Order 1364712: Essential Questions: Module 7

Chapter7Notes1 BUTCHERCH07.pptRelationship_Matters_Podcast_553.mp3

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Can you please answer each Discussion question approx. 1/2page each approx. 137.5 words Discussion 1 Part 1: Describe at least 4 key differences between men and women described by Helen Fisher. AND Part 2: What are some differences between male and female intimacy? Readings & Activities Fisher Chapter 10: Men and Women Are Like Two Feet: They Need Each Other to Get Ahead Gender Differences in Mind Associated Media: The Nature of Love link＝ https://www.youtube.com/watch?v＝UybJzG_dts4 Gender Differences in the Brain by Helen Fisher, Ph.D. (important video!) https://www.youtube.com/watch?v＝qSGd6Ojuw0Q Discussion 2 Read the material in the links to the left and check out the great videos below. 1. Are there any differences between gay and straight love? Why or why not? What does the evidence suggest regarding the similarities and differences between sexual majority and minority love? AND 2. Given what you have read, why is it so common for many heterosexuals to discuss and understand homosexuality only as same sex behavior, rather than as a complex identity no different than a heterosexual identity, with the drive to love and be loved at its core? NOTE: If you self identify as gay/lesbian/bi, what has been your experience with love? Share only what you are comfortable sharing. Readings & Activities [gaystraight-relationships-different/ link＝ https://glyswny.wordpress.com/lous-page/gaystraight-relationships-different/ ] [ gay-relationships-can-be-more-stable-straight-ones link＝ https://www.psychologytoday.com/us/blog/disturbed/201311/gay-relationships-can-be-more-stable-straight-ones ] [ www.ncbi.nlm.nih.gov/pmc/articles/ link＝ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121169/ ] Associated Media: iO Tillett Wright: Fifty shades of gay link ＝ https://www.youtube.com/watch?v＝VAJ-5J21Rd0 Homosexual Love link ＝ https://www.youtube.com/watch?v＝v1kcxSPLOEs Discussion 3 What is the difference between ″normal″ mood variation and clinically significant mood variations? Provide several examples. Readings Chapter 7 Discussion 4 Podcast Relationship Matters Podcast Number 55 “Sexualized, objectified, but not satisfied”: What are three key takeaways from this podcast? What is your experience/reaction?

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Chapter 7
Mood Disorders and
Suicide

Abnormal Psychology
Seventeenth Edition

Jill M. Hooley | James N. Butcher
Matthew K. Nock | Susan Mineka

Multimedia Directory

• Slide 14 Martha: Major Depressive Disorder (MDD)
• Slide 29

Ann: Bipolar Disorder

• Slide 36

Feliziano: Living with Bipolar Disorder

• Slide 41

Depression

• Slide 43 Research close-up: Brain Stimulation

Learning Objectives (1 of 3)

1.1 Explain how we define abnormality and classify mental

disorder

1.2 Describe the advantages and disadvantages of
classification.

1.3 Explain how culture affects what is considered
abnormal and describe two different culture-specific
disorders.

Learning Objectives (2 of 3)

7.5 Describe the causal factors influencing the
development and maintenance of bipolar disorders.

7.6 Explain how cultural factors can influence the
expression of mood disorders.

7.7 Describe and distinguish between different treatments
for mood disorders.

Learning Objectives (3 of 3)

7.8 Describe the prevalence and clinical picture of suicidal
behaviors.

7.9 Explain the efforts currently used to prevent and treat
suicidal behaviors.

Mood Disorders: An Overview

Mood disorders

• Defining feature = extremes
of emotion (affect)

• Other symptoms or co-
occurring disorders

Two key moods
• Depression

• feelings of extraordinary sadness
and dejection

• Mania
• intense and unrealistic feelings of

excitement and euphoria

Types of Mood Disorders

Unipolar
depressive
disorders

• Only depressive
episodes

Bipolar depressive
disorders

• Manic and
depressive
episodes

The Prevalence of Mood Disorders

Demographic Differences in
the United States

Native Americans have relatively high rates
of depression

African-Americans have relatively low rates

U.S. rates of unipolar depression inversely
related to socioeconomic status

Figure 7.1 Annual Prevalence of Mood Disorders Around the World
This figure shows the annual (12-month) prevalence of mood disorders using data collected via
household surveys in 17 different countries as part of the WHO World Mental Health Survey Initiative
(Adapted from WHO World Mental Health Survey Consortium, 2004.)

Unipolar Depressive Disorders

Major
Depressive

Disorder
(MDD)

• A major depressive episode
without having manic, hypomanic,
or mixed episodes

• Relapse and recurrence
• May begin at any point in lifespan,

incidence rises during adolescence
• May include additional symptoms

(specifiers)

Table 7.1 Specifiers of Major Depressive Episodes

Specifier Characteristic Symptoms

With Melancholic Features
Three of the following: early morning awakening, depression worse in the morning, marked
psychomotor agitation or retardation, loss of appetite or weight, excessive guilt, qualitatively
different depressed mood

With Psychotic Features Delusions or hallucinations (usually mood congruent); feelings of guilt and worthlessness common

With Atypical Features
Mood reactivity—brightens to positive events; two of the four following symptoms: weight gain
or increase in appetite, hypersomnia, leaden paralysis (arms and legs feel as heavy as lead),
being acutely sensitive to interpersonal rejection

With Catatonic Features A range of psychomotor symptoms from motoric immobility to extensive psychomotor activity, as well as mutism and rigidity

With Seasonal Pattern
At least two or more episodes in past 2 years that have occurred at the same time (usually fall
or winter), and full remission at the same time (usually spring). No other nonseasonal episodes
in the same 2-year period

Martha: Major Depressive Disorder
(MDD)

Click to see video with closed captioning

Persistent Depressive Disorder

Mild to moderate version of depression

• Persistently depressed mood most of
the day for at least 2 years

• Intermittent normal moods occur
briefly

• Lifetime prevalence of 2.5 to 6%
• Average duration is 4-5 years

Other Forms of Depression

Bereavement-
triggered depression

Postpartum
depression

Causal Factors in Unipolar
Mood Disorders

Causal
Factors

Biological
causal factors

Psychological
causal factors

Biological Causal Factors

Genetic
influences

Altered neuro-
transmitter

activity

Hormone &
immune system

regulation
abnormalities

Neuro-physical
& neuro-

anatomical
influences

Sleep and
biological
rhythms

Sex differences

Psychological Causal Factors

Stressful life
events

Independent
vs.

dependent

Vulnerability
in response

to stress

Risk-related
vulnerability

factors

Personality
and cognitive

diatheses
Early

adversity

Th
eo

ris
ts Freud

Behaviorists

Cognitive model

Figure 7.4 Beck’s Cognitive Model of Depression
According to Beck’s cognitive model of depression, certain kinds of early experiences can lead to the
formation of dysfunctional assumptions that leave a person vulnerable to depression later in life if certain
critical incidents (stressors) activate those assumptions. Once activated, these dysfunctional
assumptions trigger automatic thoughts that in turn produce depressive symptoms, which further fuel the
depressive automatic thoughts.
(Adapted from Fennell, 1989.)

Figure 7.5 Negative Cognitive Triad
Beck’s cognitive model of depression describes a pattern of negative automatic thoughts. These
pessimistic predictions center on three themes: the self, the world, and the future.

rie
s

Reformulated
helplessness theory

Hopelessness theory

Excessive rumination

Psychological Causal Factors
In

te
rp

er
so

na
l

ef
fe

ct
s

Lack of social support or social skills

Hostility and rejection from others

Marital dissatisfaction

Bipolar and Related Disorders

Bipolar disorders

• Distinguished from unipolar
disorders by presence of
manic or hypomanic
episodes

Cyclothymic Disorder

Cyclical mood swings

• Less severe than those of bipolar
disorder

• Symptoms present for at least 2 years
• Lacking severe symptoms and

psychotic features of bipolar disorder

Bipolar Disorders (I and II)

Bipolar I disorder

• Includes at
least one manic
or mixed
episode

Bipolar II
disorder

• Includes
hypomanic
episodes but
not full-blown
manic or mixed
episodes

Copyright © 2017, 2014, 2013 Pearson Education, Inc. All Rights Reserved.
Ann: Bipolar Disorder
Click to see video with closed captioning

Figure 7.7 The Manic-Depressive Spectrum
There is a spectrum of bipolarity in moods. All of us have our ups and downs, which are indicated here
as normal mood variation. People with a cyclothymic personality have more marked and regular mood
swings, and people with cyclothymic disorder go through periods when they meet the criteria for
dysthymia (except for the 2-year duration) and other periods when they meet the criteria for hypomania.
People with bipolar II disorder have periods of major depression and periods of hypomania. Unipolar
mania is an extremely rare condition. Finally, people with bipolar I disorder have periods of major
depression and periods of mania.
(Adapted from Frederick K. Goodwin and Kay R. Jamison. (2009). Manic Depressive Illness. Copyright ©
1990. Oxford University Press, Inc.)

Causal Factors in Bipolar Disorders

Causal
factors

Biological Psychological

Heredity

Norepinephrine,
serotonin, and
dopamine

Abnormalities in
transportation of
ions across
neural
membrane

Cortisol
levels

Shifting
patterns of
blood flow to
prefrontal
cortex

Disturbances
in biological
rhythms

P
sy

ch
ol

og
ic

ca
us

al
fa

ct
or

s
Stressful life events

Personality variables

Low social support

Pessimistic attributional
style

Sociocultural Factors Affecting Unipolar
and Bipolar Disorders

Symptoms of
mood disorders

• Can differ
widely across

cultures

and
demographic
groups

Prevalence of
mood disorders

• Also differs
across
cultures

Copyright © 2017, 2014, 2013 Pearson Education, Inc. All Rights Reserved.
Feliziano: Living with Bipolar Disorder
Click to see video with closed captioning

Cross-Cultural Differences
in Depressive Symptoms

• Western:
psychological
symptoms

• Non-Western:
physical
symptoms

Form of
depression

varies
across

cultures

Cross-Cultural Differences in
Prevalence

Rates of depression vary more than rates
of bipolar disorder

Lifetime prevalence of depression is 17-
19% in the U.S., but only 1.5% in Taiwan

Reasons for different rates of depression
are not yet clear

Treatments and Outcomes

Pharmacotherapy

Alternative
biological

treatments

Psychotherapy

Antidepressants, mood-
stabilizing, antipsychotic

drugs used to treat
mood disorders

Lithium common mood
stabilizer for bipolar

Copyright © 2017, 2014, 2013 Pearson Education, Inc. All Rights Reserved.
Depression
Click to see video with closed captioning

Alternative Biological Treatments

Electroconvulsive
therapy

Transcranial magnetic
stimulation

Deep brain stimulation

Bright light therapy

Research close-up: Brain Stimulation

Click to see video with closed captioning

Psychotherapy

Forms of effective
psychotherapy
• Cognitive-behavioral

therapy
• Behavioral activation

treatment
• Interpersonal therapy
• Family and marital

therapy

Suicide: The Clinical Picture and the
Causal Pattern

Suicide risk
significant factor

in all types of
depression

Suicide is the
15th leading

cause of death
in the world

Figure 7.11 Suicide Around the World
The rate of suicide varies dramatically in different parts of the world, as shown in this figure using data
from the World Health Organization. More people die each year by suicide than by all other forms of
violence combined.
(Adapted from World Health Organization, http://www.who.int/mental_health/suicide-prevention/en.)

Copyright © 2017, 2014, 2013 Pearson Education, Inc. All Rights Reserved.
Suicide: The Clinical Picture and the
Causal Pattern

Distinguish
between:

Suicidal
self-injury

Nonsuicidal
self-injury

(NSSI)

The Clinical Picture and
the Causal Pattern

Who Attempts and Dies by Suicide?

Psychological Disorders

Other Psychosocial Factors Associated with
Suicide

Biological Causal Factors

Theoretical Models of Suicidal Behavior

Who Attempts and
Dies by Suicide?

Suicide
attempts
and age

Completed
suicides
and age

Gender
differences

Figure 7.12 Cumulative Prevalence of Suicidal Thoughts and Behaviors During Adolescence
Data from the National Comorbidity Survey–Adolescent Supplement, a nationally representative survey
of over 10,000 U.S. adolescents, show that very few people think about suicide during childhood, but
then the percentage of people who have ever thought about suicide, plan suicide, or make a suicide
attempt increases dramatically during adolescence. These data are from the United States (Nock et al.,
2013), and a very similar pattern is observed in other countries around the world (Nock, Borges, Bromet,
Alonso, et al., 2008).
(Adapted from Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A.
M., & Kessler, R. C. (2013). Prevalence, correlates and treatment of lifetime suicidal behavior among
adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-
A). JAMA Psychiatry, 70, 300–310.)

Increase
risk of

suicide

• Posttraumatic stress
disorder

• Bipolar disorder
• Conduct disorder
• Intermittent explosive

disorder

Other Psychosocial Factors Associated
with Suicide

Psychosocial
factors

Impulsivity

Aggression

Pessimism

Family psychopathology or instability

Hopelessness

Negative affectivity

Biological Factors

Genetics

Reduced
serotonergic
activity

Sociocultural Factors

Ethnicity

• Whites have
higher rates
of suicide
than African
Americans

Rates of
suicide

• Vary across
cultures and
religions

Theoretical Models of Suicidal
Behavior

Diathesis–stress
models

Joiner’s
interpersonal-
psychological

model of suicide

Figure 7.13 Joiner’s Interpersonal-Psychological Model of Suicide
Joiner proposes that people desire to die by suicide when they perceive that they are a burden to others
and experience a sense of thwarted belongingness. However, they cannot act on this suicidal desire
unless they also have acquired the capacity for suicide. When these three factors come together, Joiner
argues, a person is at high risk for suicide.
(Adapted from Joiner, 2005.)

Treatment of Mental Disorders

Prevention of
suicide can take

the form of
treatment of the

underlying mental
disorder(s)

Antidepressant
medication or lithium

Benzodiazepines

Cognitive-behavioral
therapy

Crisis Intervention

Cope with
immediate

crisis

Maintain
supportive

contact

Help show
that distress
is impairing
judgment

Help show
distress in

not endless

Focus on High-Risk Groups
and Other Measures

Provide treatment aimed
directly at decreasing
suicidal thoughts and

behaviors among those
already experiencing these

outcomes

Use cognitive-behavioral
therapy for suicide

prevention for use with
adolescents who have

attempted suicide

Unresolved Issues

Is there a right to die?

Not all societies agree that others
should interfere with suicide

Challenging ethical and legal questions
remain

ABNORMAL PSYCHOLOGY,
SIXTEENTH EDITION
James N. Butcher/Jill M.Hooley/Susan Mineka
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Chapter 7
Mood Disorders
and Suicide

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
This new mother is experiencing postpartum blues; her mood is very labile and she cries easily.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
A person with major depressive disorder may experience a loss of energy, too much or too little sleep, decreased appetite and weight loss, an increase or slowdown in mental and physical activity, difficulty concentrating, irrational guilt, and recurrent thoughts of death or suicide.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
TABLE 7.1
Specifiers of Major Depressive Episodes
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
FIGURE 7.1
Number of Stressful Life Events Versus Probability of Major Depressive Episode. Results demonstrate the association between the number of stressful life events (between ages 21 and 26 years) and probability of a major depressive episode at age 26 as a function of 5-HTT genotype. Life events predicted a diagnosis of major depression among carriers of the s allele (ss or sl), but not among carriers of two l alleles (ll).
Source: Caspi et al., 2003. Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science, 301, 386–89. Reprinted with permission from Science, 18 July 2003, Vol. 301. Copyright © 2003 AAAS.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Functional MRI changes (see Chapter 4) in depressed patients in response to affective stimuli from pre- to posttreatment. These red and yellow images illustrate (in three different views) the increase in left prefrontal activation that occurred in a group of depressed patients following treatment compared to their activation pattern during an acute depressive episode. Thus, the red and yellow images depict the increase in cerebral blood in the left prefrontal area in response to affective stimuli from before and after successful antidepressant treatment. The second scan was obtained 8 weeks following the first scan. Patients were treated with an antidepressant medication during those 8 weeks. (This image courtesy of Richard Davidson.)
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
FIGURE 7.2
The key brain regions involved in affect and mood disorders are the (A) orbital prefrontal cortex and ventromedial prefrontal cortex, (B) dorsolateral prefrontal cortex, (C) hippocampus and amygdala, and (D) anterior cingulate cortex.
Source: From R. J. Davidson, Diego Pizzagalli, and Jack Nitschke. (2002). The representation and regulation of emotion in depression. In I. H. Gotlib and C. L. Hammen (Eds.), Handbook of Depression (pp. 219–44). New York: Guilford.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
People who live in higher latitudes (northern climates for those in the northern hemisphere) are more likely to exhibit seasonal affective disorder, in which depression occurs primarily in the fall and winter months and tends to remit in the spring or summer months.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
If a woman living in poverty is already genetically at risk for depression, the stresses associated with living in poverty may be especially likely to precipitate a major depression in her.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Children who have lost a parent through death or permanent separation may become vulnerable to depression if they receive poor subsequent care from another parent or guardian and if their environment and routine are disrupted.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
FIGURE 7.3
Beck’s Cognitive Model of Depression. According to Beck’s cognitive model of depression, certain kinds of early experiences can lead to the ormation of dysfunctional assumptions that leave a person vulnerable to depression later in life if certain critical incidents (stressors) activate those assumptions. Once activated, these dysfunctional assumptions trigger automatic thoughts that in turn produce depressive symptoms, which further fuel the depressive automatic thoughts. (Adapted from Fennell, 1989.)
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
FIGURE 7.4
Negative Cognitive Triad. Beck’s cognitive model of depression describes a pattern of negative automatic thoughts. These pessimistic predictions center on three themes: the self, the world, and the future.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Woman are more likely than men to ruminate when they are depressed. Men, in contrast, tend to engage in distracting activities when they get into a depressed mood.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Why are people without social support networks more prone to depression when faced with major stressors?
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
FIGURE 7.5
Brain Activation in Response to Maternal Criticism. When healthy (never depressed) participants hear criticism from their own mothers they show significantly greater activation in dorsolateral prefrontal cortex and anterior cingulate cortex than do people who have a history of depression but who are currently fully recovered. Amgygala activation during criticism is significantly greater in formerly depressed participants than it is in controls. (Hooley et al., 2009.)
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
TABLE 7.2
Distinguishing between Bipolar I and Bipolar II Disorder
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
FIGURE 7.6
The Manic-Depressive Spectrum. There is a spectrum of bipolarity in moods. All of us have our ups and downs, which are indicated here as normal mood variation. People with a cyclothymic personality have more marked and regular mood swings, and people with cyclothymic disorder go through periods when they meet the criteria for dysthymia (except for the 2-year duration) and other periods when they meet the criteria for hypomania. People with bipolar II disorder have periods of major depression and periods of hypomania. Unipolar mania is an extremely rare condition. Finally, people with bipolar I disorder have periods of major depression and periods of mania. (Adapted from Goodwin & Jamison, 2009.)
Source: From Frederick K. Goodwin and Kay R. Jamison. (2009). Manic Depressive Illness. Copyright © 1990. Oxford University Press, Inc. Used by permission of Oxford University Press, Inc.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Many highly creative people are believed to have had bipolar disorder, going through periods of intense creative productivity during manic phases, and often going through unproductive periods when clinically depressed. One such individual was the British novelist Virginia Woolf (1882–1941). Woolf committed suicide by drowning herself.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
In some cultures the concept of depression as we know it simply does not exist. For example, Australian aborigines who are “depressed” show none of the guilt and self-abnegation commonly seen in more developed countries. They also do not show suicidal tendencies but instead are more likely to vent their hostilities onto others rather than onto themselves.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
FIGURE 7.7
Prevalence Rates for Depression Across Several Nations. USA-NCS, United States according to the National Comorbidity Study; USA-ECA, United States according to the Epidemiological Catchment Area Study.
Source: Tsai, J. L., and Chentsova-Dutton, Y. (2002). “Understanding depression across cultures.” In I. H. Gotlib and C. L. Hammen (Eds.) Handbook of depression (p. 471). Copyright © 2002. The Guilford Press. Reprinted with permission.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
FIGURE 7.8
Rates of Mood Disorders in Writers and Artists. Although it is difficult to determine a reliable diagnosis of influential writers, poets, and artists (many of whom are long ago deceased), a number of psychological historians have compiled figures such as these, which clearly indicate that such individuals are far more likely than the general population to have had a unipolar or bipolar mood disorder. (Adapted from Jamison, K. R., 1993. Touched with Fire. Free Press.)
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
FIGURE 7.9
Survival curve illustrating how many months following the end of treatment it took patients from the two groups before they had another episode of depression (recurrence). One group had previously received cognitive therapy (CT) and the other group had received antidepressant medication (ADM).
Source: From Hollon, et al. (2005, April). Prevention of relapse following cognitive therapy vs. medications in moderate to severe depression. Arch. Gen. Psychiat., 62(4), 417–26. © 2005 American Medical Association. Reprinted with permission.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Ernest Hemingway (left) committed suicide on July 2, 1961. Thirty-five years later to the day, his granddaughter Margaux (right) took her own life as well. The Hemingway family has endured five suicides over four generations—Ernest’s father Clarence, Ernest and his siblings Ursula and Leicester, and granddaughter Margaux.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Kurt Cobain, lead vocalist of the rock band Nirvana, died from a self-inflicted gunshot wound on April 8, 1994. He left behind his wife, Courtney Love, and their daughter, Frances, to deal with the emotional burden of his suicide. Forty to sixty percent of those who successfully commit suicide are depressed.
Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Copyright © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
FIGURE 7.10
U.S. Suicide Rates by Age, Gender, and Racial Group Suicide rates are higher in males than in females and higher in whites than in African Americans.
Source: National Institute of Mental Health, October 20, 2002. Data: Centers for Disease Control and Prevention, National Center for Health Statistics.
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