Considering that people who commit suicide often don’t leave notes or provide reasons for their actions, most of the research linking suicide to depression and other mental health problems comes from studying suicide attempts. Though these attempts are much more common than actual suicide, studies show that more than one-third of those who succeed at committing suicide have made at least one previous attempt at it. This is why doctors often ask patients with depression about suicidal thoughts and why having attempted suicide at least once is a strong risk factor for future attempts.
In looking specifically at how depression and suicide are related, a 1997 study of more than eleven thousand patients showed that being diagnosed with unipolar depression significantly increases the risk of suicide. Bipolar disorder may also increase the risk of suicide depending on how severe the symptoms are.
Despite these findings, it is still important to recognize that most people dealing with depression are not going to kill themselves (and at least half never even try). But there are risk factors that can make depressed people particularly vulnerable to suicidal thoughts and actions. For example, the greatest risk of suicide occurring in people with depression is during those first few months as they are still learning to deal with their symptoms. For someone who had never had a depressive episode before, experiencing those kinds of symptoms, along with feelings of hopelessness, guilt, reduced appetite, and insomnia can be devastating.
Research looking at first-time depression patients found that suicide risk rises sharply soon after being admitted to hospital and also after being discharged. This is why patients need to be carefully monitored during the early days of admission and after they are released into the community, especially if they don’t have family members or friends to take care of them.
Dealing with other mental health issues aside from depression can also increase suicide risk. This can include drug or alcohol problems, anxiety disorders, long-term personality issues, or serious medical illnesses. Also, as we have seen, having made a previous suicide attempt is the biggest risk factor, especially if it is a recent attempt.
Under certain circumstances, even being on medication to control depression or bipolar disorder can increase suicide risk in some patients. For people dealing with multiple symptoms such as anxiety, the antidepressant may only curb the depression and cause the other symptoms to feel much more severe as a result. This is why patients being placed on medication for the first time need to be carefully questioned about suicidal history as well as be warned about the potential side effects of their medication.
As we can see, the risk of suicide in people with depression cannot be overlooked. Sadly, the greatest risk is going to be in the ones who are afraid to ask for help and who hide their symptoms from friends and family members. If you or someone you know is feeling suicidal, just recognize that there are resources out there that can help. Even if you are afraid to talk to a doctor face-to-face, online resources and nationwide hotlines are also available. Check the appendix for some recommendations.
Culture, Media, and Depression
31. How do different cultures view depression?
This can be a difficult question to answer considering that international surveys looking at depression across different countries show dramatic differences in terms of who is likely to develop symptoms. For that matter, there are some languages that don’t even have a word for what we would call depression.
Also, considering the stigma surrounding mental illnesses in different cultures, the number of people seeking help for their symptoms is going to vary widely from one country to the next. For people living in Japan, for example, only about 3 percent of the population will seek help for depression while countries such as the United States have a substantially higher percentage of people asking for help. But, does this mean that people in other cultures are less likely to develop depression? Or are they just less likely to admit being depressed?
Cross-cultural studies of depression conducted since the 1980s strongly suggest that culture differences can have a dramatic impact on the type of depressive symptoms people can show, how likely they are to be diagnosed at all, and how likely they are to seek out some kind of help. Considering the deep stigma against mental illness found in many places, it isn’t surprising that most people feeling depressed would prefer to keep it hidden, often until it’s too late.
In fact, some psychiatrists have argued that depression as we know it is mainly a Western disease that is nonexistent in some societies. For example, when psychiatrist Emil Kraepelin visited Indonesia in the early years of the twentieth century, he concluded that depression was almost nonexistent. A similar conclusion was made by psychiatrist John Colin Carothers when he wrote about depression in Africans. As far as he was concerned, any mental health issues that developed were due to their exposure to Western culture and values as well as the effects of colonization.
Even into the late 1980s, medical anthropologists continued to challenge the idea of depression in non-Western cultures though this is not a popular viewpoint today. Part of the problem is that the way people express emotional distress, including symptoms of depression, varies widely depending on their cultural background and beliefs about mental illness.
For that matter, people in other cultures may also report problems that resemble what we call depression but which do not appear to have any real comparison in Western countries (except among immigrants). As we have already seen in Question 9, these conditions can go by different names, including pena and susto in parts of Latin America, brain fag in West Africa, dhat on the Indian subcontinent, tawatl ye sni (totally discouraged) among the Dakota Sioux, shenjing shairuo in Chinese culture, and so on.
While the diagnosis may vary depending on where we happen to be living in the world, the actual symptoms are usually not that different. Whether or not people dealing with depression actually get help is often going to depend on the kind of mental health services that are available. Unfortunately, this is a particular problem in poorer countries that have only a few psychiatrists or other mental health professionals. This often means critical delays in treatment as a result. While international health agencies such as the World Health Organization are trying to increase awareness about disorders such as depression, much more needs to be done.
32. How are goth and emo subcultures linked to depression?
Beginning in the early 1980s in England, the goth subculture rapidly spread to North America where it became an extremely popular alternative to more dominant music cultures. Inspired by the “gothic rock” of bands such as The Doors as well as gothic horror movies, art, and literature, “goths” (as fans were often called) could usually be identified by their preference for “edgy” bands such as Bauhaus, Sisters of Mercy, and The Cure. Along with a conspicuously gloomy attitude, black hair, black eyeliner, dark fingernail polish, goths also preferred to wear “somber” clothing copied from the styles of previous centuries as well as to imitate the “cultured decadence” found in classic horror novels as written by Anne Rice and other authors.
While not as popular as it once was, the goth movement continues to attract followers worldwide and has become linked to other subculture movements such as punk rock and death music. Another popular subculture often identified with goth is the emo subculture. Though the actual origin of the word emo is obscure, this music genre is usually identified by the emotional expression, hardcore (and often confessional) lyrics, and the distinctive fashion styles preferred by fans.
Similar to goth styles in many ways, emo fans have a preference for studded belts, black wristbands, flat hair, and long bangs that often cover the face. In the same way that goth fans are called goths, emo fans tend to be referred to as emo kids or, simply, emos.
For both goths and emos, however, media stories have long suggested that some marginalized youths belonging to these subcultures have been involved in rampage shootings. The most well-known example was the 1999 Columbine Massacre in which the two y
ouths responsible were described in news stories as being part of a goth “cult.” Later research has disputed this conclusion and suggests that goths and emos are far more likely to be victims of violence rather than engaging in violence themselves. Still, the stigma surrounding goth and emo youths often leads to their being viewed with suspicion by police, teachers, and parents’ groups.
But there is far more evidence showing that youths who identify themselves as goth or emo are prone to self-harm behavior and suicide attempts. For example, a 2006 study examining more than twelve hundred youths from ages eleven to nineteen showed that lifetime rates of self-harm and suicide attempts was highest among youths who identified themselves as strong goths. Even adjusting for other factors such as substance use and history of depression did little to change the results.
A later study published in 2015 showed that youths who self-identified as goths at the age of fifteen were up to three times more likely to be diagnosed with depression at the age of eighteen than non-goths. Similar results were also found for the likelihood of self-harm attempts even when other possible contributing factors were taken into account. While there is relatively little research looking at youths who are part of the emo subculture, available results suggest that emo youths may also be at an increased risk for depression and self-harm.
Though there is evidence of a link between goth/emo membership and depression, it still isn’t clear why this relationship exists. Does being part of the goth or emo scene cause suicidal depression or are people who are already prone to these mental health issues more likely to become goths or emo kids? In fact, researchers have suggested that young people who are already feeling suicidal may actually benefit from joining goth or emo groups. Not only does being part of a larger movement provide young people with a sense of belonging but the friends they make in these communities can also provide them with emotional support.
As we can see, simply being a part of the goth or emo scenes don’t necessarily mean that young people will attempt suicide. Still, family members need to be alert to the different signs of depression that we have already discussed in previous sections. If you are worried about a friend or family member, it is important to let health professionals know as soon as possible.
33. Can social media make depression worse?
For most young people, spending time online on many of the different social media platforms out there has become an essential part of staying in contact with friends and acquaintances from around the world. Along with Facebook and Twitter, they can also rely on Instagram, Facebook Messenger, YouTube, Reddit, and Pinterest, to name just a few.
Not surprisingly, researchers have been taking a closer look at these different platforms and what their regular use can have on the emotions of people using them. What they have found suggests that, while social media can allow people to socialize with friends and family without ever leaving their homes, it can also make users feel more isolated than ever.
Facebook, for example, has become a way of life for hundreds of millions of people who log on each day. Along with the free exchange of news, selfies, and whatever viral memes happen to be popular at the given moment, Facebook also allows for regular interactions among people who may never even meet in real life but who can still be considered friends.
Considering the power that Facebook and other platforms seem to have, it’s probably not surprising that more and more anecdotes are emerging about the dark side of this kind of social contact. Stories of cyberbullying, mean-spirited comments, cyberstalking, and misunderstandings seem rampant, especially for young females dealing with unwanted attention. Despite efforts to curb the worst examples of this kind of abuse, the negative experiences, as described by many people, can have a powerful impact in terms of low self-esteem, depression, and social anxiety. It’s probably also not surprising that new research is highlighting the effect that negative experiences on Facebook and other social media platforms can have on depression.
One study published in 2013 looked at 264 young adults who were recruited to determine how the introduction of Facebook may have affected their emotional well-being, Along with examining the frequency, severity, and nature of the negative comments the research participants reported over time, they also completed measures of different depressive symptoms. What the researchers found was that 82 percent of all participants reported at least one negative Facebook experience overall and 55 percent reported one in the year before they took part in the study. About 63 percent said they had four or more such negative experiences. When compared to the 24 percent of participants reporting moderate- to-severe depression, overall risk of depression was 3.2 times greater in participants reporting negative experiences than those who had not. These results were particularly impressive, as it took other factors such as childhood mental health problems into account as well.
As you might expect, people reporting mean or bullying Facebook posts were 3.5 times more likely to develop depression while people receiving unwanted contacts (such as cyberstalking) were 2.5 times more likely to do so. How frequently these experiences occurred also made a difference. People reporting receiving four or more of these posts had a substantially higher risk of depression than people who didn’t.
While more research is needed, these results highlight the emotional impact these negative posts can have. All online users, but especially adolescents and young adults, need to be aware of the emotional risks associated with social media platforms, particularly Facebook. Though many people may rely on the Internet as a personal lifeline for staying in touch with others, learning to balance that with in-person social contacts can help prevent the “Facebook blues” that seem to have become so common in recent years.
34. Why is there such stigma surrounding depression?
For centuries, people suffering from different kinds of mental illness have often been treated as outcasts. Not only were they often regarded as being possessed by demons (and still are in some parts of the world), people regarded as “odd” or “sick” were often either forced into hospitals where they would live the rest of their lives or else kept hidden by family members who feared for their reputation. As recently as a generation ago, mental illness was something that people refused to talk about, even when it applied to a close family member.
Even today, people still use words like crazy, wacko, nuts, psycho, loco, and mental case to describe people or ideas that are out of the ordinary. Certainly, there are no end of television shows and horror movies depicting people with mental illness as unpredictable or dangerous. Not only are these attitudes found in just about every society but are often seen in young children who have no difficulty in using labels like weird or coo-coo with other children they see as different from themselves.
Despite attempts at changing these attitudes about mental illness, the stigma that often surrounds people dealing with psychiatric issues remains strong. Even in Western countries where psychiatric treatment is widely available, many people suffering from serious mental disorders such as schizophrenia may end up becoming homeless since they have nowhere else to live. For that matter, jails and prisons have become the largest mental health facilities in the United States and in many other countries.
While attitudes and misconceptions about depression always have the potential to be hurtful, there are two potential scenarios that can be especially dangerous. The first of these scenarios occurs when this kind of stigma affects how people with depression see themselves. People who consider themselves to be “crazy” or “hopeless” may give in to despair or refuse to seek help. The second scenario is when friends or family members either refuse to take depression seriously or else treat it as something “shameful” that needs to be kept hidden (a common attitude in many cultures).
People with depression need to be realistic about their symptoms and also need the emotional support of other people in their lives so that they can properly heal. As we can see, the stigma surrounding depression and other treatable conditions
can often make people hesitant in asking for help. It is this need to “stay in the closet” that can lead people suffering from depression to hide what is happening for as long as they can. This also means delaying treatment for much longer than necessary, which can lead to the symptoms becoming even worse with time.
Though changing public attitudes about conditions such as depression won’t be easy, progress is still being made. In recent years, many well-known people and their family members have come forward to talk about their symptoms as a way of decreasing the stigma associated with depression. Kristen Bell, Johnny Depp, Harrison Ford, Gwyneth Paltrow, Lady Gaga, Dolly Parton, and J. K. Rowling are just a few of the names of people who have tried to put a human face on depression and make it easier for others to come forward as well.
So don’t be afraid to be as open as possible about depression, whether you are dealing with it yourself or helping a friend or close family member. Fighting the stigma surrounding mental illness can be one of the most important ways of helping people with depression move on with their lives.
Treatment, Prevention, and Life after Depression
35. How can people with depression find help?
While someone dealing with depression may feel isolated and alone, getting help is probably easier now than it ever has been in the past. Not only are most family doctors, nurses, social workers, and other health care professionals getting better training for helping patients who are depressed but community mental health programs offering treatment for depression can be found in most urban areas. Even for people living in rural areas without easy access to treatment centers, there are also national hotlines that can be called toll-free from just about anywhere in the country. And then there are the online resources that provide information about depression as well as free consultation and listings for local agencies that can help.
Depression Page 9