Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes
As the second leading cause of death (after accidents) for people aged 10 to 34, suicide is a serious public health problem. Guyana’s suicide rate for 2019 was 40.30, a 2.03% increase from 2018. Worldwide, men are more than three times more likely than women to take their own lives. Firearms are the most common method of suicide (used in about half of all suicides).
However, in Guyana, the combined data on “suicide” and “suicide attempt” shows that females have a higher rate than males, even though fewer females die of suicide than males. Suicidal acts of women are often spontaneous, and they are more likely than men to take a less potent substance (such as kerosene, OTC drugs, and sleeping tablets) as well as a lower dosage of toxins. The rates among Indo-Guyanese and Afro-Guyanese were almost similar (Indo-Guyanese had a rate of 36.33 per 100,000 compared with 36.2 per 100,000 for Afro-Guyanese). The data also shows that for Indo-Guyanese, suicide attempts were 6.7 times more than suicides, while for Afro-Guyanese, the attempted suicide rate was 7.9 times more than suicides.
However, suicide is preventable. Knowing the risk factors and recognising the warning signs for suicide can help prevent suicide.
RISK FACTORS, WARNING SIGNS, AND PROTECTIVE FACTORS
Suicide is linked to mental disorders, particularly depression and alcohol use disorders, and the strongest risk factor for suicide is a previous suicide attempt. The Suicide Prevention Resource Center defines risk and protective factors and warning signs as follows:
* Risk factors are characteristics that make it more likely that an individual would consider, attempt, or die by suicide.
* Warning signs indicate an immediate risk of suicide.
* Protective factors are characteristics that make it less likely that individuals would consider, attempt, or die by suicide.
RISK FACTORS FOR SUICIDE
Certain events and circumstances may increase risk (not in a particular order, except the first one).
* Previous suicide attempt(s)
* A history of suicide in the family
* Substance misuse
* Mood disorders (depression, bipolar disorder)
* Access to lethal means (e.g., keeping firearms in the home)
* Losses and other events (for example, the breakup of a relationship or a death, academic failures, legal difficulties, financial difficulties, bullying)
* History of trauma or abuse
* Chronic physical illness, including chronic pain
* Exposure to the suicidal behaviours of others
In some cases, a recent stressor or sudden catastrophic event or failure can leave people feeling desperate, unable to see a way out; and that becomes a “tipping point” toward suicide.
A recent CDC report highlights the complexity of suicide. While a mental health condition may be a contributing factor for many people, the report notes, “many factors contribute to suicide, among those with and without known mental health conditions.” A relationship problem was the top factor contributing to suicide. This was followed by a crisis in the past or upcoming two weeks, and then by problematic substance use.
CDC reports that about half, 54 percent, of people who died by suicide did not have a known mental health condition. However, many of them may have been dealing with mental health challenges that had not been diagnosed or known to those around them.
WARNING SIGNS OF SUICIDE
* Often talking or writing about death, dying, or suicide
* Making comments about being hopeless, helpless, or worthless
* Expressions of having no reason for living; no sense of purpose in life; saying things like, “It would be better if I wasn’t here”, or “I want out.”
* Increased alcohol and/or drug misuse
* Withdrawal from friends, family, and community
* Engaging in reckless behaviours or more risky activities seemingly without thinking
* Dramatic mood changes
* Talking about feeling trapped, or being a burden to others.
PROTECTIVE FACTORS
* Contacts with providers (e.g., the follow-up phone call from a health care professional)
* Effective mental health care; easy access to a variety of clinical interventions
* Strong connections to individuals, family, community, and social institutions
* Problem-solving and conflict-resolution skills.
As with mental illness, one of the biggest barriers to preventing suicide is stigma, which prevents many people from seeking help.
The CDC report recommends a comprehensive public health approach to suicide prevention, and identifies several strategies that states and communities can undertake, including such measures as teaching coping and problem-solving skills to help people manage challenges, expanding options for temporary assistance for those in need, and connecting people at-risk to effective and coordinated mental and physical health care.
WHAT YOU CAN DO
If someone indicates they are considering suicide, listen, and take their concerns seriously. Don’t be afraid to ask questions about their plans. Let them know you care, and they are not alone. Encourage them to seek help immediately from a knowledgeable professional. Don’t leave them alone.
Five tips if concerned about a friend or loved one:
* Ask, “Are you thinking of killing yourself?” (While people may be hesitant to ask, research shows this is helpful.)
* Keep them safe. Reduce access to lethal items or places.
* Be there with them. Listen carefully, and acknowledge their feelings.
* Help them connect. Call or text the 988 Suicide and Crisis Lifeline.
* Stay connected. Follow up, and stay in touch after a crisis.
Feeling suicidal usually means that someone is hopeless. They may feel like no one can help. They may be out of better options for escaping feelings or situations that are unbearable and painful. But they can feel better again someday, and a trusted person will get them the help they need.
If someone is going to hurt themselves right now or has already hurt themselves, call 911 immediately, or take them straight to the emergency room.
