Risk Factors of suicide

The risk factors of suicide are considered factors that may contribute to increasing the possibility of suicide. These can be the causes of suicide but are not taken as the direct causes. According to Lauw, Abraham, & Loh (2018) suicide happens mainly in older than in younger people. But is still the reason behind the death of people in adolescence and late childhood at the global level. However, there are various risk factors that were found in different studies such as; mental disorders, specific personality traits, previous suicide attempts, family issues in connection with triggered psychological stressors and genetic loading, and at last availability of means of committing suicides (Pelkonen, Karlsson, & Marttunen, 2011).  In the case of Singapore, as per the report of the Institute of Mental Health, 1 adult amongst 13 adults in Singapore gets thoughts about suicide once in a lifetime. Among the total adult population in the country, 7.8% of adults plan for suicide (Lauw, Abraham, & Loh, 2018).

Out of that, 60% of people who committed suicide have suffered from at least one disorder. Mental disorder is amongst the risk factors that contribute between 37% to 54% of suicide risks in the case of adults  (Lauw, Abraham, & Loh, 2018). Depression was the most common disorder that was found among females more than males. This means when adolescent people are depressed because of any situation whether personal life or family issues or isolation they are more likely to attempt suicide (Pelkonen, Karlsson, & Marttunen, 2011). In addition to this, abuse and alcohol misuse is also connected with suicide risk mainly in males in older adolescents. More disorders that had less impact were antisocial personality disorder and anxiety disorders. With that, nearly 25% of suicide cases happened because of earlier suicide history or attempts (Choo, Chew & Ho, 2019).  As if any family members conducted suicide then this influences the behavior of adults. In this context, Crasta, Daks, & Rogge (2020) stated that greater concordance of suicidal behavior in the child is not seen because of adoptive relatives rather because of biological relatives. This is more common in boys than girls. Boys who attempted suicide previously have a 30 fold increase in suicide risk (Nock, Borges & Williams, 2018).  Hence, it can be said that in the case of adults risk factors to suicide are; mental disorders that lead to depression and suicide history attempts. As 75% of cases of suicide recorded of these two factors (Lauw, Abraham, & Loh, 2018)

Protective Factors of suicide

The older person mainly 65 and above attempts suicide because of social risk factors such as relationship issues with children and physical illness.  When old people have issues with their children such as daily fights and issues regarding financial aspects and in most cases children send their old parents to old age homes (Sareen, Isaak, Katz, Bolton, Enns, & Stein, 2014). Than in this case also older people get suicidal thoughts and attempt to suicide. Recently because of the pandemic, older people were more likely to face issues such as isolation and loneliness, and lack of stability. Because of loneliness they feel that there is no one who can take care of them and they started feeling like a burden on others. This lead to more cases of suicide amongst older people (Cantrell, Valley-Gray, & Cash, 2012).

Whereas, in 2016, suicide among those aged above 65 observed a 19% increase as in 2015 suicide deaths were 166 that increased to 197 and this has doubled in pandemic (K.G. Ng, 2021). More risk factors in this age group were employment issues, family relationships, financial worries, physical and psychological impairment, mental health, and chronic health problems (Pelkonen, Karlsson, & Marttunen, 2011). The only way forward is to strengthen protective factors and reduce these risk factors as much as possible by providing integrated and multi-sector prevention initiatives. 

Some of the protective factors are the development of coping and problem-solving skills and the availability of mental and physical care (Cantrell, Valley-Gray, & Cash, 2012).These protective factors are more useful in the case of adults. Whereas, in the case of older people, using religious and cultural beliefs can help in discouraging suicidal behavior amongst older people (Crasta, Daks, & Rogge, 2020).  With that, connections to family and friends help in developing supportive relationships through that issue of self-isolation and loneliness can be reduced which can lead to a decrease in the suicide rate. Further, for improving protective factors in the case of older people there is a focus on giving them a better quality of life for senior citizens (Pelkonen, Karlsson, & Marttunen, 2011). With that, disengagement theory states that adults voluntarily retire, creating a mutual withdrawal expected by society.  But selectivity theory states that older people remain active when they are engaged in social activities. So here for older people protection factors can improve social lives and maintaining a relationship with family and friends (Pelkonen, Karlsson, & Marttunen, 2011).  In the case of adults and older people some of the protective factors for suicide are; family who can support these individuals and influence their behavior, effective healthcare such as therapies and counseling, connectedness to individuals so that older people feel that their presence matters, and community and social institutions helps in treating people in a better way by establishing their self-esteem that reduces the risk of suicide amongst these groups (Lauw, Abraham & Loh, 2018).

Suicide Strategies for preventing suicide

The various suicidal strategies that are important and can be useful in preventing suicidal behavior amongst teenagers and adults are; be promoters of resilience that means in order to prevent and manage suicide it is important to develop coping skills and teach people about the importance of self-care (Devenish, Berk & Lewis, 2016).  When an individual start respecting their own self then an individual will find ways to promote their own well-being in their everyday lives. This resulted in hopefulness and shifts the mind of adolescents towards positive factors (Pelkonen, Karlsson, & Marttunen, 2011). This can be helpful in creating a positive environment that leads to reduction in suicides.

Further, promoting open communication can also be helpful as most of the time this can make adults speak about their issues, and through that cases of suicides can be reduced (Nock, Borges, & Williams, 2018).  When adults are isolated and not connected and able to express their emotions to others there are more chances of suicide ideation. Listening is also a thing that helps a person when they are in need as sometimes all a person needs is a listening ear (Cantrell, Valley-Gray, & Cash, 2012).Being willing to hear others without offering any solutions can be the right way to prevent suicide. Most suicide occurs because of anxiety, self-isolation, lack of family support, and financial and relationship issues (Devenish Berk, & Lewis, 2016). So these issues can be reduced by listening problems of others and creating a bond so that adults and older people can feel valued and connected and can share their issues.

On the other side, adults suicide prevention treatment approaches that are included; attachment-based family therapy this helps to address the issue of depression due to which suicides happen (Devenish, Berk & Lewis, 2016).  As a result of this therapy, adults feel safe enough to turn to their parents when they are experiencing suicidal thoughts.  Another prevention strategy can be cognitive behavioral therapy that brings clarity amongst adults about what they are feeling and thinking (Pelkonen, Karlsson, & Marttunen, 2011). Through this therapy, emotions can be identified that often bring a sense of isolation in adults and that became the cause of suicide. This therapy is useful in identifying the self-defeating assumptions and thoughts that make life more difficult (Tan, Lim, & Ong, 2021). Hence, this gives valuable insights for depressed adults.  Moreover, some of the strategies are related to experiential modalities such as music therapy and art therapy this gives adults to present their emotions through body-based practices and self-expression (Pelkonen,  Karlsson, & Marttunen, 2011).

Psychological Interventions in treating suicide

Tan,  Lim & Ong, (2021) states that psychological interventions are important as these improve at least one quality of life outcome immediately after implementation.  Martinengo, Van Galen, Lum,  Kowalski, Subramaniam, & Car’s (2019) in their study included that treating suicidal risk factors with medication or therapy or both would lead to greater improvements in risk factors and depression. Martinengo, Van Galen, Lum, Kowalski, Subramaniam, & Car, (2019) conducted various studies to know the effectiveness of the psychological intervention, and results across all these studies were the same. As interventions considered as 69% useful in decreasing the suicidal rates worldwide. There was no such difference between people who were getting medications and people who were using the psychological intervention.

References

Cantrell, C., Valley-Gray, S., & Cash, R. E. (2012). Suicide in rural areas: risk factors and prevention. Rural mental health: Issues, policies, and best practices, 213-228.

Choo, C. C., Chew, P. K., & Ho, R. C. (2019). Controlling Noncommunicable Diseases in Transitional Economies: Mental Illness in Suicide Attempters in Singapore—An Exploratory Analysis. BioMed research international, 2019. https://doi.org/10.1155/2019/4652846

Crasta, D., Daks, J. S., & Rogge, R. D. (2020). Modeling suicide risk during the COVID-19 pandemic: Psychological inflexibility exacerbates the impact of COVID-19 stressors on interpersonal risk factors for suicide. Journal of contextual behavioral science, 18, 117-127. https://doi.org/10.1016/j.jcbs.2020.09.003

Devenish, B., Berk, L., & Lewis, A. J. (2016). The treatment of suicidality in adolescents by psychosocial interventions for depression: A systematic literature review. Australian & New Zealand Journal of Psychiatry, 50(8), 726-740. https://doi.org/10.1177/0004867415627374

K.G. Ng, (2021). 452 suicides reported in Singapore in 2020 amid Covid-19, highest since 2012. The Straits Times.  Retrieved From: https://www.straitstimes.com/singapore/452-suicidesreported-in-singapore-in-2020-amid-covid-19-highest-since-20

Lauw, M. S. M., Abraham, A. M., & Loh, C. B. L. (2018). Deliberate self-harm among adolescent psychiatric outpatients in Singapore: prevalence, nature and risk factors. Child and adolescent psychiatry and mental health, 12(1), 1-6. https://doi.org/10.1186/s13034-018-0242-3

Martinengo, L., Van Galen, L., Lum, E., Kowalski, M., Subramaniam, M., & Car, J. (2019). Suicide prevention and depression apps’ suicide risk assessment and management: a systematic assessment of adherence to clinical guidelines. BMC medicine, 17(1), 1-12. https://doi.org/10.1186/s12916-019-1461-z

Nock, M. K., Borges, G., & Williams, D. (2018). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. The British journal of psychiatry, 192(2), 98-105.

Pelkonen, M., Karlsson, L., & Marttunen, M. (2011). Adolescent suicide: epidemiology, psychological theories, risk factors, and prevention. Current Pediatric Reviews, 7(1), 52-67.

Sareen, J., Isaak, C., Katz, L. Y., Bolton, J., Enns, M. W., & Stein, M. B. (2014). Promising strategies for advancement in knowledge of suicide risk factors and prevention. American journal of preventive medicine, 47(3), S257-S263.

Tan, R. Q., Lim, C. S., & Ong, H. S. (2021). Suicide risk assessment in elderly individuals. Singapore Med J, 62(5), 244-247.  https://doi.org/10.11622/smedj.2021065