Every year, over 800,00 people die from suicide. Perhaps more shockingly, for every successful attempt there are more than 20 attempts[1]. In 2018, 6,507 of them were in the U.K. Death by suicide rose by 10.9% in this year, and it is one of the leading causes of death for young people[2]. Suicide is not only emotionally traumatic for those close to the victim, but is also hugely expensive, with each one estimated to cost the U.K. economy £1.67 million pounds[3]. This article will examine various methods of suicide prevention which have been shown to be effective.

In order to understand how suicide can be prevented, it is important to know which factors can precipitate its risk. Some researchers have stated that the three main causes of suicide are; mental illness; societal pressure; and interpersonal conflicts[4]. It is important to note that these factors are not mutually exclusive, and there are broad concepts with various sub-categories.

With regards to societal pressure, one study which examined 20 notes written by people who attempted, and were successful in committing suicide, found that a common theme throughout all of the notes were a sense of being a “burden” on their community and loved ones[5]. This is pertinent for prevention as it is important to note that many potential suicide victims may not be committing it just to end their own pain; they may truly believe that they are doing the kindest thing to those around them.

Tailoring the approach of suicide prevention to various sub-sections of society has been shown to be effective; one study of New York teenagers found that screening for mood changes, depression, suicidal ideation, and substance misuse could be used in order to assess whether or not the subject needed to be recommended for mental health assessment and subsequent intervention, if it is deemed necessary[6].

It is important to note cultural acceptance of suicide has also been shown to be a risk factor, which could explain why suicide figures are higher in certain ethnic groups than others[7]. Whilst these beliefs can be challenged, often they are very entrenched in said culture. It has been shown that media reports about suicide can influence vulnerable people to imitate it, especially if they identify with the deceased person[8]. One way of reducing people’s perceived acceptance of suicide as an appropriate action is to make sure that the media reports on it responsibly[9]. This includes being careful to not spread misinformation, such as the false claim that suicides spike at Christmas, and to include the treatability of any underlying mental health conditions the victim may have been suffering from[10].

Regulating certain items which can be used for suicide has also shown to be effective. This can include selling analgesics in smaller packets, and to control the sale of toxic chemicals such as pesticides which are commonly used in some countries. Other preventative measures can include erecting barriers in sites popular for jumping, to detoxify domestic gas, and to introduce catalytic converters in cars. Gun control has also been shown to be reduce suicide risk in some high-risk individuals[11].

It is stated that mental illness is the main key predictor for suicidal ideation, although this is a blanket term which can refer to many individual illnesses of which some have a higher incidence of suicidal behaviour. In the U.K, affective disorders rank highest in diagnoses of suicide victims (43%), followed by schizophrenia (19%), personality disorder (9%), alcohol dependence (6%) and finally drug dependence (4%)[12]. This means that suicidal behaviours are not isolated incidents, but can instead be symptomatic of an illness.

Whilst reducing items associated with suicide can help in suicide prevention, it is more efficacious to treat the underlying mental health condition which can cause it. Cognitive Behavioural Therapy has been shown to reduce suicidal behaviour in adults and teenagers, and Dialectic Behavioural Therapy has also shown to reduce this risk in suicidal adolescents[13]. Pharmacological intervention are also commonly used; clozapine can benefit psychotic patients, lithium can aid patients with mood disorders, and ketamine has also been suggested as a potential fast-acting treatment. Anti-depressants have also been shown to reduce the risk of suicide in depressed patients[14], although it is important to note that some studies have claimed that they can increase this risk[15]. Patients who are comfortable with the use of the internet have also been shown to benefit from sharing their experiences with online communities[16].

It is estimated that 83% of suicidal patients contacted a doctor in the previous year. As such, it is highly important that doctors are trained in how to spot symptoms of depression and other indicators for suicide risk, such as self-harm[17]. It is also pertinent that they use the most recent screening procedures for this risk[18]. Doctors and mental health workers should also be made aware that of scenarios which heighten the risk of suicide, such as recent discharge from in-patient treatment[19].

Because of the myriad factors which can increase suicide risk, there is no “one size fits all” approach to preventing it. Instead, triangulation of various psychological, sociological, and pharmalogical methods, tailored to the subjects individual needs should be the most effective method in suicide prevention.

Sources:

[1] "Suicide". Who.Int, 2020, https://www.who.int/health-topics/suicide#tab=tab_1.

[2] "Suicide Facts And Figures". Samaritans, 2020, https://www.samaritans.org/about-samaritans/research-policy/suicide-facts-and-figures/.

[3] "Written Evidence - Department Of Health". Data.Parliament.Uk, 2020, http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-committee/suicide-prevention/written/37662.html.

[4] Lester, David, and James Bean. "Attribution Of Causes To Suicide". The Journal Of Social Psychology, vol 132, no. 5, 1992, pp. 679-680. Informa UK Limited, doi:10.1080/00224545.1992.9713907.

[5] Joiner, Thomas E. et al. "Perceived Burdensomeness And Suicidality: Two Studies On The Suicide Notes Of Those Attempting And Those Completing Suicide". Journal Of Social And Clinical Psychology, vol 21, no. 5, 2002, pp. 531-545. Guilford Publications, doi:10.1521/jscp.21.5.531.22624. Accessed 9 Aug 2020.

[6] Novick, L. "Adolescent Suicide Prevention". American Journal Of Preventive Medicine, vol 24, no. 4, 2003, pp. 150-156. Elsevier BV, doi:10.1016/s0749-3797(03)00043-6. Accessed 10 Aug 2020.

[7] Chu, Joyce P. et al. "The Cultural Theory And Model Of Suicide". Applied And Preventive Psychology, vol 14, no. 1-4, 2010, pp. 25-40. Elsevier BV, doi:10.1016/j.appsy.2011.11.001. Accessed 9 Aug 2020.

[8] Fekete, S., & Macsai, E. (1990). Hungarian suicide models, past and present. In G. Ferrari (Ed.), Suicidal behavior and risk factors (pp. 149-156). Bologna, Italy: Monduzzi Editore

[9] Mann, J. John et al. "Suicide Prevention Strategies". JAMA, vol 294, no. 16, 2005, p. 2064. American Medical Association (AMA), doi:10.1001/jama.294.16.2064. Accessed 9 Aug 2020.

[10] Jamieson, Patrick et al. "The Responsible Reporting Of Suicide In Print Journalism". American Behavioral Scientist, vol 46, no. 12, 2003, pp. 1643-1660. SAGE Publications, doi:10.1177/0002764203254620. Accessed 10 Aug 2020.

[11] Turecki, Gustavo. "Preventing Suicide: Where Are We?". The Lancet Psychiatry, vol 3, no. 7, 2016, pp. 597-598. Elsevier BV, doi:10.1016/s2215-0366(16)30068-2. Accessed 10 Aug 2020.

[12] Turecki, Gustavo. "Preventing Suicide: Where Are We?". The Lancet Psychiatry, vol 3, no. 7, 2016, pp. 597-598. Elsevier BV, doi:10.1016/s2215-0366(16)30068-2. Accessed 9 Aug 2020.

[13] Mujoomdar M, Cimon K, Nkansah E. Dialectical Behaviour Therapy in Adolescents for Suicide Prevention: Systematic Review of Clinical-Effectiveness. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2009.

[14] Turecki, Gustavo. "Preventing Suicide: Where Are We?". The Lancet Psychiatry, vol 3, no. 7, 2016, pp. 597-598. Elsevier BV, doi:10.1016/s2215-0366(16)30068-2. Accessed 10 Aug 2020.

[15] Laje, G. et al. "Genetic Markers Of Suicidal Ideation Emerging During Citalopram Treatment Of Major Depression". American Journal Of Psychiatry, vol 164, no. 10, 2007, pp. 1530-1538. American Psychiatric Association Publishing, doi:10.1176/appi.ajp.2007.06122018.

[16] Greidanus, Elaine, and Robin D. Everall. "Helper Therapy In An Online Suicide Prevention Community". British Journal Of Guidance & Counselling, vol 38, no. 2, 2010, pp. 191-204. Informa UK Limited, doi:10.1080/03069881003600991. Accessed 10 Aug 2020.

[17] Mann, J. John et al. "Suicide Prevention Strategies". JAMA, vol 294, no. 16, 2005, p. 2064. American Medical Association (AMA), doi:10.1001/jama.294.16.2064. Accessed 10 Aug 2020.

[18] Hawton, K. "Assessment Of Suicide Risk". British Journal Of Psychiatry, vol 150, no. 2, 1987, pp. 145-153. Royal College Of Psychiatrists, doi:10.1192/bjp.150.2.145. Accessed 10 Aug 2020.

[19] Windfuhr, K., and N. Kapur. "Suicide And Mental Illness: A Clinical Review Of 15 Years Findings From The UK National Confidential Inquiry Into Suicide". British Medical Bulletin, vol 100, no. 1, 2011, pp. 101-121. Oxford University Press (OUP), doi:10.1093/bmb/ldr042. Accessed 10 Aug 2020.