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Mood swings can reveal dark intent

A weekly column on how the mind works

Suicide tends to be neglected by the media. But with the suicide rate of school-age children tripling in the past 20 years, it's an issue of prime importance to teachers. About 19,000 young people attempt suicide every year. About 700 succeed, most of them young men, accounting for a fifth of all deaths of young people in the UK.

Most of the more than 7,000 people who kill themselves in the UK and Ireland each year are affected by depression. But depression is not taken as seriously as it should be because of the perception that it is not a real or profound medical problem like heart disease or cancer. Yet depression kills. Somebody commits suicide almost every hour, and the UK has one of the highest rates of attempted suicides in Europe.

Suicide is a traditionally neglected area of investigation by doctors, but fresh research from Paul Blenkiron and his colleagues at Leeds University's department of psychiatry reveals a link between the time of day when people attempt suicide and their motivation. It also reveals that the earlier in the day the attempt, the more serious the medical consequences.

The researchers suggest that as those who self-harm earlier in the day say they face huge practical problems, they might benefit from basic problem-solving techniques. Suicide attempts later in the day are more likely to be linked with alcohol, so this group, the researchers suggest, would benefit from help with alcohol and drug dependence.

Most suicide attempts happen between 4pm and 2am, yet those choosing the most violent methods tend to harm themselves earlier in the day, and most successful suicides occur between 6am and 4pm. One possible reason for these cyclic patterns is the recognised mood variations in people with serious depression: there is a strong tendency to feel awful first thing in the morning and for mood to improve gradually as the day goes on.

It is useful for teachers to be aware of this pattern as they may observe a pupil who appears low and remote in the morning but who is much more cheerful by the afternoon. If this mood pattern is repeated, the child could be exhibiting a major symptom of depression - a clue parents miss if they see their child mostly in the evenings. Teachers can, therefore, be better placed to spot the early signs of clinical depression.

The main conclusion of the Leeds University researchers is that these well-defined daily patterns mean casualty departments should maximise staffing levels when suicide attempts are most likely. At the moment, hospitals have too few resources to provide the right level of emotional help and support.

Many depressed people attempt suicide while in the grip of a particularly bleak mood. Yet this severe swing downwards is usually relatively transitory; they may feel less suicidal even moments later.

So it also appears that suicide prevention, which could save thousands of lives each year, might revolve around providing people or services for the depressed to contact. This could delay the onset of an attempt and allow the person's mood to improve and the impulse to pass. But if depressed youngsters are to confide in a teacher, pick up the phone or drop in on a service, they must feel that there are people offering hope.

This is why it's vital teachers are educated in depression, its treatments, what's available, suicide risk assessment and basic counselling skills.

Sometimes the only courage you need is the courage to get past the next few moments.

Professor Raj Persaud is a consultant psychiatrist at the Maudsley hospital and senior lecturer at the Institute of Psychiatry in London. He is this year's visiting Gresham professor for public understanding of psychiatry and will give free public lectures at Barnard's Inn Hall, London EC1 on October 20 and November 29. See for more details. Email:

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