Suicide

“In most cases, suicide is a solitary event and yet it has often far-reaching repercussions for many others. It is rather like throwing a stone into a pond; the ripples spread and spread.” ~ Alison Wertheimer

At the global level, awareness needs to be raised that suicide is a major preventable cause of premature death. Governments need to develop policy frameworks for national suicide prevention strategies. At the local level, policy statements and research outcomes need to be translated into prevention programmes and activities in communities.

THE GLOBAL PROBLEM

• Every year, almost one million people die from suicide; a “global” mortality rate of 16 per 100,000, or one death every 40 seconds.
• In the last 45 years suicide rates have increased by 60% worldwide. Suicide is among the three leading causes of death among those aged 15-44 years in some countries, and the second leading cause of death in the 10-24 years age group; these figures do not include suicide attempts which are up to 20 times more frequent than completed suicide.
• Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020.
• Although traditionally suicide rates have been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries.
• Mental disorders (particularly depression and alcohol use disorders) are a major risk factor for suicide in Europe and North America; however, in Asian countries impulsiveness plays an important role. Suicide is complex with psychological, social, biological, cultural and environmental factors involved.

EFFECTIVE INTERVENTIONS

• Strategies involving restriction of access to common methods of suicide, such as firearms or toxic substances like pesticides, have proved to be effective in reducing suicide rates; however, there is a need to adopt multi-sectoral approaches involving many levels of intervention and activities.
• There is compelling evidence indicating that adequate prevention and treatment of depression and alcohol and substance abuse can reduce suicide rates, as well as follow-up contact with those who have attempted suicide.

CHALLENGES AND OBSTACLES

• Worldwide, the prevention of suicide has not been adequately addressed due to basically a lack of awareness of suicide as a major problem and the taboo in many societies to discuss openly about it. In fact, only a few countries have included prevention of suicide among their priorities.
• Reliability of suicide certification and reporting is an issue in great need of improvement.
• It is clear that suicide prevention requires intervention also from outside the health sector and calls for an innovative, comprehensive multi-sectoral approach, including both health and non-health sectors, e.g. education, labour, police, justice, religion, law, politics, the media.

TEENS AND SUICIDE

In South Africa, research has indicated that one in five teens thinks about harming themselves, with 7.8% of these youths actually attempted suicide before, while 57.7% of the sample had told someone of their intentions to end their lives.

This is according to statistics released by the Depression and Anxiety Support Group (DASG). Other studies have found that 24.5% of attempted suicide cases amongst black South Africans have occurred in youths aged 17 and below. A total of 34% of black youths have considered suicide as an option in response to stressful life situations, such as divorce of their parents, conflict and love/relationship problems.

Why are adolescents so vulnerable?

Adolescents have to deal with physical, social and academic changes and may thus easily feel overwhelmed. At this age they need to form a separate identity from their primary family group, often resulting in self-doubt, uncertainty and low self-esteem.

“For some adolescents returning to school is filled with potential anxiety. The uncertainty of a new year, in a new class, with different classmates, is fraught with feelings of loneliness and the pressure to ‘fit in’ and re-establish relationships. The transition from primary to secondary school is often a change that many already vulnerable teenagers find difficult to cope with,” according to a DASG press release. A Johannesburg psychologist quoted in the press release states, “unresolved conflicts from childhood often surface in this period. In fact, the early symptoms and signs of psychological disorders often first emerge in late adolescence (15-18 years).”

WHAT ARE THE RISK FACTORS?

The DASG states that youngsters who commit suicide are more likely to come from a “broken home” or one in which there is significantly poor parent-child communication.

Psychiatric diagnoses are present in about 90% of all suicides. The underlying cause is almost always depression. Depressive disorders alone or in combination with aggressive behaviour and/or substance abuse or anxiety are found in over half of all suicides.

Other risk factors include:

• previous suicide attempts/current suicidal thoughts
• access to firearms
• situational stress

WARNING SIGNS OF SUICIDE

• Ideation (thinking, talking or wishing about suicide)
• Substance use or abuse (increased use or change in substance)
• Purposelessness (no sense of purpose or belonging)
• Anger
• Trapped (feeling like there is no way out)
• Hopelessness (there is nothing to live for, no hope or optimism)
• Withdrawal (from family, friends, work, school, activities, hobbies)
• Anxiety (restlessness, irritability, agitation)
• Recklessness (high risk-taking behavior)
• Mood disturbance (dramatic changes in mood)
• Talking about suicide.
• Looking for ways to die (internet searches for how to commit suicide, looking for guns, pills, etc.)
• Statements about hopelessness, helplessness, or worthlessness.
• Preoccupation with death.
• Suddenly happier, calmer.
• Loss of interest in things one cares about.
• Visiting or calling people one cares about.
• Making arrangements; setting one’s affairs in order.
• Giving things away, such as prized possessions.

If You See the Warning Signs of Suicide

Stigma associated with mental illnesses can prevent people from getting help. Your willingness to talk about depression and suicide with a friend, family member, or co-worker can be the first step in getting help and preventing suicide.

Begin a dialogue by asking questions

Suicidal thoughts are common with depressive illnesses and your willingness to talk about it in a non-judgmental, non-confrontational way can be the help a person needs to seek professional help.

Questions okay to ask:

• “Do you ever feel so badly that you think about suicide?”
• “Do you have a plan to commit suicide or take your life?”
• “Have you thought about when you would do it (today, tomorrow, next week)?”
• “Have you thought about what method you would use?”

Asking these questions will help you to determine if your friend or family members is in immediatem danger, and get help if needed. A suicidal person should see a doctor or mental health professional immediately. Calling an ambulance / emergency services or going to a hospital emergency room are also good options to prevent a tragic suicide attempt or death. Remember; always take thoughts of or plans for suicide seriously.

Never keep a plan for suicide a secret.

Don’t worry about risking a friendship if you truly feel a life is in danger. You have bigger things to worry about-someone’s life might be in danger! It is better to lose a relationship from violating a confidence than it is to go to a funeral. And most of the time they will come back and thank you for saving their life.

Don’t try to minimize problems or shame a person into changing their mind.

Your opinion of a person’s situation is irrelevant. Trying to convince a person suffering with a mental illness that it’s not that bad, or that they have everything to live for may only increase their feelings of guilt and hopelessness. Reassure them that help is available, that depression is treatable, and that suicidal feelings are temporary. Life can get better!

If you feel the person isn’t in immediate danger, acknowledge the pain as legitimate and offer to work together to get help.

Make sure you follow through. This is one instance where you must be tenacious in your follow-up. Help find a doctor or a mental health professional, participate in making the first phone call, or go along to the first appointment. If you’re in a position to help, don’t assume that your persistence is unwanted or intrusive. Risking your feelings to help save a life is a risk worth taking.

If you have thoughts of suicide, these options are available to you:

• Check yourself into the emergency room.
• Tell someone who can help you find help immediately.
• Stay away from things that might hurt you.
• Most people can be treated with a combination of antidepressant medication and psychotherapy.

The following are common misconceptions about suicide:

“People who talk about suicide won’t really do it.”

Not True – Almost everyone who commits or attempts suicide has given some clue or warning. Do not ignore suicide threats. Statements like “you’ll be sorry when I’m dead,” “I can’t see any way out,” — no matter how casually or jokingly said, may indicate serious suicidal feelings.

“Anyone who tries to kill him/herself must be crazy.”

Not True – Most suicidal people are not psychotic or insane. They may be upset, grief-stricken, depressed or despairing, but extreme distress and emotional pain are always signs of mental illness and are not signs of psychosis.

“If a person is determined to kill him/herself, nothing is going to stop him/her.”

Not True – Even the most severely depressed person has mixed feelings about death, and most waver until the very last moment between wanting to live and wanting to die. Most suicidal people do not want to die; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever.

“People who commit suicide are people who were unwilling to seek help.”

Not True – Studies of suicide victims have shown that more then half had sought medical help within six month before their deaths and a majority had seen a medical professional within 1 month of their death.

“Talking about suicide may give someone the idea.”

Not True – You don’t give a suicidal person morbid ideas by talking about suicide. The opposite is true — bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do.

Suicide Facts

• South Africa has a comparatively high suicide rate with 19 – 28 per 100 000 completed suicides per annum.
• Many who attempt suicide never seek professional care.
• There are twice as many deaths due to suicide than HIV/AIDS.
• Between 1952 and 1995, suicide in young adults nearly tripled.
• Over half of all suicides occur in adult men, ages 25-65.
• In the month prior to their suicide, 75% of elderly persons had visited a physician.
• Over half of all suicides are completed with a firearm.
• For young people 15-24 years old, suicide is the third leading cause of death.
• Suicide rates among the elderly are highest for those who are divorced or widowed.
• 80% of people that seek treatment for depression are treated successfully.
• 15% of those who are clinically depressed die by suicide.
• There are an estimated 8 to 25 attempted suicides to 1 completion.
• The highest suicide rate is among men over 85 years old: 65 per 100,000 persons.
• 1 in 65,000 children ages 10 to 14 commit suicide each year.
• Substance abuse is a risk factor for suicide.
• The strongest risk factor for suicide is depression.
• Depression will be the #1 disability in the world. (World Health Organization)
• Research has shown medications and therapy to be effective suicide prevention.
• Suicide can be prevented through education and public awareness.

Source:
http://www.who.int/mediacentre/events/annual/world_suicide_prevention_day/en/index.html
http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/index.html
http://www.save.org/index.cfm?fuseaction=home.viewPage&page_id=1
http://www.health24.com/medical/Condition_centres/777-792-807-1654,24534.asp