The severest degree of depression is when a patient thinks seriously about killing themselves. Suicide may be impulsive, on the spur of the moment (especially among adolescents), but usually, people have contemplated it for quite some time. So whenever we think a person may be depressed, we gently question and explore their mood. And if indeed they acknowledge their depression, we follow up by asking, “Does your depression ever get so severe that you ever think about killing yourself?”
We never worry about “planting the idea,” because that’s impossible. Nobody would ever say, “Oh, I never thought about that; maybe I should.” Quite the contrary, anyone who is at all suicidal can’t escape the torment. They’re usually relieved when we ask, since it’s been constantly on their mind.
Once we learn they may be suicidal, we inquire about whether they’re simply mulling the thought over, or perhaps have an actual plan. If so, we evaluate how close they may be to an attempt – have they bought a gun, picked a date, etc.? If their seriousness is imminent, we need to arrange for an involuntary hold.
Oftentimes, if a person decides to commit suicide, they don’t look that depressed, because they’ve finally made a decision. But they still may seek care (a final “cry for help”). Almost half of people who attempt suicide interact with healthcare professionals the week before, in one way or another. And it’s not for depression. Maybe they seek care for a runny nose, or a headache…
See our fuller discussion of Depression.