Suicide is painful, multifaceted and a complex issue that affects individuals, families and communities worldwide. According to WHO, suicide is the third leading cause of death among 15-29-year-olds. However, suicide can occur throughout the lifespan, from young to older adults.
Suicide is a very difficult topic to talk about and that is exactly why we should bring this topic to the table for discussion, because the more we talk about something, the easier it becomes to understand and navigate it. Let us collectively put effort and show responsibility in educating and preventing the occurrence of suicide in our society.
We should always remember that talking about suicide does not cause people to harm themselves; not talking about it might. As uncomfortable as it may sound to the listener when someone talks about their suicidal thoughts, it should be taken as a positive sign because this can be the first step towards seeking help and saving lives.
While each individual perception is different and unique, there are, however, some common threads that help us understand, prevent and respond to this complex phenomenon. But before we move on to understanding warning signs and risk factors of suicide, let us look at some of the common misconceptions related to suicide:
- Myth: Talking about suicide will encourage someone to attempt it.
Fact: Openly discussing suicide gives a person a chance to express their distress and emotional pain, makes them feel heard and cared for; this may encourage them to seek help and support.
- Myth: It is just an attention-seeking gig.
Fact: Individuals who die by suicide have sometimes mentioned their emotional pain or hopelessness to someone. It is always important to take such talk seriously.
- Myth: People who take their lives are selfish.
Fact: People who consider suicide experience tremendous amounts of emotional pain and confusion. They find it difficult to have different perspectives and to see a way out of their misery.
- Myth: Suicide occurs only among young people.
Fact: Unfortunately, suicidal behaviour is present across age groups.
- Myth: Once someone has made up their mind to die by suicide, nothing can be done, AKA suicide cannot be prevented
Fact: No one in the true sense would want to take their lives; given a chance, they would rather not attempt it. Most of them are ambivalent about dying. Quick and timely intervention by people around can help them avert these harmful thoughts and consider other support options.
- Myth: Suicide always occurs without warning.
Fact: There are always warning signs before someone attempts suicide.
- Myth: Talk therapy and medication won’t work.
- Fact: Treatments and interventions do work and can be very helpful. Getting treated for mental health conditions and learning healthy coping mechanisms can reduce the risk of suicide.
Do not ignore the following warning signs:
Verbal signs: Talking about wanting to die, being a burden to others, hopelessness in life, having no reason or purpose or motivation to live, unbearable pain, feeling trapped and wanting to escape.
Situational signs: Analyse if the person has gone through any major life changes, past or recent, which might include loss of employment, divorce, death of a loved one (by suicide or natural death), chronic illness, relationship or financial struggles and domestic violence. Family history of suicide is a good indicator too.
Behavioural signs: Might include an abrupt change in a person’s personality or appearance, poor self-hygiene, withdrawal from friends and family, initiation of alcohol or drug abuse, increased alcohol or substance abuse, absenteeism (unplanned absence from work or school), changes in sleep (may sleep too much or very little) and eating behaviours (may avoid food or eat too much), drastic mood fluctuations, reckless or impulsive behaviours, preoccupation with death in letters, packing up all prized possessions, giving away possessions, performing last rites or making a will.
Shared risk factors for suicide in both men and women
These factors tend to increase the susceptibility and likelihood of suicidality.
- Untreated mental health conditions like depression, substance use disorder, borderline personality disorder and bipolar disorder, along with chronic/terminal physical health conditions like cancer and chronic pain.
- Severe and chronic stress and lack of access to mental health support
- Major life crisis like death of a loved one, loss of job, sexual abuse, intimate partner violence, divorce, separation or desertion, extreme postnatal stress, relationship break-up, chronic neglect by loved ones or guardians.
- Bullying, unjust treatment, discrimination and displacement
- Excessive societal expectations and pressures
- Academic pressures and exam failures
- High impulsivity and low distress tolerance in a person
- Exposure to suicides through media or home/history of self-harm
- Legal/criminal troubles
Men are more likely to die by suicide than women and are still not considered as persons at risk, this is because of lack of openness and discouragement. Additionally, men have a stronger intent to complete the act of suicide and use lethal methods than women which leads to high mortality rate.
It is important to note that children with a history of abuse, neglect, school-related problems, bullying/peer-related problems and children who have lost their parent(s) are at higher risk for suicide.
Suicide at the workplace: Risk factors for work-related suicide
Work gives us a sense of meaning and social belonging. We spend a large part of our day working and the quality of our working life has a major effect on our health and a stressful and toxic workplace situation can have a negative impact on our mental and physical well-being.
Employers play a key role in understanding and managing mental health conditions in employees in order to increase productivity and decrease absenteeism and suicide risk at workplaces.
Some of the major organisational risk factors include: job strain, long working hours, unrealistic work expectations and deadlines, fewer benefits like no paid leave/inadequate compensation, job insecurity, role confusion and isolated workplace conditions that involve work away from direct contact with colleagues or supervisors (including remote workers, field workers, nightshift personnel) can increase loneliness and loss of social connection.
Furthermore, poor work-life balance, chronic burn out and toxic behaviours like harassment, corruption, discrimination and bullying can add pressure and steal the confidence and morale of employees.
Corporates should create an environment that normalises mental health talk and initiatives. Where they feel safe discussing their emotional struggles, feel heard and supported, without judgement.
In addition, the managers and team leaders should be educated regarding the warning signs of distress or suicide, so that they can refer their peers to a mental health support team or an employee assistance program (EAP). This ensures that the employee is following up with the care they require.
Quick and empathetic action on part of the manager can give the employee a chance to explain and seek mental health interventions before it is too late.
Role of family and community as a protective factor
Families and communities have a crucial role to play in the prevention of suicide and to fundamentally contribute to the mental health of people. A lack of family connectedness, poor family cohesion (bonding and emotional connection between family members), poor social involvement and support are linked to increased risk for suicidal behaviours, especially among youth.
It is known that positive and healthy relationships provide a groundwork for building resilience and happiness, especially among adolescents. On the other hand, scolding or physical punishments were associated with a higher risk of suicide.
A responsive democratic parenting style was found to be a protective factor against youth’s suicide behaviours. This style sets guidelines that are reasoned with the child/adolescent to avoid impositions, resentment and dominance.
It encourages validation of a child’s feelings while offering mutual respect and open communication, thereby fostering discipline, accountability, mutual respect and love.
Additionally, parental involvement and monitoring compliance has consistently served as a helpful factor in avoiding suicidal ideation.
Going forward, schools, colleges and religious institutions should set up counselling centres, seminars or camps for spreading mental health awareness, identification and prevention of suicide and other mental health issues among youth.
Family and community members are encouraged to educate and inform themselves about the warning signs and preventive measures of suicide.
Do not take suicide talk lightly; do not shame or degrade the person who might be experiencing depression or anxiety or may be having suicidal thoughts. Most importantly, check on your loved ones, empathise and listen attentively without judging, because you might save your loved one by doing just this.
Role of spirituality and religious attendance
Spirituality can be the foundation for self-discovery, hope, purpose and meaning in life. Spiritual beliefs and traditions enable a person to think about themselves, interact with others, care for themselves and others and cope with illness such as pain and stress.
Religious-spiritual factors such as prayer, meditation, gratitude, altruistic spirit and social connection bring peace, guidance, clarity, stability and discipline in life. It also contributes positively to our overall physical health, by encouraging people to avoid harmful behaviours like alcohol consumption, gambling, smoking and reckless sexual activity.
Research indicates that religious affiliation and religious attendance is associated with decreased suicide attempts in general population and in those with mental illness. Furthermore, spiritual gatherings foster new relationships and enhance bonding with one another.
Islam considers life as a precious gem worth preserving. It promotes self-care and prohibits suicide. Islam teaches that humans don’t own their lives absolutely; hence, they cannot end them. We are encouraged to hold on to Allah and adhere to his teachings during hard times so that we may be rewarded.
Allah says in Holy Quran: “And kill not yourselves. Surely Allah is merciful to you.” (Surah an-Nisa: Ch.4: V. 30)
And “Surely there is ease after hardship.” (Surah al-Inshirah: Ch. 94: V. 6)
Unlike human beings, God never breaks a promise nor falls short of rewarding a good deed or behaviour.
Start your healing journey by talking with a primary health care provider.
- Do not wait for the physician to enquire; you can begin by bringing up your mental health concerns in the appointment.
- Prepare your questions, review your family history, and bring a friend or a family member for support.
- Be honest about your struggles and ask questions regarding mental health diagnosis and request a mental health referral.
- It is normal that you may sometimes need to talk to a few other health care providers to find the one you are comfortable with.
The C.A.R.E model
A compassionate and structured approach will stabilise the overwhelming feeling in an individual and guide him/her to ongoing professional care.
C– Check for warning signs: Notice verbal, situational or behavioural signs. This includes talking about wanting to harm themselves physically or wanting to die. If they are in physical danger, insist on staying with them and do not leave them alone.
A– Acknowledge emotional distress: Listen actively without interruption or judgement, let them know that you understand and that their pain matters.
R– Reduce/remove access to lethal means: Remove items like firearms, medications, or sharp objects from the vicinity.
E– Encourage and escort: Guide or accompany them to a mental health care professional or a primary healthcare physician immediately.
Crisis intervention
It is okay to ask for help; reaching out is a sign of strength, not a weakness. Responding immediately to an individual in crisis might save a life. If someone you know is under significant emotional distress or has a plan to harm themselves, then contact emergency hotlines or crisis centres such as walk-in clinics or hospital-based psychiatric emergency services immediately.
Crisis centres immediately assess suicide risk and provide evaluation, stabilisation and referrals for immediate and long-term therapy and counselling.
We can protect people from suicide despite the risk factors. Hence, let us come together to enhance our responsibility and emotional connectedness and help the most vulnerable and distressed around us.
An open mind and sound mental health education can foster deep understanding and build emotionally responsive and responsible relationships that go beyond our household. The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and because of the stigma and taboo associated with it.
This suicide prevention awareness month, let us work in collaboration with healthcare professionals to raise community awareness and break down barriers to create a suicide-free world.
Note: This is general information for education and awareness purposes. Immediately contact your healthcare provider if you notice warning signs in you or anyone around you.