Last week was Mental Health Week in Australia. It was well advertised and frequently covered by the media. Q & A, which is the most popular debating forum on TV, devoted their Monday night session to depression and suicide prevention.
In fact, it seemed that Mental Health Week generally was focused on giving information about depression and suicide and where to get help for it. Since suicide is life threatening, of course it should be a priority.
However, there are other serious mental health issues that needed to be addressed and were neglected. Anxiety is one of them. Anxiety afflicts 1 in 4 people today and feels intolerable to many. But the most serious part of this omission is that anxiety can be a contributing factor in suicide.
The DSM 5, which came out last year, found that an individual who has bipolar disorder plus anxiety is more likely to commit suicide than one who has only bipolar disorder.
The DSM is the Diagnostic and Statistical Manual that is reviewed and released every ten years or so. It collates all the hard evidence gathered over the years to clarify mental health issues and their precise diagnostic features.
This finding about anxiety is huge.
- First, it helps clinicians get a better understanding of the type of patient who will commit suicide.
- Second, it gives a direction for treatment.
- Third, it can give hope to family members of patients with bipolar disorder who are worried that their loved one may kill himself.
Doctors and family members can never predict when a patient will actually go out and commit suicide. Many patients threaten suicide and some patients actually make unsuccessful attempts to kill themselves. A proportion of these groups do eventually follow through and end their lives.
However, sometimes a successful suicide is carried out by a person who has never threatened nor tried to commit suicide before. This leaves clinicians and family members feeling baffled and helpless. We had no idea that this person was at risk of ending their lives.
What we did know is that nine out of ten people who kill themselves were suffering from depression or bipolar disorder. However, not all people with bipolar disorder killed themselves. The question asked was: among patients with bipolar disorder, who is most likely to commit suicide?
The latest DSM 5 findings help in answering that question. We now know that those patients who are diagnosed with bipolar disorder comorbid with anxiety are at an increased risk of killing themselves.
This has major ramifications in terms of treatment. It means that the anxiety symptoms must be taken seriously and treated. Anxiety symptoms should not be seen as having secondary importance with the focus remaining on depressive symptoms.
This is very useful and positive because anxiety has been proven to be easily treated with excellent results. This gives family members of suicidal patients hope that anxiety management will diminish the risk of suicide.
I wish to conclude by stating that I applaud organisations like Beyond Blue for their work. I also acknowledge what a supportive government we have in Australia who fund such organisations, provide Medicare rebates for psychology sessions and foster Mental Health Week.
However, I appeal to the decision makers to see depression in a larger framework, to give anxiety some air time too and to look at the interaction between anxiety and depression which is crucial.