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Depression is characterized by symptoms that generally fall into two categories: psychological, and somatic or physical. The former are characterized by a persistent sense of sadness, termed “dysphoria,” and a persistent state of lack of usual enjoyment or pleasure in previously pleasurable activities, termed “anhedonia.” Depressed individuals with dysphoria describe themselves as being helpless and hopeless, discouraged, “blue,” “fed up,” or “down in the dumps” and “useless.” They are often easily tearful, irritable, or frustrated because they tend to have negatively biased perceptions about themselves and others to whom they relate, and a pessimistic view of their future, often manifesting as inappropriate guilt. The most serious symptom of depression with respect to mortality and morbidity is suicidal behavior . The most benign type of suicidal thinking – that “life is not worth living” – is consonant with beliefs by individuals that their lives are hopeless, they are helpless and worthless, and have no chance for future betterment. Suicidal thinking around plans to harm oneself (or others) indicates a higher level of potential risk, which is greatest when the individual is contemplating acting on the plans or has demonstrated behavior in furtherance of the suicidal thinking. Proximal risk factors for suicide include agitation, current suicidal intent or plan, severe depression and/or anhedonia, instability (e.g., alcohol abuse or decline in health), recent loss, and availability of a lethal agent. Distal risk factors include current suicidal intent with plan, personal or family history of suicide, aggressive or impulsive behavioral pattern (including possible bipolar disorder, especially if associated with psychosis), poor response to treatment for depression, poor treatment alliance, a history of abuse or trauma, and/or substance or alcohol abuse .
KeywordsDepressive Episode Suicidal Thinking General Medical Condition Grief Reaction Proximal Risk Factor
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