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Written By : SUNILA KARAN. Most days we are confronted with news about the war on cancer or the frantic race to find a cure for AIDS. We also hear
01 Jan 2011 12:00

Written By : SUNILA KARAN. Most days we are confronted with news about the war on cancer or the frantic race to find a cure for AIDS.
We also hear never-ending admonitions to improve our diet and to exercise more to prevent heart disease.
But another cause of death ranks right up there with the most frightening and dangerous medical conditions.
This is the inexplicable decision to kill themselves made by millions of people worldwide.
According to World Health Organisation, 2002, around the world suicide causes more deaths per year than homicide or war.
In line with the increasing rates of depression in our community, suicide prevalence has increased substantially in recent years, particularly among younger people.

What are the risk factors?
Family History: If a family member committed suicide, there is an increased risk that someone else in the family will also.
In fact, research shows that a six-fold increased risk of suicide attempts in the offspring of family members who had attempted suicide, compared to offspring of non-attempters.
If a sibling was also a suicide attempter, the risk increased even more.
This may not be surprising, because so many people who kill themselves are depressed, and depression runs in families.
Nevertheless, the question remains: Are people who kill themselves simply adopting a familiar solution or does an inherited trait, such as impulsivity, account for increased suicidal behaviour in families?
Existing Psychological Disorders: Suicide is often associated with mood disorders, and with good reason.
But it’s also true that many people with mood disorders do not attempt suicide, and, conversely, many people who attempt suicide do not have mood disorders.
Therefore, depression and suicide, although very strongly related, are still independent.
Looking more closely at the relationship of mood disorder and suicide, some investigators have isolated hopelessness, a specific component of depression, as strongly predicting suicide.
Stressful Life Events: Perhaps the most important risk factor for suicide is a severe, stressful event experienced as shameful or humiliating, such as a failure (real or imagined) in school or at work, an unexpected arrest, or rejection by a loved one.
Physical and sexual abuse are also important sources of stress. Given pre-exiting vulnerabilities including psychological disorders, traits of impulsiveness, and lack of social support -a stressful event can often put a person over the edge.

Is Suicide Contagious?
We hear all too often of the suicide of a teenager or celebrity.
Most people react with sadness and curiosity.
Some people react by attempting suicide themselves, often by the same method they have just heard about.
Why would anyone want to copy a suicide?
First, suicides are often romanticized in the media.
A young person under considerable pressure commits suicide and becomes a martyr to friends and peers by getting even with the (adult) world for creating such a difficult situation.
Also, media accounts often describe in detail the methods used in the suicide, thereby, providing a guide to potential victims.
Little is reported about the paralysis, brain damage, and other tragic consequences of the incomplete or failed suicide, or about the fact that suicide is almost always associated with a severe psychological disorder.
More important, even less is said about the futility of this method of solving problems.

Despite the identification of important risk factors, predicting suicides is still an uncertain art.
Individuals with very few precipitating factors unexpectedly kill themselves, and many who live with seemingly insurmountable stress and illness and have little social support or guidance somehow survive and overcome their difficulties.
Mental health professional are very thoroughly trained in assessing for possible suicidal ideation.
Others might be reluctant to ask leading questions for fear of putting the idea in someone’s head.
However, we know it is far more important to check for these “secrets” than do nothing, because the risk of inspiring suicidal thoughts is very small and the risk of leaving them undiscovered is enormous.
Therefore, if there is any indication, whatsoever, that someone is suicidal, the mental health professional will inquire, “Has there been any time recently when you’ve thought that life isn’t worth living, or had some thoughts about hurting yourself or possibly killing yourself?”
The mental health professional will also check for possible recent humiliations and determine whether any of the factors are present that might indicate a high probability of suicide.
For example, does a person who is thinking of suicide have a detailed plan or just a vague fantasy?
If a plan is discovered that includes a specific time, place, and method, the risk is obviously high.
Does the detailed plan include putting all the personal affairs in order, giving away possessions, and other final acts? If so, the risk is higher still. Does the person really understand what might actually happen?
Many people do not understand the effects of pills on which they might overdose. Finally, has the person taken any precautions against being discovered? If so, the risk is extreme.
Assessing Suicidal Risk
It is important for any person working in a healthcare setting to be able to assess suicidal risk or be able to assess and refer clients to a mental health professional who can assess the risk.
Questions for Possible Suicidal Clients
Consider the following questions for determining potential suicidal thoughts:
l Do you feel so bad that life isn’t worth continuing?
l Do you think continuously about death?
l Do you think about your own death?
l Does the idea of death sometimes seem like a welcome relief from life?
l Do you think of killing yourself?
l Have you ever tried to kill or hurt yourself?
When? What did you do?
What happened? Did you receive any medical treatment? Did you tell anybody?
What did you think would happen?
l Are you thinking of hurting yourself now? How are you thinking of hurting yourself? How close have you come to it? What has stopped you? Would you be able to tell anyone before you hurt yourself?

Preventive Steps for Dealing with a Suicidal Client
Step 1: Listen.
The first thing a person in a mental crisis needs is someone who will listen and really hear what is being said.
Every effort should be made to understand the feelings behind the words.
Step 2: Evaluate the seriousness of the person’s thoughts and feelings.
If a person has made clear, self-destructive plans, the problem is apt to be more acute than when their thinking is less definite.
Step 3: Evaluate the intensity or severity of the emotional disturbance.
It is possible that a person may be extremely upset but not suicidal. If a person has been depressed and then becomes agitated and moves about restlessly, it is usually cause for alarm.
Step 4: Take any complaint and feeling the person expresses seriously.
Do not dismiss or undervalue what the person is saying. In some instances, the person may express his difficulty in a low key, but beneath their calm exterior may be profoundly distressed feelings.
All suicidal talk must be taken seriously.
Step 5: Do not be afraid to ask directly if the individual has entertained thoughts of suicide.
Suicide may be suggested but not openly mentioned in the crisis period.
Inquiring directly into such thoughts at an appropriate time rarely results in harm. As a matter of fact, the individual frequently welcomes the query and is glad to have the opportunity to open up and bring it out.
Step 6: Do not be misled by the person’s comments that they are past their emotional crisis.
Often the person feels initial relief after talking of suicide, but the same thinking recurs later. Follow-up is crucial to ensure a treatment effort.
Step 7: Be affirmative, but supportive.
Strong, stable guideposts are essential in the life of a distressed individual. Provide emotional strength by giving the impression that you know what you are doing and that everything possible will be done to prevent them from taking their life.

Step 8: Evaluate the resources available.
The individual may have inner psychological resources, including various mechanisms which can be strengthened and supported.
Identify external outer resources in their environment, such as relatives, friends, religious leaders, teachers whom you can contact.
If these are absent, the problem is more serious. Continuing observation and support are vital.
Step 9: Act specifically.
Do something tangible; that is, give the person something definite to hang onto, such as arranging to see them later or subsequently contacting another person. Nothing is more frustrating to the person than to feel as though they have received nothing from the meeting.
Step 10: Do not avoid asking for assistance and consultation.
Call upon whoever is needed, depending upon the severity of the case. Do not try to handle everything alone. Convey an attitude of firmness and composure to the person so that they will feel something realistic and appropriate is being done to help them.

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