One person dies every 15 minutes, 4 people every hour, and 38,000 every year! Why have you not heard about this? Why is the public not outraged and demanding that the government do something to stop this epidemic? The reason is because this is an epidemic-and a public health problem-that is not spoken about. The epidemic is suicide.

We hear about homicides daily through visual and print media, even though homicide is the 16th leading cause of death in the United States. Compare that with suicide, the 10th leading cause of death. The statistics about suicide are distressing. For individuals ages 15 to 24 years, suicide is the third leading cause of death, after unintentional injury and homicide; it is the second leading cause of death for those ages 25 to 34 years, falling between unintentional injury and homicide; and fourth among individuals ages 35 to 44 years (Caine, 2013). For adults older than 65 years, there are 15 suicides per day, with a yearly total of approximately 5,000 completed suicides (American Association of Suicidology, 2012). Not only does suicide have an impact on the individual, but also on family, friends, and colleagues. These individuals can face haunting questions about what could have been done differently, and it can have an impact on their own physical and psychological health.

Another startling statistic is that 14% of home healthcare patients (or 1 in 7) meet the criteria for a diagnosis of major depressive disorder (National Institutes of Mental Health, 2010). Another 30% of home healthcare patients who do not meet the diagnostic criteria for depression suffer from depressive symptoms severe enough to interfere with their daily activities. Many home healthcare patients are older adults older than 65 years. They often have many of the triggers for suicide, including comorbidities, polypharmacy, frailty, loss of independence, recent bereavement, perceptions of burdensomeness, fear of death, and fear of placement outside of home. Additionally, a history of depression, substance abuse, and previous suicide attempts also predict suicide in older adults. Many adults have contact with a healthcare provider in the days or weeks before a suicide but generally are not able to discuss their thoughts about harming themselves and the healthcare provider does not broach this subject.

It is imperative that home healthcare nurses, therapists, social workers, and chaplains assess homebound elderly for depression and suicide ideation. Home healthcare staff sometimes rely on their observational skills to identify problems with patients. However, depression and the potential for suicide is not something that can be assessed by observation. The addition of the Patient Health Questionnaire-2 (PHQ-2) to assess for depression on admission to home care was an important acknowledgment of the high rate of depression in this population (Sheeran et al., 2010). Asking the PHQ-2 questions on the Outcome and Assessment Information Set home healthcare admission is just as important as assessing for medical and safety issues. When a patient endorses symptoms of depression, the staff member must put aside his or her own discomfort and ask the patient if he or she have thought about harming himself or herself.

It is a myth that asking someone if he or she has thought about suicide will encourage that person to make a suicide attempt. As healthcare professionals, it is important that we not allow ourselves to be distracted from excellent practice by myths. Help end this unspoken public health issue and epidemic. Do not be afraid to ask your patients the tough questions!

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