September 10, 2024 

Suicide is an act done intentionally to cause death. 

Worldwide 7.5 million people die yearly of suicide. In our country, deaths last year due to suicide was around 1.64 lac. 

Suicide is the fourth highest cause of death among teenagers and young adults. 

Ingestion of Pesticide, hanging and firearms are the commonest ways in which suicide is committed worldwide. 

Past suicide attempt is the most predictable and deadly risk factor in someone who commits suicide. 

Every year World Suicide Prevention Day (WSPD) is observed on September 10. The theme for 2024 is “Changing the Narrative on Suicide". 

The aim of the theme is to raise awareness about the importance of changing the narrative surrounding suicide and transforming how we perceive this complex issue. 

We Psychiatrists view many suicides as preventable. 

So let’s improve our understanding on suicide. 

What are the risk factors for suicide? 

• Severe depression
• Personality disorder such as borderline
• Substance dependence
• Previous suicidal attempts
• Clustering together of life stressors
• Diagnosis of severe uncontrolled physical illness such as cancer and chronic pain 

All of these are few of the factors which increase the risk of suicide. 

Research has shown that there are certain influences which deter suicidal behaviour. 

What are the protective influences against suicidal behaviour?

• Remembering a loved one or a person dependent on oneself like a child, deters suicidal behaviour.
• Religion is a protective influence in those who believe strongly in God. If my religion strongly says that committing suicide is a big sin and I will burn in hell if I kill self, it can deter my attempting suicide.
• Having a close friend or a life partner who is supportive are strong protective influences.
• Stable job and steady source of income also are known to deter suicidal act. 

Many family members who have lost loved ones to suicide, ask us what precedes the act of killing oneself? 

What precedes suicide? 

When we interview patients who have failed suicidal attempts, many heart wrenching revelations are made. Most people view, at the time of attempting suicide, that suicide is the only way to end their agony. They feel hopeless about their future and so helpless that they decide that ending their life is the only answer. 

In many cases, there would have been an immediate stress or a cluster of stressful life events which the person is unable to overcome, eg death of a supportive spouse at the time of retirement, heavy financial loss leading to fall in social stature, exam failure, break-up with lover, detection of life threatening illness such as advanced cancer or even revelations of a cheating spouse. 

Susceptible individuals are either impulsive or very depressed at that vulnerable moment. Some are non-resilient and have poor coping strategies. 

Sometimes with all of these, there may be the easy availability of means of harm such firearms, pesticide etc. Sometimes it’s just a sudden impulsive act done under intoxication and in some rare cases even a mental health professional wonders “Why did this person end his life?” 

As a psychiatrist, i tend to analyse events and behaviour leading to suicidal act. I also study at what levels it could have been prevented. This aids in managing other clients with suicidal ideation -to preserve life and prevent death!! 

One of the most important things, is never to hesitate to ask this difficult question to a depressed individual, -“Do you get thoughts of ending your life? “Many of us presume that by asking this question we can induce these thoughts, but it doesn’t happen that way. So if you think someone dear to you is depressed and tells you he is, ask him if he has suicidal thoughts and if he says yes don’t waste any time to seek professional help. You may have just prevented a death! 

Another vital thing is to see if a person who is depressed has attempted in the past. If yes, there are chances he will attempt again. Seek help as soon as possible. 

To see if there are means of harm available and enough opportunity of being alone to execute, is also required. 

In USA firearms are freely available. Suicidal deaths are more due to gunshot injuries as it’s easy to procure guns there. In our agricultural economy it’s easier to get pesticide and hence that is the method chosen. To remove means of harm from vicinity is needed. Make family members aware of this situation. Keep the person safe and monitored. It’s not that the suicidal thoughts last forever. We have to tide over the crisis with support and treat the underlying disorder.

Divorced, unemployed and those staying alone are more likely to kill themselves than those who have a good support system.

A person who takes alcohol and loses control is more likely to attempt in an intoxicated state that when sober as alcohol blurs logical thinking. With all of this knowledge we know what to expect and how to prevent. Never leave an intoxicated suicidal person alone. It’s dangerous! 

Sometimes we expect certain life events to push a person to end his life. Loss is one such state- it could be of a loved person, income, social status, reputation or health. Susceptible impulsive individuals may suddenly take this drastic step. This one is difficult to predict. Our society has lost so many youngsters who had a break-up, to suicide. It’s a pity! Young promising lives lost to suicide just because there was no visible support at that time!

Copycat suicides are seen in a follower cult like phenomenon when after death of a celebrity, people who idealist that person, may attempt similarly. A suicide in the neighbourhood or family can also trigger a similar response. Death of celebrity by suicide may cause some susceptible fans to take similar step. 

Suicide in certain populations also deserve a mention. 

Teenagers attempting suicide may often be impulsive in nature. Sudden unexpected stressors can lead them to attempt without much forethought of consequences. An acid remark from a parent stating she is useless has been a cause in some cases. Things like mobile being confiscated has also been published in some instances. It is important to note here that “was the child abusing mobile to self-medicate depression?” 

Postpartum suicides in women who have just delivered are not uncommon. There are lot of Neuro chemical and hormonal changes post-delivery and postpartum depression is seen in over 10% of the cases! Depression in postpartum period is often missed. Some women have ended their lives along with their newborn. In many cases, patient may stop medication prematurely which may result in depression relapsing with risk of suicide. Family must monitor medication. This is preventable if treated on time. 

Suicide in elderly is often hushed and not spoken about due to the shame associated with it. Old age weakens our coping. Medical illnesses only add to the risk of suicide. Being lonely and widowed compounds it. “I have become a burden on others” precedes these attempts. Be wary when seniors wish themselves dead. They may act to take their own lives. Loneliness is a predecessor. 

Another paramount but often stigmatised and underutilised avenue is seeking help for depression and suicidal ideations.

Asking for help in mental distress, seeking treatment for depression is wise. It takes courage to seek help for mental distress. It is not a sign of weakness. Consulting a psychiatrist can be the best decision to save a life! 

Treating mental illness can prevent suicide. Depression causes a person to have suicidal ideation. The symptoms of depression are death wishes, suicidal thoughts and plans to kill oneself. Treating depression stops these thoughts from coming. 

In my career which spans around 2 decades, it has been my sincere endeavour to reduce stigma against mental illness. Over years I have seen peoples’ mindset change for the better. Youngsters are coming up on their own stating issues troubling their mental health. Celebrities are talking openly about it on social media. Slowly but surely we are moving in the right direction. It is very heart-warming to see. 

My sincere prayer is that “Let no one die of suicide just because the family was in denial of his mental health needs.” 

Prevent suicide and save a life!!