Suicide: warning signs, risk and protective factors

As a young girl, I was privileged to be registered at Obafemi Awolowo University Health Centre for medical care because my father was a lecturer.

One day, I was at the health centre and I overheard some doctors and matrons discussing a particular patient who took a drug overdose and also left a suicide note.

There is a second story.

In one of the states in this country, a school principal collected the WAEC fees from students many years ago. I had no idea what he used the money for, but he eventually committed suicide because he could not account for the money.

The entire month of September is recognised as Suicide Prevention Month (often called Suicide Prevention Awareness Month), and it features World Suicide Prevention Day on September 10.

To this end, let us look into what suicide is.

Suicide is the act of intentionally causing one’s own death.

Suicidal behaviour refers to talking about or taking actions related to ending one’s own life. Suicidal thoughts and behaviours should be considered a psychiatric emergency.

The first World Health Organisation world suicide report, Preventing suicide: a global imperative, published in 2014, aimed to increase public awareness of the public health significance of suicide and suicide attempts and to make suicide prevention a high priority on the global public health agenda.

It also aimed to encourage and support countries to develop or strengthen comprehensive national suicide prevention strategies through a multisectoral public health approach.

In 2021, WHO launched LIVE LIFE: an implementation guide for suicide prevention in countries.

Accompanying resources to support the implementation of the four key LIVE LIFE interventions have also been published, including the 2024 brochure on Preventing suicide by phasing out highly hazardous pesticides to support limiting access to means.

Preventing suicide: a resource for media professionals, update 2023, was published to encourage responsible reporting of suicide, while the Helping Adolescents Thrive toolkit was developed to foster socio-emotional life skills among young people.

There is usually no single reason someone decides to take their own life.

Several factors can increase the risk of suicide, such as having a mental health disorder.

But more than half of all people who die by suicide do not have a known mental illness at the time of their death.

Depression is the top mental health risk factor, but others include bipolar disorder, schizophrenia, anxiety disorders and personality disorders.

Aside from mental health conditions, other factors that increase the risk of suicide include:

Incarceration

Poor job security or low levels of job satisfaction

History of being abused or witnessing continuous abuse

Being diagnosed with a serious medical condition, such as cancer or HIV

Being socially isolated or a victim of bullying or harassment

Substance use disorder

Childhood abuse or trauma

Family history of suicide

Previous suicide attempts

Having a chronic disease

Social loss, such as the loss of a significant relationship

Loss of a job

Access to lethal means, including firearms and drugs

Being exposed to suicide

Difficulty seeking help or support

Lack of access to mental health or substance use treatment

Following belief systems that accept suicide as a solution to personal problems

You cannot see what a person is feeling on the inside, so it is not always easy to identify when someone is having suicidal thoughts.

However, some outward warning signs that a person may be contemplating suicide include:

Talking about feeling hopeless, trapped, or alone

Saying they have no reason to go on living

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Making a will or giving away personal possessions

Searching for a means of doing personal harm, such as buying a gun

Sleeping too much or too little

Eating too little or eating too much, resulting in significant weight gain or loss

Engaging in reckless behaviours, including excessive alcohol or drug consumption

Avoiding social interactions with others

Expressing rage or intentions to seek revenge

Showing signs of extreme anxiousness or agitation

Having dramatic mood swings

Talking about suicide as a way out

It can be frightening when someone you care about shows suicidal signs. But it is critical to take action if you are in a position to help. Starting a conversation to try to help save a life is a risk worth taking.

During the conversation, make sure you:

Stay calm and speak in a reassuring tone

Acknowledge that their feelings are legitimate

Offer support and encouragement

Tell them that help is available and that they can feel better with treatment

Do not be judgmental or confrontational in your discussions with them.

Do not be afraid to ask direct questions, such as, “Are you thinking about suicide?”

Pay attention to the emotional needs of your friends and loved ones.

Be there to support and listen to those around you.

Offer to help them find a mental healthcare provider, make a phone call, or go with them to their first appointment.

Treatment for people who are at risk for suicide depends on the underlying cause of someone’s suicidal thoughts and behaviour.

They include:

Talk therapy

Talk therapy, also known as psychotherapy, is one possible treatment method for lowering your risk of attempting suicide.

Cognitive Behavioural Therapy is a form of talk therapy that is often used for people who are having thoughts of suicide.

Its purpose is to teach you how to work through stressful life events and emotions that may be contributing to your suicidal thoughts and behaviour. CBT can also help you replace negative beliefs with positive ones and regain a sense of satisfaction and control in your life.

A similar technique, called Dialectical Behavioural Therapy, may also be used.

Medication

If talk therapy is not enough to successfully lower risk, medication may be prescribed to ease symptoms, such as depression and anxiety. Treating these symptoms can help reduce or eliminate suicidal thoughts.

Lifestyle changes

Suicide risk can sometimes be reduced by simply adopting certain healthy habits.  These include:

Avoiding alcohol and drugs: Staying away from alcohol and drugs is critical, as these substances can lower inhibitions and may increase the risk of suicide.

Exercising regularly: Exercising at least three times per week, especially outdoors and in moderate sunlight, can also help. Physical activity stimulates the production of certain brain chemicals that make you feel happier and more relaxed.

Sleeping well: It is also important to get enough quality sleep. Poor sleep can make many mental health symptoms much worse.

A study titled Suicide attempts and the factors that lead to suicidal ideation: A 3-year analysis by Adem Az et al. concludes that females, young adults, singles, the unemployed, and individuals with psychiatric disorders are more vulnerable to suicide attempts, as are those who are poorly educated. Furthermore, people typically attempt suicide when alone.

And if you are already having suicidal thoughts, I want you to know that these thoughts do not represent a weakness, flaw or personal failure. They’re nothing to feel guilty or ashamed of, either, no matter your situation.

Reach out to trusted loved ones who can listen and offer emotional support, go somewhere safe, lock up or get rid of weapons, avoid alcohol and other substances, and do something that helps you relax.

Even the darkest night will end and the sun will rise. Do not contemplate suicide.