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World Mental Health Day: Suicide Prevention

Suicide

The term was coined in 1642 by Sir Thomas Browne who was a physician and philosopher; published in his piece entitled, Religio Medici. New term reflected a desire to distinguish between the homicide of oneself and the killing of another.


Derived from Latin:

Sui ----------------------------------of oneself

Caedere--------------------------------- to kill


Definitions

Suicide: “ an act with a fatal outcome, that is deliberately initiated and performed by the person in the knowledge or expectation of its fatal outcome”


Failed suicide attempt: “an episode of self injury consciously aimed at self destruction that the patient could not be sure to survive”


Para-suicide:episodes of intentional self-harm with unclear attempt (suicidal intent is vague or ambiguous)


Epidemiology-Bahamian Context


Overall rate of suicide is 2.8 per 100,000 (approx. 3/100,000) in The Bahamas; rate highest among 35-44yrs (Dr. David Allen et al).


A Bahamian male is 5.13 times more likely than his female counterpart to commit suicide. Majority of victims hung themselves (64%); fall (8%); overdose (6%) (period: 2008-2012), (Allen et al).


The research revealed a high incidence of completed suicides in the months of January and February, and could be possibly attributed to the post-Christmas blues (take notice that more empirical data is needed to fully support this finding).


The high incidence in October, could possibly be associated with the stress of the hurricane season (this is anecdotal evidence; similarly further research needs to be conducted in order to support this anecdote)


Some Risk Factors for Suicide: Demographics

Gender: more males compared to females complete suicide; of note males use more violent methods e.g. self poisoning; using car exhaust fumes; fatal gunshot injuries

Age: bimodal distribution seen (young adults, college students: 15yrs-25yrs, middle-aged: 44yrs-65yrs)

Marital status: progressively increased risk among the never married, widows and widowers and the divorced

Social Class: unemployed; highest risk in social class V (unskilled workers) followed by social class 1 (professionals)

Occupations: veterinary surgeons, pharmacists, farmers, medical practitioners, dentists

Prisoners, esp. those on remand

Mood Disorder (evident in 60-70% of suicide victims/fatalities)

Psychiatric history of past episodes of major depressive disorder; past episodes of history of self-harm that is cutting; overdoses on prescription medications or over the counter medications; expressed sense of helplessness and hopelessness

Schizophrenia (10%): young males early in course of the disorder are at risk, especially if there have been relapses, depressive symptoms, and previous academic success has been turned into failure by illness; small percentage secondary to hallucinations (command auditory hallucinations/patient hearing voices commanding them to commit suicide) or presence of persecutory delusions (persons have false fixed beliefs that a person/s known or unknown to them, is out to harm them or kill them)


Signs and Symptoms of Imminent Danger

  • person wishes to die; making statements that "they want to be gone from this current reality" or that they want to go into a place of "eternal sleep"

  • Direct statement of intent and clear suicidal plan (preparing a suicide note)

  • History of failed suicide attempt; note lethality of previous suicidal attempt

  • Pre-mediated or impulsive in his or her actions (person who is exhibiting suicidal behavior

  • Efforts of concealment or making a suicide plan in which the person would be unlikely to be found

  • Influence of alcohol or other illicit drugs, that is alcohol bingeing

  • Co-morbid (chronic) medical illnesses, that is terminal illnesses e.g. stage 4 cancers, thyroid gland cancers; AIDs, chronic pain disorders, Chronic Autoimmune Disorders

  • Recent loss – personal (bereavement or divorce), financial, or loss of status; expected loss

  • Homicidal ideas

  • Family history of suicide


What to do when encountering a person demonstrating suicidal behavior?


1. Do not be dismissive of your loved one's symptoms, provide a listening ear immediately when observing signs and symptoms of suicidal behavior


2. Listen without passing judgement (empathic listening) and provide a confidential setting for your loved one to express himself or herself


3. Be supportive of the person and then do something about the suicidal behavior (offer your time to accompany the person to see a medical professional). LISTEN---->ACT--->FOLLOW-UP


Accompany your loved one to a primary care physician immediately (that is a family medicine practitioner, or general practitioner who would complete an medical evaluation and an urgent referral to a mental health professional (psychiatrist; or for evaluation at the Community Counseling and Assessment Center, North Collins Avenue; phone: 323-3295/6).


Alternatively, after 5pm one can accompany the person, to the Accident and Emergency Department, Princess Margaret Hospital.

Get the assistance of other family members/relatives if your loved one is resisting an urgent evaluation in the A & E department, P.M.H.



Most Recent Research on Suicide in The Bahamas (further reading):


Reference:


Allen, David et al. “The Task force Report On Suicides in The Bahamas (2008-2013)

Presented to the Hon. Minister of Health, Dr. Perry Gomez.; May 15th, 2013





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