Suicide prevention

Overview

• It is common in all cultures in developed also developing country.
• Additionally, It is common among women.
• However there are more suicide thinkers than committers. [2]

Suicide prevention articles generally discuss the complex issue of suicide, focusing on raising awareness, reducing stigma, and providing resources for those struggling or concerned about loved ones.

Key points

These articles often cover the following key points:

• Understanding Suicide: Articles define suicide and explain its prevalence as a global public health concern. They often highlight statistics to underscore the seriousness of the issue and emphasize that suicide is preventable.

• Risk Factors and Warning Signs: Articles identify common risk factors for suicide, such as mental health conditions, substance abuse, and social isolation.

   They also describe warning signs that someone may be contemplating suicide, like talking about wanting to die, withdrawing from others, and giving away possessions.

• Prevention Strategies: Articles discuss evidence-based prevention strategies, including:
  
  • Promoting mental health and well-being
  • Reducing access to lethal means
  • Improving suicide risk screening and assessment
  • Providing effective treatment and support
  • Raising public awareness and education
• Seeking Help: Articles provide information about how to seek help for oneself or someone else who may be at risk of suicide.

   They emphasize the importance of seeking help immediately and offer resources such as crisis hotlines and mental health services.

• Postvention: Some articles also address postvention, the support and care provided to individuals and communities affected by suicide. This can include bereavement counseling, support groups, and community initiatives to promote healing and prevent future suicides.

In India, the 988 Suicide and Crisis Lifeline is a crucial resource for those experiencing a mental health crisis or suicidal thoughts.

Additionally, mental health helplines and organizations such as AASRA and The Live Love Laugh Foundation provide support and resources for suicide prevention.

Remember, if you or someone you know is struggling with suicidal thoughts, help is available. Please reach out to the 988 Suicide and Crisis Lifeline or another mental health professional for immediate support.

Causes

1. Impulsiveness:

• It may be a key factor in suicidal behaviour.
• In detail, An impulsive person may suddenly come to the realization that his suffering could be ended by suicide and he may act on that perception before considering the consequences.
• Lastly, This type of thinking is called as tunnel vision thinking.

2. Dependence:

• Individuals who are dependent on others also who require constant reassurance and attention are more likely to died by suicide.
• Such people are always deprived of support, approval also attention and as termed as dependent, dissatisfied persons.

3. Unrealistic expectations:

• Individuals who have unrealistically high expectations of themselves and others (extreme perfectionist) are frequently disappointed also may be unable to accept the failure.
• Such individuals become depressed also are at increased risk of suicidal behaviour.

4. Other causes:

• Dissolution especially of love relation or other significant loss.
• Change in medical condition (any prolong physical illness)
• Alcoholism / drug intoxication.
• Furthermore, An increased feeling of hopelessness.
• Sudden improvement in depressed mood.
• Dowry also marital discord; never married, divorced, widowed.
• Unemployment.

5. Predisposing factors:

Self hate due to either guilt or low self esteem.

State of extreme agitation in which individual is tense also cannot think clearly.

Constitution of intellectual forces to such extent that individual cannot think beyond the immediate situation. [2]

Types

1. Completed suicide:

• Intention of death.
• Serious attempt to kill own self and succeeds in doing so.
• 65 percent patients having severe depression commits completed suicide.
• Schizophrenics are more prone to commit this type as they have delusions also command hallucinations.
• History of previous attempts is an important factor to note.
• Additionally, 20-25 percent of successful suicides have made previous attempt. [2]
• The method is highly dependent on geographical location; for instance, in the USA shooting is the most common, whereas in the UK (which has very tight firearms laws) drug overdose, suffocation, and hanging are frequently used.
• More so than in younger patients, older people plan their suicide carefully, leaving an explanatory note and their affairs in order. [1]

2. Attempted suicide:

• Patient has serious intentions but somehow survives.
• Sometimes, in spite of complete planning, the patient somehow survives and has a strong guilt of suicidal action and again goes into depression.

3. Parasuicide:

• It is attempted in order to draw attention of others towards some overwhelming problem which patient faces at that time.
• Patient does not want to die, but wants to alter his life situation.
• The attempt is done in front of others dramatically.
• e.g. cutting the wrist, lying in front of railways or any other vehicle, consuming sleeping pills, pouring kerosene, etc.

4. Altruistic suicide:

• This type is less common and is committed for benefit of others.
• In detail, The patient may perceive it as a way to rid someone of the burden of caring for him.

5. Egoistic suicide:

Occurs when patient feels that he has never really been integrated into the society and does not belong to it. [2]

Some common risk factors 

• Age
• Physical illness
• Widowed, either divorced, or separated
• Social isolation
• Loneliness
• Grief
• Threat of moving to a residential home
• Alcohol abuse
• Depression, either past or present
• Recent contact with a psychiatrist

Pathogenesis of Suicide Prevention

Suicide prevention aims to interrupt the pathway leading to suicidal behavior. This involves understanding the complex interplay of risk factors and protective mechanisms. Here’s a deeper look:

1. Risk Factors:

• Biological:

  • Genetic predisposition: Family history of suicide or mental disorders.
  • Neurobiological factors: Imbalances in neurotransmitters like serotonin and dopamine.
  • Medical conditions: Chronic pain, terminal illness, traumatic brain injury.

• Psychological:

  • Mental disorders: Depression, anxiety disorders, bipolar disorder, schizophrenia, substance use disorders.
  • Personality traits: Impulsivity, hopelessness, aggression.
  • Cognitive factors: Negative thinking patterns, cognitive rigidity.

• Social:

  • Social isolation and loneliness.
  • Lack of social support.
  • Relationship problems, family conflict, or abuse.
  • Socioeconomic disadvantage, unemployment, or financial strain.
  • Exposure to suicide (e.g., through media or personal experience).

• Environmental:

  • Access to lethal means (e.g., firearms, medications).
  • Stressful life events: Loss of a loved one, job loss, relationship breakdown.
  • Cultural and societal factors: Stigma associated with mental illness and help-seeking.

2. Protective Factors:

• Individual:

  • Strong coping skills and resilience.
  • Problem-solving abilities.
  • Positive self-esteem and sense of purpose.
  • Religious or spiritual beliefs.

• Social:

  • Strong social support network (family, friends, community).
  • Connectedness to school or work.
  • Access to mental health care and support services.

3. The Pathway to Suicide:

Suicide is not typically a result of a single factor but rather a complex interaction of multiple risk factors and the absence of protective factors. This can be conceptualized as a pathway:

• Predisposing factors: Underlying vulnerabilities (e.g., genetic predisposition, early life experiences).
• Precipitating factors: Stressful life events or triggers that exacerbate vulnerabilities.
• Perpetuating factors: Ongoing stressors or difficulties that maintain suicidal thoughts and behaviors.

4. Suicide Prevention Strategies:

• Universal prevention: Aims to reduce risk factors and promote protective factors in the general population (e.g., public awareness campaigns, school-based programs).
• Selective prevention: Targets specific groups at higher risk (e.g., individuals with mental health disorders, those who have experienced trauma).
• Indicated prevention: Focuses on individuals who are showing signs of suicidal ideation or behavior (e.g., crisis intervention, treatment of underlying mental health conditions).

Pathophysiology

Suicide prevention aims to disrupt the underlying biological and neurological processes that contribute to suicidal behavior. Here are some key aspects:

• Neurotransmitter Dysregulation:

  • Serotonin: Low serotonin levels are associated with impulsivity, aggression, and suicidal behavior. Many antidepressant medications work by increasing serotonin availability in the brain.  
    
     
  • Dopamine: Dysfunction in dopamine pathways may contribute to anhedonia (inability to feel pleasure), hopelessness, and decreased motivation, which are risk factors for suicide.
  • Gamma-aminobutyric acid (GABA): GABA is an inhibitory neurotransmitter. Reduced GABAergic activity may contribute to anxiety and agitation, increasing suicide risk.  
    
     

• Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction:

  • The HPA axis is involved in the stress response. Chronic stress can lead to HPA axis dysregulation, resulting in elevated cortisol levels. This can contribute to mood disorders and increase vulnerability to suicidal behavior.  
    
     
  • Suicide prevention may involve strategies to regulate the HPA axis and reduce the impact of stress.  
    
     

• Brain Inflammation:

  • Emerging research suggests a link between inflammation in the brain and suicidal behavior. Anti-inflammatory medications may have a role in suicide prevention for certain individuals.  
    
     

• genetic and Epigenetic Factors:

  • Genetic predispositions can influence neurotransmitter function and stress response, increasing vulnerability to suicidal behavior.
  • Epigenetic modifications (changes in gene expression due to environmental factors) can also play a role.  
    
     

Suicide prevention strategies often target these pathophysiological mechanisms through:

• Pharmacological interventions: Antidepressants, mood stabilizers, and antipsychotic medications can help regulate neurotransmitter levels and brain function.  
  
   
• Psychotherapy: Therapies like cognitive behavioral therapy (CBT) can help individuals develop coping skills, challenge negative thoughts, and manage stress.  
  
   
• Lifestyle modifications: Exercise, healthy diet, and stress reduction techniques can promote brain health and resilience.

Homoeopathic Treatment for Suicide

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines : 

Aurum:

Attempt it due to depression.

Veretrum:

Attempts due to mania.

Carcinosin:

Attempts due to cancer or family history of cancer.

Nux vomica:

Wants to attempt but lacks courage.

Hyoscyamus:

He is bugged of his delusions so wants to attempt suicide.

Wants to attempt it due to drunkenness – Arsenic, Belladonna, Nux Vomica.

By Different attempts:

By drowning i.e.:

Argentum Nitricum, Helleborus, Hyoscyamus, Lachesis, Rhus Tox, Pulsatilla.

By Fire i.e.:

Arsenic.

By Hanging i.e.:

Arsenic, Belladonna, Aurum Metalicum, Helleborus, Natrum Sulphuricum.

By Gassing i.e.:

Arsenic, Nux Vomica

Attempts due to Homesickness i.e.:

Capsicum

Wants to Kill him with Sharp Weapon i.e.:

Alumina

Suicide after Disappointment in Love i.e.:

Aurum Metalicum, Belladonna, Causticum, Hyoscyamus, Staphysagria.

By Shooting i.e.:

Natrum Sulphuricum, Staphysagria.

Suicidal Thoughts i.e.:

Aurum Metalicum, Carcinosin, Hepar Sulphuricum, Ignatia, Natrum Sulphuricum, Psorinum, Pulsatilla, Rhus Toxicodendron. [2]

Diet & Regimen

• Diet:

  • Omega-3 Fatty Acids: The book mentions the potential benefits of omega-3 fatty acids, found in fatty fish, for mood regulation. Some studies suggest that omega-3s may have antidepressant effects.
  • Mediterranean Diet: A balanced diet rich in fruits, vegetables, whole grains, and healthy fats, like the Mediterranean diet, may support overall health and mental well-being.

• Regimen:

  • Exercise: Regular physical activity is known to have antidepressant and anxiolytic effects. It can improve mood, reduce stress, and promote better sleep.
  • Sleep: Sleep disturbances are common in mental health disorders and can increase suicide risk. The book emphasizes the importance of adequate sleep for mental health.
  • Stress Management: Chronic stress is a significant risk factor for suicide. The book highlights the importance of stress reduction techniques like mindfulness, meditation, and relaxation exercises.
  • Substance Use: Substance abuse, including alcohol and drug abuse, is strongly linked to increased suicide risk. Avoiding substance abuse is crucial for suicide prevention.

Important Considerations:

• Holistic Approach: While diet and regimen can contribute to overall mental health, they are not a substitute for professional treatment of mental health disorders. Suicide prevention requires a comprehensive approach that addresses underlying mental health conditions and provides necessary support.
• Individualized Plans: Dietary and lifestyle recommendations should be tailored to individual needs and preferences. It’s essential to consult with a healthcare professional or registered dietitian for personalized advice.

Do’s & Don’ts 

Suicide prevention do’s & don’ts

Do:

• Take any suicidal talk or behavior seriously. Even if you think someone is not serious, it’s crucial to address their concerns and seek professional help.
• Listen actively and non-judgmentally. Create a safe space for the person to express their feelings without fear of judgment or criticism.
• Ask directly about suicidal thoughts. Don’t be afraid to ask if the person is thinking about suicide. This can open up a conversation and allow them to get help.
• Encourage them to seek professional help. Offer to help them find a mental health professional or connect them with resources like a crisis hotline.
• Remove access to lethal means. If possible, remove any means the person could use to harm themselves, such as firearms or medications.
• Stay connected and offer support. Let the person know you care and are there for them. Regular check-ins and ongoing support can make a difference.

Don’t:

• Don’t ignore or dismiss their feelings. Avoid minimizing their pain or telling them to "snap out of it."
• Don’t promise to keep their suicidal thoughts a secret. It’s essential to seek help, even if it means breaking their trust.
• Don’t leave them alone if they are in immediate danger. Stay with them and call for help immediately.
• Don’t try to handle the situation alone. Seek support from other friends, family members, or professionals.
• Don’t blame yourself or the person. Suicide is a complex issue, and it’s important to remember that you are not responsible for someone else’s actions.

Terminologies 

Genral Terminologies 

1. Mental Symptoms:

• Anguish: Extreme mental distress and anxiety, often with a sense of impending doom.
• Despair: Loss of hope and a feeling of utter hopelessness.
• Aversion to life: A strong dislike or disinterest in life, often accompanied by suicidal thoughts.
• Loathing of self: Intense self-hatred and feelings of worthlessness.
• Fear of death: A profound fear of dying, which paradoxically can be associated with suicidal ideation.
• Delusions: False beliefs, such as believing one is being persecuted or is a burden to others.

2. Emotional Symptoms:

• Grief: Intense sadness and sorrow, often related to loss.
• Irritability: Easily angered or frustrated.
• Anxiety: Excessive worry and apprehension.
• Restlessness: Inability to relax or stay still.
• Mood swings: Rapid and extreme changes in mood.

3. Physical Symptoms:

• Sleep disturbances: Difficulty falling asleep, staying asleep, or experiencing restful sleep.
• Appetite changes: Loss of appetite or increased cravings.
• Fatigue: Extreme tiredness and lack of energy.
• Physical complaints: Headaches, digestive issues, or other physical symptoms that may be related to emotional distress.

4. Homeopathic Principles:

• Susceptibility: The individual’s inherent sensitivity to internal and external factors, which can influence their response to remedies.
• Causation: The underlying cause of the mental and emotional distress, which may include past traumas, grief, or chronic stress.
• Constitution: The individual’s overall physical and mental makeup, which guides remedy selection.

5. Remedies:

• While the specific remedies used will vary depending on the individual’s unique symptom picture, here are some commonly used remedies for mental and emotional distress that may be relevant in a homeopathic approach to suicide prevention:
  
  • Aurum metallicum: For deep despair, melancholy, and suicidal thoughts, often with feelings of guilt and worthlessness.
  • Natrum muriaticum: For grief, isolation, and suppressed emotions, with a tendency to dwell on past hurts.
  • Ignatia amara: For grief, disappointment, and emotional shock, with symptoms like sighing, sobbing, and mood swings.
  • Arsenicum album: For anxiety, fear, restlessness, and perfectionism, with a fear of death and disease.

Homoeopathic Terminologies

Vital Force: A core principle in homeopathy, referring to the inherent life force or energy that maintains health and balance in an individual. Disturbances in the vital force are believed to lead to illness, including mental and emotional distress.

Totality of Symptoms: This refers to the complete picture of the individual’s symptoms, including physical, mental, and emotional aspects. Homeopathic treatment aims to address the whole person, not just the isolated symptoms.

Individualization: A cornerstone of homeopathy, where treatment is tailored to the unique characteristics and symptom profile of each individual. This is crucial in addressing the complex factors contributing to suicidal ideation.

Remedy: A substance prepared according to homeopathic principles, used to stimulate the vital force and promote healing. Remedies are selected based on the totality of symptoms.

Repertory: A comprehensive index of symptoms and their corresponding homeopathic remedies. Homeopaths use repertories to help select the most appropriate remedy for a given case.

Miasm: In homeopathy, a miasm refers to a deep-seated predisposition to certain patterns of illness. Some homeopaths believe that miasms can contribute to chronic mental health issues and suicidal tendencies.

Aggravation: A temporary worsening of symptoms after taking a remedy, often seen as a sign that the remedy is stimulating the vital force to initiate healing.

Provings: Systematic studies in which healthy individuals take a substance and record their symptoms, helping to determine the substance’s potential homeopathic uses

References

1. The 11th edition of Kaplan & Sadock’s Comprehensive Textbook of Psychiatry (2022), authored by Benjamin J. Sadock, Virginia A. Sadock, and Pedro Ruiz and published by Wolters Kluwer, offers a comprehensive overview of mental health disorders and their treatment, including suicide prevention.

2. Edwin S. Shneidman’s The Suicidal Mind (1996, republished 2004), published by Oxford University Press, delves into the psychological and existential factors that contribute to suicidal ideation and behavior.

3. Night Falls Fast: Understanding Suicide (1999) by Kay Redfield Jamison, published by Vintage Books, provides a poignant and insightful exploration of suicide, combining personal experience with scientific research.

4. Suicide and Attempted Suicide: Methods and Consequences (2002) by Geo Stone, published by Carroll & Graf, examines the various methods of suicide and their impact on individuals, families, and society.

5. Matthew K. Nock’s Why People Die by Suicide (2013), published by Harvard University Press, investigates the underlying motives and intentions behind suicide, drawing on psychological and neurobiological research.

6. The Neuroscience of Suicidal Behavior (2014) edited by J. John Mann, George S. Alexopoulos, and Husseini K. Manji, and published by American Psychiatric Publishing, explores the biological and neurological underpinnings of suicidal behavior, providing insights into potential prevention and treatment strategies.

7. Suicide Prevention: A Holistic Approach (2017) by Rory O’Connor, Jacki Gordon, and Claire Casey, published by Routledge, presents a comprehensive framework for suicide prevention, encompassing individual, social, and environmental factors.

8. Completing Suicide: Giving Up on Life (2017) by Thomas Joiner, published by The Guilford Press, examines the psychological processes and factors that lead individuals to choose suicide as a solution to their problems.