A Suicide Crisis

Vatican Conference Addresses Depression

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VATICAN CITY, NOV. 24, 2003 (ZENIT.org).- Below is a summary of the address given by Dr. Bengt Safsten of Department of Internal Medicine at University Hospital in Uppsala, Sweden, at a recent international conference on the theme of depression.



The Pontifical Council for Health Care Workers organized the Nov. 13-14 conference. Organizers distributed the summary, which ZENIT adapted slightly.

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The Suicide Crisis
By Dr. Bengt Safsten

Approximately 1 million people will commit suicide annually according to statistics from the WHO. In the last 45 years suicide rates have increased by 60% worldwide. One suicide is committed every 40 seconds around the world. Suicide claims more adolescents than any disease or natural cause, and still there occur far more suicidal attempts and gestures than completed suicides.

Statistics about suicide are, however, difficult to collate and may be inaccurate because of the sensitivity of the issue; in addition, systematic errors and misclassifications blur the picture. Undoubtedly, depression and suicide have existed as long as there have been written records.

Suicidal behavior ranges from suicidal thoughts, gestures and attempts, to completed suicide. But other forms of suicidal behavior exist also. Among the elderly, self-starvation and medical noncompliance may finally lead to death, even if the intention of this is often unclear to the individual. This phenomenon is known as the silent suicide. Self-mutilation and other self destructive means of behavior in the younger generations may in some cases also be regarded as forms of suicidal behavior.

Psychiatric disorders, mainly depressive disorders are components of the malignant path toward suicide in 50-90% of cases. Alcoholism and drug abuse is not infrequently involved, and about 5% of cases have schizophrenia.

At the same time it is important to keep in mind that 10% of people who complete suicide do not have any known psychiatric diagnosis. It is also important to know that the majority of medical depressions still do not get adequate treatment for their condition. However, depressive symptoms can be reduced by medicines without reducing a suicidal tendency -- medications alone are not sufficient for treating mental disorders or suicidal tendencies.

The single most important risk factor for a completed suicide is previous attempts. Other risk factors include a situation when a close family member previously has committed suicide; past psychiatric hospitalization or discharge from hospitalization; sleep disorders; physical illness and chronic pain; recent losses (such as deaths, divorce, job or other position, honor); social isolation; migration; drug or alcohol abuse; exposure to violence; childhood trauma; and male gender.

The individual has often been wrestling with negative feelings such as hopelessness, helplessness, worthlessness and loneliness for a long time. Over time, an escalation of different pressures has often occurred, and the next stressful event -- or just the anticipation of another one -- triggers suicidal behavior, not necessarily what would be expected. Changing jobs or schools or career changes can be such events.

In general work, parenthood and a stable social network protect against suicide. It is unclear if it is the belonging per se to a defined religious population and the identity it gives, or if it is the belonging to a social network in the community that has most importance. These factors are not specific to the Western world but global.

Suicidal tendencies can be treated. Still, attitudes toward suicidal behavior vary and may, in some situations, cause barriers to treatment, intervention and prevention. Denial, rejection or taboos have historically never been serious and successful means of reducing life-threatening events.

We must deal with the suicide crises as a public health crisis and encourage national and international efforts on all levels. Not only medical health care institutions, but all organizations in the community should be involved, focused on depression, pain management, palliative care and quality of life. Children and youngsters especially must be taught successful coping skills for difficulties later in life. Guidelines and plans for awareness of suicidal situations, and handling of suicidal emergencies should be drawn up in advance for schools, work places and for organizations like dioceses and parishes.

Successful efforts to reduce suicidal behavior have been made and can be exemplified from recent projects in Finland, in Sweden (province of Gotland) and in the United States of America (U.S. Air Force). In these cases much emphasis has been put on education especially on the primary care level and by removing barriers to treatment and increasing access to help.

On the one hand, a suicidal person must be recognized and get professional help immediately; on the other, the need varies according to the situation in each case-craving knowledge of awareness and alertness. It is important to remember that such educational efforts must be continually ongoing, with new generations in mind.

Finally, efforts must also be focused on helping victims of suicidal behavior to become survivors. Individuals close to the suicide victim may have years of distress not only for the abundance of unanswered questions about the death and the assumptions of guilt. Even a previously well-integrated social network around the family disintegrates too often after a suicide, creating secondary losses. It is especially important never to forget the particular needs of children and teen-agers.

Suicide rates are falling (only) slowly despite advances in effective treatment of major psychiatric disorders. Prevention holds thus not only medical, but social, psychological, economic, moral, religious as well as political significance, and calls for interdisciplinary efforts.