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Photo: iStockphoto

Suicide: coming back from the brink

Insomnia, genetics, even parasitic infestation, can lead to suicidal tendencies. Emotional and medical support can make all the difference

Every year, as many as 135,000 Indians from all walks of life (young and old, rich and poor, urban and village dweller, educated and illiterate alike) take their own life, according to statistics from the National Crime Records Bureau. In 2012, India was declared as the country with the highest number of suicides in the south-east Asian region by the World Health Organization. In fact, new census data released in February shows that suicide is the main cause of death among Indians aged 15-29. The data also revealed that the proportion of young people resorting to suicide is higher in rural areas.

However, for every suicide that ends in death, there are thousands of failed attempts that have tragically maimed and destroyed lives. Statistics show that suicide can no longer be ignored as a desperate act committed by a marginalized few. It is important to understand what drives people to suicide and how some factors predispose a few to take this extreme step.

Clinical depression

“Depression is the leading cause of suicide, and this is the most under-researched, under-treated and most misunderstood medical condition in our country," says Roshan Jain, senior consultant psychiatrist at the Apollo Hospitals in Bengaluru. “An estimated 90% of the people committing suicide suffer from undiagnosed depression." Alarmingly, as many as 100 million people in our country suffer from severe depression and are not receiving treatment. “It’s unfortunate that most people don’t treat depression with the gravity it deserves. Depression doesn’t happen because someone is weak or unable to cope," says Dr Jain. “It is a complex condition with both environmental and physiological causes."

“By 2030, these numbers are expected to increase, with depression becoming the leading public health problem in India (today, it’s rated as the third-leading health problem in the country), surpassing all other medical conditions," he says.

While we are aware of the possibility that depression may develop as a direct result of a hostile environment, the fact that medical science plays a role too is not as well-known, and is certainly less explored.

Role of genetics

“Our brains are governed by a complex and delicate balance of bio-chemicals," says Madurai-based Dheep Rajappa, a consultant psychiatrist, founder of the TOPKIDS counselling centre and Udhavi, a suicide prevention hotline in the city. “When even one of these chemicals is out of sync, it can have an impact on our moods and behaviour."

A study of suicide victims, published in 2006 in the Annals Of The New York Academy Of Sciences journal, established that they had much lower levels of a brain chemical called serotonin. “Low levels of serotonin can increase anxiety and trigger depression. When this is persistent and left untreated, it can lead to suicidal thoughts," says Dr Rajappa, who also works as a consultant at the Taj Hospital and Apollo Speciality Hospitals in Madurai. “Even the tendency to brood over details, always thinking negatively, can predispose one to suicide and this can be a genetic trait."

The fact that genetics can play a role in suicide is intriguing. This concept is explored in depth in the book, The Neurobiological Basis Of Suicide by Yogesh Dwivedi, a professor of psychiatry at the University of Illinois, US. He asserts that family members of a suicide victim could be at a higher risk of committing suicide themselves. Indeed, in a 2015 study published in The Journal Of Clinical Psychiatry, it was established that at least six members of a family are deeply traumatized and influenced by the suicide of someone who was close to them. In our country, where emotional and psychiatric help for near and dear ones after a painful incident such as suicide is almost negligible, and existing laws only make the situation worse, family members of the person who has committed suicide, or attempted it, suffer and become vulnerable too.

“Asking the police to investigate every case of suicide is naïve, unhelpful, and doesn’t give victims a chance to heal or reintegrate with society," says Dr Jain. “It may prevent many from expressing their suicidal feelings and seeking the help they need. Criminalizing suicide is inhuman." It was widely reported in 2014 that the government would scrap Section 309 of the Indian Penal Code, under which those who attempt suicide can be fined or imprisoned for a year. However, this is yet to happen.

Insomnia and suicide ideation

We know that sleep is a healthy, restorative habit, a biological imperative that is crucial to our physical and emotional well-being. However, even though insomnia has been blamed for many health disorders, we rarely consider it a condition serious enough to lead to suicide. A growing body of research, however, links thoughts of suicide (suicide ideation) to sleep deprivation.

One of the earliest studies published in the American Journal Of Psychiatry, in 1990, listed insomnia as one of the nine clinical features that could possibly lead to someone committing suicide within a year.

According to another study, Sleep Disturbances And Suicide Risk: A Review Of The Literature, published in 2007 in the journal Neuropsychiatric Disease And Treatment, suicidal behaviour is closely associated with recurrent sleep disturbances.

“Insomnia, or sleep deprivation, affects the mental well-being of a person, making it more possible to foster suicidal thoughts," says Preeti Devnani, clinical director at the Sleep Disorders Clinic in Mumbai, and consultant at the department of neurology and neurophysiology in Mumbai’s Jaslok Hospital. “This is because (chronic) insomnia can lead to a very specific type of hopelessness, and hopelessness by itself is a powerful predictor of suicide. These studies have established that the more severe a person’s insomnia was, the more likely s/he was to express suicidal thoughts and desires, especially if the individual experienced frequent nightmares and had unhealthy beliefs about sleep."

Going to bed late, poor quality of sleep, tossing and turning in bed for more than 30 minutes, all this is significantly associated with an increased prevalence of depressive symptoms, says Dr Devnani. Many sleep disorders go untreated and this can have severe repercussions on mental health. Bringing your sleep history to the attention of your doctor and monitoring these parameters is, therefore, essential.

Parasitic infestation

Research indicates that it is possible for common parasites to play havoc with our brain chemistry. Toxoplasma gondii is a single-celled parasitic organism that is common in birds and animals. Wild or domesticated cats are the ideal hosts for this parasite, which, until recently, was thought to be harmless. However, studies in 2012 by researchers of the US’ Michigan State University, published in The Journal Of Clinical Psychiatry, have proved that this parasite subtly alters brain chemistry and people infected with the virus are seven times more likely to commit suicide.

This is just the tip of the iceberg. Much still remains to be known about the effects of physiology on suicide.

What we do know is that in many cases, emotional and medical support can help prevent suicide. Anyone can be vulnerable. A suicidal person may not ask for outright help, but will leave clues—self-abuse, depression and lethargy—that can alert people about the state of their minds. Look out for these and see how you can help someone from taking a step from where there is no return.

Help is at hand

Some of the ways in which people with depression can overcome the feeling of helplessness that can trigger suicidal tendencies

u Offer support

The teen years are especially vulnerable because this is a time of great physical transformation, hormonal and mental upheaval. Academic stress can take a toll too. “We need parents to spend both quality and quantity time with their children, so that the child always feels that s/he has someone to turn to in times of stress," says Dheep Rajappa, consultant psychiatrist and founder of TOPKIDS counselling centre in Madurai. He suggests increasing peer interaction outside the home (ensuring your child has good social relationships) and decreasing the time spent in isolation with mindless, impersonal gadgets.

u Explore gardening

According to a study published in 2007 in the journal ‘Neuroscience’, ‘friendly’ bacteria in the soil is believed to have an anti-depressant effect. Getting your hands dirty while gardening is a highly beneficial and recommended activity for people of all ages, especially if they’re suffering depressive symptoms, says Roshan Jain, senior consultant psychiatrist at the Apollo Hospitals in Bengaluru.

u Get more exercise

It has been well established that exercise can expose you to a rush of endorphins that fight depression. A half hour or 45 minutes of aerobic activity five times a week is recommended.

u Art therapy

Magdalene Jeyarathnam, psychotherapist and founder of the East West Counselling Centre and the Indian Institute of Psychodrama in Chennai, employs expressive art therapy, which includes music, dance, painting and other creative medium to process trauma, guilt and grief as a means of healing suicidal children and teens. “Art can break the barriers of the mind, allowing people to realize and deal with the subconscious issues that are disturbing them," says Jeyarathnam.

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