Suicide: from risk factors to prevention and assistance

According to WHO, suicide is the 2nd leading cause of death among young people and it is one of the three main causes of death, official statistics for which remain quite high.

While mental health conditions increase the risk of suicide, it is rarely caused by any one factor. Suicide is a complex and serious problem on a personal, family, community and national scale.

There are risk factors that can help us identify people who need support, and sometimes there are warning signs of voluntary death. But determining suicide risk is not so easy. A number of signs, when present, can be very subtle.

Problem Definition

While most people understand the term suicide to mean the voluntary or intentional acceptance of one's death, it is important to understand the arc of suicidal behavior and the associated terminology.

Fifty-four percent of people who died by suicide had no history of mental illness

In order to increase awareness and understanding of this growing health problem, it is important to review specific terminology:

• Intentional self-harm. Behavior that is self-directed and intentionally results in injury or potential injury to oneself.
• Non-suicidal intentional self-harm: Includes self-directed behavior whose purpose is to cause injury or to cause injury. But there is no evidence of deliberate or overt suicidal intent.
• Suicidal Self-Directed Violence: Involves self-directed behavior intended to cause injury or likely to result in injury, with overt, covert, or overt suicidal intent.
• Vague self-directed violence. Behavior that is self-directed and intended to cause harm to oneself, but suicidal intent is unclear based on available evidence.
• Suicide attempt. Non-fatal self-directed harmful behavior with some attempt to die. Attempting suicide is not always successful.
• Interrupted Self-Directed Violence: A person takes steps to harm himself but is stopped or stopped by another person.

Basic concepts in suicidology

• Suicide is taking one's own life in one way or another. Suicide can be completed, i.e. end in death, or incomplete and constitute a suicide attempt.
• Anti-vital experiences - disturbing thoughts about the low value of existence, statements in the form: “it’s not worth living, there’s no point”, “everything is in vain”, “not life, but a miserable living of every day.”
• Passive suicidal thoughts are fictions, ideas about one’s death, but not about taking one’s own life: “I wish I could fall asleep and not wake up,” “it would be nice to die at home.” Death seems to be something quick, even pleasant and painless. A person vividly fantasizes and comes up with pictures of how his relatives grieve and mourn, what will change after his death.
• Suicidal plans are active thinking through and preparation for committing suicide: a person is looking for a rope, strong medicine, writing suicide notes, choosing a suitable place and time to commit suicide.
• Pre-suicide is the moment from the appearance of suicidal thoughts to attempts to commit suicide itself.
• Suicidal intentions - joining suicidal plans with the desire to commit suicide.
• Parasuicide is causing harm to health, without the desire to end life, in order to get what you want, the reaction of others and loved ones. Parasuicide is committed against the backdrop of an emotional outburst and is essentially demonstrative. This behavior is typical for persons with hysterical traits and psychopathy.
• Extended suicide - when a suicide deliberately leaves life and, guided by his painful beliefs and ideas, kills the people around him (for example, his family, so that they do not suffer in this world).

Suicide trends

According to statistics, there are gender variations in suicide. Men turn to suicide as a way to “solve problems” twice as often as women, both in groups with diagnosed mental disorders and in groups of healthy people. The most common mental disorders are depression and schizophrenia. The greatest risk of suicide is observed among those who have already attempted suicide before.

Although mental health services are recommended for high-risk people who have already attempted suicide, it should be kept in mind that psychotherapeutic services will have the greatest preventative effect if they are provided before the suicide attempt. When considering the problem of suicide, the most successful are preventive measures and timely treatment of mental disorders.

Suicide prevalence

The number of suicides has been steadily increasing in recent years. The World Health Organization (WHO) estimates 1 million people die from suicide and up to 20 million people attempt suicide each year.

More people die by suicide than in all armed conflicts combined. Thus, suicide ranks 8th among the causes of death and 1st among violent deaths. Over the past 60 years, the number of suicides in the world has increased by 60%, and child and adolescent suicides by 30 times. This means that the suicide rate is currently 14–16 cases per 100,000 population.

Suicide occurs in all age groups - children, adolescents, adults and the elderly. Suicide is not determined by gender.

In Russia, there is currently a higher rate of suicidal activity in the population - 20 cases per 100,000 population. These impressive figures, of course, do not reflect the true picture of suicidological activity in the population. A huge number of cases, for one reason or another, remain unaccounted for and do not come to the attention of medical services and psychiatrists in particular.

According to official data, only 1 in 4 suicide attempts is included in statistics. This fact is associated with several reasons, such as the reluctance of the relatives of the suicide to admit that death occurred precisely as a result of suicide, the facts of suicide are hidden in order to pay for treatment through insurance, etc.

Difficulties also lie in the timely recognition and prevention of suicide. As a rule, people planning suicide and deciding to end their life rarely communicate their intentions directly. Why is suicide so common among the population? The answer lies in the factors influencing people's behavior.

Reasons for suicide. Who is at risk?

Many factors contribute to suicide. Moreover, the influence of each of them can be direct or indirect.

Although public suicide statistics show an increase in suicide rates among people who have not previously been diagnosed with mental disorders, there is a link between suicide and mental illness. For example, depression has not been shown to have a direct effect on suicide risk, but it is the most common disorder among people who have attempted suicide.

Also common: bipolar affective disorder, anxiety spectrum disorders, schizophrenia, substance abuse.

Not everyone diagnosed with a mental disorder will become suicidal, but there is an increased risk if several factors are present.

Returning to the impact of the aforementioned depression, when a person is in a depressive episode, a combination of biological and psychological factors can cause feelings of helplessness and prevent them from developing a more positive assessment of future prospects or past memories.

Additionally, research confirms that alcoholism is one of the strongest predictors of suicide. People with substance use disorders are six times more likely to die by suicide than the average of the general population. Mature addicts, addicts with a history of previous suicide attempts, heroin users, and those who abuse sedatives are at higher risk in the drug addiction population.

Research has also linked family history to suicide risk: that the suicide rate in families of suicide victims was twice as high.

Childhood trauma and abuse (psychological, physical, sexual) can be a trigger for suicidal thoughts or ideas. For example, a 2021 study found a strong correlation between child sexual abuse and suicidal ideation as adults.

Other risk factors for suicide include:

• Relationship problems.
• A recent or anticipated critical moment.
• Substance use disorders.
• Physical health problems.
• Job problems and financial difficulties.
• Loss of housing.
• Criminal legal problems.

Young people are especially at risk for suicidal thoughts and behavior, with suicide being the second leading cause of death among youth ages 10 to 24.

If a child or adolescent has several risk factors, it is necessary to seek psychotherapeutic help. Suicide can be prevented with proper and - most importantly - timely support.

Risk factors that may affect youth include:

• Recent or serious losses, such as the death of a loved one, friend, or pet; breakup, separation, parental divorce, loss of home, financial problems affecting the family.
• Mental health disorders, especially depression or traumatic stress disorder.
• Having previous suicide attempts.
• Abuse of alcohol and other psychoactive substances, as well as particularly risky behavior.
• The struggle associated with asserting one’s own sexual orientation in an environment that is hostile to it.
• Family history of suicide.
• Bullying in some social environment (bullying), including school.
• Access to lethal means.
• Long history or severe psychological trauma.
• Lack of social support or social isolation.

Current research also shows a link between increased social media use among young people and increased social isolation. While causality remains unclear, the results suggest that people who spend more than two hours a day on social media are twice as socially isolated as those who spend half an hour a day or less.

Social media can have a positive role in engaging people who might otherwise (for various reasons) be left out of daily communication, but should not be used as a replacement for human relationships.

Historical overview of the development of suicidology

Since the dawn of human civilization, people have been interested in issues related to death.
Departure from life is an irrevocable event through which, be that as it may, every existing person passes. The very essence of death is shrouded in a huge mystery incomprehensible to the human mind. Various theories and guesses about death are deeply imprinted on the mental state of dying people, on the conditions under which they leave the world of the living and on the understanding of their actions and the lives of those who continue to live. As a result, death can be interpreted and experienced in different ways.

Suicides were first described in ancient times. In many tribes and nationalities, it was customary to commit suicide in order not to die from illness or old age. For example, in Japan, weak and sick old people went to the mountains to die there and not burden their children; samurai were obliged to take their own lives by harakiri, which was considered an honorable duty.

In Orthodox Russia, however, a negative attitude towards suicide has always been maintained; taking one’s own life was considered a grave sin. People who committed suicide were always buried outside cemeteries. It is still believed that the souls of the dead will never find peace in this way.

In the Middle Ages, suicide was popularized; we all remember the story of the unhappy lovers Romeo and Juliet.

The scientific study of suicide began only in the 1820s. With the advent of the concept of J. Esquirol, suicide began to be viewed as a manifestation of a painfully altered psyche, i.e. a consequence of a mental disorder. According to the sociological theory of E. Durkheim, the causes of suicide are weakened connections between people, due to which a person becomes extremely unstable to the problems and difficulties of life.

By the beginning of the 20th century. psychoanalytic models of the causes of suicide appeared, developed by S. Freud, C. G. Jung, A. Adler. Suicide was considered an aggression directed not at the outside world, but at oneself, a desire to return to a carefree time in the womb, an escape from the problems of an inferior personality.

N. Farberow in 1958 formulated the concepts of self-destructive behavior and indirect suicide. By these terms he understood a more extended period of death due to the abuse of drugs, alcohol, a propensity for risk and gambling, and violation of doctors’ recommendations regarding health.

A.G. made a huge contribution to Russian suicidology. Ambrumova (1978). She described suicide as a violation of human adaptation due to conflict and identified the types of situational reactions and types of suicides based on the motives for their commission. The research of E. Shneidman (2001) is interesting in terms of descriptions of the harbingers of possible suicide, identifying a special personality type predisposed to suicide. He identified 3 types of suicides: based on the conflict of parts of the personality, unfulfilled desires and lack of connection with society.

At the moment, as you can see for yourself, there are a huge variety of different theories and concepts in suicidology. There is something true and logical in each of them. But they examine the mechanisms and causes of suicide from only one perspective, without putting together the individual pieces of a general and holistic understanding of suicide.

There is hope that in the near future, suicidology as a science will develop more rapidly, the experience and knowledge accumulated over generations about suicide will be used more actively and more widely.

What is a suicide infection?

This term is used to refer to the process by which the suicide of one or more people can trigger an increase in suicidal behavior in others. This impact can affect many, but especially affects those who are already thinking about suicide, have previously attempted suicide, or have risk factors.

A recent study published in the journal PLoS One showed a nearly 10 percent increase in suicide rates following the suicide of actor Robin Williams in 2014. Men aged 30 to 44 showed the largest gains during this time.

When a celebrity commits suicide, the media is filled with articles and reports about her death, including sensational information and specific details. Such information coverage (sometimes pseudo-information) can provoke people with suicidal thoughts to identify with the celebrity or experience an increased sense of helplessness.

Other causes of suicidal thoughts

In most cases, the cause of suicide is not one, but several factors. A difficult period in life, traumatic events, prolonged stress - all this, along with genetic predisposition, can cause or worsen depression.

But whatever the reasons for the occurrence of suicidal thoughts and moods, such a problem cannot be ignored.

And the best thing to do in such a situation is to make an appointment with a psychotherapist or psychiatrist. The specialist will be able to identify the circumstances that caused such sentiments, assess the patient’s condition and possible risks, and take timely measures to prevent suicide.

Signs of suicidal behavior

The most common recommendation for suicide prevention is to look for “red flags” of suicidal behavior. But it is important to understand that not all people thinking about suicide raise this “flag”, and the signs can be extremely subtle. For example, talking about suicide does not necessarily mean committing it. Much more often a person means: “You will be better off when I leave.”

But there are signs that are really worth paying attention to. For example, some people begin to prefer risky behavior or dangerous situations. Seek help immediately if you notice that a loved one is exploring methods of suicide, trying to obtain deadly drugs, organizing their affairs in an unusual way, or giving away valuables. These are clear signs of suicidal ideation.

Other possible signs include:

• Expressing feelings of hopelessness.
• Declaration of a wish to die.
• Initiating conversations about what is a burden to others.
• A statement about feeling trapped.
• Expression of feelings of unbearable pain.
• Increased substance abuse.
• Restless, agitated, or reckless actions.
• Significant mood swings.
• Increased anger or rage.
• Isolation or the feeling of it.
• Changes in sleep patterns (too much or too little).

Any warning signs should be taken seriously in both adults and children. Don't assume that people talk about feeling hopeless or want to die to get attention. Each warning sign shows that a person is struggling and needs help.

Prevention and help

From a public health perspective, comprehensive programs in communities, school systems, and the workplace play an important role in understanding and preventing suicide. If people better understand risk factors and warning signs and have access to psychotherapy, suicide can be prevented.

Mental well-being, as well as the unconditional support of family and friends, are important steps to ensure the safety of your loved one. If you feel someone is at risk, do the following:

Ask Specific Questions

In fact, direct communication removes the burden of hiding difficult emotions for fear of judgment or stigma. This can provide a sense of relief from isolation.

Be open and listen carefully to the answers. Your loved one needs to be listened to and understood. Try these questions to start a conversation:

• “When did you start feeling like this?”
• "Do you need my help?"
• “How can I help you get through this time?”

Provide support

It is important to listen without judgment and express understanding/sympathy. You may not know exactly how your friend is feeling, but you can understand that they need emotional support during this difficult time.

Avoid statements such as “You have so much to live for!” or “How can you think about suicide?” Such comments can cause feelings of shame and further isolation.

Create a care plan

People contemplating suicide may find it psychologically difficult to seek help on their own. But you can help them decide: collect information about psychotherapeutic help, motivate them to see a specialist, support positive changes in their judgments and actions.

Tactics for helping in a crisis situation

So what measures are taken to prevent suicide attempts? First of all, it is the relief of psychological stress and resolution of a traumatic situation, reducing dependence on the cause that led to suicidal behavior. Next, it is necessary to form a compensatory mechanism of behavior and a clear, adequate understanding of life and death.

The tactics for helping in a crisis situation are as follows.

1. Assess the risk of suicide and its severity.
2. Do not leave a person unattended in a situation where there is a high risk of suicide.
3. Be sure to seek medical help from specialists. Thanks to their knowledge, skills and psychotherapeutic influence, psychiatrists and psychologists have a unique ability to understand a person’s feelings, needs and problems, and help cope with mental discomfort.
4. Establish a trusting and caring relationship, become an attentive listener, do not argue, ask questions, give a sense of hope.
5. Offer constructive methods for solving the problem, help in word and deed.

Self-help in a critical situation:

• speak out;
• write a letter;
• give yourself a gift;
• get a good night's sleep;
• try to avoid people who are unpleasant to you, enjoy today, communicate with interesting people and not pay attention to other people’s opinions, plan your life and change what you want to change in yourself and the world around you!

How to get help

There are a number of resources available to help people who are attempting suicide or who are at increased risk for suicide. The starting point depends on the level of risk.

• Emergency telephone lines:

8 – around the clock for adults in St. Petersburg and the Leningrad region; 8 – for children in St. Petersburg and the Leningrad region; 8-800-2000-122 – all-Russian helpline for children and parents;

• Cognitive behavioral therapy and dialectical behavioral therapy are the recommended and most effective treatments for people with suicidal thoughts or behavior.
• Some people who are prone to suicidal thoughts need medication. The psychotherapist will select the most optimal treatment regimen.

Suicide is complex, but very often preventable. If there are people around a person who is ready to commit suicide who want to mobilize available resources and help him, this life can be saved.

Phone numbers of organizations that provide suicide assistance