Depression is not a normal state of mind – in the elderly or in people of any age.  The transition from being depressed to being suicidal can be difficult to pick up.

Medical professionals today estimate that potentially one in five Americans will experience a diagnosable mental health disorder during a lifetime, including depression. That's 44 million adults and 4 million children.  However, it is not a normal state of being.  For more information about depression and its treatment, see Second Opinion, Depression (Episode 201).

Suicide is the ninth leading reported cause of death in the United States. Statistics show that:

• Almost all people who kill themselves intentionally have a diagnosable mental disorder
• The primary at-risk populations include young adults and elderly persons
• Although depression is more often diagnosed in women, more men than women die from suicide - more than a 3-to-1 ratio
• As many as two thirds of older individuals who complete suicide have seen a physician within a month of their death -- according to one study, 20% of older patients who committed suicide visited their primary care physician on the same day as their suicide

Both doctors and patients often have difficulty identifying the signs of depression because it can show itself in so many different ways.  Suicide can be even more difficult to predict.

• Suicidal individuals may or may not give warnings of their intent
• They may be socially isolated, so there are no friends and family to help identify the seriousness of the situation
• Physicians are accustomed to treating patients who want to live rather than die – questions about suicidal ideation are normally not part of a routine medical evaluation
• Risk assessment techniques are imprecise

Many primary care physicians are becoming more proactive in dealing with depressed patients and sending them to mental health professionals.  The rest of us need to be vigilant as well with friends or family members who show signs of increasing depression.    

Warning signs include:

• Expressions of hopelessness
• Admission of suicidal thoughts – those who admit to an organized plan of action are at greater risk
• Previous attempts at suicide or a family history of suicide
• Marked changes in behavior, attitudes or appearance
• Giving away prized possessions/putting affairs in order
• Lack of future plans
• Self destructive behavior
• Withdrawal from friends and family
• Also see Signs of Stress and Depression

Things you can do:

• Ask the person if they have had thoughts of suicide
• Actively listen and take what he or she has to say seriously
• Encourage the individual to identify things that might make a difference
• Persuade the individual to see a professional (if necessary, arrange it)
• Take steps to help them end their isolation