Breaking the silence: Understanding and preventing suicide

Suicide remains a major global public health crisis, claiming over 700,000 lives each year, according to the latest data from the World Health Organization (WHO). Recent reports indicate that suicide is now among the leading causes of death worldwide, ranking as the fourth leading cause of death among individuals aged 15–29. The issue affects all countries, cultures, and communities, making suicide prevention a critical area of focus for public health initiatives and mental health professionals.

Psychiatrically, suicide is defined as “an act with a fatal outcome that is deliberately initiated and performed by the individual with the knowledge or expectation of its fatal outcome.” This definition underscores the intentional nature of suicide and highlights the importance of early intervention and mental health support.

In The Bahamas, suicide rates remain comparatively lower than the global average, with approximately 2.8 deaths per 100,000 people. However, this does not diminish the significance of the issue. Suicide is a tragedy that profoundly affects families, friends, and entire communities. Within the Bahamian context, research has indicated that men are at a significantly higher risk of dying by suicide than women, with Bahamian males being 5.13 times more likely to complete suicide than their female counterparts (Dr. David Allen et al, Task Force report on suicides; 2008-2013, to the Minister of Health Hon. Perry Gomez, 15th May, 2015).

Studies have identified various contributing factors to suicide, which include mental illness, social stressors, economic hardship, substance abuse, and personal crises. Suicide is rarely the result of a single factor but rather a culmination of various pressures that lead an individual to see no way forward. The key to prevention lies in recognizing these warning signs and risk factors, taking action, and ensuring that individuals in crisis receive appropriate care and intervention.

Research consistently shows that mental health conditions significantly increase the risk of suicide. Mood disorders, including depression and bipolar disorder, are present in approximately 60-70% of individuals who die by suicide. Schizophrenia has been identified in about 10% of suicide cases, while personality disorders, particularly borderline and antisocial personality disorders, are implicated in 33-50% of cases. Substance use disorders, particularly alcohol dependence, are also major contributors, accounting for 7-10% of completed suicides. Furthermore, cocaine and polysubstance abuse have been associated with increased suicide risk, as substance use often impairs judgment and exacerbates emotional distress.

Social and occupational factors also play a significant role in suicide risk. Unemployment is a well-established risk factor, with individuals in lower socioeconomic groups facing higher risks. Among occupations, veterinary surgeons, pharmacists, farmers, medical practitioners, and dentists have been identified as high-risk professions due to access to lethal means, high-stress environments, and demanding work schedules. In addition, prisoners, particularly those on remand, are at a significantly elevated risk of suicide due to confinement-related stress, isolation, and mental health challenges.

Understanding the common methods of suicide can aid in prevention efforts. Worldwide, the most frequently used methods include ingestion of pesticides, hanging, and firearms. In The Bahamas, hanging accounts for approximately 64% of suicide cases. Other methods, such as jumping from heights (8%) and overdosing on medication (6%), have also been documented (Dr. David Allen et al). Recognizing these trends is important for implementing targeted interventions, such as improved access to mental healthcare, and crisis intervention programs

Recognizing warning signs is crucial in preventing suicide. Suicidal individuals often exhibit behavioral and psychological signs that indicate distress. Some common warning signs include expressing a desire to die, making direct or indirect statements about suicide, and withdrawing from social interactions. Other signs include increased use of alcohol or drugs, reckless behavior, sleeping too little or too much, and putting affairs in order, such as giving away personal belongings. If a person begins to isolate themselves, avoids previously enjoyed activities, or makes unusual efforts to say goodbye to loved ones, these behaviors should not be ignored.

Family members, friends, and colleagues play a critical role in suicide prevention. If you notice someone displaying warning signs, it is essential to take their words and actions seriously. Listening without judgment, offering emotional support, and encouraging the person to seek professional help can be life-saving. Suicide should never be dismissed as mere attention-seeking behavior; rather, it should be treated as a serious health crisis requiring immediate intervention.

Taking action when someone is in crisis is vital. If an individual expresses suicidal thoughts or has a specific suicide plan, it is crucial to ensure their safety. Encouraging them to speak with a trusted healthcare provider is a good first step. Primary care practitioners, including family physicians, general physicians, and internal medicine specialists, can conduct an initial assessment and provide referrals to mental health professionals as needed. In urgent situations, particularly when an individual has a clear suicide plan and access to means, accompanying them to the emergency room for assessment and care is strongly recommended.

Suicide prevention involves a multi-faceted approach, including education, community support, policy changes, and improved access to mental health services. In many countries, national suicide prevention strategies have been developed to reduce suicide rates. These strategies often include crisis helplines, community-based mental health initiatives, and public awareness campaigns aimed at reducing stigma and encouraging individuals to seek help.

In The Bahamas, mental health services play a crucial role in suicide prevention. The Community Counseling and Assessment Centre (CCAC) situated on north Collins avenue and the corner of Collins House, is a key resource for individuals experiencing suicidal thoughts or emotional distress. The center provides professional counseling services, crisis intervention, and support for individuals and families affected by mental health challenges. Anyone in need of assistance can contact the Community Counseling and Assessment Centre at 323-3293/5 to schedule an appointment with a mental health professional. Seeking help is not a sign of weakness but a step towards healing and recovery.

Public awareness and community engagement are also critical in preventing suicide. Schools, workplaces, religious institutions, and social organizations can all contribute to creating a supportive environment that encourages open discussions about mental health. Destigmatizing mental illness and suicide through education and awareness campaigns can help individuals feel more comfortable seeking help and discussing their struggles.

One of the most effective approaches to suicide prevention is early intervention. Encouraging individuals to seek professional help at the first signs of emotional distress can prevent crises from escalating. Providing easily accessible mental health services, reducing barriers to treatment, and promoting coping strategies can help individuals manage stress, anxiety, and depression before they reach a point of crisis.

Families and friends must also take an active role in supporting loved ones who may be struggling with suicidal thoughts. Creating a safe space for open and honest conversations about mental health, checking in regularly, and offering reassurance can make a significant difference. If you suspect that someone is at risk, don’t hesitate to reach out and offer your support.

Ultimately, suicide prevention is a collective responsibility that requires efforts from individuals, families, healthcare professionals, policymakers, and the community. By fostering a culture of compassion, understanding, and proactive mental health care, we can work together to save lives.

If you or someone you know is struggling with suicidal thoughts, do not wait. Help is available to you today. Contact the Community Counseling and Assessment Centre at 323-3293/5 or email Dr. Kirk Christie at info@kirkchristie.com for more information. Do speak with a professional today, who can provide guidance and support. Remember, there is always hope, and seeking help is the first step toward healing.

• Dr. Kirk Christie is a consultant psychiatrist.