Focus On Suicide Prevention

By Dr. Junji Takeshita
Interviewed by Rasa Fournier
Wednesday - September 08, 2010
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Dr. Junji Takeshita
Chief of Psychiatry at Queen’s Medical Center

Where did you receive your schooling and training?

I graduated from Phillips Exeter Academy for high school. After that I went to Columbia in New York City for college, then medical school at Temple in Philadelphia. I completed my psychiatry residency at Yale.

How long have you been practicing?

I finished my training in 1993 and I moved to Hawaii right afterwards. I’m based at The Queen’s Medical Center as a medical school faculty with the University of Hawaii.

Can you describe your work?

From the university side, I am a professor of psychiatry and the associate chairman for clinical services. I’m also the program director for the geriatric psychiatry residency program. I function as the chief of psychiatry at Queen’s Medical Center. I also see patients in the hospital.

What demographic is most prone to suicide?

Children and adolescents get a lot of press, but the highest risk group is actually the elderly. The classic high risk patient is the Caucasian medically ill male. Military and veterans is another group of concern. They may have an underlying disorder like post traumatic stress. A lot of them have had neurological impairment because of war-related head injuries and use drugs as a way to cope.

Dr. Takeshita looks over schedules with administrative assistant Gail Mastronardi

Is PTSD a permanent problem?

Post traumatic stress disorder, like many other psychiatric illnesses, is treatable but chronic. Patients may require years of both medications and therapy. It’s not inevitable that everyone who has been traumatized will commit suicide, but a significant number will eventually kill themselves. An important issue involves treatment of the underlying co-morbid disorders like alcohol abuse. Drinking alcohol only worsens the problems of PTSD.

Is suicide usually linked to recreational/over-the-counter drugs?

There’s a strong link between suicide and substance usage, with alcohol being the predominant one. Locally, methamphetamine is a significant factor as well.

Why do the elderly have a higher risk factor?

Medical illness and social isolation are common in the elderly. Social isolation is not good for anyone, especially for the elderly, so involving them with senior citizen groups and family is important.

What are signs family members can look for in the elderly?

We take it very seriously whenever we hear someone mention suicide. Anyone who talks about suicide, especially the elderly, should be properly assessed.

Sometimes people will talk about suicide only while they are intoxicated. A small portion of these individuals will actually kill themselves while they are drunk. The public often thinks that alcohol makes people less depressed, but it actually makes them more depressed.

Are suicide attempts usually planned for some time or are they sudden?

Among younger adults, compared with the elderly, suicidal ideations and attempts are more common but less serious in nature. For instance, the young adult may take a few tablets of pills in a suicide attempt. The time between thinking about suicide and completion may be very short or the suicide attempt is even due to an impulse. When an elderly person attempts suicide, the first may be the last because of the severity. In other words, the elderly will commit suicide using a lethal means such as firearms.

They have often been planning their suicide attempt for a long time.

A practical issue for all groups is to make sure that people don’t have access to weapons. It is also important to be aware of medications and notice if people start, stockpiling medicines as obviously some medicines in overdose can be fatal.

Is it more lethal for the elderly because they are more frail?

They are not necessarily dying because they are so sick. The lethality comes from their attempts being much more serious, like putting a gun to their head. A typical scenario with the youth is that they’ll have a fight with their boyfriend or girlfriend and they’ll take a few tablets of Tylenol, and once the situation is improved they feel much better.

Are there gender differences in the nature of the attempt?

Yes, there are a lot of gender differences. For example, men use more violent means like guns. Women try to commit suicide more frequently, but men are more successful. There are male-female differences even in how people cope - men tend to use more alcohol.

Is depression always a factor?

It’s a frequent issue, but it’s not the only one. People who are medically sick are at much higher risk for depression and suicide. People don’t feel good when they are sick. It’s not a stretch to think that if you’re sick every day, you become depressed and suicidal. The typical scenario with the elderly is that they’ll get sick with a serious illness, for example, heart problems or a stroke. They become debilitated - wheelchair- and bed-bound - which results in isolation, depression and suicidal ideation.

Can you talk about hopelessness because of terminal illness versus treatable depression?

The idea you’re talking about is “futile care,” where patients are so sick that no matter what you do in terms of medical care, death is imminent. Futile care is a very different situation from depression. Depressed people refuse medical treatment because they’re so sad and depressed even though they have something that’s quite treatable. I’ve had a lot of depressed patients who initially refused lifesaving procedures because they felt that life wasn’t worth living anymore. They couldn’t see the need to go through with kidney dialysis or medical procedures that could help them. The aim in psychiatry is to give treatment so that they do feel better, no longer depressed or suicidal. Our response rate of depression to treatment is pretty good and most people get quite a bit better.

Do most sick, elderly people become depressed?

Becoming depressed is not something that is inevitable as part of the aging process or becoming sick. Most elderly, even medically ill individuals, are not depressed.

Are there positive signs to look for when someone is depressed?

Future orientation is one thing, as well as a sense of hope. Sometimes people will say they don’t want to commit suicide because of their religion. Basically we look for anything that keeps them more grounded.

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