Suicide and Depression: Using a Holistic Approach to Assessing Risk Factors

L’Wren Scott, famous fashion designer and girlfriend of Rolling Stones singer Mick Jagger, was found hanging from a doorknob which is being investigated as an apparent suicide. She was age 49 at the time of her death. New York Daily News reported that Scott was depressed, had financial strain, and was experiencing relationship problems.

What were the warning signs, and would a doctor consider financial strain and relationship problems risk factors for depression and subsequently suicide?  If a someone exhibited these risk factors while under the care of  a health care professional, would these risk factors be identified and addressed as social risk factors for depression?

Major Depressive Disorder is one of the most common mental health problems in the United States. Every year about 6.7% of adults in the United States experience Major Depressive Disorder. Throughout the lifespan, women are 70 % more likely than men to experience depression.

Common depression screening tools such as the MINI International Neuropsychiatric Interview do not screen for social risk factors of depression such as relationship problems or financial strain, although these are two major risk factors for depression. Rather, depression screening tools use a conventional symptoms-based approach to screening for depression and do not consider the whole person. The symptoms-based approach uses a mathematical formula to establish a depression diagnosis. Common symptoms of depression examined in existing screening tools include:

• Feeling sad or “empty”
• Feeling hopeless, irritable, anxious, or guilty
• Loss of interest in favorite activities
• Feeling very tired
• Not being able to concentrate or remember details
• Not being able to sleep, or sleeping too much
• Overeating, or not wanting to eat at all
• Thoughts of suicide, suicide attempts
• Aches or pains, headaches, cramps, or digestive problems.

Diagnosing depression using a symptom-based approach ignores the foundational causes of depression in a person’s development and the risk factors they have been exposed to in their life span. In social work, we use a biopsychosocial perspective where human behavior is the product of interactions between an individual and their environment. Shouldn’t our screening process use this same perspective? Research suggests that social risk factors for depression such as divorce, financial strain, relocation, or death of a loved one are just as serious as biological or psychological risk factors for depression.

Social workers can be key change agents in changing the traditional screening process and engage with patients to begin to understand the whole person. Engaging with patients in a helping relationship can assist the treatment team in working with patients in a more holistic manner where the interactions between the individual and their environment are considered in their treatment plan.

If we move away from the limited, symptoms-based approach to depression and engage with patients to explore social risk factors of depression, can we prevent individuals from committing suicide?

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Photo Credit: Courtesy of Fox News