Mental Health and Illness

Symptoms and Signs of Depression

When people are depressed they often experience:

• Negative feelings about themselves;
• Sadness, apathy (especially prolonged) or irritable mood;
• A tendency to blame themselves;
• Loss or increase of appetite (significant changes in weight);
• Changes in sleep patterns;
• Constant fatigue;
• Chronic but unexplained aches and pains;
• Loss of interest in life;
• An inability to make decisions; or
• An inability to analyze and solve problem.
  
  

They may act out by:

• Increasing alcohol or other drug use;
• Changing their pattern of school attendance e.g. truancy;
• Becoming delinquent;
• Showing major changes in school performance;
• Becoming sexually promiscuous;
• Taking risk; involving themselves in dangerous undertakings;
• Fighting with friends, family and teachers;
• Changing their level of activity e.g. restlessness to boredom;
• Rejecting past friends, family;
• Having more accidents; driving dangerously; or
• Running away from home.

Common Warning Signs of Suicide

Although individual motives for suicide vary, there are some common warning signs. These signs may indicate that someone is at risk or is having personal, family, or school problems.

Suicides seldom occur without warning.

If you’re aware of common signs and changes in behaviour, you can recognize and better help a person in crisis. The following behaviours can serve as a warning sign. These warning signs are usually physical, emotional, and behavioural in nature.

Physical Signs

• Neglect of personal appearance;
• Sudden changes in manner of dress, especially when the new style is completely out of character;
•  Chronic or unexplained illness, aches and pains;
• Sudden weight gain or loss; and/or
• Sudden change in appetite.

Emotional Clues

• Sense of hopelessness, helplessness or futility;
• Inability to enjoy or appreciate friendships;
• Wide mood changes and sudden outbursts;
• Anxiousness, extreme tension and agitation;
• Lethargy or tiredness;
• Changes in personality: from outgoing to withdrawn, from polite to rude, from compliant to rebellious, from well-behaved to "acting out";
• Loss of the ability to concentrate; daydreaming;
• Depression, sadness;
• Loss of rational thought;
• Feelings of guilt and failure;
• Self-destructive thoughts;
• Exaggerated fears of cancer, AIDS or physical impairment;
• Feelings of worthlessness or of being a burden; and/or
• Loss of enjoyment from activities formerly enjoyed.

Behavioural Signs

• Decreased school activity; isolation. Sudden drop in achievement and interest in school subjects;
• Loss of interest in hobbies, sports, work, etc;
• Unexplained use of alcohol or other drugs;
• Increased use of alcohol or other drugs;
• Withdrawal from family and former friends, sometimes acting in a manner which forces others away;
• Changes in eating and/or sleeping habits;
• Changes in friendship;
• Running away from home, skipping school;
• Accident proneness and increase in risk-taking behaviour such as careless driving, bike accidents, dangerous use of firearms;
• Sexual promiscuity;
• Giving away prized possessions e.g. CD collection;
• Preoccupation with thoughts of death; and/or
• Sudden changes in personality.

The following behavioural signs are especially significant, because these signs indicate that a decision to complete suicide may have been made.  A previous attempt is a particularly important sign. Such an attempt increases the risk of future ones.

• Making a will, writing poetry, or stories about suicide or death;
• Quietly putting affairs in order, "taking care of business";
• Threatening suicide;
• Hoarding pills, hiding weapons, describing methods for committing suicide; and
• Previous suicide attempts.

Verbal and direct statements:

• "What's the use of going on."
• "You won't have to worry about me much longer."
• "Sometimes I think my parents would be happier if I'd never been born."
• "I just can't take it anymore."
• "If I killed myself, then people would be sorry."
• "One of these days I'll do it; I'll take the pills and end it all."

A person may be more inclined to think of suicide or to take unnecessary risks when under the influence of drugs or alcohol. However, it is not easy to understand someone's motives for considering suicide since motives vary with individuals. Loss, especially loss of a relationship, is one of the most common factors preceding the suicide of a young person. Other types of loss and lack of hope for the future also often underlie thoughts of suicide.

Myths and Truths about Suicide

Myth: People who talk about suicide are not likely to attempt suicide.

Truth: Many people who attempt or complete suicide, often tell someone, either directly or indirectly. Most people do give some warning of potential suicide.

• You need to be alert to such warnings, to listen carefully to those around you who may be in crisis.
• Often the person thinking about suicide is unsure about killing himself or herself and simply wants to escape a tough situation.
• You might think it is safer not to talk about suicide with someone you think is considering it. On the contrary, talking may be the only way to understand the person's intentions or to confirm your fears. A willingness to listen indicates that you care, that you are willing to help.

Myth: Once someone had attempted suicide, the person has put aside the idea and is no longer in danger.

Truth: As many as 80 per cent of all completed suicides occurred after previous attempts, and this is especially true for young people.

• If someone who has been depressed suddenly seems happier, do not assume that the danger has passed. A person, having decided to end his or her life, may "feel better," may feel a sense of relief having made this decision.

Suicide Intervention – You Can Help

Here are ways you can help if someone wants to talk to you about his or her feelings of depression or about suicide, or if you think that someone may be acting suicidal or depressed.

• Always treat such talk or behaviour seriously; don't believe that "it's just attention-seeking."
• Do not promise to keep such talk or behaviour a secret; it is one secret you should not keep. It's too risky.
• Do not give quick advice or say that "everything will be alright."
• Be an active listener. Do a lot of listening; little talking. Let the person know you are hearing what they are saying. Try paraphrasing to check whether you are accurately hearing what is being said.
• Remember that it is okay to ask the person if they have been thinking about suicide. It won't "put the ideas in their head."
• Help the person explore his or her own feelings. Do not add to possible guilt by saying things such as "think how your friends and family will feel."
• Don't "discount" the individual's feelings of crisis by saying things like "things aren't that bad," or "that's not true, you have lots of friends."
• Show and describe your concern and caring to the person.
• Don't be afraid to talk openly about the suicidal thoughts. Try to determine whether or not the person has a plan or has attempted suicide earlier.
• Do not debate whether or not suicide is right or wrong. To do so may add to guilt or feelings of worthlessness.
• Discussions of this nature do not always progress in a straight forward manner. It may be necessary to check on some point or other. If you miss something or it becomes obvious that you "should" have said something else, don't worry. Apologize and return to what was missed or say what you think needs saying.
• Remember: You can often be a help by just being there to talk to. Many suicidal crises are immediate and short term. By talking and listening you may swing the person from feelings of "self-death" to "self-life."
• Encourage the person to go to a counsellor, minister or family member for additional help. If they won't and the risk remains, contact someone for them. You might consider:
  • contacting the person's family
  • accompanying the person to a walk-in clinic
  • phoning the family doctor
  • staying with him or her until help arrives
  • taking him or her to a mental health centre
• If the risk seems high or immediate, do not leave the person alone or send them on their own to an agency or other resource person. If possible, considering personal safety, remove the means (pills, car keys).
• Continue to be involved. Let the person know you care beyond the immediate crisis. Remember, even though the risk of suicide may be past for individual, the person may continue to need assistance - yours as well as that of a professional.

Suicide Intervention - Resources

You are not alone. There are individuals and agencies willing and able to assist you, or someone else, in dealing with depression or thoughts of suicide. These same individuals and agencies can provide information and support to assist you in working with others.

Each person's support network is unique; each community provides some kind of service. Generally, the following might provide initial and/or long-term support:

• Family physicians
• Family and community support services counsellors
• Local health clinics
• Employers
• Coaches
• Social workers
• Police
• Ministers, priests, rabbis and other religious leaders
• Medical personnel
• Psychologists
• Emergency response personnel
• Crisis/Suicide line

Find services and supports in your area.

The word trauma is used to describe many feelings and circumstances. We say that we are traumatized by divorce, workplace harassment, the death of someone close to us, being sexually assaulted, experiencing a fire, or natural disaster.

• “True” trauma occurs when the body reacts by turning on its “fight, flight or freeze” automatic pilot in response to situations involving intense fear, helplessness or horror.
• “True” trauma is not the same as severe distress. It occurs when a person is exposed to real or perceived danger, directly (for self) or indirectly (for other) that results in an extreme set of physiological and psychological responses.

Traumatic events are characterized by:

• Threat to life and limb;
• Severe harm and/or injury;
• Being intentionally harmed or injured by someone;
• Exposure to grotesque, violent or sudden loss of a loved one;
• Witnessing or learning of violence to a loved one; and/or
• Causing death or severe injury to another.

Common Causes of Post-Traumatic Stress

There are certain factors that can increase your vulnerability to post-traumatic stress:

• Witnessing domestic violence.
• Fear and fundamental lack of safety in children living with chronic parental addiction or other situations engendering anxiety, fear and insecurity.
• Losing access to an absent parent or to a primary caregiver whoever that person may have been e.g. grandparent, aunt, etc.
• Being arrested or being kept in isolation in a custodial facility.
• Being the victim of peer violence, emotional, or physical.
• Witnessing or having knowledge of the suicidal intentions or attempt of a family member, especially a parent.

General Reactions to Trauma and Loss

Reactions to trauma are not solely determined by events. There are a number of other factors including the nature and magnitude of previous losses and trauma (especially childhood trauma) and coping strategies.

• Trauma experiences can affect how we function in all areas of our lives.
• There is no one “standard” pattern of reactions to the extreme stress of traumatic experiences. Some people respond immediately, others have delayed reactions over a period of weeks, months and even years.
• Some people experience adverse effects for a long period of time while others recover quite quickly. Serious life events such accidental deaths, suicides, murders, sexual assaults, war, etc., are experiences that we do not just “get over.” They may leave long-lasting scars.
• All loss involves some degree of trauma and all traumas involve a substantial amount of loss and grief.

Myths and Truths about Trauma

Myth: If it looks OK on the outside, it must be OK on the inside.

Truth: Showing no response or little response to trauma events is often a sign someone is coping through denial. Most reactions to trauma are normal in the short term, whether they are intense emotional reactions or avoidance and numbing reactions.

Myth:  Trauma symptoms are a sign of dysfunction.

Truth: Trauma symptoms are functional and a sign of a person’s system trying to re-establish its balance. They are signs of health not illness and reflect the victim’s need to recognize the reality and impact of the trauma and also to deny what is overwhelming and unbearable.

Myth: Loss, grief and trauma are the same thing.

Truth: Trauma is often in addition to the grief process, and may interfere with grieving and mourning if it is not addressed separately.

Myth:  We should wait until victims seek help.

Truth: Victims of trauma are struggling to maintain or re-establish a sense of balance and want to appear as competent and in control as possible. Seeking out help may be difficult and victims will benefit from support and immediate trauma intervention.

Seeking Help

The roles of health professionals in responding to trauma include:

• Assessment;
• Intervention;
• Treatment; and
• Consultation to other service providers who have the primary responsibility for intervening and supporting clients experiencing post-trauma stress.

For help with post-trauma stress, contact Mental Health Services in your community.

Find more detailed mental health information at HealthLine on the following topics:

• Depression
• Mental and Behavioural Health
• Mind-Body Connection and Positive Thinking

About Eating Disorders
About Mood Disorders
About Positive Body Image
About Resiliency in Children