Is Suicide Preventable?

Key Points

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.