Depression and suicide are very touchy topics in today’s society. What a lot of people don’t realize is though depression and suicidal intent are comorbid, you do not have to have one to have the other: just because you are depressed does not mean that you are suicidal, and you can be suicidal without being depressed. When people fail to realize this small fact, they end up hurting friends or family without realizing it. Sometimes, things such as, “There is no way you were seriously suicidal! I mean, I have known you forever and you never seemed that sad or depressed,” are said. These can hurt people who are suicidal or depressed because perhaps you missed the small signs that a person was struggling, and you are further reaffirming that no one is paying attention to them. Likewise, when someone who is depressed hears, “Wait are you thinking about killing yourself? Should I hide the sharp objects?” it can be detrimental because they may not have been considering suicide- until you mentioned it.
To understand the difference between depression and suicidal intent, you first need to understand what qualifies as depressed. The clinical name for depression is Major Depressive Disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition:
DSM-IV Criteria for Major Depressive Disorder (MDD)
• Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks.
• Mood represents a change from the person's baseline.
• Impaired function: social, occupational, educational.
• Specific symptoms, at least five of these nine, present nearly every day:
1. Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
2. Decreased interest or pleasure in most activities, most of each day
3. Significant weight change (five percent) or change in appetite
4. Change in sleep: Insomnia or hypersomnia
5. Change in activity: Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
8. Concentration: diminished ability to think or concentrate, or more indecisiveness
9. Suicidality: Thoughts of death or suicide, or has suicide plan
Suicidality is a SYMPTOM of depression. Not all people who are depressed show this symptom. At the same time, you can be suicidal without being clinically depressed.
For so long, suicide has been a very taboo topic, but the newest edition of the DSM contains a new disorder: Suicidal Behaviour Disorder. According to the DSM-V:
There are five proposed criterion Suicidal Behavior Disorder, with two specifiers
- The individual has made a suicide attempt within the past two years.
- The criterion for non-suicidal self-injurious behavior is not met during the aforementioned suicide attempts.
- The diagnosis is not applied to preparation for a suicide attempt, or suicidal ideation.
- the act was not attempted during an altered mental state, such as delirium or “ confusion."
- The act was not ideologically motivated- e.g. - religious or political.
Other specifiers are:
- Current - Not more than 12- 24 months since the last attempt.
- In Remission - more than 24 months since the last attempt. (American Psychiatric Association, 2013).
With the presentation of the new DSM, we are finally dealing with suicide as its own issue rather than just a symptom or a loose, non-concrete diagnosis. With an advancement in the scientific community, we also need an advancement in public knowledge. Be careful the next time you are talking to someone and they trust you enough to open up to you about their depression or suicidal thoughts. There are usually sensitive and private topics for the person. Like always, with understanding comes acceptance and the ability to make a difference.
