Recognizing and Managing Suicidal Thoughts in Us and Those Around Us

The Book

The Book - Atmasvasth - A Guide to Ageing Healthfully

A 15-point guide to living long, healthy

AtmasvasthBhavin Jankharia

The Detailed 15-Point Guide to Live Long, Healthy

The 15-Point Guide - Detailed

The detailed 15-points guide to live long, healthy

AtmasvasthBhavin Jankharia

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Last week, after a young suicide death in the family, which has been devastating for the parents and everyone who knows them, I checked the suicide numbers in India.

In 2022, 1.7 lakh (170,000) people committed suicide in India [1], a number higher than road accident deaths, which at 1.5 lakhs (150,000) ranked 9^th/10^th in the list of top 10 deaths in India [1].

While suicide deaths in India are still the highest in the young, the 18-45 years age group accounting for more than half these deaths, they are gradually becoming a problem even in those over the age of 60.

The 2018 Lancet report on suicides in India, casts a scarier perspective on the situation [2]. It says that the number of suicide deaths is underestimated in official reports and in 2016, it pegged suicide deaths in India at around 230,000 (17/100,000 population) and given that suicide rates have been increasing year on year, even officially (10.2/100,000 NCRB in 2018 to 12.4/100,000 NCRB in 2022), this implies a rate increase to 20/100,000 in 2022 and for a population of 1.38 billion in 2022, it would mean 276,000 suicide deaths in 2022, about 100,000 more than the official NCRB numbers.  That is a lot of people. 

Since the number of people above the age of 60 years in India is just around 149 million (2020), which is less than 9% of the population, the rate of suicides per 100,000 actually works out much higher (from 24.5/100,000 men in 2016 in the 60-64 years age group to 55.0/100,000 in men in 2016 in the 80-84 years age group). And as the population ages, this problem is only going to worsen.

In short, suicide deaths are the 7^th or 8^th commonest cause of death in India, with the number of suicide deaths in people like us only expected to increase year on year. 

Not all suicide attempts are successful and clearly the issue starts with identifying suicidal tendencies in ourselves and those around us, to hopefully then prevent a suicide attempt and death. This is both, an individual issue, as well as a public health problem that needs to be addressed at multiple levels; by us, by those around us, healthcare organizations, authorities and the Govt.

So, what causes suicidal ideation? This is a list from the National Council of Aging.

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1. Loneliness. This is a growing problem even in India and increasing as more and more people live alone. I wrote about the difference between being lonely and being alone a couple of years ago. Being alone is great, but being lonely is not. 

2. Grief over loved ones. Losing a spouse or a child often triggers an intense feeling of not wanting to live anymore in this world. This is the time when we need to emotionally shore up those who have been recently bereaved.

3. Loss of self-sufficiency, both physical and economical can lead to a feeling of being inconsequential and trigger suicidal thoughts.

4. Chronic illness and pain, are challenges that if not addressed can lead to a suicide attempt.

5. Cognitive impairment is an issue that I have been addressing for the last 3 years including possible ways to reduce the rate of cognitive loss.

6. Financial troubles can be devastating the older we get, especially as our ability to recoup these losses and/or earn a reasonable amount of money just keeps reducing.

While we ourselves should be able to identify these triggers, self-awareness is not always present in those who have suicidal thoughts, and even if we are aware of our own suicidal bent, most of us have been brought up to be stoic about our mental problems and we rarely reach out to those around us or to doctors for a variety of reasons; from being seen to be weak, to social stigma and sometimes perhaps the sheer lack of awareness that help is available. It is therefore more important for those around us and our caregivers (children, siblings, spouses, doctors etc.) to be able to recognize these signs and seek help earlier rather than later. 

The NCA lists behavioral patterns that should act as red flags for the caregivers and those around us.

• Loss of interest in activities they used to enjoy.
• Giving away beloved items or changing their will.
• Avoiding social activities.
• Neglecting self-care, medical regimens, and grooming.
• Exhibiting a preoccupation with death.
• Lacking concern for personal safety.

The National Suicide Prevention Helpline in the US lists 5 steps that caregivers can adopt

1. Ask

2. Be there

3. Help keep them safe

4. Help them connect 

5. Follow-up

This has to be done by us and by those around us as part of our atmasvasth quest to live long, healthy. While institutions and doctors and the Government may lay out guidelines for us and our caregivers to follow, in the end, they are usually unable to help at an individual level, especially in our country where resources are stretched, even for those who fall in the highest income brackets. 

The Icall Helpline is one such helpline. You can call 9152987821, from Monday to Saturday between 10 to 8 and speak to someone, who will listen, guide and help. This Google Doc also gives a list of psychologists and psychiatrists who can be of help.

It is also important to realize that choosing not to accept treatment for illnesses that are unlikely to be treatable or where the treatment is not worth the life extension does not constitute suicidal ideation. I wrote about this in the piece on the “living will” where the caregivers need to respect the right of the individual to refuse treatment.

I am more ambivalent about santhara, the Jain philosophy of refusing food and water and then choosing to die, once you believe you have lived your life. While this may be an extension of “vanaprastha” that I described in the piece on the retirement conundrum, it is also possible that people who are depressed or lonely may decide this is a better way out, rather than committing suicide violently. Santhara is a grey zone and caregivers need to tread carefully in such circumstances, given the fact that it is now considered legal in our country as decreed by the Supreme Court in 2015/2016.

So what does this mean for you and I? In our atmasvasth quest to live long, healthy, we need to identify in ourselves and in those around us, signs and symptoms that have the potential to lead to suicide. In the next couple of decades, as we all grow older, the incidence and rate of suicides in our age group is only going to increase. If we find suicidal ideation in ourselves or those around us, we need to reach out and seek help and address the issues behind these suicidal thoughts and try and bring balance back to our lives or the lives of those around us with a combination of medical treatment, social engagement, physical activity, meditation, etc., preferably with the help of professionals, if and where available.

Footnotes:

1. India State-Level Disease Burden Initiative Suicide Collaborators. Gender differentials and state variations in suicide deaths in India: the Global Burden of Disease Study 1990-2016. Lancet Public Health. 2018 Oct;3(10):e478-e489.