April 2016
Suicide Prevention

Defining suicide or suicidal tendencies
Suicide or to be suicidal involves thinking about taking one’s own life, making an attempt to take one’s own life. 

How common is it?
According to the World Health Organisation, over 800,000 people die by suicide each year and there are many more people who attempt at taking their own life. Suicide occurs among all ages and was the second leading cause of death worldwide among 15-29 years olds in 2012. Suicide occurs in all countries with 75% of suicides occurring in high and middle income countries in 2012 (WHO). In high income countries, three times as many men die of suicide than woman, in lower income countries the ratio is 1.5 of men who die compared to women (WHO report 2014). Suicide is more prevalence among vulnerable groups such as refugees and migrants; lesbian, gay, bisexual, transgender, intersex persons; and prisoners. 

Methods of suicide
Common methods of suicide are suffocation, firearms or taking an excessive amount of a medication or the use of a poison. It is estimated that around 30% of global suicides are due to pesticide self-poisoning, most of which occur in rural agricultural areas in low- and middle-income countries (WHO). It is important to know the methods so that global prevention strategies can be effective and relevant. When a person is taken to a place of safety, it is important to ensure there is no access to means of suicide and therefore a successful intervention can take place.

 

Warning signs
Below are some the potential signs of a person contemplating suicide or the behaviour of someone who is at risk.

  • Sadness most of the time

  • Talking or writing about suicide, death or dying

  • Withdrawal from usual relationships or social surroundings/activities

  • Feeling of hopelessness or helplessness or being worthless

  • Loss of interest in usual activities / in life

  • Expressions of have no reason for living, no purpose to live

  • Reduction of school or work performance

  • Talking about being trapped or a burden to others

  • Feeling of excessive guilt, shame or self-blame

  • Significant changes in eating behaviour or sleeping pattern

  • Dramatic changes in mood

  • Increase in substance misuse

  • Reckless behaviour or taking part in more risky activities

Many of the behaviours stated are associated with a depressive state but may be recognised in a person who is not diagnosed with depression. Not everyone who attempts suicide is depressed.

Associated factors
There is a link between suicide and mental disorders. Depression is the most commonly associated mental disorder with a person who is suicidal. This can be made more complex when a depressed person consumes alcohol or takes drugs as the risk of suicide is increased. Many suicides however can happen impulsively in a moment of crisis or following a sudden catastrophic event where a person may not be able to cope with life stresses. The person feels there is no way out and can no longer see a future.

Risk factors
The following factors can individually and cumulatively increase the vulnerability of suicidal behaviour;

  • Previous suicide attempts

  • A family member who has committed suicide

  • A personal or family history of mental disorder, substance misuse

  • A personal or family history of physical, sexual or sever emotional abuse

  • A significant psychological loss which may involve the loss of a loved one or work

  • Chronic pain or a significant physical illness

  • Significant stress inflicted from friends or family (relationship break up)

  • Financial problems or troubled work life

  • Environmental factors such as a war

  • Exposure of suicidal behaviours of others

In general, feelings or experiences of conflict, trauma, disaster, violence, abuse, loss and isolation are associated with suicidal behaviour. The strongest risk factor is however a history of previous suicide attempt.

Protective factors
There are also protective factors which can prevent or reduce vulnerability of suicide. These factors include strong and healthy relationships with others, strong social networks within the community or social institutions, effective mental health care, positive coping strategies and a connection to religious or spiritual beliefs. Contacts with providers who support the individual through recovery and staying well also play a large part in preventing suicidal behaviour. There may be some factors that can enhance protective factors and simultaneously act as a risk factor, such as the role of culture (WHO report, 2014).

 

Treatment
Treatment may include admission to a hospital or if the risk for suicide is determined to be only modest, other treatment programs outside the hospital may be advised. Risk for acting on suicidal thinking is significantly increased when alcohol or other drugs are used and treatment for these conditions are often important in the early phases to help decrease the likelihood that an individual will act on their suicidal thoughts.

 

Prevention and intervention
Suicide is preventable. There are a number of measures which can reduce or prevent suicide or suicide attempts;

  • Reduce access to means of suicide

  • Reduce harmful alcohol consumption

  • Identify, treat and care for people with mental and substance use disorders, chronic pain and acute emotional distress;

  • Train non specialized health workers as well as the police, school teachers, community gatekeepers in the assessment and management of suicidal behaviour;

  • Raise awareness among the public of recognising the major warning signs and signposting people to where they can receive help

  • To re-address how media report on suicide with guidelines in place

  • Ensure follow up care is given to people who have attempted suicide and make sure they are supported within the community.

Communities play a large role in suicide prevention, capable of supporting vulnerable groups by engaging in follow up care, fighting and campaigning against stigma and helping grieving friends and family members of individuals who have died.

It is common that individuals who ultimately commit suicide have told someone about it in the six weeks before they have taken the action. An intervention therefore maybe missed if warning signs have been overlooked. It is therefore important to pick up on any warning signs early and if a person confides in you, to take their situation seriously. If you think someone may be having negative thoughts and considering suicide, it helps to talk to that person directly about it. Ask about how they are feeling. You can ask them, if they have had thoughts of suicide, contrary to belief this question does not encourage people to pursue suicidal behaviour. You can also ask them about their plans and what steps they have taken to explore suicide. It is good to talk and to show you care. Make the person not feel alone and ask them what resources or support do they have which could help. Any communication of distress should be taken seriously. If you believe the person is at risk of harming themselves, seek professional help.

Accessing help
A person, who is suicidal, is in need of urgent help. The situation is considered an emergency or a crisis situation and immediate help should be sought. Family and/or friends should seek immediate professional assistance. Take the individual to the hospital or contact a 24 hour crisis line, if available, as the quickest way to get immediate help. While help is being sought, ensure your own safety, do not leave the person on their own and stay until help is there, ensure the person has no means to any items which could be used to take their life, if alcohol or drugs are being used, discourage them from taking this and finally encourage them to talk. Listen without judgement, give reassurance that help is available, be respectful and do not give advice. Professionals are trained in the techniques necessary to accurately assess the risk of suicide and take the steps needed to keep the individual safe. Once in a safe clinical treatment situation, a trained mental health professional can evaluate the individual, and decide on the best course of action.

Challenges

Stigma
Stigma, especially surrounding mental disorders and suicide, means that many people who are contemplating taking their own lives are not seeking help. This remains a huge barrier. Raising awareness around suicide has not been adequately addressed and there still exists a taboo among many societies so therefore it is hidden and not openly talked about. Globally, more effort needs to be given to raising awareness in the community and for suicide to be included as a national health priority with strategic prevention strategies in place.

Data quality
Unfortunately there is a lack of available and accurate data on suicide and suicide attempts across the world. With poor quality data, it is difficult to capture or measure the true estimated suicidal rates globally. Suicides and suicide attempts are known to be misclassified or under reported due to the sensitivity regarding suicide in general and the illegality of suicide in some countries (WHO). Information such as the registration of suicide, and hospital-based registries of suicide attempts and surveys on attempted suicide could provide significant data that could make a difference to national policies and strategies in relation to public health.

‘WPA Public Education Initiative’

Dr. Avdesh Sharma, International Lead, WPA; Consultant Psychiatrist, India
Dr. Sujatha Sharma, Consultant Psychologist, India
Stefanie Radford, Senior Project Manager, United Kingdom
Rajeev Verma, Administrator, India
Pragya Mehra, Media Specialist, India
Jatin Kumar, Media Editor, India

Supported by Unrestricted Educational Grant by SUN Pharma SUN LOGO

>> Please click here the pdf version of this document

  

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