Self -Harm & Suicide: A Plague for Mental Health among Youth

World Suicide Prevention Day is officially commemorated every year across the globe on 10th of September by the International Association for Suicide Prevention (IASP) in collaboration with World Health Organization (WHO). The day aims at increasing awareness about suicide prevention among people.

The theme of the current year is “Working Together to Prevent suicide”. World Health Organization (WHO, 2015) reported suicide as the second leading cause of death among 15-29 years old. Every year close to 800 000 people take their own life and there are many more people who attempt suicide. Suicide qualifies as serious public health problem; yet its prevention remains a universal challenge.

Young people includes the age groups of 14-28 years – identified as youth, young people and young adults. This is the age in which the maximum changes occur internally as well as externally. Many a time, young adults seem to be self-directionless; unable to handle myriad of changes occurring in their lives. This makes them vulnerable to the four ill C’s – Competition, Conflict, Crisis and Chaos, influencing overall well-being of the young adult. The most essential question that bothers youth is regarding existential crisis, i.e. life worth, purpose of life, need of existence, death over life, confused identity etc. Most of the times, failing to seek an answer, unable to address it correctly, the most commonly preferred way opted is causing self-harm or contemplating about ending life.

Suicide and self- harm are related and often used interchangeably but difference exists between the two. Suicide is defined as “deliberate killing” of oneself resulting in tragic loss of life affecting family, community whereas self-harm indicates any intentional behavior that results to damage, mutilation or destruction of the body without suicidal intent.

The commonly used means of self- harm are cutting, overdosing, burning, scalding, swallowing dangerous objects or substances, picking or scratching, biting, hair pulling, head-banging or bruising one self. Cutting is the most commonly reported form of self -harm, followed by poisoning or overdosing. Globally, swallowing pesticide, hanging and guns are among the most common means of suicide.

Self-harm is reportedly more common across females whereas, suicide is more common among males. Moran Found that self-harm is rare before puberty and becomes more common in early adolescence, with the first episode of self-harm typically occurring between the ages of 12 and 16. Rates of self- harm fall in the later teenage years and continue dropping until at least the end of the twenties. Community studies in high-income countries consistently report that approximately 10%of young people report having self-harmed at least once in their lives.

Self-harm is strongly associated with subsequent suicide. The risk of suicide is highest in the first six months after an episode of self-harm and self-harm is also associated with an increased risk of accidental death or permanent disability. For every young person, who dies by suicide, approximately 30 acts of self-harm occur. Following an act of self-harm, the rate of suicide in young people increases to 50-100 times the rate of suicide observed in the general population. Approximately half of all people who die by suicide have a history of self-harm, with approximately 25% having self-harmed within the previous year.



Factors associated with self-harm

Factors associated with suicide

Demographic: Aged < 20 years, Female gender, Low socioeconomic status, Low level of education Divorced/separated, LGBTI ,Criminal record, Childhood sexual assault, Physical assault victimization,

Demographic: Aged 18-40 years, Male gender, Low socio economic status, Low level of education, Divorced/separated, LGBTI, Criminal record, Childhood sexual assault, Parental separation/ divorce, Unemployed

Psychological:  High impulsivity, Poor problem-solving skills, Hopelessness, Low self-esteem, Perfectionism, Self-criticism

Psychological: High impulsivity, Poor problem-solving skills, Hopelessness, Low self-esteem, High suicidal intent

Psychiatric: Depression, Substance abuse, Previous psychiatric hospitalization, Personality disorder, Anxiety disorder

Psychiatric: Depression, Substance abuse, Previous psychiatric hospitalization

Social: Adverse childhood experiences, Social isolation, Bullying victimization, Exposure to self-harm, Alcohol use, Onset of sexual activity, Loneliness

Social: Adverse childhood experiences, Interpersonal difficulties in adolescence (difficulty making new friends, frequent arguments with adults in authority and peers, frequent cruelty towards peers), Bullying victimization, Exposure to self-harm

Situational Factors: Current adverse life events, Intoxication

Situational: Current adverse life events, Intoxication, Media exposure of suicide.

(Source: Report developed by WFMH, 2018)

People who indulge in self- harm or suicidal intent need help. Such acts involve “CRY FOR HELP’’. Thus, providing support is extremely crucial. Letting the person know that they are not alone and encouraging them to seek professional help is the need of the hour.  Self-harm acts and suicidal intent should not be kept as secrets. Being as open as possible and ensuring safety of the person is the basic need while witnessing someone indulging in self-harm / suicide attempts. This should be followed with encouraging the person to discuss their feelings. This helps in assessing the intent of considering suicide and, where relevant, calling the local hospital or accessible mental health service. While this may be challenging, calling an ambulance or taking a young person to the nearest hospital emergency department may be appropriate if they need urgent medical attention. Psychological interventions by mental health professionals is a mandatory part of crisis services. Effective suicide prevention strategies need to incorporate public health policies and healthcare strategies incorporating measure with strongest evidence of efficacy.

In light of the association between self-harm and suicide, by intervening effectively to reduce self-harm in young people, it is likely that the number of suicide deaths can be prevented. Self-harm during adolescence should be considered by friends, family members and health professionals as more than just a passing phase.

“Caring-about people, about things, about life –is an act of maturity ~ Tracy McMillan”

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