Suicide is death caused by injuring oneself with the intent to die. A suicide attempt is when someone harms themselves with any intent to end their life, but they do not die as a result of their actions, as defined by the American Centers for Disease Control1. However, suicide is more complex and a serious concern. The World Health Organization published its 2019 Global Health Estimates Suicide report, and a breakdown of suicide rates per country was provided. It is stated that 13 774 suicides were reported in South Africa in 2019. Of these deaths, 10 861 were men while 2 913 were women. This translates to rates of 37.6 per 100 000 for men and 9.8 per 100 000 for women. South Africa recorded the third-highest suicide rate out of all African countries in the report, at 23.5 per 100 000 population.2 On average, almost 3 000 people die by suicide daily. For every person who dies by suicide, 20 or more may attempt to end their lives.3 In recent months prominent figures have died by suicide in South Africa, and their deaths are shining a light on suicide and the state of mental health.
Understanding suicide can be difficult for someone who has not experienced overwhelming feelings such as hopelessness or worthlessness or being overwhelmed by thoughts of not wanting to live. For people in this state of mind, suicide becomes an alternative to ending their pain and despair. The intention is not necessarily to die, but simply, to end the intense and overwhelming weight of their circumstances.
The complexity of suicide requires that it be understood in a broader context of mental health and social circumstances which may contribute to suicidal behaviour. Not all people who die by or attempt suicide will display these risk factors, however, this is a guide to some of the signs that may be present. The various factors that contribute to suicide include, however not limited to substance use or abuse, depression, bipolar mood disorder, anxiety, trauma, losing a loved one, either through a breakup or death, losing one’s employment, poor academic performance or being bullied, socio-economic situation, recurrent ideation about harming oneself, resolved plans and preparations to carry out the suicide, and previous suicide attempts, to name a few. Furthermore, risk can be at its greatest when an individual has the means, opportunity, a specific plan to carry out the suicide and the lack of a deterrent.
Suicide is not a singular event as it has a far-reaching impact both on the person who has lost their life or attempted suicide and on the people in the person’s life. This causes significant physical, emotional and economic disruption. The health and well-being of loved ones, friends, colleagues and the community are affected by suicide and suicide attempts; as seen with the recent and publicised deaths of actor Patrick Shai and musician Ricky Rick which had devastating effects on their family and fans. The surviving family and friends are likely to experience shock, anger, guilt, trauma, blame, and symptoms of depression or anxiety. The suicide survivor may suffer from long-term health challenges, which may exacerbate depression and other mental health problems.
Suicide can happen at any stage of an individual’s life, the differences are in the unique social, cultural, mental, emotional and economic experiences and circumstances that influence an individual to consider suicide. Suicidal behaviours among children and adolescents revealed risk factors such as difficulties in problem-solving, managing stress, social and family problems, influences of negative peer pressure or self-destructive behaviour and having suffered abuse. Further risk factors include difficulty in expressing emotions, low self-esteem and struggles with sexual identity, internally and externally, as seen in the recent News24 report of a 15-year-old Grade 9 learner from Soweto, who died by suicide after a teacher mocked him about his sexuality.
With adults, difficulties in their relationships, financial challenges, career and employment, and other social determinants and mental health issues are contributors and the current economic climate in South Africa may further exacerbate suicidal behaviours. Among the elderly, it is commonly recognised that the overwhelming feelings of loneliness, regret and stagnation and depression are the major factor attributed to suicidal behaviour. Untreated depression may lead to suicide.
It is important to note that the risk factors for suicidal behaviour differ according to age and life stages as people experience different life demands based on age, thus making it important to understand the many vulnerabilities, risk factors and triggers in a person’s life. Some people who perceive suicide as an option believe that they have become a burden on others and by no longer being around they are being selfless and that people will be better off without them, freeing them of the burden.
Most people generally struggle to speak about their mental health struggles as these in some cultures or societies are heavily stigmatised and taboo, so there is more difficulty when speaking about suicide. Thus, when a person mentions suicide, it may be their way of warning us about what they are going through or thinking. To brush it off as something frivolous can be the difference between someone staying alive or dying. It is often misconstrued that people who mention that they want to die are perceived as attention seekers or weak or cowards, while in fact, they are deeply suffering and this is their cry for help.
Talking about suicide does not necessarily lead to suicide, however, it offers people an opportunity to express what they are struggling with. At an individual level, taking time to listen and understand what others are experiencing may help save a person’s life. Most people who have suicidal behaviour and thoughts may not know where to seek help or fear talking about what they are experiencing openly out of fear of being judged as suicide carries a stigma. Educating and raising awareness and breaking the stigma and taboo around suicide is an important step in preventing suicide. Seeking professional help is critical in assessing and treating suicidal behaviour and a multi-disciplinary approach will yield better results and involve the relevant support structure in the process.
References:
Crosby A, Ortega L, Melanson C. Self-directed violence surveillance: Uniform definitions and recommended data elements, version 1.0 [PDF – 1 MB]. (2011) Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
Suicide worldwide in 2019: global health estimates. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.