According to Samaritans of Singapore (2017) – a non-profit organisation in suicide prevention – suicide is the primary cause of death among people from 10 years to 29 years old. Furthermore, it was concluded that there were two and a half times more suicide related deaths in Singapore compared to road traffic accidents, with males accounting for over two-thirds of this figure.
In order to understand why some people choose to commit such an act of desperation, one must be insightful of the underlying causes. In general, a suicidal person has a higher propensity to be consumed by negative, self-deprecating thoughts where stressful situations are perceived as extremely hopeless. This typically arises through a combination of situational stressors in tandem with feeling stranded in an impossible and unchangeable situation. People with suicidal thoughts believe that they are ill-equipped to manage life’s challenges. This leads to prolonged feelings of disempowerment and helplessness that are usually coupled with the idea of being misunderstood and/or abandoned. By extension, they may also feel the burden of solely being responsible for shouldering any difficulties that they might have. This can sometimes overwhelm the person with gripping feelings of sadness and worthlessness that easily overrides logical reasoning, thus making it much more difficult for them to see beyond their current hurdle.
More often than not, individuals struggling with suicidal thoughts experience a profound inability to carry out their basic daily functions. This often leads to the perception that their lives have lesser value than others. Also, a suicidal persons’ perception of negative events can greatly vary based on the individual’s capacity for stress management, his/her socioeconomic status, resilience, severity and simultaneity of stressors. This cumulation of overwhelming negative internal and external circumstances can lead one to make a non-objective emotionally-driven decision of taking their own lives.
STRESS & SUICIDE
In 2019, the American Addiction Centres cited psychosocial stress as one of the main triggers of suicidal behaviour. This stress usually manifests during major transitional life events such as marriage, change of employment, or having a child. However, there are numerous negative stressors associated with suicides that overlap each other. A key underlying factor is mental illness such as Major Depressive disorder which has been commonly associated with increased risks of suicidal ideation and behaviour. Major Depressive disorder is marked by prolonged low and irritable mood, feelings of guilt and worthlessness, diminished interest in daily activities, fluctuations in weight, sleep and movement disturbances, fatigue, difficulties in focusing, and recurrent suicidal thoughts. Common predisposing factors to developing depression include trauma such as bullying, serious physical illness, sexual and emotional abuse or neglect.
Individuals suffering from depression often struggle with having their emotional needs met and may feel strongly obligated or beholden to those around them. It is common for them to feel defined by this traumatic event and incorrectly attach their sense of self-worth to it.
This extends to proximal suicidal exposure, which is cited as a significant risk factor, traumatising those closest to the victim (Young et al., 2012). In 2009, Harvard Health estimates that there is an average of 6 people that are left behind for every suicide – people who have little to no choice but to manage the complexity of their grief. Research from the World Health Organization in 2015, indicates that substance abuse also has a substantial physiological effect on a person suffering from suicidal thoughts, which hinders their physical and mental coping capacities. Additionally, being diagnosed with a severe or fatal medical condition may also invoke suicidal thoughts as perceptions of losing your life becomes a paramount concern.
While suicide is still a topic that is often swept under the rug, raising awareness is the best strategy to fight the stigma surrounding its controversial nature.
NOT ALL STRESSES ARE CREATED EQUAL
Finally, there are the frequent stressors that a person experiences across his lifetime that may increase the risk of negative emotions that can surmount to suicidal behaviour. This may include emotional and relationship breakdowns, the loss of a loved one, academic struggles and financial or legal difficulties. It is important to note the experience of stress is subjective and can vary in severity. What seems catastrophic to one may be entirely manageable and trivial to another. It is for these reasons that psychotherapy is beneficial in ascertaining the mechanisms behind the factors that directly affect the distressed individual when it comes to finding solutions.
There are numerous strategies that can be implemented with reasonable efficacy on a personal and interpersonal level. Firstly, it is important to fight the fleeting and temporary thoughts of suicide. This allows for the state of negative mood to pass until such a time when the person feels less compelled and much calmer. Delaying life-ending decisions also serves as an additional buffer while the person seeks the necessary emotional support (Mayo Clinic, 2018). Secondly, it is recommended to avoid social isolation wherever possible. Social support is a significant protective factor in preventing suicide as it known to create a more conducive, safe environment that encourages resilience. For example, family members can collectively foster an inclusive environment by encouraging family cohesion, bonding and facilitating on finding new common grounds. Finally, drugs and alcohol have been cited as substances that exacerbate suicidal and impulsive feelings and consequentially should be avoided (WHO, 2015).
The practice of self-compassion and self-acceptance is greatly beneficial as it reminds us that making mistakes is normal and part of the human condition. There are several therapeutic strategies that can help promote a healthier inner dialogue and encourage lifestyle decisions that are more in line with their personal values and strengths. Assessment and treatment planning with a trained mental health professional can empower individuals with skills needed to actively problem-solve & process difficult emotions and ultimately find healing and meaning in their lives again. Evidence-based interventions may include cognitive-behavioural therapy, mindfulness-based strategies and solution-focused therapy.
On a nation-wide scale, responsible media reporting on the issue of suicide together with increased public awareness can help diminish the taboo surrounding this issue. This provides gatekeepers on a systemic and community level with general warning signs to further increase awareness (Black Dog Institute, 2016). Community awareness on the emotional triggers and available resources for someone who is suicidal will also help to intercede on behalf of a suicidal person if they are unable to. This pertains to asking someone if they are considering suicide, as research suggests it does not increase their risk (Dazzi, Gribble, Wessely & Fear, 2014). In fact, listening, encouraging and following up on how they are feeling reduces the risk of suicide.
In terms of behavioural strategies, family members can physically remove any objects within the surrounding area that can or may be used to impulsively inflict self-harm. Also, placing crisis numbers and medical contacts in an area that can be easily read can help shorten response time in case of an emergency. One of the present difficulties is the legal focus of taking punitive action regarding suicide attempt survival as it has been critiqued as an insufficient deterrent for individuals who premeditatedly do not or are unable to value their own life.
AVENUES OF CARE
Early detection of suicidal behaviour or brief psychological interventions can greatly improve prognosis for emotional recovery and help mitigate the state of severe emotional distress. Pharmacological treatment from psychiatrists and psychotherapy intervention from trained counsellors and psychologists in suicide and risk management have proven to be highly effective as most originate from treatable disorders such as anxiety and depression. Group therapy initiatives can also be beneficial as it allows distressed individuals to share a common ground and have mutual support in their recovery journey. Voluntary caring contacts (Luxton, June & Comtois, 2013) has also displayed efficacy in suicide prevention, where a corporation or designated carers periodically express their empathy and understanding through phone calls, texts and postcards to patients. Clinician-based safety planning (Stanley & Brown, 2012) provides the patient with a list of coping strategies and problem-solving procedures that promote positive life by encouraging small attainable goals. This increases patient motivation in continuing further treatment without setting rigid rules while allowing them to feel the positive rewards of their efforts. Of the abovementioned strategies, limiting access to lethal means appears to provide the most short-term reduction in suicidal behaviour (Zalsman et al., 2016). This is due to the impulsive nature of a suicidal person and how a large majority of failed suicides have reportedly did not attempt suicide again after their access to ways of committing suicide was restricted.
Despite these strategies showing some signs of effectiveness, it is still important to seek help from a mental healthcare professional in order to facilitate proper implementation because of the highly individualized nature and the varying severity of suicidality.
While suicide is still a topic that is often swept under the rug, raising awareness is the best strategy to fight the stigma surrounding its controversial nature. Do not be afraid to encourage conversations on the issue and provide resources, be it emotional or logistical for those in need. Suicidal thoughts do not discriminate and can inflict anyone experiencing a difficult time in their lives. Therefore, it is imperative for us to stay vigilant and supportive. Preventing suicide is a battle that requires commitment and involves no less than our collective effort. This battle can only be won if we all start caring for one another.
SUICIDE PREVENTION RESOURCES in SINGAPORE
24-Hour Crisis Helpline (IMH): 6389-2222
Samaritans of Singapore (SOS 24 Helpline): 1800-221-4444
* World Suicide Prevention Day is observed on September 10 each year to promote worldwide action to prevent suicides. Various events and activities are held during this occasion to raise awareness that suicide is a major preventable cause of premature death.
Dr Tracie Lazaroo
Dr Tracie Lazaroo is a graduate of James Cook University (Singapore). She completed Doctor of Clinical Psychology programme and obtained distinction in all coursework modules. She also attended the University of Western Australia February 2005–2009 and completed a Bachelor of Science degree in December 2008. Dr Tracie Lazaroo also has a triple major in Anatomy and Human Biology and Psychology; a distinction in Anatomy and Human Biology and in Psychology. She also graduated with Second Class Upper honours majoring in Psychology.