Friendship and Psychological Distress
“To lose a friend is the greatest of all losses.”
Publilius Syrus (Syrian-born Latin Writer, 1st Century B.C.E.)
Severe and persistent mental illnesses are one thing, but there are many, many more people who are miserable and unhappy, without that unhappiness necessarily getting to the level of an “illness.” The offices of primary care physicians and therapists are full of people in genuine distress for all kinds of reasons.
I first began to think about this many years ago when a woman came to see me and promptly announced, “I’ve come for psychotherapy. I’ve been in therapy for seventeen years, and I want some more.” I wasn’t being in the slightest bit flippant when I responded by asking her if, after seventeen years, she really felt that it had offered her anything? She looked at me blankly, and it soon became very clear that what she needed was not more therapy, but a friend to talk to.
There has been another puzzle: why is it that women are more likely to develop depression than men? The most profound gender difference in mood disorders begins to emerge after puberty, so it would be easy to attribute it all to hormones. But that would be a mistake.
I recently pointed out that there are some fundamental differences in the ways in which men and women interact: women tending to be more relational and men tending to be more transactional. The female sense of self tends to be more entangled with her relationships, while a man’s self-worth and sense of self is more often associated with his achievements. Most of these differences begin to emerge in early puberty: when girls talk to their friends, their conversation tends to be more emotional and to be concerned primarily with relationships, while boys tend to be more reserved and to discuss facts, statistics and achievements. There is some evidence from research in different cultures that these different styles seem to be the norm throughout the world. Yes, there are of course plenty of people of both genders who behave differently, and so it is more accurate to relate these differences to the male and female factor or essence, rather than getting it confused with anatomical differences.
Emotional language tends to put more strain on a relationship, and it is well-recognized that girls’ relationships turn over much more rapidly than boys’ ones. An interesting hypothesis proposed some years ago by Professor Sir David Goldberg, is that this high turnover in relationships may lead girls to experience more disappointing experiences in their social networks, and it is this string of disappointments that predisposes young women to depression.
A happy, healthy, dynamic network of friends is a cornerstone of developing and maintaining psychological resilience. Without them you become progressively more vulnerable to the reversals that affect all of us from time to time.
“A friend might well be reckoned the masterpiece of nature.”
–Ralph Waldo Emerson (American Poet and Essayist, 1803-1882)
“To know how to live in a brotherly way with those around us is to be rich, for each of us, with our face, eyes, voice and thoughts, contributes something alive, something warm, which nourishes everyone.”
Omraam Mikhaël Aïvanhov (Bulgarian Spiritual Master, 1900-1986)
Irritable Bowel Syndrome, Mood Disorders, the Serotonin Transporter and Integrated Medicine
Whenever we run into two common conditions, it’s easy to imagine links where none really exists. Three years ago some colleagues from Oxford reported on a person with bipolar disorder and irritable bowel syndrome, and commented that the association was uncommon.
However there may after all be a genuine link between mood disorders and irritable bowel syndrome, that is a disturbance in the “third arm” of the autonomic nervous system. The first arm is the sympathetic nervous system, the second the parasympathetic and the third is the enteric or gut nervous system that is closely linked with key regions of the brain.
Not long ago there was an interesting report of a woman who had multiple problems including environmental allergies, atypical bipolar disorder, irritable bowel syndrome and Raynaud’s phenomenon. Such odd constellations of problems are quite familiar to anyone working in the major referral centers around the world, and some can be exceedingly hard to treat. Tough cases like this often stimulate further research. I once tried and failed to treat a woman with a chronic illness. When she came back a year later to see if I had any new ideas, I told her that I now had a shelf of books and over a thousand reprint of papers about her condition: I don’t like failing someone. And I’m not unique in that.
A new study from the Karolinska Institute in Stockholm, has found that chronic widespread pain, which, as I explained recently, is the cardinal symptom of fibromyalgia, is prevalent and co-occurs with other symptom-based conditions such as chronic fatigue syndrome, joint pain, headache, irritable bowel syndrome, and psychiatric disorders.
There is more and more evidence of a link between fibromyalgia, irritable bowel syndrome and depression. It is not just that people are sick and get depressed: as we shall see in a moment, the link is more subtle than that. Another illness seemingly linked to these three is interstitial cystitis.
Now some colleagues at the National Institutes of Health have been looking at a serotonin transporter (SERT) that regulates the entire serotoninergic system and its receptors. This transporter is found throughout the animal kingdom, telling us that it must be important.
In humans the gene is located on chromosome 17, and disturbances in it have been found in people with autism, ADHD, Tourette’s syndrome and bipolar disorder. Experiments using genetic engineering suggest that SERT may be a candidate gene for several human disorders, from obesity to irritable bowel syndrome. People who have disturbances in SERT tend not to respond so well to the serotonin reuptake inhibitors (SSRI’s) antidepressant medicines.
SERT is not the whole story. Some geneticists from Los Angeles have found evidence linking irritable bowel syndrome, depression, migraine and inheritance of mitochondrial DNA.
Many approaches have been tried to help people with these groups of problems. I always find it remarkable that psychological treatments can be so effective in conditions with a genetic component, for this once again proves that biology is not destiny.
The best approaches to conditions like irritable bowel syndrome and coexisting mood disorders is to use medications and psychological approaches. Many of us have also found that the addition of nutritional, environmental and subtle energetic approaches have been of great help, together with some work to uncover the meaning and transpersonal value of a chronic illness. That last piece is not the first priority, which is to help the person gain control of his or her life. But if we don’t do something to work with the meaning and purpose of an illness, it will usually come back in some form or other. This comprehensive approach differentiates Integrated Medicine from many other types of therapy.
Social Supports, Sense of Coherence and Recovering from Depression
After writing about the importance of trying to establish a personal sense of coherence, I was just able to look at an important piece of research.
The authors are from Sweden, a country in which, from my experience, there is still a great deal of social cohesion, despite all the experiments that have been going on there in recent years.
So unlike countries in which there are terrible social supports for everyone, they had the opportunity to study the good and the bad.
Though only a small study, the conclusions are unsurprising but important. They were looking at people with a first episode of major depression, and 71% of the patients had recovered at follow up.
The sense of coherence scores were low at baseline, although the patients who recovered significantly increased their sense of coherence. Another factor of importance for recovery was a significant increase in social support.
It is intuitively obvious that social support is an important part of the restoration of a person’s sense of coherence. It can be used in interventions that include the patient’s family or close social network in combination with support to assist the patient to view his/her situation as comprehensible, manageable, and meaningful, thereby promoting or improving health.
The bottom line: professionals need to identify people’s strengths and weaknesses so that the support and interventions provided can be tailored to meet the needs of each individual.
And one of the best ways of staying healthy is to maintain your social supports, to provide them for other people, and to work on increasing your own sense of coherence.
Toxoplasmosis, Behavior and Mental Illness
This title may seem odd, but this item may actually turn out to have enormous implications for all of us.
A couple of years ago I read a fascinating book: Parasites and the Behavior of Animals, in which the author – Janice Moore from Colorado State University – cataloged some of the extraordinary ways in which parasites can impact the behaviors of a vast array of animals. As difficult as it is to interpret studies of parasites in humans, I kept coming back to some odd observations about an illness with which I’ve been involved for more than 30 years: schizophrenia. I kept wondering if some of the odd observations made over the years could be explained by the parasites?
What kind of odd observations?
- Reports of mental illness have been found throughout history, yet this strange illness that we now call schizophrenia seems to have been very rare until about 1750, when it increased dramatically throughout Western Europe. I have had the privilege of working at the Bethlem Royal Hospital from which got the word “bedlam.” I know of the incredible records kept there. Something began to change in some of the types of patients being admitted at that time. I have also had the opportunity to look at some of the records at the Philip’s Hospital in Southern Germany, which has been in existence since 1533. Again the records show the sudden appearance of many cases of something that had been quite rare until then. 1750 marked the early years of the industrial revolution in Europe and the mass migration of people from the countryside to the new and very crowded cities
- There has been recent evidence that being born and raised in a city increases your chance of developing schizophrenia.
- There is increasing evidence that acute episodes of psychosis, mania and depression are associated with increases in circulating inflammatory mediators. There is also intriguing new data that both psychosis and depression can be improved by giving people COX2 inhibitors.
- There has also been the strange observation that bipolar disorder may have been becoming more common in recent years, over and above our greater ability to recognize the illness.
Several years ago the well-known psychiatrist E. Fuller Torrey first suggested that a small protozoal parasite called Toxoplasma gondii might be responsible for all of these observations. Cats can carry it, which is why pregnant mothers are advised not to pet their cats during pregnancy.
The idea that such a complex disease as schizophrenia might sometimes be caused by a parasite caught the media’s attention, but in recent years the story – but not the ongoing research – died down a bit.
There was an excellent and provocative blog item by Carl Zimmer about this almost three weeks ago, but I wanted to check everything out before responding. He gave a brief review of a new paper published in the Proceedings of the Royal Society, by Kevin Lafferty from the University of California in Santa Barbara. Lafferty has attempted to correlate the varying rates of Toxoplasma in different countries with predominant personality traits and therefore – since our societies are aggregates of all our personalities, cultural characteristics.
That may all sound far-fetched, but I don’t think that it is. And I don’t think that the Proceedings would have taken a completely half-baked proposition.
I have also found a report published in the journal the Proceedings of the Biological Society. Four eminent authors, including Torrey, revisited the while issue of Toxoplasmosis and mental illness. When the parasite gets into the nervous system it can alter behavior: Rats are normally programmed to avoid cats, but once infected they are attracted to cats. Over the last few days I’ve been plowing the world literature, and I’ve learned some very interesting things that support the idea that Toxoplasma may be playing a role in several different types of psychiatric illness.
There is strong evidence that schizophrenia, bipolar disorder and major depressive disorder lie on a spectrum. The illnesses are not the same, but people often switch from one type of clinical presentation to another. The precise type if illness would be determined by the interaction of genes, physical and Intrapsychic environment. Nobody would be sufficiently naïve to try and reduce the whole of psychiatric illness to a single bug. Mental illness is a great deal more than just a physical problem, and apart from anything else, the rates of Toxoplasma infections show remarkable variations around the globe, while the rates of major mental illness are much the same everywhere.
So what have I learned?
- There are a remarkable numbers of studies showing that many people with schizophrenia have antibodies to Toxoplasma, including people having their first attack of the illness
- Blood donors infected with Toxoplasma have decreased levels of novelty-seeking
- In women who become infected, there are some marked changes in personality.
- Toxoplasma affects the dopamine systems of the brain that we know are intimately involved in mood, cognition, movement and motivation.
- Some drugs used to treat psychosis (haloperidol) and mood disorder (valproic acid) inhibit the replication of Toxoplasma gondii. The valproic acid already does it at concentrations lower than we normally aim for when treating humans.
- There is some intriguing work going on into the use of antibiotics to kill Toxoplasma and reverse its behavioral effects.
In the last few years, so many illnesses have turned out to have infectious origins, from peptic ulcers to arteriosclerosis and some cancers. Perhaps some mental illnesses will be next.
Last year Barry Marshall and Robin Warren were awarded the Nobel Prize in Physiology or Medicine for their pioneering work on Helicobacter. I have a strong sense that there are more prizes to come on the interaction between infectious agents, inflammation, genes, the psyche and the environment.
Perhaps the reason that some antipsychotics and mood stablizers can reverse some of the neurological damage associated with schizophrenia and bipolar disorder is becuase they are killing off the causative agents and allowing the brain to repair itself.
I shall keep you posted!
There's More to Weight Than Meets the Eye
There’s an interesting article about the associations between obesity and mental illness.
We’ve all become so used to people telling us about the physical consequences of carrying extra weight, so it is interesting to learn that obesity may also be associated with higher rates of mental illness.
We have here a typical chicken and egg problem.
Do people become depressed because they are overweight, or does depression and its treatments cause obesity?
The answer is probably "Yes." It is both.
Depression may cause insulin resistance and hypercortisolemia, which may result in weight gain. But insulin resistance alters the kinetics of some of the amino acids that are the building blocks of key neurotransmitters in the brain.
And this study re-emphasizes the importance of treating the physical, psychological, social, subtle and spiritual aspects of a problem simultaneously.
If we address only one of these dimensions, people will continue to suffer needlessly.
When our clinicians see overweight people with depression or bipolar disorder, they start by treating the mood disorder, but then immediately get to work on the weight problem. And all of it is part of the five vector, or five dimensional approach to treatment: physical, psychological, social, subtle and spiritual.
If we fail to respect and work with every aspect of a person, each problem will return to make us respond appropriately.
After all, illnesses are like any other problem: sent to educate us. Not just you, but also the person to whom you went for help.
Temperament, Depression, Class and Resilience
Within the first few weeks of life, infants show marked individual differences in their level of activity, their responsiveness to change in the environment and their irritability. Some clearly enjoy being touched and mold their bodies to the person holding them, while other stiffen and squirm and do less to adjust their bodies to another person. These mood-related personality characteristics are called temperaments. There is some evidence that temperament is one of the basic building blocks of the personality. Temperament appears to consist of inborn traits, but they can be modified by parental contact: there is actually a reciprocal relationship between child and parent. The child modifies the behavior and attitude of the parent.
It is commonly said that a child’s temperament is as fixed as handedness or eye color, but this is inaccurate: we have overwhelming evidence that temperament can be changed by environmental influences. This makes sense. In Healing, Meaning and Purpose, we discuss the implications of the new findings about genes in the brain: they do not so much determine behavior as predispose you to the way that you will handle the environment. An important questions is just how plastic is human temperament? To what extent can you overcome your genetic programming and early rearing? Some recent research has indicated that the environment of the first three years of life is not as critical to later development as we used to believe. But I think that it’s dangerous to read too much into this research. Early emotional deprivation may leave the deepest scars and also be associated with physical deprivation. If a developing brain is deprived of key nutrients, it is difficult to catch up later.
More and more research is finding key genes that contribute to temperament. There is important evidence from animal research that the temperament of infant female rats can predict life span in those who develop spontaneous tumors. It is difficult to extrapolate from that to humans, but it is a further demonstration of the incredibly subtle interactions between genes, the environment, behavior and physical illness.
Some important recent research has examined the impact of temperament on the clinical features of bipolar disorder and of ADHD and autistic spectrum disorders. As expected, people with ADHD reported high levels of novelty seeking and high levels of harm avoidance. Patients with autism spectrum disorders were low on measures of novelty seeking, they had little dependence on rewards and high harm avoidance. Cluster B personality disorders, the dramatic, emotional, or erratic disorders ones (antisocial, borderline, narcissistic and histrionic), were more common in people with ADHD and the other clusters A and C were more common in autistic spectrum disorders. This tells us that these tow clinical conditions can have some specific effects on the structure of temperament, and on the risk of developing specific personality disorders.
In a new study in next month’s issue of the Journal of Personality, Kati Heinonen and colleagues from the Department of Psychology at University of Helsinki, have found a correlation between adult pessimism and childhood temperament in low socioeconomic status (SES) families. It is no surprise to learn that children raised in higher socioeconomic groups have a more optimistic outlook on life. But this is what is interesting, and the thing that will launch a great many more studies. It was discovered that the effect of childhood socioeconomic status on pessimism tended to remain the same despite opportunities for socioeconomic fluidity. A person from a low SES childhood who moved upwards in status was less likely to be optimistic as an adult than someone from a high SES childhood who remained in a high SES environment. The inverse also held true, as people from a high SES childhood who moved downwards in socioeconomic status were more optimistic than those who remained in low SES. This indicates that children who had the chance to develop coping strategies during childhood and subsequently developed a sense of mastery and control that protected them in adulthood from the adverse effects of lower SES. By contrast children from lower SES backgrounds who are subsequently upwardly mobile may not have had the opportunities to develop those psychological resources. They are thus unable to benefit as much as possible from later experiences of success.
We already know that pessimism is related to physical and mental health, so this new study provides a critical link between socioeconomic status and long-term outcome. This is essential information for policy makers and for parents interested in helping children develop more effective coping strategies.
This research really proves that some of the excessive optimism of the self-help movement can sometimes be misplaced: just wanting something to be different does not make it so. If you had a lousy up-bringing in impoverished surroundings, it will make it more difficult to bounce back and learn essential coping skills.
More difficult, but not impossible.
Research on resilience has provided us with a great deal of information about developing mastery and coping skills in the face of being in a low SES, and we shall return to some of that work in the near future.
Technorati tags: Temperament Socioeconomic status Resilience Depression Attention deficit hyperactivity disorder Autistic spectrum disorders Personality disorders
Stress, Depression and Resilience
“Patience in calamity, mercy in greatness, fortitude in adversity; these are the self-attained perfections of great saints.”
–The Hitopodesa (Sanskrit fable from the Panchatantra, the “Five Chapters,” Translated as the “Good Advice” c.1100 A.D.)
We are all different in the way that we respond to emotional and physical stress. It is not enough to focus on one single reason why one person handles it and another does not. I have often made the point that we need to consider the physical, psychological, social, subtle and spiritual contributions to any illness or challenge.
New research is shedding light on the interaction between two of these: genes and environment. A multinational research effort assessed the impact of stressor on mood in 275 pairs of female twins. 170 sets of twins were identical: they have exactly the same genetic makeup.
The research indicates that only 12% of individual differences in reactions to stress can be attributed to genetic influences. This is stunning, and should have been reported far more widely: 88% of the differences in the way a person reacts to stress are not genetic, but personal and environmental. This is of great importance in problems such as depression. If genetic factors play such a small role, then paying attention to the development of personal resilience – as well as dealing with social factors – is more likely to be effective than anything else. And, as has been discussed elsewhere one of the ways in which some medicines help people with depression, bipolar disorder and schizophrenia is probably by increasing their resilience.
I have already started showing you some of the techniques for improving psychological resilience and in a future publication we are also going to start work on physical, subtle and spiritual resilience and how to develop more resilient and dynamic relationships.
“Never allow anyone to rain on your parade and thus cast a pall of gloom and defeat on the entire day. Remember that no talent, no self-denial, no brains, no character, are required to set up in the faultfinding business. Nothing external can have any power over you unless you permit it. Your time is too precious to be sacrificed in wasted days combating the menial forces of hate, jealously, and envy. Guard your fragile life carefully. Only God can shape a flower, but any foolish child can pull it to pieces.”
–Og Mandino (American Motivational Speaker and Author, 1923-1996)
Technorati tags: Resilience Depression Stress Environment Genetics
Revisiting Resilience
“I don’t measure a man’s success by how high he climbs, but how high he bounces when he hits bottom.”
–General George S. Patton (American General, 1885-1945)
Resilience is the process of being able to adapt and to thrive in the face of adversity, stress, trauma, tragedy or threats. A resilient person is les likely to succumb to any of these life events and is less likely to develop mental illness. But resilience is more than a passive strength or resistance to the slings and arrows of outrageous fortune: it is a dynamic capacity that not only protects us, but enables us to turn adversity into strength and an opportunity for growth.
Despite our extraordinary health care system and a multi-billion dollar antidepressant industry, the rates of depression are increasing throughout the Western world. A recent book has suggested that boredom was unknown before about 1760: the beginning of the Industrial Revolution. All this tells us that something is seriously wrong with our resilience.
“The measure of a man is the way he bears up under misfortune.”
–Plutarch (Greek Biographer and Priest to the Oracle at Delphi, A.D. 46-c.120)
In Healing, Meaning and Purpose, I pointed out some of the incredible changes that have taken place over the last one hundred years, and their impact on health. To try and apply the principles of the past to the problems of the present and future is unlikely to be crowned with success. We need to adapt. Buddhists do not normally eat meat. Except for Tibetan Buddhists, who need to eat some meat in order to survive at the high altitudes of the Himalayas. I have a good friend who created the finest integrated medicine clinic in the world, the Hale Clinic in London. Normally an abstemious vegetarian, when she was embroiled in business meetings, she would often take some meat to remain grounded. I have done the same thing myself for years. I prefer not to eat meat. I have not had a steak in more than thirty years. But if I am to do a lot of traveling and need to work with politicians and business people, a bit of chopped up fish or poultry can be essential.
The changes in our lifestyles over the past century have dramatically reduced the level of physical activity necessary to provide life’s basic resources: our effort-based rewards that are intimately involved in the regulation of mood. If you think about it for a moment, if your great-grandparents wanted to eat, there was probably a lot of effort involved. Our brains still contain a huge number of circuits that evolved to play roles in sustaining the kind of continuous effort that would be critical for the acquisition of resources such as food, water and shelter. So what happens when we suddenly on longer need much physical activity to obtain those resources? What happens to those parts of the brain that have millions of years evolving? There will be reduced activation of those brain regions essential for reward, pleasure, salience, motivation, problem-solving, and effective coping strategies. The practical consequence of that is that these systems will not sit there idling: if under-stimulated, since these systems are so heavily involved with our emotions, we would expect to see people becoming depressed. And we know that depression has been increasing throughout the Western world. Of course, many people need to stimulate these regions of the brain artificially, as with drugs, pornography or extreme sports.
Effort-based rewards are an essential component of resilience to life’s stressful challenges. Purposeful physical activity is important in the maintenance of mental health. It therefore makes sense to put more emphasis on preventative behavioral and cognitive life strategies, rather than relying solely on psychopharmacological strategies. Our strategy is geared toward protecting people from developing depression, and compensatory behaviors. One of the very interesting new ideas in pharmacology is that antidepressants and antipsychotics may act to enhance resilience at both the cellular level and in the whole person. This is a very different concept from thinking of medicines as chemicals that simply block symptoms.
Our aim is to improve resilience and gradually to increase activation of all those under-used systems of the brain to treat and then to prevent problems. All the things that mother always said were good for you: healthy exercise, meditation, a balanced diet, charity and kindness, and actions aimed at fulfilling your personal and Higher Purpose have already been shown to treat and to protect.
Here are some proven methods for improving resilience:
1. Learn to be adaptable: the heart of resilience is the ability to take things in your stride and to be able to surf the ocean of change, rather than trying to hold the hold it back.
2. Be aware of the blockages in your mind or in the subtle systems of your body that are preventing you from bouncing back form adversity
3. Attitude: avoid seeing a challenge as an insurmountable problem
4. Accept that change is part of life: you can do little about it, but you can do a great deal about how you react to change
5. Ensure that you have meaningful goals that are consistent with your core desires and beliefs, and that you are moving toward them
6. Do all that you can to work on establishing your own Purpose in life. You can create a purpose for your life, but also be aware that there is a Higher Purpose in you life
7. Take decisive actions: even if the first action may not be the best one. Any action is usually better than denying that problems exist, and hoping that they will evaporate while you are asleep or watching television
8. Develop and maintain close relationships. Even if you are not a sociable person, relationships are one of the most potent way of protecting yourself from life’s ups and downs
9. Look for opportunities to learn more about yourself, and how you react to situations. This doesn’t mean becoming an introvert or a rampant narcissist, but it does mean taking a moment each day to review where you are and what you can learn form things that are or have happened in your life. This is a big subject, but there are many good ways to answer the question, “Why is this happening to me again?” and from preventing habitual problems and routine self-sabotage. (I shall be publishing an eBook and CD about this crucial topic in the very near future)
10. Work on developing a positive self-image. I have had some harsh things to say about the excesses of the self-esteem movement, but it has now been replaced by something far more valuable: the science of positive psychology. We have a great deal of empirical data on how to improve a person’s happiness and resilience. Again, we can speak about that some more if you are interested.
11. Maintain hope for the future. We have done research that has shown that one of the best ways of predicting a positive outcome with major mental illness, or of reducing the risk of recurrent substance abuse is to instill hope. Again, there are techniques for doing this, even when the whole world seems to be against you.
12. Maintain perspective: do not blow things out of proportion, and remember that this too shall pass.
13. Take care of yourself, physical, emotionally and spiritually. Listen to yourself: what does your body need? What do you need emotionally? What do you need from a relationship? What do you need spiritually?
14. Are you giving others what they need from you? If you have a nagging sense that you are not giving a child or a spouse that they need and deserve, it can dramatically reduce you resilience.
15. Rather than just thinking about and worrying over your problems, or problems that may turn up in the future, get into the habit of thinking of yourself not just as an individual who is going through problems, but as a boundless spiritual being who is learning a lesson.
16. Never forget to think about the legacy that you are going to leave. Not just to your family, but to the world at large. If you can’t think of one, this is a good time to begin to create one. That is an enormously powerful perspective on the world and on your problems.
“I am an old man and have had many troubles, most of which never happened.”
–Mark Twain (a.k.a. Samuel Langhorne Clemens, American Humorist, Writer and Lecturer, 1835-1910)
Technorati tags: Resilience Life event Life balance Legacy Stress management
Helping to Prevent Suicide
Unless you work in psychology or psychiatry, you may not know that in the United States, there are considerably more suicides each year than there are murders.
Though there is sometimes little warning that someone might be about to harm themselves, in the majority there have been some warning signs.
The American Association of Suicidology expert consensus panel has just published a mnemonic to help professionals and the general public recognize some of the major risk factors. You can find a brief article with a link here.
Here is the whole mnemonic:
I Ideation
S Substance abuse
P Purposelessness
A Anxiety
T Trapped
H Hopelessness
W Withdrawal
A Anger
R Recklessness
M Mood changes
This is only a first attempt at an evidence-based summary of some of the major risk factors, and the sensitivty and specificity of the list is still quite low. But If awareness of some of these warning signs and risk factors saves even a single life, this post will have been worthwhile.
Technorati tags: Suicide Depression Self-harm
