Suicide is an epidemic not just in Nigeria but in the world at large with the World Health Organization (WHO) estimating that each year approximately one million people die from suicide globally, which represents one death every 40 seconds. It is predicted that by 2020 the rate of death will increase to one every 20 seconds.
Due to the rapid explosion of suicide cases, different preventive methods have been established by concerned government and citizens, however all of these methods can be categorized into three:
1. Primary suicide prevention.
This is perhaps the most common of the three, it involves targeted efforts at reducing the number of new suicide cases.
2. Secondary suicide prevention
This targets high risk patients like individuals with mental health problems (who make up 90% of all suicide cases) or individuals who have previously attempted suicide. The goal is to make sure they do not reattempt suicide.
3. Tertiary suicide prevention
Tertiary suicide prevention tries to moderate suicide contagion (clusters of suicides in an area) and copy-cat suicides.
Secondary suicide prevention methods are crucial in the prevention of suicide, but unfortunately it doesn’t quite get the attention it truly deserves. To identify which method of secondary suicide prevention is the most effective, it is imperative that we know the factors that make an individual a high risk patient. These factors can be categorized into biological, psychological and more proximal stressors.
Examples of biological factors include:
- Low blood cholesterol levels
- Medical or neurological illnesses (such as, stroke, Huntington disease, and epilepsy)
- Cigarette smoking
Examples of psychological factors are:
- A childhood history of physical or sexual behavior
- Discouraged help-seeking behavior
- Aggressive/impulsive traits
- Low self-esteem
- Poor access to psychiatric treatment
More proximal stressors include:
- Relationship problems
- Financial troubles
- A family or personal history of suicide
- Major depression
- Substance use
With a myriad of secondary suicide prevention methods available, only five effective ones will be highlighted. They are:
- pharmacological interventions
- psychological interventions
- follow-up care
- reduced access to lethal weapons or means
- responsible media reporting of suicide
Antidepressants (medications that can help relieve symptoms of depression, social anxiety disorder, anxiety disorders, or mild chronic depression, as well as other conditions) are the most popular and commonly used pharmacological intervention. Serotonin and noradrenaline reuptake inhibitors (SNRIs) and Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant. SNRIs raise levels of serotonin and norepinephrine, two neurotransmitters in the brain that play a crucial role in stabilizing mood.
SSRIs are more commonly prescribed because they have less side effects than other antidepressants. They block the reuptake, or absorption, of serotonin in the brain. This makes it easier for the brain cells to receive and send messages, resulting in better and more stable moods.
This involves therapy which seeks to curtail the repetition of suicidal thoughts and or actions, ensure treatment adherence and overall wellbeing of the client.
Cognitive therapy works well in lessening both suicidal thoughts and the rate of patient reattempting suicide. Intensive care coupled with outreach and interpersonal psychotherapy also helps to moderate suicidal thoughts. Dialectical behavior therapy (which involves training patients to reverse their negative thoughts and behavior) when paired with partial hospitalization in a psychoanalytically centered institute increase treatment adherence and decreases suicidal behavior more than typical after-care. Problem solving therapy endeavors to make better facilitating factors of suicidal ideations; such as hopelessness and depression.
Follow Up Care
This ensures that the patients are consistent with their treatments. It is also effective in preventing repeated suicide attempts. Social factors that should be taken into consideration include the involvement and support of the family or guardian. Support individuals (general practitioner, case manager, family and friends) should be contacted about patient’s wellbeing and follow up arrangements. Places where such follow up care techniques are employed have fewer treatment dropout rates and fewer repeat suicide.
Reduced Access to Lethal Weapons/Means
Numerous studies have revealed that legal restrictions on certain objects and or methods (for example, firearms, domestic gas, or pesticides) that are utilized for suicide have led to significant decrease in suicide through such methods. Although there is the possibility of individuals substituting methods, the moderating effects of restricting lethal means, basically making it difficult for people to commit suicide can help in cases of impulsive suicide. An example of a lethal means used nationwide in Nigeria is sniper a DDVP (2, 2-Dichlorovinyl dimethyl phosphate compound), promoted by Swiss-Nigerian Chemical Company — initially intended for farm use, but over time has been incorrectly domesticated by most Nigerians for use as household pesticide and rodent-killer. This chemical was banned by the National agency for food and drug administration and control (NAFDAC) sometime in July but was set to take effect from 1st of September 2019.
Responsible Media Reporting of Suicide
Finally, numerous studies have shown why it is important that there is a crucial decrease in the reporting of suicide and the vital need for responsible reporting. The increasing report on suicide have caused it to be romanticized by the public, because it is portrayed as a viable and sometimes the ultimate solution to life’s problems. The Internet is also a growing source of distress, with blogs and chat rooms trivializing suicide and even using it for humor. For these reasons, putting in place guidelines for the responsible reporting of suicide might help to counter these effects.
Although research and findings have helped in providing insight on the best methods for secondary suicide prevention, there are still many gaps in research and new findings would help with filling up these gaps and answering the previously elusive questions.
— OKETUNBI OLOLADE