Depression and Suicide – An overlooked public health crisis

Suicides are preventable. The red flags or signs are not difficult to identify, we just need to educate ourselves and enable ourselves in reaching out to people in need of help.

This is a very worrying trend as the most severe forms of mental health conditions increase the risk of suicide.
This is a very worrying trend as the most severe forms of mental health conditions increase the risk of suicide.

By – Dr Rishi Gautam

While the whole world has been focused on tackling the COVID pandemic and its aftermath, another crisis has been brewing. A suicide and mental health crisis. Research is quite clear on how the pandemic has affected all of us on an emotional level. Globally, the rates of depression and anxiety have increased by a massive 25%, in just 2 years. (WHO-March 2022) The issues of alcohol and substance use disorders have sky-rocketed as well with consistently seen jumps averaging between 20-30% as compared to times before the pandemic started. (Chacon et al, Discoveries, December 2021)

This is a very worrying trend as the most severe forms of mental health conditions increase the risk of suicide. A very preventable and unfortunate cause of early mortality. More than 7,00,000 people die as a result of suicide every year in the world. The actual numbers are likely much higher due to inconsistencies and stigma in reporting these accurately. In India, there has been a year on year increase of around 7% in suicide deaths since 2019 with over 1.5 lakh people dying from it in 2021”. (National Crime Records Bureau annual report). It is the number one cause of death amongst those 15-29-year-ol d(NSPS-GOI 2022).

Suicides are preventable. The red flags or signs are not difficult to identify, we just need to educate ourselves and enable ourselves in reaching out to people in need of help.

The Mental Health First Aid manual lays down some of these warning signs:

1. Endorsing wishes to hurt themselves
2. Seeking access to means to kill oneself
3. Talking or writing about death or suicide- in a journal, social media post etc.
4. Feeling hopeless
5. Acting recklessly or engaging in risky activities
6. Increased use of drugs or alcohol
7. Withdrawing from family or friends
8. Appearing persistently angry, irritable, agitated or depressed
9. Consolidating money, preparing wills and assets in preparation of foreseen death

At an individual level the first step in identifying these is to listen non-judgmentally and be empathetic to other people’s experiences. Help connecting them to appropriate help once a problem is identified. But this is a problem of public health magnitude and interventions at that scale are required to minimize the damage caused by them.

The Ministry of Health’s National Suicide Prevention Strategy is a great framework which aligns different stakeholders to achieve a common goal of decreasing death by suicides by 10% by 2030.

Some components of it require aggressive dissemination in the public domain, such as educational material about identifying risk factors and protective factors of suicide and information on how to access mental health treatment.

Risk Factors Protective Factors
  • Psychiatric Illness- Depression, Bipolar Disorder, Schizophrenia etc.
  • Alcohol and substance use disorders
  • Aggressive-impulsive tendencies
  • Developmental trauma, sexual trauma, abuse
  • Family history of suicide
  • Debilitating medical illness
  • Primary prevention by focusing on developing resilience in children and youth. Encourage skills focused on problem solving, conflict resolution, adaptive self-advocacy.
  • Healthy lifestyle including balanced diet, sleep hygiene, avoiding consumption of alcohol or intoxicants
  • Psycho-social support which includes strong familial bonds, community support, friends and colleagues at workplace
  • Access to quality mental health treatment and as early as possible
  • Restricted access to potentially fatal means of self-harm. Such as firearms, poison etc.
  • Religious affiliation which discourage self-harm and promote self-preservation

Finally, the value of community-based support system in our lives can never be overstated. There is a need to rethink the concept of “social distancing”. Physical distancing surely saves lives during a pandemic, social distancing does not. It is recommended that you continue to maintain regular contact with family and friends even if it is over a tele-medium. Bonding and social interactions are protective against isolation, depression, substance use and suicidality.

Please alert emergency medical services if you suspect someone to experiencing a mental health or suicidal crisis.

Dr Rishi Gautam is a US-based physician on Psychiatry specialising in adult & childhood anxiety. Dr Gautam is an Assistant Professor of Psychiatry at GW School of Medicine & Health Sciences; an instructor (Paediatrics) at John Hopkins University School of Medicine, Baltimore and is the Medical Director of Psychiatry at Sinai Hospital, Baltimore in USA.

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