A separate study, again in Australia, explored this issue further by seeking to define factors that put separated people at higher risk for serious suicidal ideation, defined as having “thought seriously about suicide.” Based on interviews of 228 separated males and 142 separated females recruited from counseling services and self- help groups, researchers found that a prior suicide attempt, sub- stance abuse in the past year, higher scores on measures of shame, and difficulties with financial or property issues predicted greater risk of serious suicidal ideation for men. For women, mood disor- ders in the past year, higher shame scores, and greater amounts of alcohol use predicted serious suicidal ideation (Kloves K et al., J Affect Disord 2010;120:48–53). The reliance on patient self-report for all information on mental health diagnoses is a clear limitation of this study.

TCPR’s Take: Marital separation is a particularly dangerous period for our patients, especially those with prior suicide attempts, alcohol or other substance abuse, a feeling of being ashamed of the separation, and, especially among men, financial worries.We would do well to ramp up the intensity of our treatment, medication and/or psychotherapy, for such patients.