Suicide: A Loss of Hope

Abstract

If it were straightforward to understand suicidality in patients and family members, it would be straight forward in assessing the realistic probability of suicide. And while some cases of suicidality are sadly predictable, many are not.

           Having suicidal thoughts or suicidal ideation is far more common than might be acknowledged by the general society, even among young people and children (Gallagher & Miller, 2018). These thoughts can range from a passing idea, to a detailed plan, which doesn’t actually include the carrying out of the final act of suicide. Suicidal thoughts common for many people, particularly when undergoing stress or experiencing depression (Stewart et al., 2019). In the majority of situations, suicidal thoughts are fleeting however such thoughts particularly when revisited place the person at an elevated risk for the eventual attempt at suicide (Lew et al., 2019). Those individuals who are experiencing stress, particularly posttraumatic stress or depression and are having thoughts of suicide should seek treatment as soon as possible. Those persons with a family history of mental illness or having a family member who has committed suicide at significantly increase risk are both suicidal thoughts (Stewart et al., 2019).

           Symptoms of suicidality can include feeling or acting as if trapped or in hopeless situation, feelings of overwhelming emotional pain, an abnormal interest or preoccupation with violence or dying, mood swings, talking of revenge or shame, heightened state of anxiety, agitation, changes in personality or sleeping patterns increased drug or alcohol use, risky behavior, impaired concentration, talking about being a burden, increased isolation, unable to experience pleasurable emotions or events, severe remorse for self-criticism, talking about suicide or dying. Still, a significant percentage of people with suicidal ideation keep these thoughts and feelings to themselves and show no signs (Lew et al., 2019).

           The causes for suicidal ideation range from a person feeling that they are simply unable to cope with the situation which may include financial problems, divorce, debilitating illness, or death of a close friend or family member (Gradus, 2018). Along with these situational associations with suicidality there are a number of risk factors that directly impact the probability of an individual experiencing suicidality including:

A.  Family history of mental illness.

B.   Family history of substance abuse.

C.   Family history of violence.

D.  Family history of suicide.

E.   Being gay with no family support.

F.   Issues with law-enforcement.

G.  Disciplinary or school problems (in teens and children).

Moreover, several comorbid conditions have been positively associated with a higher risk of suicidal ideation including:

1.    Adjustment disorder

2.    Anorexia nervosa.

3.    Bipolar disorder.

4.    Body dysmorphic disorder.

5.    Borderline personality disorder.

6.    Dissociative identity disorder.

7.    Gender identity disorder.

8.    Major depressive disorder.

9.    Severe panic disorders.

10. PTSD.

11. Substance abuse.

12. Schizophrenia.

13. Exposure to suicidal behavior of others.

They may be genetic factors that significantly increase the risk of suicidal ideation and suicide, and persons with a family history of suicide or suicidal thoughts are at significantly greater risk of both suicidal ideation and suicide (Jollant et al, 2018). In ascertaining a diagnosis, reflecting on the DSM-5 (APA, 2013), five propose criterion for suicidal behavior disorder along with two specifiers which include:

A.  The person has made a suicide attempt in the past two years.

B.   Criterion for non-suicidal/self-injurious behavior is not met during the previous attempts.

C.   The diagnosis is not applied to preparation for a suicidal attempt or suicidal ideation.

D.  The suicide attempt was not made during an altered mental state.

E.   The attempt was not motivated by ideology, for example religion or politics.

Specifiers:

1.    Current, no more than 12 to 24 months since last attempt.

2.    In remission, greater than 24 months since last attempt.

Yet as discussed, many persons who are suicidal do not exhibit any outward symptoms, but it may be very difficult to ascertain the suicidality of many individuals.

Researchers suggest that family and friends may notice subtle changes in the day today speech patterns, affect and demeanour of those who are considering suicide (Schatten et al., 2020). It must be understood that suicide ideation may well be a symptom of an underlying mental health problems including depression or bipolar disorder. Mini mental health problems including posttraumatic stress disorder, bipolar disorder and depression can be treated with combination therapy including cognitive behavioral therapy in conjunction with medications (Bryan et al., 2016). Even if current ideation is diminished, there is a significantly elevated risk of reoccurrence, therefore the focus should be placed on reducing the risk of future suicidal ideation.

Reducing suicidal ideation and suicide attempts will necessitate monitoring and input from those who are exposed on a daily basis to the individual. These include friends and family members. Persons experiencing unwanted suicidal ideation should avoid alcohol and drugs, isolation, removing guns knives and dangerous drugs from their environment. At the same time, attending a self-help or support group may prove beneficial as well as ongoing therapeutic interventions and following treatment guidelines, understanding that the comprehension of pain and suffering may feel overwhelming to the person (Smith et al., 2016).

References

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