDREN

Children develop an understanding of suicide at an early age and that follows their understanding of what it means to die and to be dead. Although children very rarely commit suicide before adolescence, they almost invariably witness suicide attempts and suicide threats on television. In addition, they talk about suicide with other children.
Children's Understanding of Suicide

Research indicates that by age seven or eight almost all children understand the concept of suicide. They can use the word suicide in conversations and name several common methods of committing suicide. Younger children, as young as ages five and six, are generally able to talk about "killing oneself," even if they do not know the meaning of suicide, and learn the unsettling effects of such talk on adults. By age seven or eight almost all children report that they have discussed suicide with others on at least one occasion, and these discussions are almost invariably with children their own age. In one 1999 study conducted by Brian Mishara, half of all children in first and second grade and all children above second grade said that they had seen at least one suicide on television. These suicides usually occur in cartoons and involve the "bad guy" who kills himself when he has lost an important battle with the "good guy." Children also experience suicide attempts and threats in soap operas and adult television programs. Surveys of parents have found that 4 percent of children have threatened to kill themselves at some time.

In Western cultures, children ages five to twelve rarely have positive attitudes toward suicide. At all age levels, children consider suicide an act that one should not do; few feel that people have a right to kill themselves. When there is a suicide in the family, children usually know about it, despite parents' attempts to hide the fact by explaining that the death was an accident. For example, in studies conducted in Quebec, Canada, by Mishara, 8 percent of children said that they knew someone who had committed suicide, but none of the children said they were told about the suicidal death by an adult.
Children's Understanding of Death

Although children understand death and suicide at a young age, their conceptions of death often differ from an adult understanding. Very young children do not see death as being final (once someone is dead, he or she may come back to life), universal (everyone does not necessarily die someday), unpredictable (death cannot just happen at any given time), nor inescapable (taking the right precautions or having a good doctor may allow someone to avoid dying). Furthermore, for the youngest children, once someone is dead he or she may have many characteristics that most adults reserve for the living, such as being able to see, hear, feel, and be aware of what living people are doing. These immature understandings of death change fairly rapidly, with children learning at a young age that death is a final state from which there is no return. Also, children learn at an early age that all people must die someday. However, as many as 20 percent of twelve-year-olds think that once a person has died, he or she is able to have feelings or perceptions that living people experience.
Children's View of Suicide

It is naive to think that young children do not know about suicide. However, the image that children get from television is different from what occurs in the vast majority of suicides in the real world. Those who commit suicide on television almost never suffer from severe depression or mental health problems, they are almost never ambivalent about whether or not they should kill themselves, and it is rare that children see suicidal persons receiving help or any form of prevention. This contrasts with the reality in which mental health problems are almost always present—where there is tremendous ambivalence and the fact that persons who consider suicide rarely do so, as most find other ways to solve their problems.
Prevention and Intervention Approaches

To counter such misconceptions and to reduce suicidal behavior later in life, several preventive strategies have been tried. One provides accurate information about suicide to children in order to correct erroneous conceptions that children may develop from their television experiences or discussions with other children. Another focuses upon children's coping abilities. Research on adolescents and young adults who attempt suicide indicates that they have fewer effective coping strategies to deal with everyday problems. Although it may take many years before programs begin teaching young children that there is a link between effective coping and long-term suicide prevention effects, this approach has had promising short-term effects in increasing children's abilities to find solutions to their problems and improve their social skills. For example, the Reaching Young Europe program, called "Zippy and Friends," is offered by the Partnership for Children in different European countries. Developed by the prevention organization Befrienders International (and now run by Partnership for Children), Zippy and Friends is a twenty-four-week, story-based program for children in kindergarten and first grade that teaches through games and role play on how to develop better coping skills. Short-term evaluation results indicate that, when compared to a control group of children who did not participate in the program, participants had more coping strategies, fewer problem behaviors, and greater social skills.

Research results suggest that it may not be appropriate to ignore self-injurious behavior in children and suicide threats because of the belief that children do not understand enough about death and suicide to engage in "true" suicidal behavior. According to official statistics, children almost never commit suicide. However, perhaps more children commit suicide than coroners and medical examiners indicate in reports. They may classify some deaths as accidental because of the belief that children are too young to know about death and suicide and are only "playing," or to spare parents the stigma of suicide. Nevertheless, there are numerous case histories and several investigations of factors related to suicidal behavior in children. Studies on the social environment generally focus on the greater likelihood of suicidal behavior in children from families where there is parental violence or sexual abuse, or have family histories of alcohol and drug abuse, depression, and suicidal behavior.

Depression in children appears to be a risk factor for suicide, although depressive symptoms in children are difficult to recognize and diagnose. Symptoms of depression in children include long-lasting sadness, which may be linked with frequent crying for little or no apparent reason, monotone voice, and seeming to be inexpressive and unemotional. Other possible symptoms include the development of inabilities to concentrate and do schoolwork, being tired and lacking energy, social withdrawal and isolation, refusing to continue to participate in games and group activities, not answering questions or having long delays before answering, and a variety of "somatic" complaints. These somatic complaints include sleep difficulties such as insomnia, frequent nightmares, and incontinence, anorexia, stomach pains, and complaints of physical difficulties that seem unfounded. Often depressed children seem anxious and may have multiple phobias or fears. Some children try to fight against depression by acting out or being angry a lot of the time. In these cases, the depressive symptoms are generally also present. If a child has several of the preceding symptoms, or symptoms are intense and long lasting, consultation with a professional is indicated. This is particularly true if a child threatens to commit suicide or becomes interested in suicide methods, such as tying nooses or playing suicide games with other children or with dolls.

It can also be beneficial to ask direct questions to a child who talks about suicide. Questions might include: "Are you thinking of killing yourself?" "Have you thought about how you would do it?" "Do you think you might really commit suicide?" Despite common adult beliefs that asking questions might "put ideas" in a child's head, if a child threatens suicide, the child almost always knows about suicide and it is impossible to suggest suicide behavior by talking about it. It is also important to ask suicidal children what they think will happen after a person dies. If the child gives the impression that one can return from the dead or being dead is like being alive, it may be useful to correct this impression or describe in some detail what it means to die and be dead.

One should seek advice from a mental health professional if a child has symptoms of depression and/or threatens suicide. It is also important to talk about what occurred when a child experiences a suicide in the family or in the family of friends or at school. Such discussions may begin by asking a child what he or she thinks about what occurred, including why the child thinks the person committed suicide and what the child thinks it is like to be dead. Often children have a good understanding of what has occurred, a fairly realistic notion of what happens when one dies, and a negative attitude toward suicidal behavior. However, in the event that a child glorifies or trivializes a death by suicide or feels that the suicide victim is "better off" now, it is important to continue the discussion to clarify the nature of what occurred and if necessary seek counseling or professional help. It is also important for children to be able to express their feelings about a loss by suicide (even if those feelings include "unacceptable" feelings such as anger at the person for having left). It is important for children to develop an understanding of the suicide as being a tragic avoidable death and not a situation with which the child can easily identify.

Although suicidal behavior in children is rare, one should not minimize suicidal threats and attempts in children, and it is important to be aware of persistent indications of depression in children.

See also: C HILDREN AND A DOLESCENTS' U NDERSTANDING OF D EATH ; C HILDREN AND M EDIA V IOLENCE ; L ITERATURE FOR C HILDREN
Bibliography

Dyck, Ronald J, Brian L. Mishara, and Jennifer White. "Suicide in Children, Adolescents and Seniors: Key Findings and Policy Implications." In National Forum on Health Determinants of Health, Vol. 3: Settings and Issues. Ottawa: Health Canada, 1998.

Garfinkel, Barry D., Art Froese, and Jane Hood. "Suicide Attempts in Children and Adolescents." American Journal of Psychiatry 139 (1982):1257–1261.

Mishara, Brian L. "Conceptions of Death and Suicide in Children Aged 6 to 12 and Their Implications for Suicide Prevention." Suicide and Life-Threatening Behavior 29, no. 2 (1999):105–118.

Mishara, Brian L. "Childhood Conceptions of Death and Suicide: Empirical Investigations and Implications for Suicide Prevention." In Diego De Leo, Armi N. Schmidtke, and Rene F. W. Diekstra eds., Suicide Prevention: A Holistic Approach. Boston: Kluwer Academic Publishers, 1998.

Mishara, Brian L., and Mette Ystgaard. "Exploring the Potential of Primary Prevention: Evaluation of the Befrienders International Reaching Young Europe Pilot Programme in Denmark." Crisis 21, no. 1 (2000):4–7.

Normand, Claude, and Brian L. Mishara. "The Development of the Concept of Suicide in Children." Omega: The Journal of Death and Dying 25, no. 3 (1992): 183–203.

Pfeffer, Cynthia R. The Suicidal Child. New York: The Guilford Press, 1986.

BRIAN L. MISHARA
THE ELDERLY

Until the 1970s suicide was most common among the elderly, while in the twenty-first century younger people have the highest suicide rate in one-third of all countries. Reasons for such a change are unclear; however, many countries of different cultures have registered an increase in youth suicide that has been paralleled by a decline in elderly rates. Since the 1970s, the decline in elderly suicide has been particularly evident in Anglo-Saxon countries, and especially among white males in United States (around 50%). Proposed explanations have considered improved social services, development of elderly political and social activism, changing attitudes toward retirement, increased economic security, and better psychiatric care. By contrast, the lack of specific services for the elderly in Latin American countries may account for the increase in suicide rates in recent years. Moreover, the spontaneous support provided by traditional family structure has been progressively declining without being replaced by alternative sources of formal support or any better education on coping with age.

Despite tremendous cultural variability across nations, suicide rates in the elderly remain globally the highest for those countries that report mortality data to the World Health Organization (WHO), as shown in Figure 1. In general, rates among those seventy-five years and older are approximately three times higher than those of youth under twenty-five years of age. This trend is observed for both sexes, and it is steeper for males. Suicide rates actually present several distinct patterns in females. In some nations, female suicide rates rise with age, in others female rates peak in middle age while, particularly in developing nations and minority groups, female suicide rates peak in young adults. Based on 2001 data, half of all suicides reported in women worldwide occur in China.

Suicide is most prevalent among male subjects, and remarkably so at seventy-five and more years of age. Particularly in the Western world, this seems to contrast with the poor health and social status experienced by elderly women that results from more compromised psychophysical conditions secondary to greater longevity, poverty, widowhood, and abandonment. To explain this difference, social scientists have suggested that women might benefit from better established social networks, greater self-sufficiency in activities of daily living, and commitment to children and grandchildren.
General Characteristics of Suicide in the Elderly

There are characteristics that are particular to this age group. Older people are likely to suffer from a physical or mental illness, and in general tend to plan their suicides rather than act on impulsivity. The suicide methods chosen by elderly persons (including women) are generally violent with a high degree of lethality, expressing strong suicidal intention. The most common self-destructive methods are by hanging, firearms (particularly in the United States), jumping from high places (particularly in Asian metropolitan cities like Hong Kong and Singapore), self-poisoning (especially with medicine, benzodiazepines, and analgesics, among women), and drowning.

In most cases of elderly suicides, the act is performed at home alone. When suicide notes are left, they usually contain financial dispositions and burial instructions. The notes indicate a high degree of determination, accurate planning, and emotional detachment.
Underreporting of Suicidal Behavior in the Elderly

Suicide mortality data usually carry an underestimation of their real number, a phenomenon that is thought to be particularly frequent in the elderly. For a variety of reasons, there may be reluctance to call a death a suicide, particularly in those regions where religious and cultural attitudes condemn suicide. In general, a suicide may be voluntarily hidden to avoid public stigmatization for social convenience, for political reasons, to benefit from insurance, or because it was deliberately masked as an accident. Suicide can also be misclassified as an undetermined cause of death or as a natural cause (e.g., when people neglect to take life-sustaining medications).

Suicide can also go unrecognized when people overdose on drugs, starve themselves to death, or die some time after their suicide attempt (in these cases usually it is the clinical cause of death which is officially reported), or in cases of euthanasia or assisted suicide.
High-Risk Factors in Suicide among the Elderly

Although the majority of elderly persons may be suffering from psychiatric disorders at the time of suicide, the large majority of them who commit suicide do not have a history of previous suicidal behavior. In addition, researchers found that only a small percentage of psychologically healthy individuals have a "desire to die."

Psychopathology. Psychiatric pathology represents the most important risk factor for suicide in the elderly. Over three-fourths of elderly victims
FIGURE 1
FIGURE 1
are reported to suffer from some sort of psychiatric disorder at the time of their death. Mood disorders are highly associated with suicidal behavior at all ages but appear to play the most fundamental role in suicide in older adults. A study conducted by Harris and Barraclough in 1997 revealed that the mean suicide risk in subjects affected by major depressive disorder and dysthymia (a less severe form of mood disorder) was, respectively, twenty and twelve times higher than expected, in relation to the general population. An excess risk persists into old age, during which time the combined suicide risk is thirty-five times higher than expected. Most elderly victims suffered from major depression: 67 percent of suicides were aged fifty or over in a 1991 study by Yates Conwell and colleagues; 83 percent in those aged sixty-five and over in the 1993 study by Clark and Clark; and 44 percent of the over-sixty age group in the 1995 research by Markus Heriksson and colleagues.

The predominant role of mood disorders in increasing the risk of a serious suicide attempt suggests that elimination of these disorders could reduce the incidence of serious suicide attempts by up to 80 percent, particularly among older adults (sixty years and over), where the association between mood disorder and suicide attempts is stronger. However, the underrecognition and undertreatment of depression in older adults in the community is very common.

Older persons often do not present with the classic symptomatology. Nearly half of them lack a depressed mood (one of the most recognizable symptoms) in the clinical presentation. Furthermore, given the frequently simultaneous presence of a physical illness, often masking the symptoms of depression, older persons may deliberately deny symptoms such as suicidal ideation. The problem of underrecognition of elderly depression is exacerbated by very low rates of antidepressant treatment. Even if physicians recognize that the depression may need treatment, they are often concerned about adding to the already complex regimen of medications.

Similarly, identification of persons at risk of suicide is also particularly problematic in the elderly. The lack of forewarning of suicide attempts in elderly suicide leads to particular importance being placed on the detection of suicidal ideation. Recent research examining suicidal ideation in seventy-three completed suicides found that 38 percent had expressed their suicidal intent to their doctor prior to their death. However, when consulting with friends and confidants of the deceased they found that 85 percent had communicated their intent. Several patients had denied their intent to suicide to their doctor. These figures highlight the difficulty in detecting suicidal ideation in older patients in a primary care setting, as well as advocating consultation with close ones when suicidal ideation is suspected.

Alcohol abuse and dependence are present according to different studies in 3 to 44 percent of elderly suicide victims, which is higher than the general population of the same age, and are more common among those aged sixty-five to seventy-four. The combination of drinking and depression may produce a very high risk of suicide in the elderly, especially where drinking is a maladaptive coping mechanism. Only a small number of elderly suicides were suffering from schizophrenia or other psychotic conditions, and the same holds true for personality disorders. Suicides may generally be associated with the personality trait of "lower openness to experience," inability to form close relationships, tendency to be helpless and hopeless, inability to tolerate change, inability to express psychological pain verbally, loss of control, and feelings of loneliness, despair, and dependence on others.

Finally, the role of anxiety disorders seems to be relevant only as an added condition, especially in conjunction with depression. Likewise, dementia hardly features on the diagnostic list of suicides. It has been proposed that in the early stages of Alzheimer's disease there could frequently be suicidal ideation, but cognitive impairment may impede realization. Loss of insight from the very beginning of the disorders is more marked among subjects with deeper involvement of frontal lobes.

Physical illness. There is controversy as to the influence exerted by physical illness on suicidal behavior. In a study by McKenzie and Popkin (1990), 65 percent of older adults were afflicted by a severe, chronic physical pathology at the time of suicide and 27 percent suffered from persistent, severe illness. Because these conditions were likely to reduce autonomy and necessitate a change of lifestyle, they may induce symptoms of depression, helplessness, and hopelessness, particularly among men and those over seventy-five. Lack of trust in medical intervention and endless suffering were commonly found in depressed elderly suicides. However, the constant co-presence of a structured depressive disorder or other psychiatric pathology (e.g., substance abuse) suggests that physical illness alone does not bring about suicide outside of a psychopathological context. Researchers have suggested that most physical illnesses presenting an increased risk of suicide were associated with mental disorders, substance abuse, or both, and that these factors may be a link between medical disorder and suicide.

Recent studies reported increased suicide rates across cancer patients, especially in the first months after diagnosis and in men. However, among them a high prevalence of psychopathology has also been identified (e.g., severe depression, anxiety, and thought disturbances). An important aspect of suicide risk in relation to physical illness has to do with how patients feel about their illness and their unique fears. In most cases their fears are a manifestation of a deeper psychological problem.

Life conditions and events. Widowed, single, or divorced people are overrepresented among elderly suicide victims, particularly among men. The relatively low suicide rates for married people may reflect not only the companionship of marriage, but also its outlet for aggressiveness.

Up to 50 percent of elderly suicide victims, particularly women, are reported to live alone and to be lonely. Generally speaking, suicidal elderly have been found to have fewer resources and supports and to have less contact with relatives and friends than the younger. However, some researchers claim that apart from more frequent losses and the presence of physical illness in the elderly, there is no particular excess of social isolation and stressful life events, compared to youth. Suicide in the elderly could be related to a narcissistic crisis due to the inability to tolerate the accumulation of minor day-to-day failures. Suicidal behavior may then be precipitated by these events in conjunction to depression or alcohol abuse.

Retirement does not constitute an important suicide risk factor per se, unless it is abrupt and involuntary, particularly in the case of white men under seventy-five and in subjects who lack the flexibility to deal with role change or health and social support. Socioeconomic decline does not appear to be as important a risk factor for the elderly suicide as it is in younger populations. Conversely, bereavement very frequently represents a stressful life event in late life, and the death of a close relative or friend is a very important factor in precipitating suicide. Risk appears to be higher when it concerns the loss of a spouse, especially if it is sudden. Men seem to be more exposed than women.

Biological factors. The study of aging brain processes showed alterations of synaptic conduction and neurotransmitters systems, such as a reduction in dopamine and norepinephrine content in various areas of the brain of the elderly and an increase in monoamine-oxidases, the enzymes that eliminate those neuro-hormones. The hypothesized higher vulnerability of elderly people to depression and suicide could be related to a defective compensatory mechanism, which may favor onset and chronic course of psychopathological process. It has been suggested that impaired regulation of the hypothalamus-pituitary-adrenal axis and alterations in the circadian rhythm, both common in the elderly, may in turn play a part in inducing suicidal behavior.
Prevention and Intervention of Suicidal Behavior

Preventative initiatives include the introduction of social security programs, reduction in the percentage of elderly persons living below the poverty line, the development of flexible retirement schemes, and improved health care availability. Greater opportunities for relations with peers and better access to recreational facilities may provide support for urban elderly people and facilitate role transition typical of old age, including retirement and children leaving home. A systematic monitoring of physical health seems to be particularly important, in the light of its possible impact on suicidal behavior.

Identifying suicidal ideas and tendencies among the elderly is a first goal of fundamental importance. Abilities to detect mental suffering should be improved by appropriate training and educational programs, addressed particularly to general practitioners and other health professionals, such as nurses and social workers. Particular emphasis should be placed on recognition of early and atypical symptoms of psychopathology in the elderly (particularly depression in men) and on the need to eradicate passive therapeutic attitude and old-fashioned fears about psychotropic drugs to allow adequate treatment of potentially reversible mental illness. Some nonpharmacological approaches to the treatment of senile depression might also be considered, particularly cognitive therapy and interpersonal psychotherapy.

Suicide prevention programs and general mental health facilities are underutilized by elderly suicide victims. Reasons range from poor information available to the public, conviction that these services are costly, and the low credibility given by older adults to all types of agencies or institutions. An attempt to overcome elderly people's reticence to contact centers for collecting alarm signals has been through the use of active outreach programs. One such program is the "Tele-Help/Tele-Check Service" established in the Veneto region of Italy, where most disadvantaged elderly people (by loss of autonomy, social isolation, poverty, and/or poor mental health) are actively selected within the community by general practitioners and social workers. They are then assisted with at least two phone calls per week from well-trained personnel. This program is associated with a statistically significant decrease in the number of expected deaths among the elderly.

Ongoing strategies are more successful with female subjects. A possible explanation for success involves the generally more pronounced attitude of women to communicate their inner feelings and receive emotional support. Especially in Western cultures, men are less willing to express their emotions. Thus, it is more likely that males at risk are more often underdiagnosed and undertreated, especially by general practitioners, than their female counterparts. The most promising avenues include the development of crisis intervention techniques that are able to modify the male client attitude and environment in a way that promotes in them more adaptive strategies.

Individuals affected by the suicide of a relative or close friend experience emotional stress requiring special attention, as they too are at high risk for suicide. The most important differences in the grief experience of suicide survivors compared to survivors of accidental or natural deaths concern the associated stigma of the suicide and its ramifications: feelings of guilt, blame, embarrassment, shame, loneliness, and social isolation. Supportive interventions should therefore pay special attention to the elderly, be they survivors of peer suicides or younger individuals (children, grandchildren), bearing in mind that older adults rarely take advantage of formal crisis intervention and support facilities. A particularly important role in identifying needs and organizing the feasibility of such intervention could be assumed by general practitioners, who are often the only contact elderly people actively seek or request of health and social services.

See also: S UICIDE B ASICS : E PIDEMIOLOGY ; S UICIDE I NFLUENCES AND F ACTORS : G ENDER , M ENTAL I LLNESS ; S UICIDE T YPES : T HEORIES OF S UICIDE
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