Dr Tariq Jagnarine

MD, MMed Family Medicine, Endocrinology/Diabetes, CCFP
Every 40 seconds, a person takes his or her own life. In a year, this amounts to 800,000 human beings. Moreover, for each suicide committed, 135 people suffer intense grief, or are otherwise affected. In addition, for every suicide, there are 25 people making a suicide attempt, and many more have serious thoughts about suicide.
Globally, suicide accounts for 1.4% of all deaths, making it the 15th leading cause of death. These are just statistics, and behind every number there is a personality, memories, and a life. In order to help out, organisations throughout the world are calling for suicide prevention methods and awareness-rising activism.
World Suicide Prevention Day (WSPD), observed on September 10, is a day that focuses specifically on raising awareness on ways to prevent suicide. It is a day of commemoration, but also of awareness. WSPD aims to help people in need of mental support.
Suicide occurs throughout the world, affecting individuals of all nations, cultures, religions, genders and classes. Guyana ranks 3rd in the world for suicide rates, with an incidence rate of 29.2, with a higher incidence in males than females.
A recent research done in Guyana, at the Georgetown Public Hospital Corporation, indicates the following risk groups, for whom a tailored approach to their mental health is necessary for the suicide risk to be reduced.

These groups include:
* Indo-Guyanese males
* Young people of reproductive age who are from broken families
* People with depression (treated or not)
* Specific occupational groups, such as farmers, agricultural workers, and medical workers
* People who are especially vulnerable due to social and economic circumstances
* People who misuse drugs or alcohol
* Children and the elderly
* Survivors of abuse or violence, including sexual abuse
* People living with long-term physical illnesses

Suicide is the act of taking one’s own life, while suicidal behaviour refers to talking about, or taking actions related to, ending one’s own life. All suicidal thoughts and behaviours should be considered a psychiatric emergency, and each requires immediate assistance from a healthcare provider.

It is difficult to understand or see what a person is feeling on the inside. However, some outward warning signs that a person may be contemplating suicide include:
* Talking about feeling hopeless, trapped, or alone
* Saying that there is no reason to go on living
* Making a will, or giving away personal possessions, especially if once cherished or valuable
* Searching for a means of doing personal harm, such as buying a gun
* Sleeping too much or too little
* Eating too little or eating too much, resulting in significant weight loss or gain
* Engaging in reckless behaviours, including excessive alcohol or drug consumption
* Avoiding social interactions with others
* Expressing rage or intentions to seek revenge
* Showing signs of extreme anxiousness or agitation
* Having dramatic mood swings
* Talking about suicide as a way out.
It can feel scary, but taking action and getting someone the assistance they need may help prevent a suicide attempt or death.

There is usually no single reason why someone decides to take their own life. Several factors can increase the risk of suicide, such as having a mental health disorder, for instance. Nevertheless, more than half of all people who die by suicide did not have a known mental illness at the time of their death.

Aside from mental health conditions, other factors that increase the risk of suicide include:
* Incarceration
* Poor job security, or low levels of job satisfaction
* History of being abused, or witnessing continuous abuse
* Being diagnosed with a serious medical condition, such as cancer or HIV
* Being socially isolated or a victim of bullying or harassment
* Substance-use disorder
* Childhood abuse or trauma
* Family history of suicide
* Previous suicide attempts
* Having a chronic disease
* Social loss, such as the loss of a significant relationship
* Loss of a job
* Access to lethal means, including firearms and drugs
* Being exposed to suicide
* Difficulty seeking help or support
* Lack of access to mental health or substance-use treatment
* Following belief systems that accept suicide as a solution to personal problems.

A healthcare provider may be able to determine whether someone is at high risk for suicide based on their symptoms, personal history and family history, when symptoms started, and how often the person experiences them. In addition, the past or current medical problems and underlying mental illness that may run in the family is reviewed.

An assessment of the following is done:
* Mental health. In many cases, thoughts of suicide are caused by an underlying mental health disorder, such as depression, schizophrenia, or bipolar disorder. If a mental health issue is suspected, the person would likely be referred to a mental health professional.
* Substance use. Misusing alcohol or drugs often contributes to suicidal thoughts and behaviours. If substance use is an underlying problem, an alcohol or drug addiction rehabilitation programme may be the first step.
* Medications. The use of certain prescription drugs, including antidepressants, may also increase the risk of suicide.

Treatment will depend on the underlying cause of someone’s suicidal thoughts and behaviours. In many cases, though, treatment consists of psychotherapy (talk therapy) and medication.
Psychotherapy is one possible treatment method for lowering the risk of attempting suicide. Cognitive behavioural therapy (CBT) is a form of talk therapy that is often used for people who are having thoughts of suicide. Its purpose is to teach persons how to work through stressful life events and emotions that may be contributing to suicidal thoughts and behaviours. CBT can also help to replace negative beliefs with positive ones, and regain a sense of satisfaction and control in one’s life.

When psychotherapy seems inadequate to successfully lower suicide risk, medication may be prescribed to ease symptoms such as depression and anxiety. Treating these symptoms can help reduce or eliminate suicidal thoughts, along with continued CBT and counselling.

In addition to psychotherapy and medication, suicide risk can sometimes be reduced by simply adopting certain healthy habits, such as:
* Avoiding alcohol and drugs. Staying away from alcohol and drugs is critical, as these substances can lower inhibitions and may increase the risk for suicide.
* Exercising regularly. Exercising at least three times per week, especially outdoors and in moderate sunlight, can also help. Physical activity stimulates the production of certain brain chemicals that make persons feel happier and more relaxed.
* Sleeping well. It is also important to get enough quality sleep. Poor sleep can make many mental health symptoms much worse.
* Talk to someone
Persons should avoid trying to manage suicidal feelings entirely on their own. Getting professional help and support from loved ones can make it easier to overcome any challenges that are causing these feelings. Many organisations and support groups can help individuals to cope with suicidal thoughts. Recognising that suicide is not the best way to deal with stressful life events, the first step is to talk to someone.
* Take medications as directed
Avoid changing dosages, or stop taking medications prescribed for mental illnesses, unless encouraged by a healthcare provider. Suicidal feelings may recur, and persons may experience withdrawal symptoms by suddenly stop taking medications.
* Never skip an appointment
It is important to keep all therapy sessions and other appointments. Sticking with a treatment plan is the best way to deal with suicidal thoughts and behaviours.
* Eliminate access to lethal methods of suicide
Get rid of any firearms, knives, or serious medications. Especially if persons are worried, they may act on suicidal thoughts, or retry previous attempts that were made using these methods.
Being open and honest about suicide helps people to realise that this leading cause of death is something that affects so many persons. A suicide is like a pebble hitting a pond. The waves ripple outward. When someone dies by suicide, their family, loved ones, and communities are often forever changed. Keep talking about suicide, sharing and caring for others, saving lives in simple ways. ‘WORK TOGETHER TO PREVENT SUICIDE’