- Suicide is a global public health problem
- Suicide and suicide attempts have far-reaching consequences for individuals, families, and communities
- The death toll from Suicide is rising every year
- Suicide is multifactorial
- SUICIDE IS PREVENTABLE
Suicide is a significant public health problem affecting individuals, families, communities, and the nation, and it is a global challenge as the rates of Suicide are rising yearly. India also shows a rising trend in suicide cases, with about 1 lakh 63 thousand people dying from Suicide in 2021.
Usually, the age group most vulnerable to Suicide is between 18-45, but a significant rise in Suicide has been noted in children and adolescents.
Suicide is usually associated with several risk and protective factors. Like other human behaviours and mental disorders, Suicide also has no single determining cause.
Suicides mostly happen in response to multiple influences like biological, psychological, environmental, interpersonal and societal factors that interact for a prolonged period and in adverse situations affect the mental well-being of individuals and increase the risk for Suicide.
Many of these risk factors and their influence on the individual can be identified well ahead of time, and changing them can protect the individual from reaching the point of no return.
Risk and Protective Factors of Suicide
Risk Factors in Suicide
Life is not fair for anyone, and we all have our share of hardships and struggles in life. Depending upon the genetic make-up and environmental exposure, we develop the skills required to fight odd life situations and to cope with the stressors. Some factors pose a risk of Suicide for vulnerable individuals, and a few of them are:
Risk Factors at Individual Level –
- Genetic and biological vulnerability
- Depression or other mental illnesses in primary/first-degree relatives
- Mental Illnesses like – Depression, Anxiety & reaction to stress, Personality traits of aggression and impulsivity, borderline, antisocial or narcissistic personality
- Hopelessness and helplessness
- Substance Abuse, addiction to alcohol or drugs
- Chronic physical health conditions
- Chronic pain, living alone
- History of repeated self-injurious behaviour
- Previous suicide attempts,
- Victims of violence, including domestic violence
- Physical and sexual abuse
Risk Factors at interpersonal and relationship level –
- Highly conflictual or violent relationships
- Marital problems
- Financial difficulties, hardship and work stress
- Parental death by Suicide
- History of Suicide in the family
- Family dispute
- Housing insecurity
- Perceived humiliations
Risk factors at Community Level –
- Inadequate connectedness in the community
- Separation based on the social and financial status
- Barriers to health care like lack of access to quality physical and mental health care
Risk Factors at the Societal level –
- Poverty and economic hardship
- The stigma associated with mental illnesses and Suicide
- Sense of isolation and lack of social support
- Glorifying and unsafe reporting of Suicide in media
- Availability of lethal means of Suicide
Protective Factors in Suicide
Every disease outcome is an interplay of nature and nurture, which means genes and environment. Despite genetic vulnerability, a cordial atmosphere, social support, and better accessible and affordable health care facilities can prevent many instances of Suicide. Some protective factors for Suicide include:
- Good social support
- Warm and supportive family environment
- Financial stability
- Accessibility to the quality healthcare facility
- Housing securities
- Productive, meaningful occupation
- Tolerance and ability to cope with difficult life situations
- Positive life events
- Good education
- Parenthood/Motherhood – having a child <2 years old
- Spirituality in phenomenological terms
- The ability to regulate emotions
Warning signs of Suicide
Suicidal intentions and contemplation are not always apparent to the eyes not trained to understand them. Most of the time, persons intending to attempt Suicide keep their endeavour hidden.
However, some of the signs reflect in behaviour and understanding and becoming familiar with subtle signs can identify a person at risk and may save the lives of near and dear ones.
Signs which may help in the identification of persons planning for suicide include
- Feeling about hopelessness, helplessness and worthlessness
- Failure to find a reason to continue life
- Feelings of being trapped in a life situation from which escape is not possible
- Trying to get their possessions and affairs in order, trying to arrange things for loved ones, making a will, donating personal possessions
- Searching for a means to end life, reading about modes of harming, arranging dangerous and lethal stuff
- Disturbed biological functions
- Little or excessive sleep
- Little or excessive appetite
- Showing signs of distress, despair
- Rapid mood swings
- Maybe agitated, aggressive or anxious
- Significantly reduced social interactions, tendency to stay alone and aloof, avoiding contact and communications with family members, friends and relatives
- Excessive use of alcohol and other drugs
- Recent experience of severe stressors like the death of a spouse or loved one, job loss, financial crisis, loss of reputation etc
- There may be a history of suicidal thought, intent or act in the past.
Can Suicide be Prevented?
Even though every case of Suicide feels baffling and makes us feel helpless, the fact that Suicide is preventable brings some relief.
If not all, a large majority of suicidal deaths are preventable. Most risk factors associated with the causation of Suicide are identifiable and modifiable; if intervened on time, risk can be minimized.
Suicide prevention requires management at individual levels and prevention and protective strategies at all levels of society, including plans for individuals, families, cultures and communities.
We can minimize the risk of Suicide and improve the outcome for vulnerable persons through various planning, strategies and policies. They are
By identifying and supporting people at risk
- Gatekeeper training – we all must equip ourselves to read the warning signs of contemplation of Suicide so we can intervene on time to save a life.
- Crisis intervention – timely support during a crisis help the vulnerable individual to sail through the tide
- Treatment for people at risk of Suicide – medications are of utmost importance in saving individuals having suicidal thoughts and plans. Treatment should be regular under the care of an expert equipped to deal with such patients with sensitivity and respect.
- Treatment to prevent re-attempts – previous suicide attempt is a significant risk factor for further attempts. Management plans should include long-term treatment and follow-up to guard against subsequent attempts.
By Strengthening the access and delivery of proper and timely suicide care
- Accessibility to quality mental health care for all
- Accessibility to affordable mental health care facilities
- Awareness and education about the available care and support system
- Inclusion and coverage of mental health disorders in health insurance policies
- Promotion of utilization of public mental health care facilities by underprivileged sector
- Reduce provider shortages and enhance resource allocation in underserved areas
By Strengthening the financial and economic support
- Stable job and financial security
- Stable housing facilities – homeless persons are highly vulnerable to mental disorders, abuse and Suicide. Providing a regular and stable place of living may reduce the risk.
- Means of financial support during crisis – most suicides occur during the period of concern, especially in financial situations like poverty, loss and indebtedness. Establishing a means of financial support during difficult periods is proven to be a life-saving measure,
By Creating a protective environment
- Reducing access to lethal and dangerous means among persons at risk of Suicide can prevent the act during a crisis
- Creating a supportive atmosphere at the workplace can contain the Suicide
- By introducing the community-based approaches and support groups to reduce substance abuse and suicidal acts
By Promoting connectedness
- Enhancing the social connectedness among peer groups may reduce the occurrence of suicidal acts
- Promoting several community activities add meaning to life and reduce feelings of worthlessness
By Teaching coping and problem-solving skills
- Social-emotional learning programs enhance coping and problem-solving skills and lead to the development of resilience and confidence, which reduce the risk of Suicide
- Parenting skills and family relationships are essential factors in suicide prevention.
By Lessening the harm and preventing future risk
- Safe reporting and messaging about Suicide – After a celebrity suicide, the number of copycat suicides increases by sensationalized reporting of Suicide. It is the responsibility of our media friends to convey positive messages sensitively while reporting a suicide case to impart knowledge and create awareness about Suicide.
- Postvention – family and friends of suicide victims are at increased risk for Suicide themselves; measures should be taken to support the bereaved.
Together We Can
Every member of society must join hands to prevent Suicide. We need to train our eyes to read the warning signs of Suicide, and we must extend our helping hands to support, guide, and bring the person in need to a mental health care facility.
We also need to commit ourselves to help and investing in the recovery process of vulnerable persons and promoting prevention by resilience building and by engaging ourselves to assist in bringing out social change.