🚨988-WATCH — Suicide Warning Signs to Notice and Name
Asking about suicidal thoughts does NOT plant the idea — landmark evidence on this. The patterns below are the changes a family member, friend, coworker, or clinician should notice and name. The most concerning combination is intent + plan + access to means. Any expression of wanting to die, hurt self, or be a burden warrants a 988 call or ED visit. Use plain language: "Are you thinking about suicide?" Don't soften the question.
🎯Three Phases · One Force Field
Every square belongs to one of three content types — not three levels you climb. They tell you what kind of square you’re reading: a concept to understand, a habit to live, or a way to share what you’ve learned. Where you actually track personal progress is your Prepared Patient Course (modules completed) and the Skills Lab (skills signed off). Inside each square’s detail panel, the four sections — Concepts · Skills · Actions · Plan — are the building blocks of these phases.
📘 Learn It Content type
Identity earned: Self-Advocate. The "know" — what depression is (a medical condition, not a character flaw), the major types (MDD, persistent depressive disorder, postpartum, SAD, bipolar depression), the PHQ-9 scoring bands, suicide warning signs and 988 / Crisis Text Line, and the honest framing that most people with depression do get better with treatment.
🛠 Live It Content type
Identity earned: Care-Team Member. The "do" — daily skills (PHQ-9 self-tracking, sleep hygiene, regular exercise as antidepressant, behavioral activation, social-connection routines, alcohol/substance moderation, mindfulness, crisis plan in writing) and this-week actions that turn skills into habits — including building the Ambassador "Notice and Name" partnership.
📣 Share It Content type
Identity earned: Ambassador. The "carry forward" — handle stigma honestly (depression is a medical condition, period), mentor a newly-diagnosed person via NAMI / AFSP, navigate the ADA / FMLA / Mental Health Parity workplace conversation, and address the cultural-competence gaps in men, AA / Latino / AAPI / Indigenous communities, LGBTQ+ youth, and older adults.
🛡️Your Force Field — 16 Squares
Click any square to open its detail panel. Each square is a tile in your shield. Keep clicking, learning, and acting — your Force Field gets stronger every step.
What Is Depression?
A real medical condition that affects mood, energy, sleep, appetite, thinking, and motivation — not a character flaw, not weakness, not "just being sad." Depression is among the most common medical conditions worldwide and among the most treatable. Most people who get treatment get better.
Primer360 Human Anatomy
Brain Networks & Mood
Depression is no longer understood as a simple "chemical imbalance." It involves brain networks — the default-mode network, salience network, and prefrontal-cortex circuits — plus neuroplasticity, stress-system dysregulation, inflammation, and sleep-circadian disruption. Understanding the circuit-and-network model makes treatment make sense.
AnatomyWho Gets It? — Types & Risks
Major Depressive Disorder (MDD), Persistent Depressive Disorder (dysthymia), Postpartum Depression (1 in 7 birthing parents), Seasonal Affective Disorder (SAD), Bipolar Depression (different — needs different treatment), Treatment-Resistant Depression. Risks: family history, postpartum period, chronic illness, trauma, substance use, social isolation, social-determinant stress.
PrimerThe Numbers — PHQ-9
~21 million U.S. adults experience MDD in a year (~8%). Lifetime risk ~17%. The validated PHQ-9 screen is 9 questions, scored 0–3 each, total 0–27, with action bands at 5 (mild), 10 (moderate), 15 (moderately severe), 20 (severe). Treatment works: ~60–70% remit on first med + therapy combination; more with sequencing. Untreated depression is a leading cause of disability worldwide.
PrimerRecognize Warning Signs (988-WATCH)
Suicide warning signs: Talk about wanting to die or be a burden; Plan + Means (with access to firearms / pills — most concerning); Giving Away possessions, saying goodbye; Withdrawal + severe hopelessness. Any of these warrant 988 (call or text) or ED. Asking about suicidal thoughts does not plant the idea — landmark evidence on this.
Learn ItPHQ-9 Screening + Wellness Visits
PHQ-9 is the validated, family-friendly, patient-and-Ambassador-administerable screen for depression. USPSTF recommends universal screening in primary care for adults including pregnant and postpartum women. Item 9 ("thoughts of being better off dead, or of hurting yourself") triggers a same-visit safety conversation regardless of total score. Repeat PHQ-9 weekly while in active treatment to track response.
Learn ItKnow My Numbers
PHQ-9 score + trend · sleep hours + quality · energy · anhedonia (loss of pleasure) tracking · suicidal-ideation check-in · medication adherence · side-effect log. Bring them to every visit. The numbers are the dashboard you and your team use to steer.
Learn ItLifestyle Force Field
Regular exercise (30+ min most days, aerobic + resistance — proven antidepressant on its own and with treatment) · sleep 7–9 hrs, regular schedule · Mediterranean-style diet (lower depression risk) · social connection (a non-negotiable, not a nice-to-have) · sunlight exposure (daily; light therapy for SAD) · alcohol moderation (alcohol worsens depression) · mindfulness · cannabis/substance use moderation.
Learn ItMedications + Therapy — All Three Levers
Therapy works: CBT, IPT, behavioral activation, problem-solving therapy — all evidence-based and first-line for mild-moderate. Medications work: SSRIs first-line (sertraline, escitalopram, fluoxetine), SNRIs (duloxetine, venlafaxine), atypicals (bupropion, mirtazapine). Combination wins for moderate-severe. 4–6 weeks to full effect. Withdrawal is real — taper, don't stop cold. Esketamine for treatment-resistant depression. ECT remains very effective for severe — destigmatize.
Live ItCare Team Members
Psychiatry (or PCP managing if mild-moderate) · Behavioral Health (psychologist / LCSW / LPC trained in CBT or IPT) · PCP · RN care manager in collaborative-care models · peer support / NAMI peer mentor · pastoral care if relevant · family Ambassador · addiction medicine if substance use comorbid · OB/GYN if perinatal · geriatric psych if older adult · Veterans Affairs if veteran.
Live ItTelemedicine & Tech
Telehealth therapy works as well as in-person for most people (BetterHelp, Talkspace, health-system tele-BH) — and improves access. PHQ-9 self-administration apps (How We Feel, Daylio, MyChart symptom diaries) for trend tracking. Light therapy boxes (10,000 lux, 30 min/morning) for SAD. 988 Lifeline 24/7 (call or text). Crisis Text Line: text HOME to 741741. Behavioral-activation worksheets. Sleep apps.
TechInsurance, Treatment Cost & Help
Mental Health Parity and Addiction Equity Act (MHPAEA) requires insurance to cover mental health on par with medical. Most SSRIs are generic and cheap. NAMI HelpLine 1-800-950-6264 for navigation. Sliding-scale therapy via training clinics, community mental health centers, Open Path Collective. SAMHSA 1-800-662-HELP for substance + mental health treatment locator. FMLA covers depression treatment leave; ADA covers accommodations; SSDI for severe disabling depression.
Live ItEquity, Stigma & Cultural Competence
Depression presentation, stigma, and help-seeking vary substantially: men (more irritability, anger, substance use; lower help-seeking; higher suicide rates) · African American communities (somatic presentation; faith-community partnerships matter) · Latino communities (cultural idioms like "ataque de nervios"; stigma) · AAPI communities (lowest mental-health-care utilization) · Indigenous communities (historical trauma; community-based healing) · LGBTQ+ youth (4× suicide-attempt risk vs. peers) · older adults (often missed; presents as memory or somatic). Plain framing: depression is medical, not moral.
Share ItTalk to Kids, Partner, Employer
Kids: plain language + age-appropriate honesty — "Mom's brain is sick, the doctors are helping, it's not your fault." Partner: the Ambassador "Notice and Name" role; ASK about suicidal thoughts (asking does NOT plant the idea); reduce access to means (lethal-means counseling: gun safe storage, locked medications, distance from access at peak risk). Employer: ADA covers depression as a disability; FMLA covers treatment leave; MHPAEA protects coverage. Disclosure is strategic — HR should be your partner.
Share ItMentor & Share Insights
NAMI Peer-to-Peer, NAMI Family-to-Family — robust, free, evidence-based peer-mentor programs. AFSP (American Foundation for Suicide Prevention) "Out of the Darkness" walks + advocacy. Depression Bipolar Support Alliance (DBSA). The newly-diagnosed person who hears "I had PHQ-9 of 18, I tried two meds and CBT, I'm 2 years into remission, here's what I wish I'd known" gets a different orientation than statistics alone. Honest framing > pep talk. Stigma dies one disclosure at a time — but only when the person is ready.
Share ItJoin the ROI Study (PHIT)
PHIT — Population Health Impact Tracking. Aggregate & anonymous. Help prove this program improves outcomes — earlier PHQ-9 screening, faster treatment initiation, more sustained remission, fewer ED crisis visits, better suicide-prevention reach into men / AA / Latino / AAPI / Indigenous / LGBTQ+ / older-adult communities — for depression populations.
Study🩺 Hand-off to my Depression Team
Print and bring to your next visit. This page tells your team what you have prepared for, what you want to focus on, and how you would like to participate as an active member of your own care team.
- I am a Prepared Patient in training for depression. I have reviewed all 16 squares of this Force Field Fact Sheet.
- I have started building my Health Passport, my weekly PHQ-9 log, my sleep / energy / anhedonia tracker, my medication + side-effect list, and my written safety plan (988 Lifeline, Crisis Text Line, trusted contacts, lethal-means safety) to bring to every visit.
- I want to teach back what I have learned and have you correct anything I have misunderstood — especially around my type (MDD / persistent / postpartum / SAD / bipolar / treatment-resistant), my PHQ-9 trend, my treatment plan (therapy + meds + lifestyle), the 4–6 week wait for med effect, the importance of NOT stopping meds cold, and when to call the team versus 988 versus the ED.
What helps my visit
Two minutes for me to teach back. One question I prepared. My latest PHQ-9 score + 4-week trend. Sleep / energy / anhedonia log. Med list with side effects. Confirm latest screening, treatment plan, and follow-up interval on the chart. Ask me about Item 9 directly.
What I am working on
PHQ-9 weekly · daily exercise + sleep · behavioral activation worksheet · alcohol moderation · social-connection routine · safety plan + lethal-means safety · therapy attendance · medication adherence · family Ambassador "Notice and Name" partnership · NAMI peer connection.
How I want to participate
Shared decisions. Honest conversation about treatment options (therapy, meds, combination, ECT, esketamine if relevant). Tell me your top 1–2 priorities so we agree. Use AHRQ SHARE Approach. Refer to behavioral health early. Coordinate with my PCP. Lethal-means counseling without judgment.
🔬 Help Prove This Works — Join the FFH ROI & PHIT Study
The Prepared Patient program is being studied to see whether better preparation actually improves outcomes — earlier PHQ-9 screening, faster treatment initiation, sustained remission, lower relapse, fewer ED crisis visits, better Ambassador "Notice and Name" reach, more equitable access in men / AA / Latino / AAPI / Indigenous / LGBTQ+ / older-adult communities — for depression patients and families. Your participation is voluntary, your data is aggregated and anonymized, and you can withdraw at any time.
➕ Add-On Force Field Card · Depression Skill Mastery
If your care plan adds a specific skill or device, bolt on a 5-step Add-On Card. For depression common bolt-ons include: weekly PHQ-9 self-administration, written safety plan with 988 / Crisis Text Line / trusted contacts, lethal-means safety (firearm safe storage, medication lockboxes), behavioral activation worksheet, sleep-hygiene routine, light-therapy box for SAD (10,000 lux, 30 min/morning), exercise prescription (30 min most days), CBT thought-record practice, mindfulness routine, ECT preparation if recommended, esketamine clinic visit prep, postpartum-specific routine, family Ambassador "Notice and Name" drill.
Introduce
What it is, why it matters, what it does
Coach
Watch a demo + walk-through
Practice
Do it with a coach watching
Train
Use it daily with a check-in
Test
Demonstrate competence + earn badge
Ready to go deeper?
The Prepared Patient · Depression course turns this fact sheet into a guided journey: pre/post knowledge checks, type-specific literacy (MDD, persistent, postpartum, SAD, bipolar depression, treatment-resistant), PHQ-9 administration + interpretation, the bidirectional mood-medical loop with chronic illness, evidence-based therapy + medications + lifestyle, written safety plan with 988 + lethal-means safety, family Ambassador "Notice and Name" role, cultural-competence framing, ADA / FMLA / MHPAEA workplace literacy, and your printable Health Passport. Earn Aware → Active → Certified.