How to Recognize Symptoms of Suicidal behavior

Overview

Suicide is succumbing to one’s own life. According to the World Health Organization, annually about 8 lakh people fall prey to this and many more make an attempt to suicide. Since suicide is a delicate issue, it could be likely that the figures are an under estimation of the actual prevalence due to societal stigma and taboo. Suicidal behavior indicates talking about or behaving in a manner to take one’s own life. It includes suicide thoughts, suicide attempts and completion of suicide.

It is said to be a global phenomenon around the globe and is seen in a similar trend in high-income as well as low and middle-income countries. It is more common in men as compared to women, however women are twice as likely to attempt suicide. Each suicide is tragic and has profound impacts on families, society and nation.

At Risk Population

In a lot of cases, suicide is preventable. Research shows that the best way to prevent suicide is to know what the major risk factors are.

The association between suicide and mental disorders is known in many high income countries and on many occasions it goes undiagnosed and unaddressed. Depression, bipolar disorders, schizophrenia, anxiety disorders, post-traumatic stress disorder and personality disorders are some of the common mental disorders that can snowball into a suicide. Some of the other occasions where suicide occurs are in moments of impulsiveness, crisis due to inability to deal with stress.

Apart from this,

• Having major conflicts
• Violence
• Physical, emotional or sexual abuse
• People who are unmarried, unskilled or unemployed with very low self esteem
• Severe loss and sense of isolation are strongly linked with suicidal act
• Poor job security or poor job satisfaction
• Serious medical condition like cancer, HIV
• Victim to bullying and harassment
• Childhood abuse or trauma
• Past family history of suicide
• People experiencing chronic pain or terminal illness
• Social loss – loss of significant relationship
• Difficulty in seeking support
• Inaccessibility to mental health treatment are other enlisted reasons for attempt to suicide

Suicide rates are more common in the so-called ‘vulnerable’ groups who undergo discrimination like refugees, migrants, lesbians, gays, bisexuals, transgenders, intersex (LGBTI) persons; prisoners, along with past history of previous suicide attempts

Warning Signs

One is never able to gauge what goes on in the minds and lives of their other fellow beings and it is difficult to identify or pick suicidal thoughts. Generally, suicide does not have one single attributable cause. These warning signs are sometimes directly observable, often as immediate and acute alerts which may point to presence of suicidal crisis. These warnings signs should be taken extremely seriously. They are exhibited through verbal, behavioral and environmental signals. Some of the warning signs that a person may have suicide on his or her mind are :

• Expressing hopelessness and not having a will to live
• Writing down a will or distributing assets
• Looking out for a way to cause personal harm, for instance, buying a gun
• Insomnia or hypersomnia
• Bingeing on food or starving – causing weight gain or weight loss
• Substance abuse like alcohol and drug
• Talking and feeling like a burden to others and worthlessness
• Cutting off from social interactions and conversations
• Expressing anger or vengeance
• Extreme anxiety
• Major trouble at school or work
• Mood swings or emotional instability
• Social isolation from friends and family
• Impulsive and aggressive behavior
• Talking about suicide as a means to solve ‘problems’

Apart from these, on physical examination on the following areas should be looked into:

• Body injuries caused by risk taking behaviors
• Intentional cutting or scarring (commonly of wrists)

Pay heed to these

• Excessive sadness : Deep rooted sadness and mood swings can be a warning sign and a major risk for suicide
• Sudden calmness : Unexpected quietness after an episode of depression can be a cue that the person is contemplating on ending his or her life
• Withdrawal : Social isolation and aloofness, avoiding group activities, are some of the symptoms of depression. This could mean loss of interest or pleasure in activities the person previously enjoyed
• Changes in personality or appearance : A person who has suicide on his or her mind may show a change in attitude or behavior in daily routine. Also, the person may turn indifferent to their physical appearance
• Dangerous or self-harmful behavior : Potentially dangerous behavior such as careless driving, engaging in random unsafe sex, increased substance abuse indirectly shows that the person no longer values his or her life
• Recent trauma and life crisis : A major life setback can potentially cause a suicide attempt. These setbacks include death of a dear one, divorce, break-up of a hopeful relationship, diagnosis of a major terminal illness, loss of a job, or financial crunch
• Making arrangements : A person considering to end one’s life would start to put his or her personal assets and belongings in place. This could imply meeting friends and family members, disowning personal possessions, making a will or writing a note
• Threatening suicide : Every threat of suicide should be taken seriously.

Some of the less recognizable warning signs

• Accessing lethal measures : Gathering and arranging lethal means could be a missed warning sign. Someone may start acquiring and stocking pills or poison. They are easy to hide and often go unnoticed. It is important to be aware of all lethal means a person could have access to
• Emotional distancing : People preparing for suicide may become detached from life in general. They start to distance themselves from other people, society, work place and withdraw from routine activities
• Physical pain: Physical pain is often missed as a sign of depression and also suicide If an individual has unexplainable pain, one should be worried

Assessment of high risk groups

A trained health care professional can determine if someone is at a risk of committing suicide based on their symptoms, past history and family background. They would need information on when the symptoms started, frequency of these symptoms along with any past or present medical conditions. This can help them to draw possible explanations for danger signs and what more would be required to combat the problem

Suicide causes in teenagers and older adults :

Suicide Causes in teens

Teenage suicide is a grave problem. The age is such that it is emotionally challenging and stressful for the teenagers. The teens struggle with self-worth and self-esteem issues, of the many other problems. In some cases, it may lead to suicide. Some of the other risk factors are:

• Childhood abuse (physical / sexual)
• Recent trauma
• Absence of support network
• Hostile social environment
• Exposure to other teen suicides

Suicide Causes in elders

Most suicide rates are seen among people aged 65 years and older. The major reason is depression, which often goes unnoticed and untreated. Other risk factors include:

• Death of a loved one
• Isolation and loneliness
• Physical illness, disability or pain
• Major life changes – retirement or loss of independence
• Abandonment from family, especially children

Stages of Suicide

1. Ideation : This is when the person is contemplating and forming ideas or concepts of suicide
2. Threatening : In this stage, the individual could give out some verbal and non-verbal cues of attempt to suicide or exhibit suicidal behavior
3. Attempting : This is the stage where the person carries out the act of ending one’s life using any of the lethal means

Generally, in the first two stages of ideation and threatening, some kind of reversible interventions are possible if the suicidal behavior is identified and picked up.

It is said that approximate 20% of all worldwide suicides are due to pesticide ingestion, most of which happen in rural farms in low and middle income countries. Other common ways are hanging, firearms, drug overdose, fatal injuries, suffocation and drowning.

This information of most widely used suicide methods is important to chart out prevention methods to reduce access to suicide methods

What can be done

Comprehensive multisectoral strategies are essential to attain reduction in suicide rates. Community-level approaches should be used to make it more effective.

• Control access to means
• Identify the risk factors
• Work with media to increase reporting on suicide
• Aiding the youth to acquire methods to cope with life’s challenges
• Timely recognition and management of vulnerable population, along with short term and long term follow- up

Protective factors

These are attributes that makes a person unlikely to engage in suicidal behavior. They foster positivity and ensure togetherness during difficult times, reducing the chances of suicidal attempts. They include :

• Access to mental health care
• Restricted access to lethal means of suicide
• Inculcating strong bonds with family and friends
• Engage in follow up care and increasing awareness
• Skills in problem solving, resolution of conflicts, dealing with pressure and anxiety
• Support from society
• Lifestyle approach like engaging in exercise, meditation and leisure activities

In some occasions, society members may assume the role of ‘gatekeeper’ in identifying people who are at risk of suicidal behavior. This can be achieved by fostering social connectedness and improving skills and mindset required for coping with challenges.

Conclusion

Suicide is a permanent solution to a temporary problem. It is a very tragic incident to which a lot of people given to. It is extremely important to look out for any kind of cues or signs of suicidal behavior in the vulnerable and oppressed group of people in the community. It can very well be prevented if identified in the nick of the time. Many preventive strategies are available to combat suicidal behavior once recognized.

References

1. https://www.mdpi.com/1660-4601/15/9/2028
2. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00234-2/fulltext
3. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174675
4. https://journals.sagepub.com/doi/10.1177/070674371405900303