When it comes to “suicide”, many people feel uncomfortable and avoid talking about it. In Chinese, the same word as “suicide” is also used in the expressions “self-extinction” and “self-planting”. In contemporary times, whether we want to talk about it or not, “suicide” has become something we cannot ignore, especially in recent years when cases of teenage suicide are often seen in different media. Suicide has become a huge and complex public health problem worldwide. The World Health Organization estimates that approximately 1 million people die by suicide worldwide each year, accounting for 1.4% of the total global disease burden. The number of deaths by suicide each year is far greater than the number of deaths from war, terrorist attacks and homicide. Xu Yunqiang, psychiatry department, Xiangshan County Heart Hospital
This year, the World Mental Health Alliance and the International Association for Suicide Prevention have placed the theme of both World Suicide Prevention Day (September 10) and World Mental Health Day (October 10) on the relationship between mental illness and suicide, calling on people to take active action to raise awareness of mental illness prevention and reduce the risk of suicide. Although most patients with mental illness do not die by suicide, evidence of different forms of mental disorders can be seen in 90% of suicide deaths in Europe and the United States. More than 90% of suicides in the United States are related to mental illness and/or substance abuse. In the UK, a diagnosis of mental illness existed at the time of suicide or before in 50% of suicide cases. The lifetime risk of suicide for patients with mood disorders (mainly depression) is 6-15%, while the lifetime risk of suicide for patients with schizophrenia is 4-10%. A UK-wide audit found that a quarter of successful suicides had been receiving mental health services in the 12 months prior to their death. Of these, 16% were psychiatric inpatients and 24% were recently discharged psychiatric patients in the last three months. Therefore, from the perspective of suicide prevention and intervention, reducing the risk of suicide occurrence and preventing suicide must start with early intervention by raising public awareness of mental illness prevention, dispelling some misconceptions about suicide, understanding the relationship between mental illness and suicide, reducing risk factors of mental illness leading to suicide, and identifying early signs of suicide. Mental illnesses that can increase the risk of suicide Mental illness is a major health hazard for humans.
A large proportion of people suffering from mental illnesses are affected to varying degrees in their work, study, daily life and other social functions, and some patients are not cured for a long time, which eventually leads to mental disability. In terms of risk factors for suicide, poverty, poor economic status, social isolation, and lack of effective interpersonal support are associated with suicidal mental illness and active concern for suicide. Patients with mental illness have such characteristics and therefore will have a high rate of suicide.
However, mental illness does not only increase the risk of suicide from changes in socioeconomic factors due to mental illness; in fact, many mental illnesses directly contribute to suicide, such as depression, schizophrenia, and substance abuse. We just do not realize this, the seriousness of suicide, and the danger of mental illness leading to suicide, so it is very important to know the relationship between mental illness and suicide, and to understand under what circumstances mental illness is prone to suicidal ideation or attempts, or even suicidal behavior.
Risk factors for suicide in patients with depressive disorders
Depressive disorders are the most common mental health problem worldwide. Globally, 5.8% of men and 9.5% of women experience depressive episodes each year. Among mental illnesses, depressive disorders are the most common mental illnesses that lead to suicide. Statistically, about 45-70% of people who commit suicide are depressed, and 15% of depressed patients eventually die by suicide. Some longitudinal studies have shown that those who have made one suicide attempt have a 2% success rate within the next year, 8% within the next 5 – 10 years, and 10 – 15% within 10 – 15 years. Studies have reported that the chances of suicide occurring increase when the following factors are present in patients with depressive disorders and require our extra attention.
(1) late onset depression cases after the age of 45 years.
(2) People with a previous history of self-injury or a family history of suicide.
(3) Very severe depressive symptoms or with psychotic symptoms.
(4) Concomitant alcohol or drug abuse.
(5) Concomitant severe or chronic physical illness
(6) With significant anxiety, stress or personality disorders.
(7) The presence of a serious life event, such as marital failure, death of a loved one, etc.
Among depressive disorders, there are several special cases that need our attention. One is postpartum depression in women. In many countries, postpartum suicide is the second leading cause of death among first-time mothers. Eight to 15 percent of mothers will suffer from postpartum depression. The majority of these maternal suicides suffer from postpartum depression and are most likely to occur within one year after the birth of a child. Another condition is bipolar depression, which is a type of depression in which there has been a previous episode of hypomania. After depression, bipolar disorder is the second most common mental illness leading to mental disability. Among other things, patients with bipolar depression have 15 times the normal risk of suicide, often under extreme stress at school, work, home or emotionally, and women have an increased risk of suicide after childbirth or during menopause. With continuous, ideal treatment, normal social functioning can be restored, and if systematic treatment is not available, the risk of suicide increases. Factors associated with suicide in schizophrenic patients It has been estimated that the lifetime chance of suicide in schizophrenic patients is 4 -10%, and suicide attempts can reach 40%. Studies by the World Health Organization have found that the most common cause of death in schizophrenic patients is suicide.
Factors associated with suicide in schizophrenic patients include.
(1) Obvious positive symptoms: The patient can hear someone ordering him to commit suicide, or feels that people around him are trying to trap him and there is no way out but to kill himself, etc.
(2) The presence of severe depressive mood at the same time.
(3) No proper treatment and no effective control of psychiatric symptoms.
(4) The patient is left unattended or inadequately cared for and is prone to accidents.
(4) The patient is unattended or inadequately cared for and prone to accidents.
(5) Accompanied by chronic physical illness, resulting in physical and mental exhaustion.
(6) Those with a good educational background, with high professional expectations, who are aware of their mental problems and future discrimination and fears.
(7) Those who live alone or cannot live with their families, substance abusers.
Patients with schizophrenia are at increased risk of suicide when the above relevant factors are present, but there is a certain pattern to their suicides. Generally speaking, there are several key risk periods or periods of high suicide prevalence in schizophrenic patients. One is the period when psychotic symptoms are severe, leaving the patient completely detached from reality. During this period, the patient is completely under the control of psychotic symptoms and is prone to accidents. The second is the period when the patient is in severe depression. Patients are dominated by depression and have negative perceptions and even suicide attempts. Third, within 6 – 9 months of the first medication. Patients realize that their disease will affect their future situation, such as employment, study, marriage, family, etc., which makes them fearful of the future and prone to suicidal behavior. Fourth, in the initial period after discharge, patients are left alone all day, unable to communicate and interact with their families and society. The difficult situation they face and the discrimination and prejudice they may encounter make them prone to or exacerbate negative perceptions and behaviors. The Relationship Between Substance Abuse and Suicide International health experts note that alcohol is the most abused substance in the world, but the extent of global problem drinking is highly variable, with about 1.7% of the world’s population abusing alcohol overall. In Eastern Europe and parts of North America, experts estimate that 5% of the population abuses alcohol, and the prevalence of illicit drug abuse and drug addiction ranges from 0.4% to 4%. in 2003, the World Health Organization estimated that 5 million people worldwide inject drugs illicitly. In studies of suicide risk factors, substance abuse and problem drinking are more common in young people and early adulthood than in older adults, and male substance abusers are at high risk for suicide.
Certain specific populations, such as indigenous populations, immigrants, surrounded by foreign cultures, depression, and substance abuse may co-exist to constitute risk factors for suicide. There are several ways in which alcohol and substance abuse can lead to suicidal behavior. In addition to depression, people who abuse substances often have social and economic problems and are commonly found in people with impulsive behaviors, self-injury, and other high-risk behaviors. These people are often more likely to act impulsively or aggressively in a suicidal manner. Evidence linking substance abuse and suicide includes.
(1) Patients with severe alcohol dependence or intoxication are at increased risk for suicide, and suicide attempts often occur during episodes of alcohol abuse.
(2) Depression and other mood disorders are associated with most suicides, substance abuse increases the prevalence of depression, and untreated substance abuse worsens the outcome of mood disorders.
(3) Problem drinkers who have been hospitalized for alcohol use are at 10 times the risk of suicide than problem drinkers who have not been hospitalized, and substance dependence can raise the risk of work, family, and health problems that are even increasing in severity.
(4) Suicide risk is significantly higher among alcohol-dependent individuals who also use cocaine, and suicide rates are higher in areas with higher alcohol consumption per unit of population.
(5) Alcohol-dependent individuals who die by suicide have more partnership problems and other serious life stressors than drinkers who do not attempt suicide.
(6) Studies in Canada have shown that nearly 80% of schizophrenic patients experience substance abuse at some point, and that this abuse is associated with suicidal behavior. Individuals at high risk for alcohol dependence can be those who are co-morbid with depression, who have had previous suicide attempts and who have cruelly abused themselves in the past.
(7) The risk of suicide in alcohol-dependent individuals increases over time, with a significantly higher risk of suicide in problem drinkers after 10 years.
Psychiatric disorders more closely associated with suicide Anorexia nervosa and bulimia nervosa are the highest mortality group of all psychiatric disorders. Causes of death from eating disorders include suicide and co-occurring disorders. The rate of suicide attempts related to eating disorders varies according to different studies and different types of disorders. Outpatient anorexia nervosa patients had the lowest rate of suicide attempts at 16%. Suicide attempts were 23% in outpatients and 39% in inpatients with bulimia nervosa, and up to 54% in patients with bulimia nervosa who also had alcohol abuse. The incidence of non-fatal, self-inflicted injuries was higher among patients with eating disorders. Many female patients suffer from other psychiatric disorders such as depression, drug or alcohol abuse, fear, and anxiety. Approximately 84% of patients with eating disorders have at least one other psychiatric problem. In recent years, self-harming behavior has also received much attention in recent years among adolescents. It is estimated that self-harm occurs in at least 1 in 1,000 people worldwide each year. Self-harming behaviors can take many forms, including binding, amputation, hanging, biting oneself, pulling hair, and cutting, scratching, or burning one’s skin. Patients with mental illness are more likely to engage in self-harming behaviors. One outpatient survey showed that 33% of mentally ill patients committed self-injurious behaviors within a 3-month period. Self-injurious behavior can be an early predictor of suicidal behavior. Approximately half of all suicides have a prior history of intentional self-injury, and 20% – 25% have self-injured in the year prior to death.
Mental Illness and Suicide at Different Ages
A worldwide public health issue, it is also a social and health concern at different ages. Suicidal behavior in young, middle-aged, and older adults has a significant negative impact on families, communities, and nations; mental illness at different ages, particularly depression and schizophrenia, can also pose varying degrees of suicide risk for people.
The relationship between childhood mental illness and suicide
Studies from 32 countries conducted by the Leah Institute for Suicide and Prevention have shown that suicide rates in childhood are generally low. However, over the past 40 years, there has been a general trend toward higher rates of suicide among children. From 1960 – 1999, the child suicide rate increased by 92% in Australia, 240% in Canada, 420% in New Zealand, and 3900% in Ireland. Although the actual figures for child suicide remain the lowest of all ages, the increasing rates of suicide among children require our vigilance in the face of decreasing trends in suicide rates at other ages. Although depression and suicidal behavior are growing rapidly in childhood, systematic research is limited. Suicide is the 10th leading cause of death in children under 14 years of age. For each child who dies by suicide, it is estimated that there are at least 50 or more non-fatal suicide attempts. Depression is experienced by children of all ages, but varies in presentation across age groups. In addition to mental illness, other factors increase children’s risk for suicide: previous suicide attempts; history of death by suicide of a close family member; history of prior psychiatric hospitalization; loss of a loved one or recent loss before age 12: e.g., death of a loved one, parental separation, breakdown of friendships; and exposure to violence in the home or social environment, with the belief that violence can be a way to solve life’s problems. Social isolation leads to suicide in children who have no social resources to choose from and lack the skills to seek options. Drug or alcohol abuse can reduce impulse control and predispose to impulsive suicide.
The relationship between adolescent mental illness and suicide
Suicide rates among adolescent males increased in all countries during the 1980s and 1990s, while in Western Europe there was a downward trend. Since 1997, this downward trend has also been seen in Eastern and Southern Europe, Asia, Australia, and New Zealand. Suicide rates among adolescent females have also trended downward globally, but remain relatively high among adolescent females in some countries, such as India. The increase in adolescent suicide rates continues to be associated with an increase in the prevalence of mental illness among adolescents. Consistent with findings in adults, close to 90% of adolescents who die by suicide have at least one psychiatric disorder. Information from a Canadian suicide information and education center suggests that adolescents report more suicide attempts than adults, while suicide rates are lower. Adolescent females make 4 – 7 times more suicide attempts than their male peers. In general, males use lethal means of suicide more often than females. Males are more likely to use guns, hanging, etc., while females are more likely to use drugs, poisons, and gas. Unfortunately, in recent years, females have also begun to use more lethal means of suicide. A large percentage of adolescents think about, plan, or attempt suicide without seeking or getting any help. Males are more reluctant to seek help than females. This finding underestimates the importance of adult recognition of the warning signs of depression and suicide. Increasing this awareness and opening up life-saving discussions could keep teens from committing suicide. The study also showed that teens like to trust their peers first, before their own relatives. About 25 percent of adolescents who know their peers are having suicidal thoughts turn to adults. Considering the way adults respond and protecting peer confidentiality often keeps young people who are aware of the risk of suicide from seeking adult help. Reasons for youth not seeking help include: fear of discrimination or shame, fear of negative outcomes (including hospitalization), lack of trust in caregivers based on previous experiences, belief that no one or nothing can help, attachment to group values that limit help seeking, and lack of awareness of the need to seek or receive help.
Characteristics of individuals at high risk for adolescent suicide.
(1) Adolescents who engage in risky or self-destructive behaviors (smoking, risky driving, unsafe sex, substance abuse)
(2) Those who have been exposed to violence against themselves or others or have a history of violence against others
(3) Youth who are homeless or in the custody of a youth protection agency
(4) Young people who have experienced significant loss or relationship breakdown
(5) Those who have had high expectations of themselves or have faced problems with their sexual orientation (self-acceptance in the face of discrimination)
(6) Persons with a history of self-injury other than suicide attempts
(7) Young adults with serious mental illnesses (including depression, mood disorders, and schizophrenia).
Mental Illness and Suicide in Early Adulthood and College Students
Somatic illnesses can easily kill a person when their resistance to physical illness is weakened by stress. When a person’s psychological balance is disrupted by stress, mental illnesses can also easily strike. In late adolescence and early adulthood is the period when we are at our most vigorous as a person. During this period, qualitative factors inherited from the family, personal expectations of maturity, the desire to advance academically, and family and social pressures can easily upset their mental balance, leading to mental illness and suicidal behavior or attempts. Unlike heart disease and cancer, which are most often seen in adults or the elderly, mental illness is more often seen first in young people. According to the World Health Organization, in 2001, suicide among people under the age of 45 accounted for more than half of all deaths by suicide in a year, making it one of the top three causes of death in early adulthood. Suicide among college students seems to have a higher rate due to the media attention it receives. In reality, relatively few suicides occur among college students compared to their peers. Factors associated with college student suicide include the fact that certain college students are at high risk for suicide, such as foreign students. The annual suicide death rate for foreign students in the United States and the United Kingdom is 80 per 100,000 many times that of other students. Psychosis and depression are major risk factors for suicide among college students as they are for other age groups, but suicide among college students has different personality characteristics than suicide among other young people. Other young people who commit suicide tend to have risk-taking, impulsive personality traits and are often substance abusers; college student suicides, on the other hand, tend to be depressed, quiet, socially isolated, rarely abuse drugs or alcohol, and rarely attract attention from others. Many suicidal students experience anxiety, insomnia, and other psychiatric symptoms, but these symptoms disappear soon after the young person decides to commit suicide. Almost half of the suicidal students sought medical help in the months prior to their suicide, but they rarely mentioned their suicidal intent and did not receive psychiatric services.
Adult Mental Illness and Suicide
Women are a vulnerable population for depression, and there is a high prevalence of depression among women who die by suicide. Studies done in Europe, Asia, and the United States are consistent, with the prevalence of depressive disorders among women who die by suicide ranging from 59% to 91%. In primary preventive care, providers of services to women should be aware of the relationship between depression and suicide, identify patients at risk for suicide, and provide timely mental health services. Women seem to be more prone to suicide when their relationships with others are severely broken. Therefore, caregivers of female patients should be concerned about the patient’s home environment. Domestic violence or family stress plays an important role in a woman’s decision to make a suicide attempt. Caregivers should pay careful attention to symptoms of self-harm, such as wrist slitting, burning, or other self-inflicted injuries. Women presenting with self-harm often have a strong association with a history of somatic or sexual abuse. Caregivers should question these wounds about suicide, and such women also need to be referred to a mental health counselor for professional guidance. According to the National Institute of Mental Health, men are more likely than women to abuse drugs and alcohol. But no matter how severe their substance abuse is, it is also rare that they come to the end of their lives at the drop of a hat. An important reason why suicide attempts by men can often be fatal is that they tend not to seek help for their depression. In industrialized countries, although depression is diagnosed far less often in men than in women, four times as many people die by sexual suicide as in women. Women are more likely to make suicide attempts. Men have a higher success rate of suicide than women, mainly because men are aggressive and use more lethal means. Numerous studies have shown the relationship between depression and suicide. To prevent male suicide, it is important to change the behavior of men who rarely seek help regarding depression to help them save their lives.
Mental Illness and Suicide in Older Adults
Suicide in older adults over the age of 18 is the highest of all age groups. Suicide rates among older adults have declined considerably since the 1950s, but they remain high and are highest among male older adults. Suicide among older adults is strongly associated with depression, physical pain or illness, living alone, despair, and guilt. Community surveys have found that 10-20% of older adults may suffer from depression, but only a small percentage seek the services of a generalist or psychiatrist. Most older adult suicides occur in the community, but most do not receive geriatric mental health services. Only 25% of older adults with depression receive community-based geriatric mental health services, and most do not seek help from a family physician even a month before they commit suicide. Many community-serving physicians misdiagnose geriatric depression as cognitive impairment, despite the many reasons why older adults are prone to depression. In fact, older adults are very prone to depression. For example, hearing impairment, physical illness, retirement, (widowed) living, bereavement, and social isolation can all contribute to depression in older adults. In turn, depression affects the physical and social functioning of older adults and can exacerbate depression. It is particularly unfortunate that geriatric depression also often coexists with physical illnesses, such as heart disease, stroke, diabetes, cancer, and Parkinson’s disease. This leads health providers to often ignore depression in older adults and even consider some depressive symptoms in older adults to be a normal emotional response. These factors lead to low recognition and treatment rates of geriatric depression, which hinder the treatment of geriatric depression, impede the recovery from physical illness, and lead to the vulnerability of older adults to suicide attempts or suicidal behaviors. Therefore, the main focus of suicide prevention in the elderly is the recognition, treatment and disposition of depression. In addition, there are other factors that contribute to suicide in the elderly. For example, the divorce or death of a spouse can increase the risk of suicide in older adults. According to a 1998 U.S. survey, among older adults aged 75 and older, the suicide rate among divorced men was 3.4 times higher than among married people, and the suicide rate among residents was 2.6 times higher than among nonresidents. In the same age group, the suicide rate was 2.8 times higher for divorced women than for those who were married, and 1.9 times higher for widowed women than for those who were married. Other things such as great upheaval in the lives of older adults can also increase the risk of suicide in older adults. For example, changes in social roles, leaving retirement, etc.
Measures to reduce the risk of suicide among patients with mental illness
Patient suicide prevention begins with raising public awareness about the relationship between mental illness and suicide, what factors can lead to suicide in patients with mental illness, and what factors can reduce suicide in patients with mental illness. At the same time, it is necessary to eliminate misconceptions and discrimination formed regarding suicide among mental patients, to strengthen education on the prevention and treatment of mental illness, to establish a sound mental health service system, and to build a community-wide mental health service and prevention system can greatly improve the identification rate, correct diagnosis rate, and treatment rate of mental illness, thus reducing the suicide attempts and suicide rate of mental illness patients. Education on the identification of risk factors for suicidal behavior To prevent suicidal behavior, it is important to first understand what factors can promote suicidal behavior. Existing research understands that suicidal behavior is complex and can involve many factors, including biological, psychological, social, and cultural factors, and that these factors can interact with each other. Examples include unemployment, living in poverty, loss of a loved one, arguments with family members or friends, breakdown of relationships, legal or work-related problems; family history of suicide, family environment and genetic factors influencing suicide; alcohol and substance abuse, history of childhood physical or sexual abuse, distressing or disabling physical illness, mental illness problems (e.g., depression, other mood disorders, schizophrenia, despair), etc. Experts believe that mental illness can significantly increase a person’s risk of suicide. Many studies in the West show that more than 90% of people who commit suicide suffer from more than one mental illness at the time of death. In Asian countries, as in the West, mental illness is also a strong risk factor for suicide. The lifetime risk of suicide in depressed patients is estimated to be about 10-15%; bipolar disorder is 12-20 times higher than normal; schizophrenia patients have a 4% lifetime risk of suicide in the United States; eating disorders and anxiety disorders also increase the risk of suicide; and substance abuse further exacerbates the risk of suicide in patients with mental illness. Broad advocacy targeting these risk factors for suicide to minimize their role can prevent suicide.
Reinforcing the role of protective factors for suicidal behavior
Studies have learned that high self-esteem, good social connections, a stable and happy married life, social support, and accessibility to means of suicide can be protective factors for suicidal behavior. Fully exploiting the role of these factors can reduce the risk of suicide in patients with mental illness. To improve each individual’s self-esteem so that he or she can be self-knowledge, self-love, self-improvement, self-confidence, and cherish his or her life. By providing patients with more social support and more detailed and intensive care through good social relationships and a happy family life, mental illness will be treated promptly and systematically, thus reducing suicide. The accessibility of suicide tools can also be reduced through legislative or other administrative measures. Evidence from many countries and regions shows that reducing the accessibility of a particular route of suicide reduces the rate of suicide committed in that way and sometimes reduces the overall rate of suicide. Examples include reducing the use of household gas, legislating restrictions on gun ownership, reducing carbon monoxide emissions from cars, and limiting the use of pesticides; reducing the packaging of painkillers, installing guardrails in places where suicide is common, and limiting the prescription of easily poisoned drugs.
Enhance identification of warning signs of suicide
(1) Frequent talk of suicide (to kill oneself).
(2) Always talking about or thinking about death
(3) Talking about feelings of despair, helplessness, or worthlessness.
(4) Frequent statements such as “I wish I wasn’t here” or “I’m leaving”.
(5) Increasing depression (deep sadness, loss of interest, sleep and eating problems).
(6) A sudden and unexpected change from sadness to peace and tranquility, or even a pleasant appearance.
(7) Having a “death wish” and attempting risky behaviors that lead to death.
(8) Loss of interest in things you used to care about.
(9) Visiting or calling to say goodbye to others.
(10) Putting things in order, organizing things to be thrown away, or changing the will.
(11) Concentrating on ways to commit suicide, looking for information (e.g., the Internet) to put into practice, and seeking access to the means to do so.
Understanding these warning signs can help us identify possible suicide risks in our daily lives and control the occurrence of suicide.
Eliminating some misconceptions about suicide
People hold some misconceptions about suicide that lack a basis in reality, and public education should be used to eliminate these widespread and dangerous misconceptions and to raise the level of awareness and action on suicide prevention. “People who talk about suicide don’t actually act on it.” Virtually everyone who attempts suicide gives advance warning. Ignoring these warnings can be extremely deadly. When someone says, “You’ll be sorry if I die” or “I don’t see any way out,” we need to take it seriously. No matter how carelessly they say these words, those around them should take them seriously. These words are a sign of serious suicidal feelings. “People who try to commit suicide must be crazy.” In fact, most people who commit suicide do not have a serious mental illness. They simply feel hopelessness, deep despair or sadness. “There is no way to stop a person if they decide to take their own life.” In fact, the greatest desire of most people who want to take their own lives is not to die, but to end unbearable suffering. The urge to end it all doesn’t last long. “People who want to kill themselves are reluctant to seek help.” Many studies of suicide victims show that more than half of them had sought medical help in the six months before they died. The question is how to accurately identify the risk of suicide when these individuals seek help for mental health or general health issues. “Talking about suicide may give some people ideas.” People in close relationships should not give suicidal ideas to patients who are ready to self-destruct. The opposite is true; bringing up the topic of suicide and helping the person cope with this suicidal impulse is the most beneficial thing a close person can do.
Systemic treatment of mental illness is key
The tendency is treatable. Treating mental illness, including treatment for substance abuse, can reduce the risk of suicide. These treatments include medications, psychotherapy, support groups, marital therapy, and awareness of mental illness and suicide prevention and treatment by professionals and caregivers. Psychotropic medication can control the symptoms of mental illness and make the patient’s life more hopeful and easier to arrange.
Lithium maintenance treatment for bipolar depression can reduce the suicide rate of patients. In fact, lithium salts may have specific antisuicidal effects in bipolar depressed patients that can be distinguished from their antidepressant and antimanic effects. Other antipsychotic medications can help reduce suicide risk in patients with schizophrenia, and antidepressants have also shown a suicide-reducing effect. Pharmacotherapy alone is not sufficient to treat psychiatric disorders or suicidal ideation; psychotherapy can provide the necessary interpersonal support relationships that can reduce the risk of suicide. Among these, cognitive behavioral therapy is particularly promising, while problem-solving skills training can also reduce suicidal ideation and attempts.
Sick patients have a higher risk of suicide in the weeks following hospital discharge, with 3.4 times more patients discharged to suicide than patients in outpatient care. Outpatients can reduce suicide rates through community services or continuous pharmacotherapy. Psychological autopsy studies show that only 6-14% of depressed suicide victims receive appropriate treatment, and only 8-17% of all suicides have been treated with prescribed medications. People who die by suicide and attempt suicide, regardless of whether their mental illness is treated or not, remain in contact with health care providers until they die or make a suicide attempt, which means we have the opportunity to provide appropriate treatment and prevent many suicide attempts and deaths.
On top of that, more than 50%-70% of successful suicides have been in contact with a health care provider in the days or months before they died. Encouraging early help-seeking and access to help Since preventing mental illness can prevent the emergence of suicide, it is important to get treatment for patients with mental illness and timely help for those who develop suicidal thoughts or attempts. In current mental health services, there are many factors that prevent people with mental illness from receiving effective mental health services. Approximately two-thirds of diagnosable mental illnesses do not receive any form of treatment. Discrimination against mental illness often discourages people from seeking help, and inadequate mental health services and the price of services are important factors that affect access to mental health services. Economic analysis of mental health service utilization shows that utilization of mental health services is influenced by price.
An increase in price is associated with a decrease in utilization; and utilization of mental health services is higher in regions with more extensive health insurance coverage. Suicide is strongly associated with mental illness and substance abuse, and discrimination against mental illness and substance abuse, as well as against suicide itself (which is shameful and sinful), can similarly deter people from seeking treatment. Rather than seeking help, people who are suicidal often try to stay away from people who can help them.
Discrimination against mental illness and suicide leads to other problems as well. Insufficient attention to mental health, insufficient funding, and inadequate preventive services available; narrow health insurance coverage for mental illness and substance abuse, and the construction of a separate system of mental health services is far less than the construction of a health system for somatic illness. All will be well if the above problems can be solved. The integration of services, the disappearance of discrimination, the public’s perception of mental illness as a real disease like somatic illness, and the perception of mental health services as basic health services can increase the utilization of mental health services. Active action by the whole society, playing their respective roles Suicide prevention among patients with mental illness requires the participation of the whole society, with family members, mental health workers, educators, primary health care providers, friends and colleagues, and everyone else playing a role in the identification, referral, and early intervention of people at high risk for mental illness and suicide. It is important to increase knowledge about mental illness and suicide among family members, friends, and colleagues to improve the identification of people at high risk for mental illness and suicide. At the same time, education and primary health care workers should be educated about mental health to improve their ability to proactively identify people with mental illness and suicide. More importantly, it is important to have not only doctors and nurses in primary health care settings such as factories, schools, and the military, but also social workers and counselors in these institutions. Training on mental illness and suicide-related knowledge for the above-mentioned people, such as family planning personnel and patient caregivers, will be fully coordinated to form an extensive safety network so that everyone can receive good mental health services in primary health care settings.