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Clinical Crossroads |

A 52-Year-Old Suicidal Man

Douglas G. Jacobs, MD, Discussant
JAMA. 2000;283(20):2693-2699. doi:10.1001/jama.283.20.2693.
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DR PARKER: Mr D is a 52-year-old man who, in despair, almost jumped in front of a moving train. He attributes this episode to gambling debts piled up in the prior 6 months and the ensuing conflict with his family. He is a resident of Boston and has health insurance through his blue-collar job.

Mr D describes a history of depression dating to his youth. He grew up in a "tough" family, with a father who gambled and drank and brothers who used drugs and alcohol. He has had suicidal thoughts on many occasions but strongly contemplated suicide only once before when he was briefly held in solitary confinement while in jail for a minor crime.

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Figure. The Harvard Department of Psychiatry and National Depression Screening Day Scale
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Copyright 1998 President and Fellows of Harvard College and Screening for Mental Health, Inc. All rights reserved. For use in conjunction with programs of Screening for Mental Health only. Duplication or use without prior permission for any other purpose is prohibited. For permission to use the HANDS, please contact Screening for Mental Health at One Washington St, Suite 304, Wellesley Hills, MA 02481-1706, Attn: JAMA–HANDS permission. DSM-IV indicates Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

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