Prof. Dr. Shyam P. Lohani

This year the World Suicide Prevention Day is being marked on September 10 with a theme of “Working Together to Prevent Suicide”. Globally, around 16 million people attempt suicide and a total of 800, 000 people die due to suicide every year (WHO, 2018).
The above data shows that for every suicidal death, there are around 20 suicidal attempts. At present, one person dies of suicide every 40 seconds in the world and it is projected that by 2020, it will account one death in every 20 seconds. Of the total suicides, about 79 per cent occur in low and middle-income countries. In Nepal, a total of 5,317 people killed themselves in 2017/18 (Nepal Police, 2018). That means almost 15 persons died every day.
It is often difficult to reach a conclusion why and what leads people to commit suicide. The individual may be your relative, friend, close acquaintance or celebrity. Usually, there might not be any warning signs and people wonder what led to life-ending act. Suicide can happen to people of any age, sex, marital or economic status. However, the risk is higher with specific age group, gender, occupation and disease state. Men are more likely to die by suicide than women. However, women are more likely to attempt suicide. Males use more violent methods of suicide such as firearms, hanging, jumping and suffocation while females use less violent methods such as poison. Globally, suicide is the second leading cause of death among 15-29 age groups.
There are many risk factors for suicide. Familial history of suicide is one of them. The child who was maltreated in the past is more likely to commit suicide. People with the previous attempt of suicide, history of mental illness particularly clinical depression, history of alcohol and substance abuse, feelings of hopelessness, impulsive or aggressive behaviours are more prone to suicide. Similarly, feelings of helplessness, isolation, barriers to accessing mental health support, chronic physical illness, adverse stressful life events, access to lethal methods, lack of social support and unwillingness to seek help due to stigma are other risk factors for suicide.
Most of the individuals give signs or signals of their intention to carry out the suicidal act. The warning signs include but not limited to talking about wanting to die or to kill oneself; looking for a way to kill oneself; talking about feeling hopeless or having no purpose and talking about feeling trapped or being in unbearable pain. People who are talking about being a burden to others; increasing the use of alcohol or drugs; acting anxious, agitated, or reckless are more likely to commit suicide. Those suicidal people are sleeping too little or too much; withdrawing or feeling isolated. People showing rage or talking about seeking revenge, and displaying extreme mood swings and writing poems or stories on death are other warning signs of suicide.
The intensity and duration of suicidal thoughts have been studied to find its relation with suicide. The higher intensity and longer duration of such thoughts have a strong relation with completed suicide. Most often there is a long struggle and unbearable pain associated with each suicide and suicidal attempt. During this period of unbearable pain and struggle, the suicidal individual often communicates the feelings to family members or friends. Although most people who experience suicidal ideation do not carry it through, some may make suicide attempts. Oftentimes, people do not want to end life but are trying to seek help from significant others.
The most dramatic impact of suicidal death is felt by family members, friends, co-workers, and classmates. The feeling is more intense to those who will miss the physical presence of the deceased. A large number of people are directly affected by each suicide. It has been estimated that one suicidal death causes psychological effect to at least 135 individuals. This means 108 million people worldwide are affected by the intense grief owing to suicide.
Suicide is preventable. The preventive measures should be directed to individual, family, community or country levels. A suicidal person may not ask for help but does not mean help is not accepted by that individual. The preventive measures start with identifying warning signs and taking them seriously. If you find someone is considering suicide, talking with them openly. When it is necessary, it is advisable to bring the issue to the healthcare professionals to save a life.
Although it is not a national priority, the government should take initiative to develop a national strategy for preventing suicides. The strategies should target vulnerable groups such as women of reproductive age group, women who have undergone gender-based violence or sexual abuse and those who are bereaved by suicide. Basic psychosocial counseling should be provided to them. The restriction on lethal means such as banning highly toxic pesticide and illicit drugs, policy to decrease harmful use of alcohol and responsible reporting by media by not disclosing the name of poison involved for suicide may help reduce suicide. The school-based and community-integrated mental health programmes to identify the individual in need of help should be targeted and appropriate psychosocial interventions and treatment should be made available.

(Prof. Lohani is the Clinical Director of the Nepal Drug and Poison Information Centre and can be reached at lohanis@gmail.com)