Suicide means an intentional or voluntary determination to end one’s life. The willingness to die originates within the person. The presence of a known or hidden reason causes one to end one’s life.
* Suicide is a state in which choices or options are never considered before the act.
The first acts of suicide probably occur before the beginning of written records. Historically, society’s attitudes towards suicide reveal a wide range between rational one of acceptance, an irrational one of superstition and a hostile one of punishment. In 19th century, the approach to an understanding of suicide has changed from religious, moral and philosophical approach to one psychological, statistical and sociological approach.
Worldwide suicide rates have increased 60% in the last 45 years. Nearly 1 million people die each year from suicide, globally. One death every 40 seconds. Suicide is among the 3 top causes of death for those between the ages of 15 and 44. Suicide is the 2nd leading cause of death for those between the ages of 10 and 24.
World suicide prevention
Suicide rates among young people has increased so dramatically that they have surpassed suicide statistics for elderly males, becoming the highest risk group in a third of countries (both developed and developing). Mental disorders (particularly depression and substance use disorders) are a major risk factor for suicide.
Suicides globally by age are as follows: 55% are aged between 15 to 44 years and 45% are aged 45 years and over. It is estimated that over 100,000 people die by suicide in India every year. India alone contributes to more than 10% of suicides in the world. The suicide rate in India has been increasing steadily.
High risk includes – Divorced/single or separated, socially isolated, familiar relationship between an individual and society ends or changes abruptly as with the loss of loved one, the loss of a job, discovery of a major health problem, psychiatric illness( Depression, alcohol use ) and prolonged illness.
A high Risk profession includes – Doctors, Policemen and Armed Forces.
Biggest question –
* Can suicides be prevented ?
* Can lives be saved ?
* Are there effective approaches ?
The answer is definite ‘YES’.
Preventing suicide includes –
* Identifying the problem in its various dimensions.
* Understanding risk factors.
* Developing interventions and
Establishing what works or does not work in individual societies.
Protective factors –
* Children in the home, Pregnancy, Deterrent religious beliefs, Life satisfaction, Reality testing ability, Positive coping skills, Positive social support.
Acute phase treatment – To be done only by a qualified mental health professional (pharmacotherapy, MECT, psychotherapy etc).
HIGH RISK SUICIDAL MANAGEMENT –
* 2-3 attendants to accompany the patient. Not to be left alone, to be assisted even to toilet.
* Constant supervision by staff. No medicine to be left with the patient.
* Potentially lethal object to be removed and preferably plastic utensils to be used. Repeated search of the patient.
Myths Versus Facts
* People who talk about suicide don’t complete suicide (FACT: Many people who die by suicide have given definite warnings to family and friends of their intentions. Always take any comment about suicide seriously).
* Suicidal people are fully intent on dying (FACT: Most suicidal people are undecided about living or dying, which is called “suicidal ambivalence.” A part of them wants to live; however, death seems like the only way out of their pain and suffering. They may allow themselves to “gamble with death,” leaving it up to others to save them).
* Men are more likely to be suicidal (FACT: Men are four times more likely to kill themselves than women. Women attempt suicide three times more often than men do).
* Asking a depressed person about suicide will push him/her to complete suicide (FACT: Studies have shown that patients with depression have these ideas and talking about them does not increase the risk of them taking their own life).
* Improvement following a severe depression or a suicide attempt or crisis means that the risk is over (FACT: Most suicides occur within days or weeks of “improvement,” when the individual has the energy and motivation to actually follow through with his/her suicidal thoughts. The highest suicide rates are immediately after a hospitalization for a suicide attempt).
* Once a person attempts suicide, the pain and shame they experience afterward will keep them from trying again (FACT: The most common psychiatric illness that ends in suicide is Major Depression, a recurring illness. Every time a patient gets depressed, the risk of suicide returns).
* Sometimes a bad event can push a person to complete suicide (FACT: Suicide results from having a serious psychiatric disorder. A single event may just be “the last straw”).
* Suicide statistics to stress the fact that every ‘suicide’ is a loss to the society.
* Celebrity suicide shouldn’t be given undue emphasis.
* Detailed descriptions should be avoided.
* A realistic description of the impact of suicides on survivors and families should be provided.
* Misconceptions and myths about suicide should be explained; raising awareness and changing people’s belief.
* Emphasis should be how the act or attempt could have been avoided.
Warning signs should be conveyed; possible remedial measures should be suggested.
The COVID-19 pandemic presents a serious threat to the mental well-being of almost every individual on the planet and suicide risk to some vulnerable section. Increase in suicide risk is not something which cannot be controlled as suicide risk (Depression, Substance use disorder etc) have well-defined risk factors. The time has come when suicide prevention strategies must be prioritized as a serious health concern. Pandemic is clearly indicating an alarming sense of urgency in prioritizing suicide prevention strategies at National and community level.
(The author is DNB Psychiatry)