The World Health Organisation estimates 800,000 suicides occur every year worldwide. The data in India as per the National Crime Records Bureau from 2021 finds around 164,000 deaths by suicide which makes up about 20 per cent of the world’s figure. This number could be more because there may be several unreported or ‘unsure’ verdicts. The states of Maharashtra and Tamil Nadu consistently recorded the highest number for three years.
For every suicide, there are 25 attempts in young and four attempts among elderly people. Every suicide or attempt brings distress to the family members in addition to facing soci- etal stigma. Suicides are common across all age groups. They occur in rich or poor, in high or low-income countries. The majority of likely causes are family related problems, illness, addiction to drugs or alcohol, marital problems, and love affairs.

Stressful events directly hamper mental health. Difficulties in childhood due to marital problems in parents, bad experiences in school such as being bullied, being unable to attain academic standards or meet expectations of the family, or repeated humiliation due to poor academic performance can all contribute to mental health problems. Many children may be without siblings and both parents may work, which may mean they miss out on sharing their worries, and feelings. This can continue to build up. There is a need to provide life-skills training, and resilience building in all secondary school students. Stress, mental health, coping, meditation, and concepts of mindfulness may also be taught as part of the school curriculum.

Adolescents have unique sets of issues. This is also the age where long term chronic mental illness could begin. They strive for novelty and action and many want to do something to make them stand out from their peers. They swing between being a child and an adult. There is a fear of missing the teenage period. They may do risk-taking activities and experiment with new things including smoking, alcohol, or drug use, especially in groups.

Though many have some control, a few may become dependent on these. Relationship breakdowns can lead to feelings of low self confidence or loneliness and have lead to pessimistic thoughts, suicide attempts, and suicides. Parents must develop trust to make them come to them for any problems and open up to them to make them feel listened to or reassured.
There is another set of adolescents who are busy preparing to crack IIT, NEET, or State Entrance tests. There is no doubt that some profes- sional courses can be the gateway to lucrative employment. How to choose a professional course is not structured or in other words would not undergo the right evaluation. Many do not know their strengths or weaknesses, their skills or lack of particular skills, for them to choose the right career path. Competitive exam preparation not only requires subject preparation, but also preparing the mind to be calm, and confident throughout. Avoid comparison with peers, be realistic, and understand that competition is only against your previous best. If there are any negative thoughts or thoughts of death, dying, or suicide, immediately seek professional help.

There could be unidentified anxiety or depression which is treatable. This if not treated, can hamper the concentration and consequently the exam performance. Many of these mental health issues build up slowly, therefore with anyone coming with mental distress, or severe anxiety closer to exams, the best thing is damage limitation. Students must realise there is so much competition and always have plan B and plan C. Some students decide to drop another year in a rush, and this decision-making may also be done in discussion with men- tors, parents, and teachers. Practicing mindfulness-based meditation may help some to keep their emotions and thoughts under control, thereby improving their concentration levels. Coaching Centres must be mindful of the stress on their students and have emergency helpline numbers and access to local psychiatry clinics.

Relationship difficulties, separation, waiting for a legal hearing for divorce, and subsequent divorce can make the person feel lonely. An unemployed, separated man who is drink- ing alcohol excessively is at higher risk of suicide. Workplace stress is common, as superior authorities could also be under stress, expectations to compete with the market, and striving to improve. Initially, it is only you who has to identify if the workload is excessive, the work environment is inspiring, and this job is something you are passionate about. There are only two ways forward if you don’t like your job, either adapt soon, start to say you like the job, make peace with it, or find a new job. Ambivalence and procrastination lead to severe stress and can lead to not only mental health issues such as anxiety, depression, addiction to alcohol, changes to personality, loneliness, and sleepless- ness but also contribute to diabetes, hypertension, heart disease, and frequent infections due to low immunity.

There can be ripple effects on relationships around you too. There is a need to spend time with friends and family, on hobbies, going on tours, exercise, walking, yoga, meditation, diet, and practice good sleeping habits. If work is stressful, discuss it with your partner or friend, seek counselling, or see a nearby psychiatrist at the earliest.

Depression and anxiety are also common in older people in addition to chronic physical ailments, needing regular health care. These need to be identified early and treated. Express- ing the desire to go far away should also be considered a suicidal gesture. Sometimes, without families noticing, they could be skipping their regular pills to make their physical illness worse, thus wanting to die.

Women during adolescent age, around pregnancy, and menopause are at higher risk of developing mental health issues. Social support could help reduce this. There are reports of a mother having killed her new-born baby and then herself. Depression and so-called psychosis can occur in this period. So, identify and treat the mental health symptoms at the earliest.

The person suffering from chronic illness with pain, and disability can contemplate suicide. Caregivers of persons with prolonged illnesses such as cancer and dementia know these can be stressful. Survivors of suicide attempts must be followed up for mental health issues and treated appropriately. Someone expressing thoughts of suicide must be taken seriously until proven otherwise. Engaging them, giving them time and making them feel they are important, can prevent some. There is a need to provide first-aid gatekeeper training to many.

Many suicides are preventable. Change in behaviour in your friend or relative should not be ignored. They can be offered support. Everyone must understand the concept as well as the skills of problem-solving. Suicide is not a solution to any problem. There could be underlying depression, anxiety, or other mental health issues that can be treated, so see a psychia- trist soon. India has its own national suicide prevention strategy unveiled in November 2022. There is also a national telemanas helpline 14416 for free counselling for the public.

(The writer is a psychiatrist at NIMHANS, Bangalore)