Warning signs you shouldn’t ignore

The alleged suicide of Trina Etong, wife of broadcaster Ted Failon, brings into focus the tragic, but preventable, act of a person taking his own life.

There are warning signs when a person is contemplating suicide:

1. Abrupt changes in personality or behavior

2. Giving away possessions

3. A previous suicide attempt

4. Use of drugs and/or alcohol

5. Change in eating pattern — significant weight change

6. Change in sleeping pattern — insomnia/oversleeping

7. Unwillingness or inability to communicate

8. Depression

9. Extreme or extended boredom

10. Being accident-prone (carelessness)

11. Unusual sadness, discouragement and loneliness.

12. Talk of wanting to die

13. Neglect of academic work and/or personal appearance

14. Family disruptions — divorce, trauma, losing loved one

15. Running away from home or truancy from school.

16. Rebelliousness — reckless behavior.

17. Withdrawal from people/activities they love

18. Confusion — inability to concentrate

19. Chronic pain, panic or anxiety

20. Perfectionism

21. Restlessness

Knowing the warning signs, it is also important to know the risk factors of suicide:

1. Problems with school or the law

2. Breakup of a romance

3. Unplanned pregnancy

4. Stressful family life (having parents who are depressed, or are substance abusers, or a family history of suicide)

5. Loss of security — fear of authority, peers, group or gang members

6. Stress due to new situations; college or relocating to a new community

7. Failing in school or failing to pass an important test

8. A serious illness or injury to oneself

9. Seriously injuring another person or causing another person’s death (e.g. a vehicular accident)

10. Significant loss — of a loved one, a home, divorce in the family, a trauma, a relationship

People who are likely to commit suicide are categorized as high-risk or low-risk. In a study published at the Emergency Psychiatric Medicine: Kaplan and Sadock’s Synopsis of Psychiatry, those who are considered high-risk are people who have chronic illness, are hypochondriacs and have excessive substance intake. Mentally speaking, in high-risk, too, of committing suicide are people who have severe depression, psychosis, severe personality disorder and have cases of substance abuse and hopelessness. On a personal-social level, those who have poor achievement, poor insight, poor rapport, socially isolated or have irresponsible family members are considered high-risk.

Under low-risk are the ones who have good health, mild depression, are social drinkers and have concerned family members.

A lack of future plans, giving away personal property, making a last will and testament, and having recently experienced a loss (for example, death of a loved one or loss of one’s lifetime savings) all imply increased risk of suicide. The psychiatrist’s decision to hospitalize a patient depends on the following: [1] diagnosis, [2] depression severity, [3] suicidal ideation, [4] the patient’s and the family’s coping abilities, [5] the patient’s living situation, [6] availability of social support, and [7] the absence or presence of risk factors for suicide.

Patients recovering from a suicidal depression are at a particular high risk. As the depression lifts, patients become energized and, thus, are able to put their suicidal plans into action (paradoxical suicide). Sometimes, depressed patients, with or without treatment, suddenly appear to be at peace with themselves because they have reached a secret decision to commit suicide. Clinicians should be vigilantly suspicious of such a dramatic clinical change, which may progress into a suicide attempt.

A patient may commit suicide even when in the hospital. According to one survey, about one percent of all suicides were committed by patients who were being treated in general medical-surgical or psychiatric hospitals, but the annual suicide rate in psychiatric hospitals is only 0.003 percent.

If you are severely depressed or if a friend or relative has the warning signs of suicide, don’t hesitate to seek professional help. There are government hospitals where one can seek psychiatric consultation for free like the Philippine General Hospital at Taft Avenue, Manila and the National Center for Mental Health at Nueve de Pebrero Street, Mandaluyong City.

Suicide victims are not trying to end their life, perhaps they are just trying to end their pain! Help them handle their pain by referring them to a psychiatrist.–Dr. Nina Halili-Jao, Philippine Star

(For questions, e-mail me at nina.halilijao@gmail.com)