Perspectives
Single female, age 16
Dear Mother & Dad,
Please forgive me. I have tried to be good to you both. I love you both very much and wanted to get along with you both. I have tried. I have wanted to go out with you and Dad, but I was always afraid to ask, for I always felt that the answer would be no. And about Bud: I want to dismiss every idea about him. I don’t like him any more than a companion. For a while, I thought I did, but no more. In fact, I am quite tired of him. As you know, I get tired of everyone after a while. And mother, I wish that you hadn’t called me a liar, and said I was just like Hap, as I’m not. It is just that I am afraid of you both at times, but I love you both very much.

So long
Your loving daughter that will always love you

Mary
PS: Please forgive me. I want you to; and don’t think for one minute that I haven’t appreciated everything you’ve done. (Art Kleiner, Suicide Notes)

LET ME say something about Part I of this perspective on suicide. We defined suicide as the intentional destruction of one’s life. Suicide is the ninth-ranking cause of death in Guyana. More males than females committed suicide in Guyana; and the suicide rate is about 200 cases per year.

And today, suicide is the 11th ranking cause of death in the United States. The Centers for Disease Control and Prevention (CDC) in the US indicated that suicide is the third leading cause of death among young people aged 15 through 24. In a third of the world, the World Health Organisation (WHO) reported that suicide rates among young people are so disturbingly high that today, they are classified as the highest risk group.

Some explanations see suicide as occurring because of a lack of social integration in people’s social relations, the presence of social disorganization, and using the socialization perspective to provide the learning paths to committing suicide; these factors could then produce conditions of depression and hopelessness, conditions giving birth to suicidal thoughts.

And so, preventive intervention would need to first address these a priori factors: Inadequate social integration; disorganization; and learning paths to suicide. If intervention at this stage is successful, then there is no need to tackle hopelessness and depression.

This week, Part II of the perspective on suicide will descriptively present some aspects of the US National Strategy for Suicide Prevention (NSSP). This strategy utilises a public health approach, and not the clinical medical approach. The clinical medical approach investigates the history and health conditions resulting in suicide in a single person; the public health approach concentrates on recognizing suicide patterns and suicidal behaviour within a population or group.

And application of the public health model requires an appropriate definition of the problem; but this is not always possible for several reasons. Suicide data is generally available, but those on attempted suicide are not easy to come by. And even some suicides may not be reported as suicides because of inadequate evidence, or respect to culture or family. And so, Clark et al, Gibbs et al, and O’Carroll believe that the real suicide rate in the US may be higher than what is documented.

Defining the problem appropriately faces other barriers, too; over time, suicide rate varies among subgroups of the population. In the US, between 1989 and 1996, the suicide rate in children aged 10-14 rose by 100 per cent; this may very well not be the case today. In fact, the CDC biennial Youth Risk Behaviour Survey, again and again, found that young people between the ages of 12 and 17 think or attempt suicide.

Suicide costs the US quite a lot. Miller et al advised that in 1995, the total economic cost of suicide in the US was $111.3 billion, inclusive of medical expenses at $3.7 billion, workplace losses at $27.4 billion, with quality of life costs amounting to $80.2 billion.

Clearly then, interventions are critical to reducing the incidence of suicide through identifying the risk factors, and then assessing the level of protection needed. And so, how can we identify risk, and then intervene with some kind of protection or protective factors. Protective factors are biological, psychological, and social factors that seek to prevent the onset of a disorder. And then we have risk factors that are biological, psychological, and social factors that induce the development of a disorder.
Protective Factors for Suicide

Source: National Strategy for Suicide Prevention, SAMHSA CDC, NIH, HRSA

Risk Factors for Suicide

Bio-psychosocial Risk Factors

Environmental Risk Factors

Social-cultural Risk Factors

Source: National Strategy for Suicide Prevention, SAMHSA CDC, NIH, HRSA

At the end of the day, what matters is how we can reduce the rate of suicide; and so, interventions become critical at this juncture. Interventions may reduce risk or strengthen protective factors, or speak to both of them. What follows is a Figure showing the types of suicide prevention that are vital to saving lives and improving the quality of life. The Figure shows three types ofprevention efforts: Universal, selective, and indicated, compiled from the NSSP.

Source: Extrapolation of Figure from NSSP data

But selecting a mix of prevention efforts will produce a comprehensive prevention programme that is more likely to reduce the suicide rate than if only one risk or protective factor is tackled. Also, far too often, some people merely engage a problem without an appropriate definition of that problem; the problem of suicide is no different, for its definition will determine its prevention design. This approach is a sure way of achieving effective suicide prevention efforts.

Part III on REDUCING THE INCIDENCE OF SUICIDE continues next week.