Perspectives
PULL QUOTE: ‘Some professions rush to claim an exclusive monopoly over the diagnosis, treatment, and cures for suicides; no profession should make this claim, including Psychiatry, or the Behavioral Sciences; for suicide is more than a mental health problem…

GUYANA IS teeming with suicides; the prevalence rate of suicide is up and up. Suicide is preventable. Some professions rush to claim an exclusive monopoly over the diagnosis, treatment, and cures for suicides; no profession should make this claim, including Psychiatry, or the Behavioral Sciences; for suicide is more than a mental health problem; as for so many health conditions, including suicide, the strategic response would need to apply the public health model and not rely solely on 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 recognising suicide patterns and suicidal behaviour within a population or group. And the clinical medical model invariably, in history, resulted in an over-medicalisation of medicine.

Suicide is the seventh leading cause of death in Guyana, and the eighth 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. And the World Health organisation (WHO) statistics show that suicide is among the top three causes of death among people aged 15-34, the productive years of these people’s lives; and WHO notes that about one million persons commit suicide per year.

Source: Ministry of Health

Guyana recorded 186 suicides in 2007. And Guyana averaged 189 suicides per year between 2003 and 2007.

Between 2003 and 2007, Region Six, with an average suicide death rate 50.1 per 100,000, and Region Two, with an average suicide death rate of 36.2 per 100,000, undoubtedly, are the danger zones for suicidality in Guyana.

In the years 2003-2007, the 25-29 age group carried the highest average of suicides per year, with 26; then came the 20-24 age group with an average of 24.4 per year. Closely following were the 35-39 age group with an average of 24 per year, and the 30-34 age group with an average of 23 suicides per year. Clearly, ages 20 through 39 are the critical years for suicidality in Guyana.

Again, for the period 2003 through 2007, Indians had an average of 153 suicides per year, Africans with an average of 15.6 per year, and Amerindians with an average of 6.2 per year.

This increased suicide rate in Guyana, therefore, points to the need for effective prevention intervention, inclusive of an application of public health perspectives. Any half-baked approach will stagnate prevention intervention.

What is it that makes a person commit suicide? Let’s start with a definition of suicide. Suicide is the intentional destruction of one’s life. Suicide, therefore, is a deliberate act.

It was Durkheim’s study of suicide in 1897 that pointed out the relationship between suicide rate and the value of social bonds. He argued that personal characteristics of individuals could not explain suicide rate; and that it was only through the amount of social bonding that we may be able to explain suicide.

At a micro level, therefore, youths with strong bonds with their families may be less prone to surrender to suicidality (Thorlindsson & Bjarnason); also, youths with strong bonding with their families may have less contact with suicidal persons; and the influences of the suicidal person may be negligible within the presence of strong family bonding.

But how do people come to commit suicide? What is their state of mind when they are on the threshold of committing the act? People contemplating suicide do not experience mental derangement, or experience insanity. Since suicides are intentional, mental disorders may hinder suicide. Suicides, on the whole, therefore, are rationally planned.

The Maris study of suicides in Chicago from 1966 through 1968 concluded that depression was important in the research, but hopelessness seemed to have greater weighting than depression. This is important to know in the development of preventive intervention. The Rudd study supported hopelessness as a major factor.

However, these factors, as is a person’s inadequate bonding with families, disruptions in a person’s life, and a person learning to commit suicide, generally come before both depression and hopelessness. And so, preventive intervention would need to, first, address these earlier factors that seem to bring on depression and hopelessness.

But at the end of the day, what matters is how we can stop suicide; and so, interventions become critical at this juncture. Interventions may reduce risk or strengthen protective factors, or speak to both of them. The WHO five-country study on 1,867 suicide attempters between 2000 and 2005 identified three types of intervention: Universal: Preventing access to the suicide path; Selective: Targeting high-risk groups; and Indicated: Targeting suicide attempters.

This study randomly allocated two groups: The experimental group of 922 suicide attempters receiving brief intervention and contact (BIC) with professionals up to 18 months from the discharge point; and the control group of 945 suicide attempters getting treatment as usual (TAU).

In this study, more suicide attempters (18) died in the TAU than in the BIC (2) groups; in fact, this five-country study shows that a brief information and contact (BIC) modality may have a head-start on preventing deaths from suicide up to 18 months from the time of discharge from the ER.

The researchers in this study concluded the following: BIC provided social support for those suicide attempters; suicide attempters did not have appropriate communication relations with their families and other close people; BIC improved understanding of the problems that gave rise to the suicidal behaviour; and increased suicide attempters’ emotions of wanting to bond with close people. This study showed that suicides are preventable, and that reducing suicides is not beyond human capability.