Suicidal behaviour prevention

1 September 2021

Prepared by: Doctor-psychotherapist D.E. Virynskaja

 

Suicidal behavior is a complex phenomenon that has attracted for many centuries the attention of philosophers, theologians, doctors, sociologists and artists: according to the French philosopher Albert Camus, expressed in his essay "The Myth of Sisyphus", suicide is the only truly serious philosophical problem. It is difficult to explain why some people choose to commit suicide, while others, in the same or worse circumstances, do not. Howbeit, a significant proportion of suicides are preventable.

Suicidal behavior – behavior that manifests itself in the form of fantasies, thoughts or actions aimed at self-harm or self-destruction. Suicidal behavior usually includes self-killing (suicide), suicidal attempts (parasuicides), thoughts and statements about suicide. The reasons for suicidal behavior are manifold. Every year around 1 million suicides are committed in the world and about 10 times more suicide attempts.

Suicide prevention is a very difficult but feasible complex task, the solution of which is possible through the interaction of various structures of society (social sector, government agencies, educational institutions, law enforcement, health care, religious organizations), since the causes of this phenomenon are very diverse.

The suicidal act is viewed as the result of the interaction of numerous "basic" risk factors with each other and with "trigger" (triggering) factors (crisis situation). Basic factors are only probabilistic in nature and belonging to a risk group does not mean a mandatory "verdict" of suicide. The risk increases significantly when several risk factors are integrated, but a trigger factor is needed to "trigger" suicidal actions, which is usually a conflict or crisis.

 It is customary to refer to the "basic" risk factors as socio-demographic, biographical, medical and individual psychological factors.

I. Socio-demographic factors of suicidal risk.

1) Gender. The suicide rate in men is 3-6 times higher than in women. The level of suicide attempts, on the contrary, is about 1.5 times higher among women.

2) Age. The suicide rate in the population increases with age, and reaches a maximum after 45 years. Suicide rates are highest in older people. The maximum of suicidal attempts occurs at a young age – 20-29 years.

3) Marital status. Suicide rates are higher among unmarried, divorced, widowed, childless and lonely individuals.

4) Professional status. Violation of a professional stereotype (job loss, retirement, unemployed status) is associated with an increased risk of suicide.

5) Religion. Suicide rates are higher among atheists compared to believers. Among the major denominations, the highest levels of suicide are recorded among Buddhists, the lowest among Muslims; Christians and Hindus are in between.

 II. Medical factors of suicidal risk.

1) Mental pathology. The greatest risk of suicidal action is associated with mood disorders, personality disorders and substance dependence, schizophrenia and other psychoses.

2) Somatic pathology. The connection between somatic pathology and suicidal behavior is very strong. Studies show that approximately 70% of people who commit suicide have an acute or chronic illness at the time of death. About 50% of this group have a combination of mental illness and physical illness. The greatest risk of suicide is associated with the following conditions: epilepsy; oncological and diseases of the hematopoietic organs; cardiovascular disease (IHD); respiratory diseases (asthma, tuberculosis); congenital and acquired deformities; loss of physiological functions; HIV infection; conditions after serious operations and transplantation of donor organs and tissues; among patients with an artificial kidney.

 III. Biographical factors of suicidal risk.

1) History of suicidal attempts. A history of a suicide attempt is one of the most significant risk factors for suicide and re-parasuicide.

2) Suicidal behavior of biological relatives. Among the biological relatives of people who commit suicidal acts, the suicide rate is higher than in the general population. This is due to both the patterns of inheritance of mental disorders and certain behavioral characteristics of the individual (impulsivity).

3) Suicidal behavior of "significant others". In some cases, it is of great importance to copy the behavior of emotionally significant persons (relatives, partners, idols of mass culture. Behavior through models is typical for children, adolescents, members of religious sects.

IV. Individual psychological risk factors.

These factors reflect not so much the risk of suicidal behavior, as the likelihood of a person's reduced tolerance to emotional stress. These include the following personality traits: emotional instability, including during age crises (pubertal, involutionary); impulsivity; emotional dependence; low or high self-esteem; maximalism and categorical character; strongly expressed desire to achieve goals; anxiety and exaggerated feelings of guilt.

 

Trigger factors for suicidal behavior are:

  • Diagnosis of a serious illness
  • Expectation of surgery
  • Separation or breakup with a partner
  • Loss
  • Family conflicts
  • Changes in occupation or material security
  • Rejection by a significant person
  • Situation of an individual's accusation

State of high suicidal risk is characterized by:

  • Persistent death fantasies, non-verbal "signs", thoughts, direct or indirect statements about self-harm or suicide.
  • State of depression.
  • Manifestations of feelings of guilt, severe shame, resentment, intense fear.
  • High level of hopelessness in speech.
  • Noticeable impulsivity in behavior.
  • A fact of a recent or current crisis and loss.
  • Emotional and cognitive fixation on a crisis situation, an object of loss.
  • Severe physical or mental suffering (pain syndrome, "mental pain").
  • Lack of social and psychological support / non-accepting environment.
  • Patient reluctance to accept help / inaccessibility to therapeutic interventions / regret that "stayed alive".

Myths and facts about suicide.

Myth number 1. People who talk about suicide don't actually commit it.

Fact 1: Most of those who committed suicide before the act of suicide definitely warned of their intentions. 80% of suicides hint at their plan and need help.

Myth number 2. Suicidal people are determined to die

Fact 2: Most suicides are ambivalent. The vast majority of suicides hesitate in the choice between life and death. The suicide wants to get rid of the unbearable mental pain rather than really wants to die.

Myth number 3. Suicide happens without warning.

Fact 3: People prone to suicide often give very clear directions on what they are going to do.

Myth number 4. Improvement after the crisis suggests that the risk of suicide has decreased.               

Fact 4: Many suicides occur during a period of improvement, when a person has enough energy and will to turn desperate thoughts into decisive action.

Myth number 5. If a person has a tendency to commit suicide, then it remains with him forever.                

Fact 5: Suicidal thoughts can recur, but they are not constant and in some people they never appear again.

Myth number 6. Talking about suicide can provoke him to leave.                  

Fact 6: Talking about suicide cannot cause or encourage suicide. Frank, heartfelt conversation is the first step in suicide prevention.

Myth number 7. All suicides cannot be prevented.                  

Fact 7: This is true. However, most can still be prevented.

Any manifestations of a person's suicidal activity should be treated as carefully as possible, in no case should they be ignored, this is always a request for help.

No human being is completely suicidal. Even the most passionate desire to die is in its psychological essence contradictory. Part of the personality wants to live, the other seeks to disappear into oblivion. The suicidal mood of the soul is transient - these feelings can appear, disappear, arise again, but almost always pass. This pattern is the basis for providing assistance in case of potential suicide.

What can you do to help the person and prevent suicide?

1. Look for signs of possible danger. Suicidal prevention is not only about the caring and involvement of friends, but also about the ability to recognize the signs of suicidal behavior. Look for signs of potential danger: suicidal threats, prior suicide attempts, depression, significant changes in a person's behavior or personality, and preparations for the final act of will. Capture the manifestations of helplessness and hopelessness, and determine if the person is lonely and isolated. The more people aware of these warnings, the greater the chances of suicide disappearing from the list of leading causes of death.

2. Accept the suicidal person. Accept the possibility that the person is indeed suicidal. Do not assume that he is incapable and will not be able to decide to commit suicide. It can sometimes be tempting to deny the possibility that someone can keep a person from suicide. This is why thousands of people – of all ages, races and social groups – commit suicide. Don't let others mislead you about the frivolity of a particular suicidal situation. If you think someone is in danger of suicide, act in accordance with your own convictions.

3. Establish a caring relationship. There are no all-encompassing answers to such a serious problem as suicide. But you can take a giant step forward by taking a position of confident acceptance of a desperate person. In the future, a lot depends on the quality of your relationship. They should be expressed not only in words, but also in non-verbal empathy; in these circumstances, it is more appropriate not to moralize, but to support. For a person who feels that they are useless and unloved, the caring and participation of a sympathetic person is powerful reassurance. This is how you best penetrate the isolated soul of a desperate person.

4. Be an attentive listener. Suicides especially suffer from intense feelings of alienation. Because of this, they are not inclined to accept your advice. Much more they need to discuss their pain, frustration and what they say: "I have nothing to live for." If a person suffers from depression, then he needs to talk more himself than talk to him.

You may develop frustration, resentment, or anger if the person does not immediately respond to your thoughts and needs. Realizing that the person you care for is suicidal usually causes the helper to fear rejection, unwillingness, powerlessness, or uselessness. Regardless, remember that it is difficult for this person to focus on anything other than their desperation. He wants to get rid of the pain, but he cannot find a healing outlet. If someone confesses to you that they are thinking about suicide, do not blame them for these statements. Try to remain as calm and understanding as possible. You might say, "I really appreciate your candor because it takes a lot of courage from you to share your feelings right now." You can be of invaluable help by listening to the words that express the person's feelings, be it sadness, guilt, fear, or anger. Sometimes, if you just sit silently with him, it will be proof of your interested and caring attitude.

5. Don't argue. When faced with a suicidal threat, friends and relatives often respond: "Think, you are living much better than other people; you should have thanked fate." This response immediately blocks further discussion; such remarks cause even more depression in an unhappy person. By wanting to help in this way, loved ones contribute to the opposite effect.

You can often come across another familiar remark: "Do you understand what misfortune and shame you will bring on your family?" But, perhaps, behind it lies exactly the thought that the suicide wants to carry out. Do not be aggressive if you are present when talking about suicide, and try not to express shock at what you hear. By entering into a discussion with a depressed person, you can not only lose the argument, but also lose him.

6. Ask questions. The best way to intervene in a crisis is to carefully ask a direct question, "Are you thinking of suicide?" He will not lead to such a thought if the person did not have it; on the contrary, when he thinks about suicide and finally finds someone who cares about his feelings and who agrees to discuss this forbidden topic, then he often feels relief, and he is given the opportunity to understand his feelings and respond to them.

You should calmly and intelligibly ask about the disturbing situation: "Since when do you consider your life so hopeless? Why do you think you have these feelings? Do you have specific thoughts on how to end your life? If you've contemplated suicide before, what was stopping you?" To help the suicidal person understand his thoughts, you can sometimes paraphrase, repeat his most significant answers: "In other words, you say...". Your agreement to listen to and discuss what they want to share with you will be a great relief for a desperate person who is afraid that you will judge him and is ready to leave.

7. Do not offer unwarranted consolations. A person can be driven to suicide by banal consolations just when he desperately needs sincere, caring and frank participation in his fate. The reason a suicide initiates his thoughts is because he wants to raise concerns about his situation. If you are not interested and responsive, the depressed person may consider judgments like, "You really don't think so," as a manifestation of rejection and distrust. If you conduct a conversation with him with love and care, then this will significantly reduce the threat of suicide.

Suicidal people disdain remarks like, "That’s all right, everyone has the same problems as you," and other similar clichés, as they are in stark contrast to their suffering. These conclusions only minimize, demean their feelings and make them feel even more unnecessary and useless.

8. Suggest constructive approaches. Instead of telling the suicidal person, "Think about the pain your death will bring to your loved ones," ask them to think about alternative solutions that may not have occurred to him yet.

The desperate person needs to be reassured that he can talk about feelings without hesitation, even about negative emotions such as hatred, bitterness, or a desire for revenge. If the person still hesitates to show his innermost feelings, then perhaps you will be able to lead to the answer, noting: "I think you are very upset," – or: "In my opinion, you will cry now." It also makes sense to say, "You are still excited. Maybe if you share your problems with me, I will try to understand you."

If the crisis situation and emotions are expressed, then the next step is to find out how the person resolved similar situations in the past. This is called "assessing the means available to solve the problem. "It involves listening to descriptions of previous experiences in a similar situation. For initiation, the question may be asked: "Have you had similar experiences before?" There is a unique opportunity to jointly explore the ways in which a person has dealt with a crisis in the past. They can be useful for resolving real conflict as well.

Try to find out what remains, however, positively meaningful to the person. What else does he appreciate? Notice the signs of emotional revival when it comes to the "best" time of his life. Which of the things he has remains meaningful to him? Who are the people who continue to excite him? And now when the life situation has been analyzed, have any alternatives emerged? Is there a ray of hope?

9. Provide hope. Hope helps a person get out of their suicidal thoughts. The loss of hopes for a decent future is reflected in the notes left by the suicides. Self-destruction occurs when people lose the last drops of optimism, and their loved ones somehow confirm the futility of hopes. Someone wittily remarked on this: "We laugh at people who hope and send those who have lost hope to hospitals." Be that as it may, hope must come from reality. It makes no sense to say, "Don't worry, everything will be okay," when everything cannot be okay. Hope cannot be built on empty consolations. Hope does not arise from fantasies separated from reality, but from the existing ability to desire and achieve. A loved one who has died cannot return, no matter how much you hope and pray. But his loved ones can discover a new understanding of life. Hopes must be justified: when a ship crashes against rocks, there is a difference between the hope of "sailing to the nearest shore or reaching the opposite shore of the ocean." When people completely lose hope for a decent future, they need supportive advice, some kind of alternative. "How could you change the situation?" "What outside interference could you resist?", "Who could you turn to for help?"

10. Assess your risk of suicide. Try to determine the severity of the possible suicide. After all, intentions can vary, starting with fleeting, vague thoughts about such a "possibility" and ending with a developed plan of suicide by poisoning, jumping from a height, using a firearm or rope. It is very important to identify other factors, such as alcoholism, drug use, the degree of emotional disturbance and disorganized behavior, feelings of hopelessness and helplessness. It is an indisputable fact that the more developed the method of suicide, the higher its potential risk.

11. Do not leave a person alone in a situation of high suicidal risk. Stay with him as long as possible, or ask someone to stay with him until the crisis is resolved or help arrives. You may need to call the ambulance station or go to the clinic. Remember that support comes with a certain responsibility.

12. The importance of maintaining care and support. If the crisis is over, professionals or families cannot afford to relax. The worst may not be over. Improvement is often mistaken for an increase in the patient's mental activity. It so happens that on the eve of suicide, depressed people rush into a maelstrom of activity. They ask forgiveness from everyone they have offended. Seeing this, you sigh with relief and weaken your guard. But these actions may indicate a decision to pay off all debts and obligations, after which you can commit suicide. Indeed, half of suicides commit suicide no later than three months after the onset of the psychological crisis. The risk of a suicidal situation will not be resolved until the suicidal person adapts to life.

13. Conclusion of an anti-suicidal contract. In order to show the person that others care about him and create a sense of life prospects, you can conclude a so-called anti-suicidal contract with him – ask for a promise to contact you before he decides on suicidal actions in the future in order to be able to once again discuss possible alternatives of behavior. Oddly enough, such an agreement can be very effective.

14. Seek professional help. Suicides have a narrowed field of vision, a kind of tunnel consciousness. Their minds are unable to reconstruct a complete picture of how unbearable problems should be dealt with. The first request is often for help. Working with self-destructive people is serious and responsible. In most cases, suicides need the help of specialists in resolving a difficult life situation. Sometimes the only alternative to helping a suicide, if the situation is hopeless, is hospitalization in a psychiatric hospital. Delay can be dangerous, hospitalization can bring relief to both the patient and the environment.

We all need to know that in most cases, suicidal people are driven by conflicting feelings. They experience hopelessness and at the same time hope for salvation. And if relatives, friends, acquaintances and specialists show warmth, care and insight towards such a person, they can change his future destiny.