DEPRESSION
AND SUICIDE
Case
Presentation
Mr. H. is an 85 year old white
male who presents complaining of increasing fatigue, weakness,
shortness of breath, difficulty sleeping at night, and pain
"everywhere". On further questioning, he admits he is feeling more
and more hopeless about life, and doesn't feel life is worth living
anymore. He is planning to give away his two birds that he has
enjoyed in the past, and says they no longer give him pleasure. His
history is notable for alcoholism, degenerative arthritis, and mild
chronic obstructive pulmonary disease. In addition, he has a history
of social isolation, and has alienated most of his neighbors and
former friends with his quick temper and angry outbursts over the
years. He was hospitalized for depression about 3 years ago, but has
refused psychiatric follow-up and antidepressant medication since
then.
Q: Based on this profile, what
would you judge his risk for suicide to
be?
Click
here for answer.
Suicide is common in
elderly people
- Elderly white men are at
the highest risk
- 3-4X higher risk than
general population
- Completed suicides occur in
~ 50:100,000 males >age 80
Factors Associated
with Suicide in Elderly People
- Male sex
- White race
- Widowed or
divorced
- Blue collar or low-paying
job history
- Retired or
unemployed
- Urban
- Living alone,
isolated
- Poor physical
health
- Depression (past or
present)
- Alcoholism
- History of poor
interpersonal relationships
Presentation of
Depression in Older People
May present primarily with
physical symptoms ("masked depression")
- General:
- fatigue, weakness,
anorexia, weight loss, pain "all over", anxiety,
insomnia
- Cardiopulmonary:
- dyspnea,
palpitations
- GI:
- abdominal
pain
- Neurologic:
- headache, memory
problems, dizziness
- Other differences in
presentation
- Older people often deny
dysphoric mood
- Apathy and withdrawal
are common
- Loss of self-esteem may
be prominent
- Inability to
concentrate, memory impairment, other cognitive problems are
common
- depression may cause
dementia-like syndrome: "depressive pseudodementia"
Useful Questions to
Identify Depression
- "Do you often feel sad or
blue?"
- "Does it often seem like
life isn't worth living anymore?"
- "Are you hopeful about the
future?"
- "Do you have trouble
concentrating?"
- "Do you feel full of
energy?"
- "Have you dropped many of
your activities and interests?"
- "Do you find life exciting
and enjoyable?"
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Disclaimer
Copyright 1999, 2000 David A. Gruenewald, M.D. and
Kayla I. Brodkin, M.D. All rights reserved.