World Suicide Prevention Day: Let's pay attention to the ones left behind
World Health Organization (WHO) states that approximately 8,00,000 people die due to suicide every year, with one death by suicide occurring every 40 seconds. In India, according to the National Crime Record Bureau (NCRB) data, over 1,00,000 people die by suicide. The data published by NCRB shows that in 2017 the suicide rate was 9.9 (out of one lakh) whereas, in 2018, it increased to 10.20. Experts in India says that the reason behind the high rate of suicide is because India doesn't have a structured national level suicide prevention program.
In 2018, 1,34,516 suicides were reported in India; out of these cases, 46,912 belonged to the age group of 18-29 years. Young people are considered as assets in any country, especially in developing countries like India as they contribute to all sectors. The value of a country is assessed not by the wealth or the assets it possesses, but by its people, especially the younger lot. A wealthy nation can ruin itself if their newer generations are unable to keep pace. A nation can grow fast if the youth of the country is enthusiastic. But if that young population are at risk of suicide, it will affect the growth of the nation. The NCRB data shows that it is on the rise, instead of declining or coming to an end. Suicide is not only a problem in India, but it's a global crisis that needs immediate intervention at every level.
The death of a young child is the worst nightmare for the parents, near relatives, and close friends. What makes it even worse is when the death is by suicide. The question is who is the most affected, and how can it be prevented?
If anyone is most affected by this crisis, they are the parents. After the suicide of their child, the following questions come up: Why did this happen to us? What went wrong in our upbringing? We gave everything to our child; how could this happen? And the list goes on and on.
These questions can lead to self-blame or guilt. Suicide can leave the loved ones battling with a whole range of other difficult feelings as well like sadness, frustration, helplessness, and anger. Parents sometimes also have to face shame from their neighbours due to the stigma around suicide.
Many studies have shown that the distressed family goes through severe ordeals post a suicide of their young ward.
A study by Pitman A.L. et al., 2016, UK, found that adults bereaved by suicide had a higher probability of attempting suicide than those bereaved by sudden natural causes. It also found that the effect of suicide bereavement was similar whether bereaved were blood-related to the deceased or not. With the findings from the study, we can say that the death by suicide in a family not only affects the blood relatives or the family but also to them who are not related by blood, i.e. friends, neighbour and the colleagues of the deceased one compared to the sudden natural death.
N. Walsh (2012) published an article in MedPage Today, which says that parents who lose their child to suicide are vulnerable to depression, anxiety and alcohol abuse. The chances of them suffering from any mental illness are as high as 60 per cent if compared to before death and after the death by suicide of their child. Not only mental health but the parents' physical health is also affected by children's suicide. The article says that parents of children who kill themselves had significantly higher rates of suffering from heart disease, chronic lungs disease, blood pressure, diabetes, or any physical illness compared to non-bereaved or parents who lost their child in a road accident.
Another study by PL Omerov, 2014, Sweden, Stockholm, found that bereavement by suicide was associated with a high prevalence of psychological morbidity two to five years after the loss. It also found that the bereaved parents had more than the two-fold increased risk of being depressed and more than the three-fold higher risk of anxiety in comparison with the non-bereaved parents. The risk was found among both those with pre-morbidity and those without.
A study by W Feigelman et al., 2008, USA, investigated the short-term and long-term impact of an adolescent friend's suicide on an adolescent's depression and suicidality. The results of the study suggest that a friend's suicide is associated with heightened suicide thoughts and attempts and also with greater depression during the first year after the loss of a friend to suicide.
Dr Gail Saltz, a psychiatrist at the NY Presbyterian Hospital (USA), in one of his interviews, has said, "The first year after losing a younger child, a parent is at an increased risk for suicide and everything from major depression to complicated grief."
So, looking at the above research articles, we can clearly say that direct exposure to suicide is a risk factor for the family members, specifically for parents and friends. Having a child is a protective factor for the parents since a child in the family brings happiness to them. If parents lose their child to suicide, it's a massive blow to their overall system of security and happiness. After losing their child to suicide, they are not only at risk for physical illness, mental illness, but also at risk for suicide themselves.
For teenagers, a friend's suicide can cause an existential crisis. A friend's suicide can also evoke anger and challenge in them. They face the same amount of guilt and anger as family members do. They blame themselves for unable to save their friend, which leads them to suffer from depression and have suicidal ideation. In other words, the studies suggest that one suicide can lead to another one, with-in family and friends if timely intervention and proper care or help is not provided to such friends and families.
People often ask, how can we identify if someone is suicidal or not? What are the warning signs? There is not really any typical pattern of behaviour for someone who is suicidal, but there are common warning signs which we can keep an eye on like, excessive sadness, change in their sleep cycle or pattern, talking about dying or wanting to die or harming themselves, talking about feeling empty, hopeless, or having no way out of problems they are facing, expressing strong feelings of guilt and shame, they may speak of having no reason to live any more, social withdrawal and isolation can be seen in them, sometimes people do give away their stuff and wrap up loose ends, and most important one, saying goodbye to their friends and family.
As we know the signs and symptoms, what can we do to prevent it? Is there a way? Can suicide be prevented? Yes, it can be prevented if appropriate measures are taken. There is a myth that we can do nothing to prevent suicide, but it is preventable, and you can be the one to help prevent suicide near you with timely intervention.
If you come to know that someone is suicidal, you can start by acknowledging their feelings, emotions and not judging them at first. Everyone has their way of expressing their feelings and emotions. Acknowledging their emotions and feelings can make them feel comfortable. Being a good listener can be another effective way of helping. People need listening ears, someone who can listen to them and acknowledge them. You can also motivate them to talk and make them feel comfortable so that they can talk. Assurance of keeping things confidential will help them open up more, this will also help you know them more, and it will make them feel relieved and calm.
Asking them about their suicidal ideation doesn't trigger or inculcate the idea of suicide in them instead of asking them about it can help identify the person at risk. As everyone is not a professional in handling such a situation, you can seek help from professionals and also motivate that person to seek help. At first, if that person is not comfortable visiting the professionals, you can suggest that person to seek telephonic counselling or help for the same. Professionals from the other side of the phone will keep the conversation confidential and provide appropriate help to them.
If someone is suicidal and it seems that they are at imminent danger, do not leave them alone. Take steps to get away from the means that can be used to hurt themselves, i.e. medicines, poison, sharp objects, and cleaning agents. Seek medical help immediately and help them to go through the process, be supportive and tell them that they are not alone.
Coping with the loss is never easy. If you or your close one have lost someone to suicide, dealing with the loss is difficult. The first thing that we can do to cope with the loss is to accept the emotions like grief and despair, shame, anger, confusion, anxiety, and loneliness should be accepted as it is normal to have it after the loss of close ones.
Giving up on food, medicines, and sleep won't help you. You should take care of yourself, getting enough sleep and eating regularly, healthy meals will improve your mood and give you the strength to cope. Talking to someone is another way of coping. Talking about your feelings will help you feel relieved and calm. You can speak to your close friends, families, if you're not comfortable with them then, you can talk to the professionals, i.e. counsellors. Joining a support group also helps to cope in a better way. Support groups can help you regulate your emotions alongside others who are going through the same situation and feelings. Many people often find such groups very helpful to cope.
Often when a person attempts suicide or dies by suicide, especially a young person, the reason for the death is known only to the family and no further discussions are done within the family or outside the family because of the stigma. This stigma is not only in India but around the world. Even if someone tries to talk about it, or discuss it, the people around will shutdown that topic because suicide in India is not taken too seriously and often ignored. The belief people have that if someone talks about harming themselves won't harm themselves or commit suicide. The hush-hush about suicide is so common due to the stigma that we don't even ask our close friends and the family members if they're suicidal. The reason is people believe that asking can be a trigger for them, and they will be blamed if it happens in the future.
It's high time we start constructively talking about suicide, like other issues. It's time we extend our help to them without any stigma and take suicide as a serious issue.
In case of immediate need for help, call these following helplines, they have a confidentiality and anonymity policy.
- Connecting NGO: 9922004305 (Marathi, Hindi and English)
- iCall: 02225521111 (Marathi, Hindi, English, Konkani, Gujarati, Tamil, Telugu, Malayalam and Punjabi)
- Aasra: 9820466726/022 27546669 (Hindi and English)
- Sneha: 04424640050 (English and Tamil)
Inputs from Madhumitha Balaji
(Arjun Kumar Shah is an MSW in Medical and Psychiatric from University of Pune. He works as a senior research assistant working for the Young Lives Matter project (YLM) in Pune.)