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Suicide; Everything You Wanted To Know

Updated: Aug 23, 2021

Suicide is a serious public health problem. The effects of suicide go beyond the person who acts to take his or her life. It can have a lasting effect on family, friends, and communities. However, suicides are preventable with timely, and often low-cost interventions. And this is this article is so important for you to read.

The WHO statistics around suicide are shocking:

  1. Approximately 1.5% of population globally dies by suicide

  2. In absolute numbers, there are almost a million suicides in the world each year. Rates of suicide have increased by 60% from the 1960s to the present

  3. For every suicide that results in death there are between 10 and 40 attempted suicides.

  4. Males are twice as likely as females to commit suicide.

  5. Suicide is the second leading cause of death among 15-29 year-olds globally

  6. Suicide does not just occur in high-income countries. In fact, over 75% of global suicides occur in low- and middle-income countries.

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Who Is At Risk Of Suicide?

Suicide does not discriminate. It can touch anyone, anywhere, at any time. Suicidal thinking results from an interplay of behavioural, socio economic and psychological factors, which can contribute to the risk of suicide:

  • Having attempted suicide before; single most important factor

  • Depression and other mental health disorders

  • Alcohol or drug use disorder

  • Childhood abuse, neglect or trauma

  • Medical illness, including chronic pain

  • Family history of a mental health disorder

  • Family history of an alcohol or drug use disorder

  • Family history of suicide

  • Family violence, including physical or sexual abuse

  • Access to lethal means including firearms and drugs

  • Being in or having recently gotten out of prison

  • Being exposed to others' suicidal behaviour, such as a family member, peer, or celebrity

  • Stressful life event, such as a job loss, financial problems, loss of a loved one, or a breakup of a relationship

Neurobiology Of Suicide

Low levels of brain-derived neurotrophic factor (BDNF) are both directly associated with suicide and indirectly associated through its role in major depression, post-traumatic stress disorder, schizophrenia and obsessive–compulsive disorder. Post-mortem studies have found reduced levels of BDNF in specific parts of the brain, namely the hippocampus and prefrontal cortex, in those with and without psychiatric conditions.

Serotonin, a brain neurotransmitter, is believed to be low in those who die by suicide. Other evidence includes reduced levels of a breakdown product of serotonin, 5-hydroxyindoleacetic acid, in the cerebral spinal fluid.

Types Of Suicide

There are broadly four different types of suicide, which are egoistic suicide, altruistic suicide, anomic suicide and fatalistic suicide.

Egoistic suicide stems from the absence of social integration. It is committed by individuals who see themselves as being alone or outsiders. These individuals are unable to find their place in society and have problems adjusting to groups. Suicide for them is a solution to free themselves from loneliness.

Altruistic suicide occurs when social group involvement is too high. Individuals are so well integrated into the group that they are willing to sacrifice their own lives for the collective benefit of the group or for the cause that the group believes in. An example is the hijackers that crashed the airplanes into the World Trade Centre in 2001. Suicide bombers around the world are willing to give up their lives in order to make a political or religious statement because they firmly believe in their group’s cause.

Anomic suicide is caused by the lack of social regulation and it occurs during high levels of stress and frustration. Anomic suicide stems from sudden and unexpected changes in life. For example, when individuals suffer extreme financial loss, the disappointment and stress that individuals face may drive them towards committing suicide as a means of escape.

Fatalistic suicide occurs when individuals are kept under tight regulation. These individuals are placed under extreme rules or high expectations are set upon them, which removes a person’s sense of self or individuality. Slavery and persecution are examples of fatalistic suicide where individuals may feel that they are destined by fate to be in pathetic conditions, and choose suicide as the only means of escaping such conditions. Besides these 4 types, ritual suicide is performed in a prescribed way, often as part of a religious or cultural practice. These rituals are largely of historical importance, so I won’t be discussing them.

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Methods Of Suicide

Methods of suicide vary widely with different countries, and that’s largely due to availability of different tools to commit suicide. Common methods of suicide include hanging, pesticide poisoning, firearms, falling from a height, and cutting. Knowledge of the most commonly locally used suicide methods is important, since one can prevent a suicide simply by making any or all of these methods unavailable to the suicidal individual.

Warning Signs

Most people who take their lives exhibit one or more warning signs, which are also called suicidal gestures. They can be the following:

Warning Sign: Talk

The person talks about:

  • Killing themselves

  • Feeling hopeless

  • Having no reason to live

  • Being a burden on others

  • Feeling trapped

  • Unbearable pain

Warning Sign: Behaviour

Behaviours that may signal risk, especially if related to a painful event, loss or change:

  • Increased use of alcohol or drugs

  • Sleeping too much or too little

  • Looking for a way to end their lives, such as searching online for methods

  • Withdrawing from activities

  • Isolating from family and friends

  • Visiting or calling people to say goodbye

  • Giving away prized possessions

Warning Sign: Mood

People who are contemplating suicide often display one or more of the following moods:

  • Depression

  • Anxiety

  • Loss of interest

  • Irritability

  • Humiliation/Shame

  • Agitation/Anger

  • Relief/Sudden Improvement

Suicide Prevention

About 60% of people with suicidal thoughts do not seek help. If you or someone you know has the warning signs for suicide, get help right away. These five steps are critical to prevent a suicide:

  • Ask yourself/the person if they're thinking about killing themselves

  • Keep yourself/them safe. Stay away or keep them away from things that they can use to kill themselves

  • Be there with them and for them. Listen carefully and find out what they are thinking and feeling. If you’re contemplating suicide, reach out to your near and dear ones

  • Help them connect to resources that can help them. There are various 24/7 helpline numbers available at the touch of a button.

  • Stay connected. Staying in touch after a crisis can make a difference.

Let's explain how professional help works. The first step is to consult a Psychiatrist. Remember that treatment of a highly suicidal person will be inpatient, and not outpatient. Your psychiatrist will then advise you single or combinations of 3 main options to tackle suicidal thoughts:

1. Medicines: Traditional medicines include antidepressants like SSRIs, SNRIs, TCAs, newer antidepressants, and mood stabilisers like Lithium. Recently, Ketamine infusion has shown great promise when it comes to reducing suicidal thoughts.

2. Psychotherapy: Cognitive Behaviour Therapy will significantly reduce suicidal thinking. Psychotherapy is one of the most important parts of an intensive inpatient suicide management program.

3. Noninvasive brain stimulation: Includes Transcranial Direct Current Stimulation (tDCS), Cranial Electrotherapy Stimulation (CES), Audio Visual Entrainment (AVE), and Low Intensity Transcranial Pulsed Electromagnetic Field Therapy (Li tPEMF). Electroconvulsive Therapy (ECT) is reserved for severe and pervasive suicidality.

All these treatments result in correction of the dysfunctional circuitry in the brain, i.e., increase BDNF and Serotonin levels. The more options you exercise simultaneously, the better the results.

Now here is a video on the same topic:

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