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Suicide, causes and prevention

Every year, more than 1, 00,000 people commit suicide in our country. Suicidal behavior is “a desperate cry for help” or” a way of showing one’s anger and frustration “which includes suicidal threats (suicidal ideations), and suicidal actions (suicidal attempters and completers).
There are various causes of suicides like professional/career problems, discrimination, sense of isolation, abuse, violence, family problems, mental disorders such Depression, addiction to alcohol, financial loss, chronic pain
Suicide is the act of intentionally taking one’s own life. Nearly one million people worldwide die by suicide each year. This corresponds to one death by suicide every 40 seconds. Suicide is one of the leading causes of death in the world, especially among young people. Every year more than one million people commit suicide, every year, almost one million people die from suicide; a “global” mortality rate of 16 per 100,000, or one death every 40 seconds accounting for 1 to 2 per cent of total global mortality. Suicide is a leading cause of premature death, especially among youth.
Attempted suicide, deliberate self-harm are terms used to describe behaviors through which people inflict harm upon themselves, with non-fatal outcome. This is also called non-fatal suicidal behavior. Suicidal attempts are approximately 25 times more frequent than suicidal deaths.
Many studies have shown that at least I0 per cent of the adolescent’s report attempting suicide at some time, A study done by Sidharth and Jena in 2006 involving 1205 adolescent students of two schools from New Delhi reported, one year suicidal indention suicide (last year) was 11.7%. They also found that physical abuse by parents, feeling neglected by parents, history of running away from school, history of suicide by a friend and death wish were found to be associated with non-fatal suicidal behavior
Process: Suicide is typically seen as the fatal outcome of a long-term process shaped by a number of interacting social, economic, cultural, situational, psychological, and biological factors. The life situation preceding suicide is typically characterized by an excess of adverse life events and recent stressors. Usually, suicide is a process in which chain of events will lead to the final act of committing suicide, and usually this process is triggered by a precipitant
Warning signs of suicidal behavior
A person may show various signals like not taking Personal care, withdrawn behavior, decreased appetite, decreased interest in almost all activities, increased amount of substance use and even they may verbalize `directly ‘plans of harming self (by saying’ life is not worth living’, ‘wish, I would have not been born, ‘I will kill myself) or’ indirectly’ (‘everything will be all right within a few days saying good bye’,’ meeting the loved ones before the act’, ‘donating all their favorite articles/things to others’)
Suicide is usually preceded by months’ weeks of death wishes, suicidal ideas, pessimistic feelings, withdrawn or odd behaviors, plans and subtle warnings. It has been Proven beyond doubt that:
* Half of all who commit suicide, would have attempted suicide at least once previously.
* 15-25 per cent of the suicidal attempters will attempt suicide again within a year.
* Hopelessness, depression, and substance use are strong predictors for suicide.
* Family history of suicide in first degree (close) relatives.
* Sudden change in behavior can be noticed (like decreased socialization, aggressive,
Suspicious, fearful, crying spells, academic decline).
These kinds of indirect data will provide an opportunity for suicide intervention before it occurs. Only if we are trained in identifying the symptoms of depression and risk factors you can prevent majority of the suicides.
Common causes for suicide: They are social, environmental, role modelling, psychological, and biological.
Social: Financial problems, poverty, life events, toss in social status, humiliation.
Cultural: Religious cult, group belief (terrorist), religious belief.
Family discord: Family discord, loss of loved one.
Environmental Stress, work pressure, failures, physical illness.
Psychological: Low self-esteem, impulsivity, pleasure seeking.
Role modelling: From media, imitation of others’ behaviors.
Biological: Brain injury, decreased serotonin and hereditary.
Physical illness Like HIV, cancer, sudden loss of vision or limb
Mental illness: Depression, substance use, psychosis, personality disorders.
People at risk for having suicidal behavior:
* Younger age
* Ongoing and/or recent life-events (like loss of relationship, failure in exam, financial loss)
* Past history of suicidal attempt
* Loss of social status/reputation in the society
* Family history of suicide, poor family support, broken family physical abuse by parents, feeling neglected by parents and loss of loved ones
* Loss of romantic relationship or discord in a relationship
* Chronic medical/surgical illness like HIV, cancer
* Mental illness like-depression, substance use, anti-social behavior, psychosis
* Evolving personality disorders
* Poor social integration (lack of confiding relationships/ long standing relationship problems), poor problem solving skill
* Aggression, hopelessness, impulsive, sudden change in behavior, sudden decline in academic performance, conduct problems like truancy/stealing lying.
Acute precipitants: The most common precipitating factors for suicide in adolescents are humiliation by their parent friends/relatives / teachers, punishment for misdeeds in front of others, exam failure, arguments or fights with the loved ones and the loss of romantic relationships
MANAGEMENT OF SUICIDE
Suicidal attempt: Immediate hospital referral to save the person’s life.
*Inform family members immediately and involve them in helping the person.
Non-fatal suicidal behavior
1) Never scold a person who has attempted suicide. Usually people/elders in the family demean their act as cowardly, Stupid, Crazy, foolish, sinful (God will never forgive), attention seeking and so on. But you should always keep this in mind suicidal behavior is “a desperate cry for help”(a last hope). So, do not scold, act shocked, argue about the value of life and make the person feel more guilty, sad and depressed, about causing suffering for themselves, family and friends, which may worsen the situation rather than helping him.
2) Avoid giving lecture/advice on value of life. Instead allow him to talk and express his emotions/feelings. This can be done only by active listening. Please avoid comparing them with anyone else.
3) Discuss about their behavior or feelings by using opening statement like
a, what circumstances/situations made him to choose that step?
b, what made him to feel so helpless and hopeless?
c, what made him to think that there was no way out of that situation?
d, explore about his recent life events and substance use
e, Explore past history of suicidal attempts and family history of suicidal attempt.
4) Ask for any plans of completing suicide or hurting himself in near future. There is a high possibility he may attempt again. Hence, ask for future or attempting again. Ask for any specific plan or ideas in his mind to commit suicide. Exploring suicidal ideas or thoughts does not increase suicidal behavior. Intact, many studies proven beyond doubt that by exploring for suicidal plans or ideas, you can get an opportunity to intervene.
5). Reducing mc availability of means/modes of committing suicide.
6). Try to help him in all possible ways, knowing your limitations. Avoid unnecessary delay in the process of providing help. Communicate your concern and support for his recovery. Acknowledge your limitations in front of them and try to assure them that you will do your best to help them.
7). Do not challenge a person who has attempted.
8.) Do not leave him alone at any cost. Make someone to stay with him all the time.
9) Do not give false reassurances.
10). If there are multiple threats and attempts, severe suicidal attempt, history of aggression and impulsive, signs and symptoms of mental illness (like depression/psychosis substance use) and poor socializing behavior. Then discuss with family members about the risk and advise them to take help from mental health professionals.
II) These are emotionally charged situations. You may get stressed out easily, which may be detrimental in many ways to you and to the person who had attempted suicide, Hence, do not handle these situations alone. Involve your friends, survivor’s family members and others Try to get help from all possible means.
12) Take help from mental health professionals to deal with such situations.
Suicides in schools and colleges
1. If a student has committed suicide can have severe psychological impact on his friends and to the staff of the school or college. It can even set an example for other students as a method to tackle their problems. Hence a protocol should be developed by the school authorities for dealing with such situations. School authorities should get adequate information about the event, then information should be given to all the students by their class teacher. To avoid rumors, all students should get the same information. Don’t describe the suicidal event in detail to the students. Do not glorify the suicidal act. Allow students to discuss about their thoughts and feelings. Severely affected students (close friends) of the deceased should be allowed to ventilate and if required counselling services should be offered. It would be appropriate to inform their family members and help them to cope with the situation. This opportunity should be utilized later for discussing of brain storming sessions or seminars about suicide, help seeking behavior, available services problem solving techniques and depression.
2) If a student had attempted non-fatal suicidal behavior,
*Treat him as a normal student.
* Encourage other students to interact with him.
*Help him in coping with his studies or any other distressing issue,
* If possible a teacher should be assigned to that student so that, he can discuss with the teacher about his thoughts, feelings and problems.
*To develop a contract with the student that he will not attempt again.
Communicate your concerns and support.
*Student should be clearly told that he can seek help without any barrier.
*f required referral to mental health professionals if possible discuss with the student and their family Professionals. Initially, family members may refuse. Try to explain them in simple words about depression, Prevention is better than cure
(The writer is a Psychiatrist from Rajouri and can be reached: [email protected]