Preventing suicides

Tomorrow is World Suicide Prevention Day. The Quezon City government, together with the Natasha Goulborn Foundation and the University of the Philippines’ psychology department, has organized some activities in advance of this occasion.

“Intentional self-harm” is the term used in the World Health Organization’s International Classification of Diseases (ICD) to refer to suicide. This category is broken down to 25 sub-categories, each one to refer to particular methods of suicide. There are five categories just dealing with drugs. Alcohol is a separate category, which got me wondering about alcoholics literally drinking themselves to death. There are categories listing pesticides, gases and vapors, firearms, and explosive materials.

I don’t want to go into detail, but you’d be surprised at how even over-the-counter drugs have been used for suicide. The WHO categories do show, even if in generalized terms, that people will try all kinds of methods if they are serious about suicide.

The suicide rate in the Philippines is relatively low compared to other countries’. This is explained by the fact that the country has a Catholic majority population. Although most major religions look negatively at suicide, the Catholic Church tends to be the most judgmental, with threats of eternal damnation and some Catholic priests refusing a church burial. I say “some” because the tide seems to be changing, with a growing number of priests adopting more compassionate responses.

Where suicides do occur, they end up being under-reported because even the attending physician might concede to the bereaved family’s wishes and report another cause of death. Besides the religious angle, suicide is still connected to stereotyped ideas that someone who commits suicide must be “weak,” unwilling to face life’s challenges.

Such views are not universal. In eastern Asian countries (Japan, China and Korea), suicide is seen as an act of courage, when done to save face or to protect the reputation of the family or community. When scandals are about to erupt with a politician or a government official, the politician or official may choose to kill themselves.

Contrast that with the Philippines where politicians stare defiantly, even expressing righteous rage, even when confronted with voluminous evidence of wrong-doing.

We might, however, forget that suicide is also tied to depression. I am not referring to passing depression, which all humans frequently experience in our lives.  Depression can be “pathological,” meaning a condition that is almost chronic, famously described by Winston Churchill as a black dog following you around. I used quotation marks because I don’t want readers to think of people with depression as “diseased.” Many famous people, Winston Churchill being only one, fought depression all their lives but were accomplished in their fields.

On the other hand, depression is serious, and people with depression will have suicidal thoughts more often than someone without the condition.

I’m mentioning all this to emphasize that suicide prevention must involve families and communities, and that this includes an understanding of what depression is and what triggers might be set off, leading to suicide attempts. An understanding of depression also means recognizing the risks of improper medical intervention, including indiscriminate use of medicines, which can aggravate the risks of suicide.

Risks

We do have Department of Health statistics on deaths from suicide, which can help us to identify who are particularly vulnerable. Remember again that the statistics are under-reported, and that these do not include suicide attempts.

Using the latest Philippine Health Statistics yearbook, we find almost 1,500 reported deaths from suicides, males outnumbering females by a ratio of 3:1. I have been told that this only reflects males being more “successful,” i.e., they tend to choose the more drastic methods to kill themselves.  The Department of Health statistics do not have a breakdown according to the methods used, so it’s hard to say if this is the case.

In terms of age-groups, we find suicide deaths in 10-14 age-group, with the rates jumping in the 15-19 and 20-24 age groups, which tells us that adolescents and young adults are particularly vulnerable. Again, we do not have statistics on the reasons for the suicides, which would have to come from suicide notes or from the family’s recollections, but I would suspect in these age groups the reasons for suicide would be mainly failed relationships. Note that in East Asian countries suicides among young people are also caused by poor grades or failure to pass university entrance exams.

Suicide rates are lower in older adults, but the numbers are still large – and alarming because one would presume most of these deaths involve economically active adults who are supporting families.  Each suicide brings not only emotional trauma but also economic dislocation for those left behind.  From newspaper reports, the causes of suicide in older adults seem to be more connected with financial problems.

The suicide reports continue well into old age.  I would suspect that in older people, triggers for suicide will come from catastrophic illnesses such as cancers, often because of a fear of the burden an illness brings to the family.

The reasons for, and the impact of, the suicides will vary, but they are all needless deaths, made the more tragic because they can be prevented.

Guidelines

De La Salle has posted very good advice on helping people who seem to be suicidal: https://www.dlsu.edu.ph/offices/osa/occs/suicide-1st-aide-guide.pdf. The De la Salle guide was based on a more technical article that appeared in the International Journal of Mental Health Systems, coming out of the consensus of 34 expert mental clinicians.  That article, by Erminia Colucci, Claire Kelly, Harry Minas, Anthony Jorm and Dinah Nadera, gives the results of consensus consultations with 34 Filipino expert mental clinicians.  You can also access that journal article: https://www.ijmhs.com/content/pdf/1752-4458-4-32.pdf

The activities today in Quezon City will start with a “Fit and Fun” run around the UP Academic Oval with registration starting at 5:30 a.m. (sorry for this late announcement, but maybe some early Inquirer readers can still catch a lecture at UP’s Palma Hall (“AS”) at 9 a.m.: “Taming the Demons in Our Midst: Finding Healing From Bullying and Depression.”

Afternoon activities will be at the Liwasang Aurora at the Quezon Memorial Circle and will include a Mass at 1 p.m., booths from UP, Miriam and Ateneo de Manila which will be open from 2 p.m. to 5 p.m., a Candle Light Memorial Walk at 5:30 p.m., and a Music for Hope Concert at 6:30 p.m. with 8-Track, Q-York, Miriam San Miguel, Christopher Ong, and Geoff Taylor.