That game of life is hard to play
I’m gonna lose it anyway
The losing card I’ll someday lay
So this is all I have to say…
The sword of time will pierce our skin
It doesn’t hurt when it begins
But as it works its way on in
The pain grows stronger, watch it grin
I realize and I can see…
That suicide is painless
It brings on many changes
I can take or leave it if I please
– Mike Altman
Depression and suicide when seen through the eyes of 14-year old songwriter Mike Altman is pretty chilling. But depression actually cuts through demographics and financial status. Lately, the close succession of suicides of high-profile, successful personalities like musician Avicci, actor Vern Troyer, designer Kate Spade and celebrity chef Anthony Bourdain affirm the alarming findings of the American Foundation for Suicide Prevention that suicide is on the rise in the United States. Suicide is now the 10th leading cause of death in America – a rate that has been rising since 1999.
CDC reports that some states experienced a 38%-58% rise in suicides over the last 18 years with 25 states reporting an increase of over 30%. It’s also distressing to note that there seems to be a “contagion” effect every time there is a high-profile personality involved. In fact, the National Suicide Prevention Lifeline logged 65% more calls while the Crisis Text Line reported a 116% increase in volume after Kate Spade’s suicide. The same phenomenon was observed after the death of Robin Williams. The World Health Organization (WHO) claims that depression, which oftentimes triggers suicide, affects 121 million people worldwide and is one of the leading causes of disability in the U.S. In 2015, it was reported that about 6.7% of adults in the U.S. had at least one major depressive episode. Even worse it is that over half of those suffering from depression also have anxiety disorder, a highly treatable condition affecting 18% of the population for which only 36.9% receive treatment.
Older adults are particularly at risk because depression may manifest more subtly and go on unrecognized. A sense of worthlessness, guilt, tiredness, irritability, fatigue, insomnia, anger, changes in sleep patterns or appetite, and in extreme cases, recurrent thoughts of death or suicide can manifest alongside a tendency to be associated with co-morbidities like alcohol abuse.
Untreated depression greatly increases the risk for suicide. This is where preventative medicine (e.g. Annual Wellness Visit, PHQ-9 screening, etc) plays a crucial role because the condition can be caught early and the patient can be recommended for counseling. Electronic provision of these screening methods are a relatively new tool that make detecting depression more efficient and allows a practice to cast a wider screening net within their patient base.
Sending questionnaires to patients prior to their visit is another way to screen for depression and other mental issues. We provide one form of this through our Pre-Visit Outreach system, which sends questionnaires to the patient to be answered electronically and automatically imported back into the patient record. Self-reported instruments are easy to administer and allow the patient to take the screening when they are most able to and then have the results discussed with them during a future visit. Further, most major insurers and Medicare will reimburse a practice for depression and other preventative mental health screenings.
Depression also qualifies as a chronic condition in Medicare’s Chronic Care Management. In addition to providing needed off-site care to your patients, Medicare reimburses an additional $40 per qualified patient, per month for CCM services. Older patients suffering from more than one chronic condition such as disability, substance abuse, diabetes, heart disease or cancer are at an even higher risk, meaning the 20+ minutes of monthly care management has the potential to greatly increase a patients well-being, or even save their life.