What Is POTS??

What Is POTS??

Monday, April 10, 2017

SUICIDE RISK IN CHRONIC ILLNESS AND PAIN





I've been thinking about suicide, not for myself, but suicide in the news and how suicide affects people with chronic illness. There was a recent incident in the news about an 11-year-old boy who committed suicide. When I was 12, my very first boyfriend, who was only 13, committed suicide and it colored the rest of my life. facebook-prank-leads-11-year-old-boy-commit-suicide/

My maternal grandmother was chronically ill most of her life. She eventually gave up and became catatonic. She was 1/4 Cherokee Indian and Native Americans used to go off by themselves and will themselves to die when they believed they had become a burden on their society. I believe in my heart that is what she did.

Other members of my family were bipolar and I am familiar with threats to just give up and die, quit taking medication, shoot themselves, burn down the house, etc. It's one reason I am determined never to do that to anyone if I can help it. 

The areas of personal knowledge that I have come to experience with regard to chronic illness are: heart disease, diabetes, COPD, Parkinson's Disease, Crohn's Disease, Systemic Lupus Erythematosus, Sjogren's Syndrome, Chronic Kidney Disease and Kidney Failure, Postural Tachycardia Syndrome, Rheumatoid Arthritis and Osteoarthritis, Migraines, Depression, Bipolar Depression and several other illnesses.

In people with chronic illness, there doesn't have to be any clinical depression involved. People with chronic illness become suicidal because of poor quality medical care because their illness is difficult to diagnose and to treat; being told by everyone around you from doctors to friends and family that your illness and symptoms are all in your head; decreased mobility; poor memory, confusion and other cognitive function that decreases their quality of life; lack of support and love from the very people who are supposed to be there for you; and due to that, feeling isolated and alone; feeling like you are a burden; and an overall loss of hope.

“Comorbid conditions that pose risks for suicide, especially depression, are prevalent in people living with chronic pain. The true numbers of failed attempts and successful suicides are unknown and may never be determined. Yet risk factors for suicidal ideation are so high in this population that it must be assumed that some proportion of those who die of drug overdoses might have intended to end their lives, not just temporarily relieve their pain.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125689/

“Between 2005 and 2007, emergency department visits for drug-related suicide attempts increased by 30% and there was an overall 55% increase in opioid-related attempts.”

Those are staggering statistics when you think about it. Since those statistics were released, the United States has had a heroin epidemic. I happen to live across the Ohio River from America's Death Capitol, Huntington, WV. In America's drug death capital: How heroin is scarring the next generation

In modern society, suicide is considered to be a deviant act and believed to be a sign of severe mental illness or something done on impulse or out of despair. But for many people, committing suicide may appear to be the only way out of their situation which is causing their suffering be it mental, physical or both.

In 2007, statistics showed suicide was the 11th highest cause of death in the United States. More than 34,000 people die due to suicide and over 376,000 people visit emergency rooms due to self-inflicted injuries annually. Among those who died, one-third tested positive for alcohol and one in five showed evidence of opiates including prescription drugs and heroin.

And between 1999 and 2014, suicide rates have jumped 24%.

Among the risk factors for suicide is a family history of suicide, history of childhood abuse, previous suicide attempts and history of mental disorders, which include depression, alcohol and substance abuse, impulse disorders. aggressive behavior, isolation, loss of jobs and/or family, physical illness and access to the means to kill themselves, along with a reluctance to seek help because of the stigma that is attached to mental disorders.

People commit suicide because they see it as an easy way out and a permanent solution to a problem. I feel hopeless as if it is their only option and an escape from the emotional pain that they're in.

                                     CLICK ON GRAPHIC FOR LARGER VIEW

It is not hard to see that people who are living with chronic pain have much in common with these people. People with chronic pain often experience hopelessness and isolation due to that pain. Socially they experienced losses that include their job roles and family roles. And then due to their pain their prescribed opioids. And when the pain becomes too much the opioids are handy.

Having already experienced being overlooked and ignored by the medical community because of hard to diagnose chronic illnesses, these people are often reluctant to seek psychiatric treatment. Unfortunately, many of them have already been accused of having mental problems or drug seeking tendencies, they don't want to seek treatment for their illnesses. One survey found that 50% of chronic pain patients had seriously considered committing suicide due to the pain.

“These findings highlight the importance of pain as a potentially independent risk factor for suicide, particularly among those with head pain or multiple forms of co-occurring pain. Individuals suffering from chronic pain may be particularly appropriate for suicide screening and intervention efforts.”

Studies have found that the relationship between pain and suicidal ideation are affected by sleep disorders and catastrophizing. Catastrophizing is an exaggerated and negative focus on pain that leads to depression intensifying the pain and disability. The level of depression and pain catastrophizing was a pretty good predictor of the degree of suicidal ideation and poor pain coping skills were also associated with suicide independent of the level depression and pain severity. This study found that improving sleep and pain coping skills may reduce the incidence of suicidal thoughts and attempts.

Those most at risk for suicide are people over the age of 45, women, those with a dependence on alcohol, previous suicide attempts, and previous psychiatric hospitalizations. Other factors are besides chronic illness are frequent suicidal thoughts, a lack of social support, unemployment, having been divorced, and how severe their psychiatric disorders are. Things that indicate an increased risk of suicide are: giving away personal property, a lack of future goals, making a will, and/or having experienced a recent loss.

SUICIDE AND AUTOIMMUNE DISEASE

One of the most disturbing things I read when I decided to write this was that people with high levels of inflammatory markers have high suicidal ideation. That means that people like me who have one or more autoimmune diseases and the inflammatory processes that come with it are more prone to suicidal thoughts. And it can be a vicious cycle because psychological stress, in turn, raises levels of inflammation. Blood Test for Suicide Risk?




An article in the Journal of American Medical Association (Autoimmune Diseases and Severe Infections as Risk Factors for Mood DisordersA Nationwide Study)showed that autoimmune diseases and infections are risk factors for subsequent mood disorder diagnosis.

A prior hospital contact because of autoimmune disease increased the risk of a
subsequent mood disorder diagnosis by 45%. Any history of hospitalization for infection increased the risk of later mood disorders by 62%. The 2 risk factors interacted in synergy and increased the risk of subsequent mood disorders even further. The number of infections and autoimmune diseases increased the risk of mood disorders in a dose-response relationship. Approximately one-third (32%) of the participants diagnosed as having a mood disorder had a previous hospital contact because of an infection, whereas 5% had a previous hospital contact because of an autoimmune disease.

SUICIDE AND MIGRAINES AND BACK PAIN

Two of the types of chronic pain with the highest incidence of suicidal thought are migraines and back pain. Pain from migraine & severe headache increases suicide risk I have to say I understand why migraine sufferers have a 4 times greater risk of suicide. I have prayed to die during a migraine. The study showed that even though migraine sufferers also often have depression, it was their pain level that made them suicidal.

“These findings highlight the importance of pain as a potentially independent risk factor for suicide, particularly among those with head pain or multiple forms of co-occurring pain. Individuals suffering from chronic pain may be particularly appropriate for suicide screening and intervention efforts.”

After patients with chronic illness have been screened for depression and suicidal ideation, they should be referred for counseling with a behavioral health specialist. Whether or not they require inpatient treatment basically depends on how severe their depression and suicidal ideation is. It also depends on whether their thoughts of suicide have been vague or if the have had specific plans and also the means to carry out the plans, such as access to medicine in high enough doses to be lethal, or previous attempts, a history of impulse control problems. The level of support from family and friends and their coping ability also are significant. People who are severely depressed and suicidal but also need to take opioids should only have access to small amounts at a time. Their doctor can write their prescription for small amounts and their family members can give them their medicine daily. Overall, having their family involved in their treatment is vital. They also need to be given medication for depression and to help sleep problems. There are other treatments for relaxation and insomnia as well. Efficacy of guided imagery with relaxation for osteoarthritis symptoms and medication intake.



HOW CAN YOU HELP?

One of the best ways to help people with chronic illness is to listen to them and believe them when they tell you they are sick and how they feel. Telling someone that it is all in their head is not helpful and is downright damaging to them. Help them find medical care and keep looking until they find a doctor with the answers.

Reach out to them by phone or text if you can't see them in person so that they don't feel so isolated and lonely.

Know the signs.



If you think they might be suicidal, ask them and if they say yes, take it seriously. Sometimes suicidal people just haven't been able to bring themselves to say it out loud and need help asking for help.

Help them get help. You really don't want to be wrong.



The following is information and videos for you or anyone you know who is or might be suicidal or having suicidal thoughts.

There are tools to screen for depression and anxiety. They are usually baed on the (DSM-IV TR).

Highest Score is 66. To rate the severity of depression in patients who are already diagnosed as depressed, administer this questionnaire. The higher the score, the more severe the depression.



This one is an interesting assessment for how disabled you are and asks questions about how difficult it is for you to go about your day to day activities. It includes things like difficulty remembering things, concentrating, standing, sitting, getting along with other people, household tasks, school/work, and social activities. WHODAS 2.0 (World Health Organization Disability Schedule 2.0, 36-item version, self-administered.

This website has confidential screening tests for Depression, anxiety, bipolar, PTSD, alcohol or substance abuse and several others.


This news story and video shows you how to flag a video if you see a video of someone planning to commit suicide.

The following URL will take you to a site with a number to text if you are in crisis.


Who can text?

People of all ages – we’re not just for teenagers. Parents, college students, older adults, and anyone else are welcome to text.
What happens when you text us?

You’ll be connected to a trained Crisis Counselor who is ready to take you from a “hot moment” to a “cool calm.” They’ll actively listen to you to help you determine your next steps to stay safe. They won’t offer direct advice, but they can guide you to coping skills.
FreeCrisis Text Line does not charge for the support it provides. Standard messaging fees are waived on Verizon, AT&T, T-Mobile, and Sprint, and texts to 741741 will not appear on your phone bill if you use one of these carriers.

Confidential – What you say stays between you and the Crisis Counselor. If you are in immediate risk of seriously hurting yourself or others, emergency services may be contacted. We are mandated reporters for cases of abuse of a minor.

24/7 - Help is available around the clock – we answer over 90% of texters within 5 minutes or less.

Nationwide – Volunteers from around the country, supporting people in crisis across the country.


NATIONAL SUICIDE PREVENTION HOTLINE-- 1-800-273-8255




                                       16 Minutes- Suicide Prevention Video




                                       Why do chronic pain patients kill themselves?



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