Dealing with suicidal behavior

By Flavia Nassaka

Experts call for urgent interventions to deal with suicide as a public health issue

The death of an American  Oscar winning actor and  comedian Robin Williams through committing suicide in August  last year got the world wondering about how a person with such a sense of humor could ever think of taking his own life.   The following month, the World Health Organization (WHO) released their first ever comprehensive report on suicide prevention. The report showed that the number of suicide deaths was on the increase with more than 800,000 people dying every year. More than 75% of all the deaths happen in developing countries.

It’s estimated that a person ends his/her own life every 40 seconds.  According to World Health Rankings, Uganda ranks among the top 30 countries with the highest cases of suicide. Dr. Eugene Kinyanda, a consultant psychiatrist, confirms this. He says though they have scanty data on the problem, suicide is a growing public health concern that needs to be paid attention to.  He says the reasons for suicide are many and varied, which include the changing life style that eventually leads to mental problems.  “The economy is increasingly becoming cash-based. For one to live a decent life, they have to earn more income. When some fail to live to this standard, they get stressed and eventually depressed,” he says. He adds that when some people discover they are HIV positive for the first time, death is the first thing they think of.

He says suicide has been found to be a major cause of death among people with mental illness whereby one in ten people will kill themselves explaining that at times a suicide attempt may be an early warning sign that one is developing a mental problem.  Dr. Harriet Oketcho, a psychiatrist at Butabika Mental Hospital in Kampala, says in many cases, suicide is linked to feelings of hopelessness and worthlessness whereby males aged between 20 – 40 years dominate the list of those who commit suicide through hanging, over-dosing or ingestion of poison.

Mental conditions linked to suicide

It’s estimated that 90% of people who attempt or die by suicide have one or more mental health conditions. However, in some cases, the condition may not have been formally diagnosed by a medic. Dr. Kinyanda explains conditions that should be watched as they lead to the biggest risk of suicide.

Depression and bipolar disorders are the highest cause of suicide since they come with symptoms of low mood, tiredness, loss of interest, despair and hopelessness that interfere with a person’s life. Such people will attempt suicide at least once.

An eating disorder called anorexia nervosa is a high risk of suicide. People with anorexia feel fat and try to keep their weight as low as possible. They do this by strictly controlling and limiting what they eat. At times they might feel they are consuming unhealthy foods and therefore may start inducing vomiting every after meal. He says one in five people with this condition will make at least one suicide attempt.

Hallucinations and delusions – believing, hearing or seeing things that are not real – cause change in behavior and as a result 20% of people with such a condition will take their own life when they experience their first symptoms.

Personality disorders that involve disturbed thinking and unstable emotions, which make a person have unstable relationships with other people. People with such disorders, Dr. Kinyanda adds, most times have a history of sexual abuse especially in their childhood, which makes them feel like harming themselves. He says half of all people with personality disorders will attempt suicide in their lifetime.

How to help a suicidal person

Dr. Oketcho says a suicidal person shouldn’t be blamed or judged because nobody attempts to take their life for fun. They don’t want to die but just want to stop hurting, which means almost for every suicide victim, there is a problem that needs fixing, he says. The first step is recognizing the warning signs such that the family or friends of the victim can seek the root cause of the problem that drove one to such depths of despair.

She says with a help of an expert it is easier to find the problem as a test can identify a gene that is common in depressed people as they have a DNA marker that can help a doctor spot changes that are likely to put a patient at risk of committing suicide. Such people can be put under closest supervision when they are on treatment since they themselves can’t notice that they have a problem.

However, experts say suicide cannot only be addressed through mental health services, which is why victims and their relatives should look at the full range of complex reasons that may have caused it since some tendencies are inherited from parents or a family member who has ever attempted to kill him or herself.   They say people who have attempted suicide before are more likely to do it again but with medical intervention, counseling, social support and time, many of those who have attempted suicide, or who have seriously thought about killing themselves have healed to live productive lives.

Dr. Kinyanda therefore believes there is an urgent need to educate the entire population about suicide since these cases are rarely talked about and in most communities considered a taboo whereby when a person hangs himself, they won’t be given a decent burial.

He said recognizing suicide as a health problem would help in integrating psycho- social support into the treatment regime and also in devising ways of averting suicidal intentions.