Anjana Shrestha, University of Wollongong, Australia
As the world is changing its face every day, a suicidal problem in society is increasing day by day. When we hear the news of suicide lots of questions arise in a human mind. What makes the person take their own life?? People begin to probe in the person’s personal life to figure out the actual cause of committing suicide. No matter whether the problem is big or small, the impact of death from suicide becomes more prominent and devasted among the relatives, families, and the whole community.
Suicide is when people direct violence at themselves with the intent to end their lives, and they die because of their actions. However, the suicide attempt is when people harm themselves with the intent to end their lives, but they do not die because of their actions (National Institute of Mental Health, 2020). The most common methods of suicide are hanging, pesticide self-poisoning, firearms, jumping off the cliff (WHO, 2016). According to the Centres for Disease Control and Prevention (CDC, 2016), men are more likely to die by suicide than women, but women are more likely to attempt suicide. Men are more likely to use more lethal methods, such as firearms or suffocation and women are more likely than men to attempt suicide by poisoning.
According to WHO (2016), one person dies every 40 seconds from suicide. Around 800,000 people die due to suicide every year. Thus, WHO recognizes suicide as a public health priority. Suicide is a growing problem among developed and underdeveloped countries. According to WHO, 79% of the world’s suicides occurred in underdeveloped countries, developed countries had the highest rate, at 11.5 per 100,000. Nearly three times as many men as women die by suicide in developed countries, in contrast to underdeveloped countries. Despite, the mortality rate is dropping due to advanced health system, suicide is currently one of the 10 leading causes of death overall and within each age group 10–64years (M. Heron.2013). However, suicide was the second leading cause of death among young people aged 15-29 years (WHO, 2016). As per report of WHO (2015), Nepal is ranked 126th by suicide rate globally and Nepal has an estimated 6,840 suicides annually or 8.2 suicides per 100,000 people.
Causes of Suicide
While studying about the causes, Suicide is considered the outcome of a multidimensional and complex phenomenon, which is a result of the interaction between several factors. As a human being we feel low, sad and depressed at any instance of our life and it’s so obvious. Not all the person with the tough problem commit suicide. The one person with same tough situation may commit suicide and another person cope with the same tough situation.
A different study shows that people attempt suicide to escape with problems, feelings of rejection, hurt, or loss, some might feel angry, ashamed, or guilty about something, some worried about disappointing friends or family members and some may feel unwanted, unloved, victimized, or like they are a burden to others (Lyness D, 2014).
However, the study shows major depression plays an important role among the psychiatric diagnoses associated with suicide (Chachamovich, E., Stefanello, S., Botega, N., & Turecki, G.,2009). A person with depression has so negativity in the mind that they only see the darker side of life with no hope. And the suicidal intention becomes so intense that they think if they die everyone will be happy. Whereas some study shows hopelessness has been recognized as a risk factor for various types of suicidal behavior, including completed suicide, suicide attempts, and suicide ideation (Brown GK, Beck AT, Steer RA, Grisham JR, 2000).
Besides that, Epidemiologic factors: Widowed or divorced, Living alone, Presence of stressful life events, Access to firearms. Psychiatric disorders: Substance abuse (particularly alcohol), Schizophrenia, Panic disorder, Borderline personality disorder. Additionally, in adolescents: impulsive, aggressive and antisocial behavior, presence of family violence and disruption stress, contagion, bullying, and peer victimization may be a risk factors (Pandey, GN 2013). History of previous suicide attempts. A family history of suicide attempts (American Family Physician, 1999) may put a risk of suicide.
So, a question might arise in mind do all depressed people commit suicide?? As depression and suicide has become so interlinked. Depression may be the cause of suicide but may not be the solo cause of suicide as discussed earlier. A person is said to be depressed when feelings of intense sadness, negativity and low mood has become so intense that it is affecting your relationships, your work, or you are neglecting activities you once found to be simple or enjoyable lasting for a long period of time i.e. two weeks or more (MensLine Australia n.d., 2018).
Study shows series of incidents may trigger depression and it is very difficult to narrow the possible cause of depression and sometimes there is no obvious reason why a person may be depressed (ReachOut Australia 2019b). Some of the causes may be irregular mood regulation in the brain, chemical imbalances (endogenous), Genetic inheritability, exposure to stressful life events (such as trauma or loss),effects of medication, other health problems (such as traumatic brain injury), other mental health conditions (such as bipolar), environmental stressors (Harvard Medical School 2019; Jesulola et al. 2018; SANE Australia n.d., 2018).
Signs of suicidal Idealization
It is believed that suicide attempts happen impulsively, in a moment of feeling desperately upset but sometimes a depressed person may plan a suicide in advance (Lyness, D 2014). The signs may be:
- Talking about death or violence
- Talking about dying or wanting to die
- Accessing weapons or things that could be used for suicide, such as large amounts of certain over-the-counter or prescription medications
- Rapid changes in mood
- Talking about feeling trapped, hopeless, worthless, or as if they’re burdening others
- Impulsive or risky behavior, including substance misuse, reckless driving, or practicing extreme sports unsafely
- Withdrawal from friends, family, or social activities
- Sleeping more or less than usual
- Extreme anxiety or agitation
- Saying goodbye to others as if it were the last time
- Seeming to be unable to experience pleasurable emotions from normally pleasurable life events such as eating, exercise, social interaction, or sex
- Severe remorse and self-criticism
- Talking about suicide or dying, expressing regret about being alive or ever having been born
- A significant number of people with suicidal ideation keep their thoughts and feelings a secret and show no signs that anything is wrong.
- A calm or quiet mood, especially after agitated or emotional behavior (Legg TJ, 2019).
Suicidal ideation can occur when a person feels they are no longer able to cope with an overwhelming situation. As per (Lyness, D 2014), this could stem from financial problems, death of a loved one, a broken relationship, or a devastating or debilitating illness.
The most common situations or life events that might cause suicidal thoughts are grief, sexual abuse, financial problems, remorse, rejection, a relationship breakup, and unemployment.
The following risk factors may have an impact on suicidal ideation ((Lyness, D 2014):
Genetic factors may increase the risk of suicidal ideation like family history of suicide or suicidal thoughts.
- A family history of mental health issues, substance abuse, violence.
- A feeling of hopelessness
- A feeling of seclusion or loneliness
- Being gay with no family or home support
- Being in trouble with the law
- Being under the influence of alcohol or drugs
- For children, having disciplinary, social or school problems
- Psychiatric disorder or mental illness, previous suicidal attempt
- Being prone to reckless or impulsive behavior
- Sleep deprivation
Knowing, identifying, or being associated with someone who has committed suicide. So, in my opinion news of suicide should be published in a descent manner. In addition, in Nepal committing suicide live streaming in social media is being practised in recent days. This act should be discouraged which may provoke many suicides.
As per (Jason, M 2020) shame and humiliation can cause suicide. In this modern world of social media public shaming on mass scale may provoke the suicide as every one love reputation and good name. For instance, in South Korea, a former president killed himself after a corruption investigation in 2009. In 2017, a Kentucky state legislator killed himself after allegations of sexual misconduct. Despite that Gossip and scandals in small towns and villages can lead to suicide. As we are aware of the recent news in Nepal Girl committing suicide after her ex-boyfriend exposed their relationship who was engaged to another guy.
Every country in the world take Mental Health as serious issue and has hotline number to seek help. So, if a person feels low, that person can contact the hotline number to discuss issues. For example in Australia the number is 13 11 14, for Nepal Mental Health Helpline Nepal: 1660 013 3666 which is available around the clock.
As suicide is related to number of mental health problems, including depression, can be successfully treated or managed with medications and talking therapies, such as cognitive behavioural therapy (CBT) or counselling.
The most effective treatment lies inside a person self-determination, self-enthusiasm to live and a great family support. Family and friends are the first person to notice speech or behaviour that they could be at risk of committing suicide. Let us think does a mother sacrifice, love, pain to up bring a life outweighs a suicide. Does a father’s dream outweigh a suicide? You will be replaced in a job, you will be replaced everywhere but you will leave a deep wound inside your family which they have to live with rest of life in a despair and guilt thinking “ I wish I could save you’’. When you feel low get the family support talking to them about how you feel and asking them to meet your health provider and possibly attend sessions with you.
As the world is advancing to new technology, everyone is busy in their own life and enjoying in virtual world of social media. There is none to talk with or share the problem if you want to. People suspect whether they might be judged if they share the problem. So, lets listen to each other, avoid isolation and stay connected to the outside world as much as possible. Let be non-judgemental and save lives. Let’s shower the world with love and care. Rather expressing condolences and showering love after death, lets save life with proper interventions when the person is alive. So as a family and friend let us take a time to save life by keeping them safe by staying around and removing means of committing suicide, such as knives, where possible. Listening to them and being there for them. Encouraging them to call a helpline or contacting someone the individual might turn to for support, for example, a friend, family member, or spiritual mentor. Keeping some emergency phone numbers at hand, for example, a trusted friend, a helpline, and the person’s doctor.
Nowadays, everyone uses social media, if we see any person posting the post of suicidal intention/low mood. Let us take a time to ask and help them to get out of the situation. It is a human nature to gossip and being interested in scandal, now it is time to change our mindset. Let us support each other and spread positivity.
- Avoid alcohol and illegal drugs
- Regular exercise, meditation, yoga, eating a well-balanced, healthful diet
- Getting at least 7-8 hours continuous sleep in every 24-hour period
- Seeking out things that give you pleasure, such as being with friends or family you like, and focusing on the good things you have
- Attending a self-help or support group, where you can discuss issues with people who understand, get help from others, and help people with similar problems to get through their difficulties.
LET’S TALK AND LISTEN…SAVE A LIFE.. PLEASE SAVE A LIFE
The Writer is a registered nurse in Nepal and Australia. Former instructor in Nepal and currently working as a manager in Residential Aged Care Facility in Australia