Suicide Watch

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t of the media attention goes to youth suicide," says Dr. Herbert Hendin. "Yet the rates of suicide are much, much greater in people over 50 than in those under 50." Hendin, medical director of the American Foundation for Suicide Prevention in New York City and author of five books on the subject, tells TIME what telltale signs friends, colleagues and family members — especially spouses and children — can watch for, and what they can do to head off tragedies.

ARE THERE LIFE EVENTS THAT MAKE SENIORS MORE VULNERABLE TO SUICIDE? Serious medical illness, a change in work where people retire at 65 or are forced out, or a bereavement about the death of a spouse.

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IS THERE A DIFFERENCE BETWEEN MEN AND WOMEN IN THIS AREA? It's predominantly a problem of older white males. In this country about 4 out of every 5 suicides are among men. When you get to the older population, the ratio becomes much greater. White men over 55 constitute 10% of the population but 33% of all suicides. Women are going to be equally concerned, because the survivors tend to be women, the ones who have to live with it.

HOW CAN YOU TELL THAT AN OLDER PERSON IS AT RISK? Depression is the major risk factor. Very often you can ask if they are depressed, and they will tell you. An equal sign is the loss of pleasure in things that they used to enjoy. The person won't go to a movie when they used to enjoy movies or won't even read the newspaper when they used to do that every day. There are also physiological signs — somebody's sleep pattern being severely disturbed. Usually with older people, it's that they sleep much less. Some people stop eating. There's a loss of energy. People feel hopeless about the future, guilty, that their life has no meaning.

HOW CAN YOU DISTINGUISH A PERSON WHO IS AT RISK FOR SUICIDE FROM ONE WHO IS SUFFERING FROM MORE ROUTINE DEPRESSION? People don't function in the same way. If they're working or have social relationships, you start to see a deterioration in those relationships. They're difficult to be around. If they drank occasionally, drinking may become a problem where it wasn't before. They become irritable and easily angry with people in ways they weren't before. Some of them openly express feelings of desperation. Very often there's a lot of anxiety, which is also a big risk factor. The other emotion you see very often in elderly suicides is guilt, that somehow they did wrong in their relationship with their children or with their husband or wife. Even if there's a germ of truth in it, it's exaggerated a hundredfold. You also need to look for signs where the person talks as if they're not going to go on living. They say things like "You will all be better off without me, because of the trouble that I am." Some will give away possessions.

DO THESE PEOPLE NEED TREATMENT? Everybody who is in a suicidal state certainly does. If someone meets all the criteria for a diagnosis of depression, I would say he or she does too. There are certainly milder states of depression that people go through and get over without help. There's a tendency to feel that the only thing older people can benefit from is medication, that somehow they're too rigid in their personalities or set in their ways that they couldn't be helped by something other than medication. For severe depression, they will need medication, but they can also benefit from psychotherapy. WHAT SHOULD YOU DO IF YOU SUSPECT A PARENT OR AN OLDER FRIEND IS SUICIDAL? Get them professional help. Indicate that they look unhappy to you and that you think that they should talk to somebody. Sometimes you have to help them make the appointment and go with them the first time. There's a certain inertia that's part of the disease. People sometimes need help in getting mobilized.