Chapter 5 - Physician's Guide To HD
should always be asked about suicide, and this should be regularly reassessed. It is a misconception that suicidal patients
will not admit to these feelings.
The question should be asked in a non-intimidating, matter-of-fact
way, such as "have you been feeling so bad that you sometimes think life isn't worth living?" Or, "have you even thought about
If the patient acknowledges these feelings, the clinician needs
to ask more questions to evaluate their severity and decide on the best course of action.
Are the feelings just a passive wish to die or has the patient
actually thought out a specific suicidal plan?
Does the patient have the means to commit suicide?
Has she prepared for a suicide, such as by loading a gun or
Can the patient identify any factors which are preventing her
from killing herself?
What social supports are present?
Some patients, although having suicidal thoughts, may be at
low risk if they have a good relationship with their doctor, have family support, and have no specific plans. Others
may be so dangerous to themselves that they require emergent hospitalization.
Although there have been cases of non-depressed patients with HD harboring
chronic suicidal feelings, we feel that most, if not all, suicidal patients with HD suffer from Major Depression and can be
So as not to miss such cases, it is helpful to think of all patients
with HD who are suicidal as depressed until proven otherwise. If the clinician is unsure, the patient should be treated presumptively.
This is not to say that a person with HD, particularly early in the
course of the disease may not express a fear of becoming helpless one day, or a desire not to live past a certain degree of
A physician should listen supportively to these concerns, realizing
that most patients will be able to adapt if they are not suffering from depression.
Lets Talk Facts About . . .
Adolescenceit can be a turbulent time. Teenagers deal with a vast array of new experiences during
this transitional period, such as new relationships, decisions about the future, and the physical changes that are taking
place in their bodies.
Some teenagers, however, can become overwhelmed by the uncertainties of adolescence and feel
they have nowhere to turn. Their search for answers may lead them to begin "self-medicating" their pain by abusing drugs or
alcohol. Or they might express their rage and frustration by engaging in acts of violence. They dont want to talk about their
emotions or problems because they may think that will make them a burden or that others will make fun of them. Too often,
these troubled teens opt instead to take their own lives.
The strongest risk factors for attempted suicide in youth are depression, alcohol or drug abuse,
and aggressive or disruptive behaviors. If several of the following symptoms, experiences, or behaviors are present, a mental
health professional or another trusted adult, such as a parent or a school counselor, should be consulted.
- Depressed mood
- Substance abuse
- Frequent episodes of running away or being incarcerated
- Family loss or instability; significant problems with parents
- Expressions of suicidal thoughts, or talk of death or the afterlife during moments of sadness
- Withdrawal from friends and family
- Difficulties in dealing with sexual orientation
- No longer interested in or enjoying activities that once were pleasurable
- Unplanned pregnancy
- Impulsive, aggressive behavior; frequent expressions of rage
Adolescents who consider suicide generally feel alone, hopeless, and rejected. They are especially
vulnerable to these feelings if they have experienced a loss, humiliation, or trauma of some kind: poor performance on a test,
breakup with a boyfriend or girlfriend, parents with alcohol or drug problems or who are abusive, or a family life affected
by parental discord, separation, or divorce. However, a teenager still may be depressed or suicidal even without any of these
Teenagers who are planning to commit suicide might "clean house" by giving away favorite possessions,
cleaning their rooms, or throwing things away. After a period of depression, they may also become suddenly cheerful because
they think that by deciding to end their lives they have "found the solution."
Young people who have attempted suicide in the past or who talk about suicide are at greater
risk for future attempts. Listen for hints like "Id be better off dead" or "I wont be a problem for you much longer."
Some Suicide Statistics
- Suicide is the second leading cause of death among young people ages 15 to 19 years.
- Every day, 14 young people (ages 15 to 24) commit suicide, or approximately 1 every 100 minutes.
- Almost all people who kill themselves have a diagnosable mental or substance use disorder; the
majority have more than one.
- Fifty-three percent of young people who commit suicide abuse substances.
- Four times as many men as women commit suicide, but young women attempt suicide three times
more frequently than young men.
What Can Be Done?
Teens arent helped by lectures or by hearing all the reasons they have to live. What they need
is to be reassured that they have someone to whom they can turnbe it family, friends, school counselor, physician, or teacherto
discuss their feelings or problems. It must be a person who is very willing to listen and who is able to reassure the individual
that depression and suicidal tendencies can be treated.
Treatment is of utmost importance. Local chapters of the American Psychiatric Association can
help by recommending a psychiatrist, a physician with special training in emotional and mental health. Help can also be found
through local mental health associations, family physicians, a county medical society, a local hospitals department of psychiatry,
a community mental health center, a mood disorders program affiliated with a university or medical school, or a family service/social
In short, simply taking the time to talk to troubled teenagers about their emotions or problems
can help prevent the senseless tragedy of teen suicide. Let them know help is available.