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, โDoes your depression ever get so severe that you ever think about killing yourself?โ
We never worry about โplanting the idea,โ because thatโs impossible. Nobody would ever say, โOh, I never thought about that; maybe I should.โ Quite the contrary, anyone who is at all suicidal canโt escape the torment. Theyโre usually relieved when we ask, since itโs been constantly on their mind.
Once we learn they may be suicidal, we inquire about whether theyโre simply mulling the thought over, or perhaps have an actual plan. If so, we evaluate how close they may be to an attempt โ 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 donโt look that depressed, because theyโve finally made a decision. But they still may seek care (a final โcry for helpโ). Almost half of people who attempt suicide interact with healthcare professionals the week before, in one way or another. And itโs not for depression. Maybe they seek care for a runny nose, or a headacheโฆ
See our fuller discussion of Depression.