October 11, 2021
By Linda Lee
Suicide is a serious and heavy topic. It is a human instinct to reproduce and survive, and there are very complex reasons behind the act of voluntarily ending one's life against one's instincts. It is important to be clear that although depression is the most common cause of suicide, individuals who have suicidal thoughts and behaviors do not always stem from depression.
When a depressed person experiences extreme pain and despair, the combination of depression and helplessness and the physical and psychological powerlessness caused by the illness, seeking death is the only “best solution” that the person can think of and do to escape from the pain in a moment of extreme distress and desperation. Because of the taboo against talking about death and the stigma associated with depression, people are often unwilling to talk about suicidal thoughts. Nonetheless, most patients are willing to seek help, but are unable to do so or are confused or ashamed about how to get help. Most patients who have suicidal thoughts still have a fear of death and a desire for life before they actually commit suicide. As the patient's family and friends, we need to understand that when a patient is desperate enough to hurt himself or herself to relieve his or her pain, his or her heart is usually eager to be understood, accepted, supported and rescued.
When a depressed person is suffering from a serious illness and the patient himself is unable to get rid of the pain, as loved ones and friends, they should be fully aware of the possibility and urgency of the risk of suicide. The vast majority of suicides can be prevented if the signs are detected earlier, the patient is made to feel the meaning and value of living in love and companionship, and the patient is accompanied to actively seek medical treatment.
Combining the stories I know and the accepted views in the academic arena, patients with the following characteristics suggest a higher risk of suicide and require special attention and vigilance from their families ：
- Cases of death by suicide among family members, especially blood relatives
- A fellow patient or close friend recently died by suicide
- Having had severe trauma in childhood but failing to heal
- Sufferers have expressed:" Without me, others would be better off” “It's all my fault, I'm a burden to others, I'm useless, worthless, I'm dragging down my family " "Too tired to live, I don't want to hold on "
- Experienced repeated self-injury (e.g., repeated cuts) and even had specific plans and schemes for suicide that just hadn't been carried out
- Recent recurrence of extreme impulsive and risky behavior or abuse of medications without medical advice or reckless heavy drinking or refusal to take medications.
- In addition to depression, there are other co-morbidities. Such as severe physical illness, physical disability, difficulty in self-care or co-occurrence of other psychiatric disorders.
- Lack of social resources, high stress in real life, poor social life, no friends, no hobbies, poor kinship relationships or lack of family support.
- Recent major stressful events such as major illness, postpartum, divorce, loss of love, death of a loved one, unemployment, financial loss or experiencing a serious negative life event that you are unable to resolve
- The great stress faced will be relieved to some extent by suicide. For example, debt disputes, legal disputes, etc.
Most depressed people do not commit suicide out of the blue with impulsive thoughts. Most patients go through a period of painful thinking and struggle, and only make difficult decisions when despair is so extreme and this gains time for family and friends to help the patient. And they can keep an eye on the patient to see if he or she is behaving differently than before. For example, observing a significant change in the patient's mood from before, becoming moody, not taking medication actively or even refusing to take it. Or if the patient's mood seems to have improved significantly when the difficulties have not been solved in reality, or if he or she “suddenly thinks about it” or “doesn't care anymore”, or if he or she is angry and sad but unusually calm, or even seems happy and cheerful. Depressed patients are usually struggling and weighing their feelings before committing suicide. The strong psychological prominence can seriously disturb sleep and appetite.
Some patients sleep badly before committing suicide, even have trouble sleeping through the night, have poor appetite, and lose weight. For example, in the past, patients were able to keep a certain range of social interaction, but recently, they suddenly became reluctant to communicate with others, suddenly distant, or showed reluctance and unusual emotions when interacting with someone close to them. Some patients give away their precious items to others, take the initiative to arrange their belongings, browse online websites and information about suicide, buy dangerous items and hide drugs or write suicide notes, all of which are highly suggestive of suicide risk.
For depressed patients who have suicidal tendencies, it is important to create a safe, private environment and opportunity for them to open up. Remember not to criticize or blame, and not to ignore or deny the patient's feelings of distress or requests for help. When you find clues that suggest danger, ask directly, “Are you having suicidal thoughts?” This is much more valuable than the critical accusatory concern and unfounded promises of “you can't do anything stupid” or “you think too much, everything will be fine”.
As a family member, you do not need to avoid discussing suicide with the patient. It is not easy for the patient to talk about suicide, but if the patient is willing to discuss suicide with you, it means that he is very eager to be helped. Usually the patient will not commit suicide by discussing the issue with his or her loved ones. Instead, it helps to release the patient's psychological stress by talking about the “little secret” and pain that he or she has been suppressing for a long time. Listening patiently and without judgment as a loved one is in itself an effective form of support and assistance. At the same time, discussions can help patients find reasons to live and solutions to their problems, which can truly stop suicide.
In addition, as loved ones and friends, it is important to help patients manage controllable risks. Reinforce 24-hour companionship and form a group of family and friends that the patient trusts, and provide a supportive team that is always available to help her/him. Medications are kept by a dedicated person to ensure that each dose is accurate, which reduces the risk of patients saving and hiding medications. Prevent various safety measures in the home, manage deadly tools, stay away from dangerous locations, and manage hazardous materials such as alcohol and gas. Ensure that the patient has a regular routine, a balanced diet, and enough sleep under medication. Try to have outdoor physical activities and enough light, create opportunities to interact with others, let them experience the joy in life, and help them discover their own value and the meaning of survival. If family members feel inadequate to help a loved one with suicidal thoughts, they should be the first to accompany the patient to seek professional medical help.
The problem of suicide is a difficult and challenging issue in the treatment of psychiatric disorders, and every life is precious and needs to be saved to the best of one's ability. Preventing the risk of suicide requires the participation of patients, their families, medical professionals and the whole society to work together with love and science to help patients get out of the difficult situation in their lives.
- World Health Organization. Public health action for the prevention of suicide: a framework[M]. Geneva, Switzerland: the WHO Document Production Services.2012.
- National Suicide Prevention Lifeline. https://suicidepreventionlifeline.org/how-we-can-all-prevent-suicide
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