By : Krish Virmani
Keywords: Suicide Prevention, Protective factors, Risk-factors, Warning-signs
The act of ending one’s life, or suicide, is often the result of the complex interplay between environmental, genetic, and psychosocial factors. Generally speaking, suicidal behavior can present itself in three forms, namely, suicidal ideation (frequent thoughts of ending one’s life), suicide attempts, and completed suicide. It is an alarming public health issue that has claimed at least 1.4 lakh Indian lives in 2019 alone and remains to be the fourth leading cause of death in 15 to 30-year-olds worldwide. A closer look at these trends shows that even as the quality of life and other such provisions continue to improve, the suicide rates in our country remain to worsen. Therefore, we as a community should be aware of certain information that one can use to identify individuals who are at risk of suicide and discuss possible intervention strategies to prevent any significant harm to human life.
Identifying the Victim
Even though the consensus between mental health practitioners states that suicidal behavior is majorly treatable by low-cost intervention strategies, it continues to be a devasting issue due to problems with identifying who needs help promptly. The primary problem with identifying suicidal behavior is that it isn’t a standalone disorder by itself but is the consequence of whatever negative experience the individual is facing in their lives. Most individuals who are experiencing suicidal thoughts differ from one another in terms of their causes and risk factors. While some individuals who appear to be at risk might never attempt suicide, other seemingly healthy individuals might decide to end their lives. Further, the manifestations of such suicidal feelings vary from individual to individual making it extremely difficult to make a cross-sectional diagnosis.
Despite the variations, there are few keys signs that one can look out for as possible indicators of an at-risk individual.
Firstly, the most significant risk factor for suicide is a past history of suicidal behavior which includes familial history as well as previous attempts at one’s own life. This risk factor is often the most closely related risk-factor for any future attempts at suicide and extreme consideration and care should be paid while dealing with such individuals.
Another important risk factor for suicidal behavior is associated with the general physical and mental health of the individual. The most common mental health illness associated with increased risk is depression which most often reveals itself through different symptoms such as extremely low mood, feelings of hopelessness or helplessness, and a lack of motivation, to name a few. Even past episodes can serve as a helpful indicator since individuals with a history of depressive disorders are more likely to trigger an attempt upon experiencing trauma. While depression is the most common, the prevalence of any mental or physical health disorder, especially ones that are painful and chronic, is closely associated with an increased risk of attempting suicide.
Exposure to traumatic experiences such as violence or sexual abuse is often reported as a risk factor in suicide. Moreover, stressful life events such as financial difficulties, loss, separation, and interpersonal stressors such as bullying, harassment, or shame may further contribute to suicide risk. It is not only traumatic experiences but exposure, either directly or indirectly, to others’ suicidal behavior leads to increased periods of suicidal ideation in the individual themself. This is especially true for younger people who are considered more suggestible and thus are more prone to contagion or imitation effects. Therefore, it is generally a good idea to check up on individuals who are experiencing such traumatic experiences and make sure that they are doing okay.
Other than the above-mentioned risk factors, there are various behavioral warning signs that one can pay attention to, to ascertain whether an individual is at imminent risk of suicide; these include:
- Threatening to hurt or kill themselves/Planning or trying to access means to kill themselves.
- Talking about death in inappropriate amounts
- Expressing feelings of worthlessness or hopelessness
- Sudden change in mood: that includes sudden calmness after extreme depression, withdrawing from others, as well as changes in personality and appearance.
- Experiencing recent trauma or life crises
- Preventing Loss
Firstly, it is crucial to treat any possibility of suicide as a priority even if you feel like their problems aren’t severe; take all suicidal threats and talks seriously, and be sure to not be dismissive but rather create a warm and empathetic environment for them to feel safer in. If it appears that the individual is in immediate danger of suicide, then the best course of action would be to contact an emergency number such as a mental health practitioner or a suicide hotline (mentioned below). This might require you to encourage the individual to seek help, but it is also a possibility that you intervene and get their family or the authorities involved. Try to remove any means of suicide while making sure that they aren’t left alone. It is important to get involved and be interactive without appearing judgmental towards them.
Be a good listener to the individual; avoid giving unwanted suggestions or fixes as they might appear insensitive, but rather focus on understanding their plight so as to make them feel heard. Refrain from statements such as “It’s not as bad” or ” It will get better soon” as it implies that you are underestimating their feelings.
Ultimately, while the above-mentioned methods might serve as brief intervention strategies, it is important to explore more long-term solutions in the form of various psychotherapies to tackle the problem at its roots. This involves therapies such as CBT and DBT as well as courses of antidepressants and/or antipsychotics.
Protective Factors
I would like to briefly explore some personal and environmental characteristics that can serve as an aid against suicidal ideation and can be used in intervention as well as prevention programs to reduce the likelihood of suicide. A few such factors include:
- Access to Treatment
- Strong Peer and Community Support system
- Personal Qualities such as Problem solving skills, spiritual faith as well as involvement in hobbies, and community connectedness.
- External factors such as pets, strong relationships, responsibilities, and restricted access to lethal means.
- Strengthening these factors should be an ongoing process to increase resilience during the presence of increased risk factors or other stressful situations.
