Suicide – a Sure Concern for Our Children

10th of September was World Suicide Prevention Day. It is created by the International Association of Suicide Prevention (IASP), meant to raise awareness that suicide is preventable and hence must be prevented.

Global Suicide Pattern

The World Health Organization (WHO) reported approximately 800,000 deaths worldwide due to suicide. To put things into perspective of time, that is a person losing his or her life with every 40 seconds ticking by (World Health Organization, n.d.).

Suicide is a global concern that occurs in every age group, both sexes, all ethnicities and socioeconomic status – everyone including children are vulnerable.

Globally, suicide is reported to be the second leading cause of death (after road accident) among people aged 15 to 29 years old which amounts to more than 200,000 deaths. Results display a trend that younger adults have a higher rate of suicides as compared to the elderly. The reported numbers also show the horrifying realities that children as young as 10 to 14 years old are already having suicidal thoughts, attempts or worse, actual suicide cases.

What about Malaysia?

Malaysia suicide rates do not offer much consolation as well. The 2016 crude suicide rates (per 100,000 individuals) for Malaysians aged 15 to 29 years old are 3.9 for both sexes. On the other hand, suicide rates for Malaysians aged 30 to 49 years old are 5 per 100,000 persons (World Health Organization, 2018).

While the age group variable differs from the global trend in that elderly Malaysian adults have a higher suicidal rates than the younger adults, it doesn't change the fact that the nation is not successful in reducing its suicidal tendencies. Overall, Malaysia's crude suicide rate was estimated to be 5.5 in 2016 as compared to 5.1 in 2010 (per 100,000 Malaysians) (Statista Research Department, 2020).

More alarmingly, WHO reported that the age-standardised suicide rate for all ages and both sexes in 2016 was 6.2 for everyone 100,000 individuals. At the meantime, the statistics shown could be under-reported, suggesting the rate to be possibly higher in actuality (CodeBlue, 2019).

The objective of the World Suicide Prevention Day is to make known that suicide is preventable, and everybody plays a crucial role. Interventions can be effectively implemented at the population, sub-population and individual levels (World Health Organization, n.d.).

We must investigate, understand and be sensitive to the causes of suicide affecting the young people of our generation and deepen our understanding of any trends that could be leading up to this momentous tragedy. Only then can we prevent suicidal cases from heightening.

Mental Health and Suicide

One of the major causes of the increased trend of suicide notions and occurrence is due to mental health issues. The National Health and Morbidity Survey 2019 showed that 7.9% of children age 5 to 15 were discovered to suffer from mental health issues, largely due to poor social interactions with their peers. The NHMS 2019 also reported that 424,000 children were discovered to have mental health issues (National Health and Morbidity Survey 2019, 2019).

For a broader overview of anxiety and depression in children, see Child Anxiety and Depression: Mental Health in Children.

The Head of Psychiatry Services at the Ministry of Health Malaysia states that the reasons for suicide are mental disorders such as depression. Emotional stress, relationship issues, anxiety, poverty, abuse, alcoholism and drug abuse and unemployment are also common factors (Khan, Azhar & Azmi, 2012).

It is especially true that psychiatric disorders are affiliated with high suicidal behaviour. An estimate of 90 to 95% of suicidal cases have some form of mental disorders history. Suicide ideation, that is to have the thought of taking one's own life is common in people with low mood, poor control of impulses, alcohol or substance abuse and psychotic disorders (Khan, Azhar & Azmi, 2012).

Looking deeper into depression, it is characterized as the deterioration of a person's functionality from psychological effects such as having a low mood, losing interests or pleasure, feeling worthless or guilt and having frequent ideations of suicide. Depression also affects a person's physical well-being (Ng, 2014).

People with existing medical conditions or chronic illness tend to have higher risks to succumb to suicide as well due to the immense stress they go through during therapy and facing the suffering (Ng, 2014).

Looking into the younger generation, schools are also finding increased occurrence of depression, anxiety, and stress among Malaysian youths. The issue is often multifactorial, some of which include a high expectation and pressure to excel academically leading to overwhelming stress and cyberbullying (Statista Research Department, 2020).

Could this be Depression? – Signs and Symptoms

We find the term 'depression' commonly used loosely to describe being sad or down in a tough situation. But major depressive disorder is much more complicated. Being unhappy or disappointed are not the same as being depressed. Here are some things to look out for.

1. Hopeless Outlook

Having a hopeless outlook on one's own life is a very common sign of depression. A depressed person may harbour feelings of worthlessness, self-hate, or inappropriate guilt in their minds over a long period of time without voicing them out. They may also constantly talk about being a burden to others or having no reason to live. You may find them having these recurring thoughts "It's always my fault" or "What's the point of trying?".

2. Loss of Interests

Depression can cause a person to lose their enjoyment or interests in the things they always love. A withdrawal from activities that they once looked forward to is also a common indication.

3. Isolation

Depressed people may also withdraw themselves from others including family and friends.

4. Increased Fatigue and Sleeping Problems

Depression may come with a lack of strength and an overwhelming feeling of fatigue. This might lead to excessive sleeping. On the flip side, depression is also associated with insomnia (the difficulty of sleeping or remaining asleep). Depression might lead to insomnia and vice versa, causing a downward spiral to both issues. The lack of quality rest can also lead to our next point which is anxiety.

5. Anxiety

Anxiety usually comes together with depression, usually accompanied by restlessness, nervousness, panic or dread, increased heart rate, rapid breathing, heavy sweating, trembling or muscle twitching, difficulty paying attention or in a constant state of distraction from worrying.

6. Changes in Appetite and Weight

Depending on the individual, some may have increased appetite and start gaining weight, yet others may not be hungry leading to losing weight. A depressed person's weight and appetite may fluctuate and it varies from person to person.

7. Uncontrollable Emotions

Mood swings are another mark of depressed individuals. One may face an outburst of anger at a moment, and at the next moment, they may be crying without restraint. This drastic emotional change may not necessarily have an external factor or trigger.

If the mentioned signs and symptoms are things you have been facing currently for more than two weeks, you might be suffering from major depression disorder. There should be no shame in having this disorder. What is more important is to identify it early on so that early intervention and the right help can be administered.

There are various treatments available including lifestyle changes to medications. No matter the treatment option you select, looking for professional help is the first step to getting back to feeling like yourself again (Healthline, 2017).

What can Parents Do to Intervene?

If you are a parent and you suspect that your children are suicidal as they fulfil most of the signs and symptoms, then here are things to take note of and act accordingly.

If you notice your child is acting unusual and you suspect they are depressed, do not jump the gun and react based on your emotions or unfounded assumptions.

Take note to be aware and sensitive to the usual signs of depression as most children especially boys are often too embarrassed to confide their unhappiness to others, especially their parents.

Low self-worth can accompany depression. For related guidance, see Child Low Confidence: What Parents Can Do.

After seeing certain depressive signs, you should not wait for children to approach you with their problems and burdens. Rather, parents are expected to make the first move, by initiating a conversation, "You seem unhappy lately, would you like to talk about it? Perhaps I can help.".

Identifying if depression is something they are suffering with is a preliminary step to their recovery or the prevention of suicide ideation or attempts. Be open to talk about suicidal thoughts directly (Kids Help Line., n.d.).

Once they confide with you their internal struggles, it is good to let your child know that you are concerned and you care. Put the effort to listen to your child without judgement. Prior to them sharing their feelings, they need to know that they will not be further humiliated by their parents when they share their true and deep emotions (Kids Help Line., n.d.).

Take the warning signs seriously (Kids Help Line., n.d.). As parents, you should never dismiss any threats of suicide as typical teenage melodrama. While children especially in their teen years may have more fluctuating emotions and behaviours, things they utter such as "I wonder how many people would come to my funeral.", "Sometimes I wish I could just go to sleep and never wake up." or "Everyone would be better off without me" should not be taken lightly. In fact, in a situation such as this, it is better to "over-react" than to "under-react". Often, children who attempt suicide have dropped hints to their loved ones repeatedly that they intend to end their lives. The perceived threats of suicide can be a desperate plea for help. Even if they do not intend to take their life, what parents would risk being wrong in a situation such as this? (Committee on Psychosocial Aspects of Child and Family Health., 2019).

Parents should once again remember not to react based on their emotions, usually anger or frustration. Remarks like "Are you out of your mind?" or "You don't mean that." may add oil to the fire and be particularly hurtful to a child who is facing suicidal ideations (Committee on Psychosocial Aspects of Child and Family Health., 2019). Your instinctive response should be to focus on consoling and mend any underlying attitude issues later.

Sometimes, sharing your feelings help as well. Let them know that they are not alone in feeling immensely helpless and hopeless as you, their parents face them too. Take note while doing this, you do not minimize their anguish, but be assuring that these bad times do not have to be permanent and you are willing to work this through with them (Committee on Psychosocial Aspects of Child and Family Health., 2019).

Also encourage them not to withdraw from family or friends in moments such as these. Engage in exercise with them or encourage them to do continue taking part in a sport they enjoy. Physical activities can help lessen the effects of depression as physical activities causes the brain to release endorphins, a chemical that improves mood and eases pain or stress. These healthy lifestyles also distract them from the presenting problems and redirects their attention to something more worthwhile (Committee on Psychosocial Aspects of Child and Family Health., 2019).

Building coping skills over time also matters. See Building Resilience in You for ways to strengthen emotional recovery after setbacks.

Lastly, parents must remember that you are not trained professionally, if things are out of hands, make sure to not delay and seek for professional help like a psychiatrist, psychologist or a counsellor who will know exactly what to do. Reaching out for professional support is important for the wellbeing of your children and might even preserve their life (Kids Help Line., n.d.).

Suicide is a Challenge – Worth Fighting On

The need for psychiatrist to aid people with mental health issues and subsequently prevent suicides are unfortunately far from sufficient. The World Health Organization recommends one psychiatrist to 10,000 inhabitants. However, up till 2019, Malaysia only has an estimated of 1 for every 200,000 inhabitants (Statista Research Department, 2020).

This burden is coupled by the prevailing social stigma of psychological health. Conversations about mental health are not happening enough. People who are affected by depression and other similar issues shy away from confiding to a closed one like a family or friend, in fear of being judged, dismissed, or shunned. Malaysians are also not open to visit a mental health professional. A survey in 2018 showed that 64% of Malaysians have never been to a mental health professional (Statista Research Department, 2020).

Previous Health Minister Datuk Seri Dr. Dzulkefly Ahmad stated in one of his tweets that stigma on mental health must be demolished. He added that the community ought to be more open in talking about such issues (Cheah, B., 2019).

The shortage of professionals in this field and this cultural stigma are 2 big hurdles that must be overcome at the population level.

In conclusion, we want to remind and encourage our readers that suicide is preventable. There is help that you can find access to around you and there is no shame in doing so. If you or your close ones are facing suicidal tendencies, be courageous and reach out to professional support today.

Contact Befrienders here: https://www.befrienders.org.my/

References

CodeBlue. (2019). WHO: One Dies by Suicide Every 40 Seconds. https://codeblue.galencentre.org/2019/09/10/who-one-dies-by-suicide-every-40-seconds/

Cheah, B. (2019). Suicidal tendencies on the rise in Malaysia, says Health DG. https://www.thestar.com.my/news/nation/2019/10/10/suicidal-tendencies-on-the-rise-in-malaysia-says-health-dg

Committee on Psychosocial Aspects of Child and Family Health. (2019). 10 Things Parents Can Do to Prevent Suicide. https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Ten-Things-Parents-Can-Do-to-Prevent-Suicide.aspx

Healthline. (2017). Signs of Depression. https://www.healthline.com/health/depression/recognizing-symptoms

Khan, T. M., Azhar, S. S. S. and Azmi, M. H. (2012). Factors associated with suicidal behaviour among depressed patients in Penang, Malaysia. https://pubmed.ncbi.nlm.nih.gov/23018361/

Kids Help Line. (n.d.). Supporting a child who is thinking of suicide. https://kidshelpline.com.au/parents/issues/supporting-child-who-thinking-suicide

National Health and Morbidity Survey 2019. (2019). Fact Sheet NHMS 2019. http://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2019/Fact_Sheet_NHMS_2019-English.pdf

Ng. C. G. (2014). A Review of Depression Research in Malaysia. https://www.e-mjm.org/2014/v69s1/a-review-of-depression-research-in-malaysia.pdf

Statista Research Department. (2020). Crude suicide rate in Malaysia 2000 to 2016. https://www.statista.com/statistics/701895/malaysia-crude-suicide-rate/

World Health Organization. (n.d.). Suicide data. https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

World Health Organization. (2018). Suicide rate estimates, crude, 5-year age groups up to 29 years. https://apps.who.int/gho/data/node.main.MHSUICIDE5YEARAGEGROUPS?lang=en

World Health Organization. (2018). Suicide rate estimates, crude, 15-29 and 30-49 years. https://apps.who.int/gho/data/node.main.MHSUICIDEAGEGROUPS15293049?lang=en