Suicide rates across the world are expected to rise in the wake of the COVID-19 pandemic and associated effects such as job losses, increased poverty, a spike in alcohol and drug dependency and a sense of fear and isolation as the virus continues to spread.
A recent study in China surveyed 52, 730 people during the COVID-19 epidemic and found that about 35% of the participants had psychological distress. These results are consistent with a US survey indicating that 45% of adults in the USA report that their mental health has been negatively impacted due to worry and stress over the coronavirus.
And record numbers of women are seeking mental health services with 27% of females polled by leading global humanitarian agency Care International admitting an increase in problems linked to mental illness since lockdown.
Although there was no guarantee the impact of COVID-19 would lead to higher suicide rates, counselling charity Samaritans said its research, based on calls to its helpline, found the pandemic had exacerbated known risk factors for people already vulnerable.
Chief executive Ruth Sutherland said: “With the impact of the pandemic this year taking a huge toll on people’s mental wellbeing, we should be even more concerned. Volunteers are telling us that many callers have been worried about losing their job and/or business and their finances, with common themes around not being able to pay rent/mortgage, inability to support the family, and fear of homelessness.”
Vicki Nash, the head of policy and campaigns at the charity Mind, said: “Not all suicides are mental health-related but many are, and we know that a significant proportion of people who take their own lives have asked for support for their mental health within the last 12 months, which means that services are failing people when they need help the most.”
The concept of suicide is an exceedingly complex issue that causes pain to millions of people around the world.
Close to 800,000 people take their own life every year, and there are countless others who attempt it. On average, that’s one person losing their life every 40 seconds. In 2020, it was forecast that the number could inconceivably drop to one life lost every 20 seconds.
Due to the stigma associated with suicide – and the fact that it is illegal in some countries – this figure is also likely to be an underestimate, with some suicides being classified as unintentional injuries.
Globally, suicide rates are highest in people aged 70 years and older. Somewhat unsurprisingly though, suicides follow an almost linear pattern of the more senior the age group, the higher the death rate.
However, the issue of concern for many mental health experts and professionals alike are the numbers involving young people. America’s Center for Disease Control found that teenage suicide rates had increased 56% in a decade from 2007-2017. What’s worse is that mental health experts have little concrete evidence for what’s driving this increase, making it difficult to form a strategy to provide early intervention.
Understanding suicide and its risk factors
Every suicide is a tragedy that affects families, communities and entire countries. It has long-lasting effects on the people left behind.
Suicide behaviours are complicated, and there is no single explanation of why people choose to commit suicide. Social, psychological, and cultural factors can all be reasons that lead a person to suicidal thoughts or behaviour. In many cases, an attempt may occur after a long period of suicidal thoughts or feelings, while in others, actions can be more impulsive.
Using data from the United States indicates that suicide attempts are more impulse-driven than many people realise. Nearly half of suicides occurred less than 10 minutes after an individual first seriously contemplated it. Around 60% of suicides happen within the same day. What this tells us is that some suicides are undoubtedly preventable.
While the connection between suicide and mental disorders (particularly, depression and drug-dependency disorders) is well-documented in high-income countries, many suicides occur suddenly in moments of crisis. This crisis commonly manifests as an emotional breakdown, stemming from an inability to deal with life stresses, such as financial problems, relationship issues or chronic pain and illness. According to the WHO, by far the most potent risk factor for suicide is a previous suicide attempt. Despite that, in the US, around 70% of suicide survivors will never attempt suicide again, and 23% will have a non-fatal attempt. 7% of those who had survived a suicide attempt will eventually have a fatal suicide attempt.
Suicide was the second leading cause of death among 15-29 year-olds globally in 2016.
Suicide is one of the leading causes of death in adolescence and early adulthood worldwide.
The deaths caused by suicide account for almost one-fifth of all deaths among European older adolescents and young adults together (15–29 years), representing about 24,000 deaths each year. In comparison, suicide is not even in the top ten most frequent causes of death in the older age groups. The fact that these statistics relating to young people have continued to grow year on year has caused great concern among scientists and policymakers.
The increasing awareness regarding the harmful effects of youth suicidality is not only troubled by the loss of so many young lives but also in the disruptive psychosocial and adverse socio-economic effects on a broad societal scale. From the perspective of public mental health, suicide among young people is one of the main issues to address through effective preventive measures.
Key risk factors of suicide in young people
It’s crucial to note that correlation does not equal causation, and most mental health experts caution against isolating one “cause” or factor when discussing suicide.
Although certain factors such as a history of mental illness or substance use increase the risk of teenagers to take their own lives, the mental health establishment simply doesn’t have enough research to draw “firm scientific conclusions” about what causes spikes in suicide.
That said, research does indicate that early intervention in the form of initiatives like suicide screening at emergency rooms and paediatricians’ offices do play a role in helping to prevent suicide, as does exposure to positive stories about people recovering from feelings of suicidal ideation.
Depression and other mood disorders are widely recognised among the most critical risk factors for suicide.
Close to 90% of people who commit suicide have suffered from some form of mental health disorder. Two points are worth emphasising:
- mood disorders – mainly depression – account for the largest share of diagnosed disorders in suicide cases, and
- suicide is found associated with a variety of mental disorders.
Previous suicide attempts
As previously mentioned, researchers have strong beliefs in the links between previous suicide attempts, or a history of self-harm, and suicide.
Around 25–33% of all cases of suicide were preceded by an initial suicide attempt. This phenomenon was more prevalent among boys than girls. Research indicates that boys with a previous suicide attempt have a 30-fold increase in suicide risk compared to boys who have not attempted suicide, but the gap between genders is closing.
First and foremost, suicide is associated with impulsiveness. While it’s true that the suicidal process can take weeks, months or even years, the fatal transition from suicidal ideation to an actual completed suicide often occurs suddenly, unexpectedly and impulsively, especially among adolescents.
Young people who committed suicide were also found to have had poorer problem-solving skills than their peers. Instances of their behaviour were characterised by a passive attitude, waiting for someone else to solve the problem for them, for simple problems as well as for more complex interpersonal problems.
Another reason points to a rigid way of thinking in the minds of young suicide victims. Scientists call it ‘dichotomous thinking’, where people experience events and express their experiences as totally ‘black’ or ‘white,’ very good or very bad, with little space in between.
Compounding, this also accounts for their self-image. The inability to problem solve and regulate their mood often causes insecurity, low self-efficacy and self-esteem, but it can also lead to anger and aggressive behaviour, emotional crisis and suicidal crisis, especially in combination with perfectionist personalities.
It is estimated that in 50% of youth suicide cases, family factors are involved.
A key factor is the family history of mental disorders among direct family members themselves, especially depression and substance abuse. Adoption studies indicate a more significant relationship between suicidal behaviour with biological relatives than adoptive relatives, which highlights more genetic explanation.
Poor familiar communication is also found in many cases of suicide, not specifically involving the child and their problems, but in general, between family members. Studies have shown that direct conflicts with parents can have a profound impact, but so does the lack of communication and the neglect of communication needs.
Domestic violence is something that also seems to be present in the background of suicide victims, notwithstanding events that the young person experiences but also as a way of dealing with problems. Parental divorce is only weakly associated with suicide as it is likely compounded by the practical, financial and socio-economic implications of living in a single-parent family.
Specific life events
Risk factors of suicide directly linked to specific important life events are very diverse, but some are more common than others.
Most young people hold great importance to being involved in social groups, developing relationships and establishing confidence and identity. Therefore, it is not a great surprise that interpersonal losses such as relationship break-ups, the death of friends and peer rejection may have a great impact in youth, and are found in one-fifth of youth suicide cases.
Issues at school and academic stress were found in 14% of suicide cases. Young people who are “drifting,” i.e., not going to school nor working a job, are of much greater risk of suicide, due to a lack of structure and predictability.
Social isolation contributes to the pathophysiology of psychiatric disorders and suicidal behaviour.
The risks associated with COVID-19 may lead to the development or exacerbation of stress-related disorders and suicidality in vulnerable people including individuals with pre-existing psychiatric disorders, low-resilient persons, and those who live in high COVID-19 prevalence areas.
A recent study in China surveyed 52 730 people during the COVID-19 epidemic and found that about 35% of the participants had psychological distress. These results are consistent with a US survey indicating that 45% of adults in the USA report that their mental health has been negatively impacted due to worry and stress over the coronavirus.
Younger people are more impressionable and thus more prone to ‘contagion’ by the behaviour of others (models) than older people.
Imitation of suicide behaviour by young people can occur at a macro level (e.g., by mass media reports), but is also likely to be caused by direct contact in their living environment (e.g., peer groups, friends, school environment).
The young person can be influenced by a number of factors. Primarily, how close the youngster is to the ‘model’, whether they identify similarities in their personality or predicament and even if they admire them (celebrities). Secondly, if the model’s behaviour is reinforced in a positive manner, i.e. if the model is seen to be respected or brave can significantly influence a young person’s perspective. Thirdly, the frequency of that positive message and how often a young person is exposed to it.
Availability of means
People thinking about suicide are usually equivocal about the decision.
The transition from suicidal ideation to actual suicide often occurs impulsively as a reaction to acute psychosocial stressors, especially among young people. Some studies have shown that restricting the physical availability of means of committing suicide can be crucial in suicide prevention strategies.
How to talk to a person that might have suicidal thoughts
If your friend or someone you know is currently at risk of attempting suicide, call your local emergency services straight away.
Imminent danger is when a person is in possession of a weapon, pills, or other means to commit suicide. If possible, it’s best not to leave them alone and do your best to negate any possible means they can use to hurt themselves. When safe, you may also drive your friend to an emergency unit. Doctors will assess their mental and physical health and ensure there is a plan for the future.
However, if you believe the threat is serious, but not imminent, it’s still important to act, but you may take the time to show support, listen, and encourage them to seek professional help. Help is available.
Your role here is to be a supportive and empathetic friend. The key is to avoid being judgmental or dismissive of what your friend is feeling.
Speak from the heart
There are no right or wrong things to say if you are speaking out of concern for a loved one. Just be yourself. Show the person that you care by talking to them, holding them while they cry, or however you feel comfortable. Research proves that acknowledging what they are experiencing may help them process their thoughts and may reduce their suicidal thoughts.
This is the most critical step. A suicidal person usually feels at the end of their tether, as if they are in an inescapable situation. Offer to listen as they vent their feelings of despair, anger, and loneliness. Sometimes this is enough to lighten the load just enough for temporary emotional relief.
Validate them and be open
Try to act sympathetic, non-judgmental, patient, calm, and accepting. The person will pick up on your attitude and begin to mirror it for themselves.
Confirm their suicidal thoughts
You should never be afraid to ask, “Are you having thoughts of suicide?”
Studies have revealed that asking at-risk friends and family members if they are thinking about suicide does not increase suicidal thoughts. Essentially, by asking you are not putting ideas in their head. On the contrary, asking will give you valuable information about how to proceed and help.
Keep them talking
Continuing to talk to the person will help reduce the emotional burden and give them time to become settled. The longer you keep them talking, the better job you do of taking the edge off their emotions. Be prepared to frequently check in with that person throughout the following hours, days and weeks. Knowing someone is aware of their situation and that they care is massive for anyone.
When to seek help
If the conversation leads you to believe they are in immediate danger, do not hesitate to contact the authorities. They might say that you are betraying them or making them angry. You may begin to think that you will lose their friendship if you take action. What you shouldn’t forget is that you may permanently lose their friendship if you don’t. When they’re well again, they will be there to thank you.
Avoid trying to solve the problem
Try not to offer fast solutions or belittle the person’s feelings. What really matters is how big they perceive the problem and the real pain they are suffering. Keep in mind that rational arguments do very little to persuade a person when they are in this state of mind. What you can do is offer your empathy and compassion for what they are feeling without making any judgments about whether they should feel that way.
Avoid saying things like “It’s not that bad,” “Stay positive” or “You’re being selfish”. Belittling or invalidating a person’s feelings is not helping them. In fact, their ability to verbally express their feelings is a huge step. This isn’t a contest where some ‘deserve’ the right to be depressed. When a person is struggling, what’s most important is helping them with their reality, not comparing it to others.
Suicide prevention with a Continuing Care programme
When an individual faces the challenge of addiction or a behavioural disorder, it may often require a swift intervention, which brings together family and friends.
Our Continuing Care Programme at The Kusnacht Practice provides ongoing support for lasting recovery. This programme is a crucial part of dealing with a past suicide attempt and ensuring that you go back to your daily life with the most support possible. The programme is designed to make certain that our clients continue their recovery and put into practice the healthy coping mechanisms they developed during their treatment.
Continuing Care includes a mentor programme, daily/weekly telephone / Skype contact and regular face-to-face meetings with specialists during return visits to our treatment centre. We can also put clients and their families in touch with trusted, independent consultants in any location to assist with the intervention.
Mentoring involves the client’s primary counsellor typically returning home with them and living with them for a period lasting from a few days to several months. The mentor assists the client in establishing a recovery programme, adapting their lifestyle to their programme and working through problems that arise during the early period following their return to home life.