Strong human bonds help prevent suicide
On Sept. 10, a month after the shocking news that comic great Robin Williams took his own life, the world will celebrate World Suicide Prevention Day. The International Association for Suicide Prevention (IASP) and the World Health Organization (WHO), both committed to preventing suicide, recognize World Suicide Prevention Day as an important day to mobilize efforts of organizations and individuals to save lives.
The first celebration was 11 years ago. This year, the global theme is “Suicide Prevention: One World Connected.” The focus is on connections that are important at several levels to fight suicide.
Leading cause of death
According to IASP, suicide is a major public health problem. “The psychological pain that leads each of these individuals to take their lives is unimaginable. Their deaths leave families and friends bereft, and often have a major ripple effect on communities,” they said.
More than 800,000 die from suicide every year or roughly one death every 40 seconds. In fact, IASP stressed that the number of lives lost each year through suicide exceeds the number of deaths due to homicide and war combined.
Globally, in 2012, suicide is the fifth leading cause of death among those aged 30-49 years old and is the second leading cause of death in the 15-29 years age group. It is estimated that in 2012, for each adult who died of suicide, there were 27 others who made suicide attempts.
“In 2012, suicide accounted for 1.4 percent of all deaths worldwide, making it the 15th leading cause of death. Mental disorders (particularly depression and alcohol use disorders) are a major risk factor for suicide in Europe and North America; however, in Asian countries, impulsiveness plays an important role. Suicide is complex with psychological, social, biological, cultural, and environmental factors involved,” IASP elaborated.
Factors that increase suicide risk
According to everydayhealth.com, certain characteristics and conditions increase suicide risk.
First is gender. “Although women are more likely to attempt suicide, men are more likely to complete suicide. In fact, four times more men than women die by suicide, according to the US Centers for Disease Control and Prevention,” they noted. “In 2012, researchers examined why some men are at greater risk for suicide, independent of mental health issues. Factors that played a role included lower socioeconomic status, the breakdown of a relationship, job loss, and middle age,” they added.
Second factor is age. While suicide has been prevalent in the elderly and the young, it has been noted that suicide rates among the middle-aged have risen sharply. The American Foundation for Suicide Prevention reports that the highest suicide rate in 2011 occurred among people between the ages of 45 and 64. Suicide rates among that age group in the United States jumped 40 percent from 1999 to 2011. The second highest that year was among adults 85 or older.
Third factor is race. Suicide rates in North America, where a person takes his life every 13 minutes, were highest among whites (14.5 percent). “American Indians and Alaska natives made up the second highest group of suicides (10.6 percent). Suicide is the second leading cause of death among American Indians and Alaska natives aged 15 to 34 years old. Among Asians and Pacific Islanders, African-Americans, and Hispanics, suicide rates were 5.9 percent, 5.3 percent, and 5.2 percent, respectively,” they reported.
Fourth factor is mental illness. Ninety percent of those who die by suicide were previously diagnosed with a mental illness, according to the National Alliance on Mental Illness. The mental illnesses most commonly linked to suicide include depression, eating disorders like bulimia nervosa and anorexia nervosa, bipolar disorder, schizophrenia, and anxiety disorders like post traumatic stress disorder.
Fifth factor is chronic health problem. “People who suffer from health conditions like chronic pain and rheumatoid arthritis (RA) may be at increased risk for suicide or suicide ideation. Depression is common among people living with chronic health conditions. For example, a study published in the journal Rheumatology found that people with RA are twice as likely to suffer from depression. Another study found that women living with RA are almost twice as likely to have suicidal thoughts compared to the general population,” they added.
“However, a 2013 study published in JAMA Psychiatry found that people suffering from chronic migraines or back pain were more likely to attempt suicide – regardless of whether they also had depression or another mental illness.”
Sixth factor is poor sleep, linked with an increased risk for suicide in older adults. In a study of 420 people with an average age of about 75 over the course of 10 years, those who reported poorer sleep quality independent of depression had 1.2 times increased risk for suicide. The study also found that difficulty falling asleep and non-restorative sleep were associated with a higher suicide risk.
Detecting depression
Sanjay Gupta, MD of CNN, gave everydayhealth.com readers guidelines on how to detect depression.
Dr. Gupta said that while Robin Williams had spoken publicly about his struggles with depression and addiction, some are not as transparent.
“The National Institute of Mental Health estimates that depression affects 17 million Americans each year. You may work with someone who’s depressed and not know it – one in eight US workers has been diagnosed with depression, according to a Gallup poll. Even children can become depressed: Roughly 11 percent of kids between 13 and 18 years of age experience depression,” they said.
“Everybody feels down sometimes. It might be related to a traumatic life event like the death of a loved one, a divorce, or losing your job. Even one of life’s great joys, the birth of a child, can make a new mother feel overwhelmed or moody. With depression, symptoms last longer and are more severe than normal feelings of sadness,” he added.
“So how do you spot depression? Besides persistent feelings of sadness, signs may include: difficulty sleeping or sleeping more than usual, changes in appetite, withdrawal from social interaction, loss of interest in things that used to be pleasurable, lack of energy, difficulty concentrating or remembering things, feeling worthless and helpless. Younger children who are depressed may avoid school, complain of feeling ill, or become clingy with parents. Adolescents may become sulky and defiant. Depression is a serious illness, and its signs should never be ignored,” Dr. Gupta said.
Focus on prevention
“Suicide is the outcome of multiple, often interacting biological, psychological, and social risk factors,” study researcher Rebecca Bernert, director of the Suicide Prevention Research Laboratory at Stanford University, said in a statement. “Disturbed sleep stands apart as a risk factor and warning sign in that it may be undone, which highlights its importance as a screening tool and potential treatment target in suicide prevention,” Bernert said.
Bernert and her colleagues are currently conducting a study to examine whether treatment for insomnia can prevent suicidal behaviors and depression.
“Connectedness is crucial to individuals who may be vulnerable to suicide. Studies have shown that social isolation can increase the risk of suicide and, conversely, that having strong human bonds can be protective against it. Reaching out to those who have become disconnected from others and offering them support and friendship may be a life-saving act,” wrote IASP.
“Connectedness can also be understood in terms of clinical care. Mental illness, particularly depression, is an important risk factor for suicide. Primary care providers, often the first port of call for people with mental illness, are not always able to diagnose and treat mental illness. Specialist mental health care providers are not always available, so referral options may be limited. Even when services are available, they are not always sufficiently well-coordinated to provide optimal care. Connectedness and collaboration between services are also important at this level in preventing suicide. The right service or individual clinician must be available at the right time for someone with mental health problems, and must be able to offer and deliver effectively the full range of treatment options,” they added.
“World Suicide Prevention Day in 2014 is significant because it marks the release by the WHO of the World Suicide Report (WSR). The report follows the adoption of the Comprehensive Mental Health Action Plan 2013-2020 by the World Health Assembly, which commits all 194 member states to reducing their suicide rates by 10% by 2020,” IASP announced.
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