By Beatrice Nakibuuka
From a statement like, “I wish I could sleep and never wake up or get knocked by a speeding car,” to taking an overdose, herbicides, pesticides, hanging, or jumping off a building, suicidal thoughts and attempts are the second leading cause of death among the youth between 15 to 29 years, according to World Health Organization (WHO).
Suicide is the act of taking one’s own life. Globally, more than 800,000 people die due to suicide every year.
For every suicide, there is likely to be a prior attempt. A prior suicide attempt is the single most important risk factor for suicide in the general population.
Suicide is the fourth leading cause of death among 15-19 year-olds and about 77 per cent of global suicides occur in low and middle-income countries.
Uganda meets the criteria of a low-income country, with high cases of clinical depression which leads to suicide rates being high.
According to a Transcultural Psychosocial Organisation (TPO) report, Uganda registered 368 suicidal cases in the year 2021; 128 of them being women and 240 men.
Franko Olong, a psychological therapist at Strides of Hope (SoHope) remarks that women are more susceptible to suicide because they are greatly affected by depression and women attempt suicide three times more than men.
However, since men have better access to suicidal tools and consider acknowledging a need for help as a weakness, more men actually commit suicide than women.
“Women value interdependence, they consult friends and readily accept help, whereas men think that they are independent and it may be hard to change their decisions, especially about suicide,” he says.
Olong says when one has suicidal tendencies, there are different stages; one can have the idea, a plan on how to execute it, and actually, attempt to commit suicide.
Causes of suicide
“Suicide is not a stand-alone mental health problem. It can be triggered by a multitude of factors, but most importantly from depression and a lack of understanding of self,” says Evelyn Kharono Lufafa, a counseling psychologist at Makerere University.
She says one of the chief causes is the loss of hope that stems from clinical depression.
This happens when a person comes to a point in life where they feel they can no longer cope with an overwhelming situation.
When Peter Musiime (not real names) was duped to sign an investment deal that led to the loss of over Shs 50 million at his company, he lost all hope to live and contemplated suicide.
At the moment, he was preparing to wed his longtime girlfriend and realised his plans had been cut short.
At the company, he was fired and asked to either pay the money or go to prison.
He did not know how to disclose to his girlfriend that he had lost his dream job and worse still, that he had to pay that much.
Prison was unthinkable for him, yet he did not have the money. For several days, he did not go home and switched off his phone.
After failed attempts to reach him, his girlfriend decided to go to his house, which she found messy, with a few items missing.
When she inquired at his workplace, she was told he had not reported for a week, and she decided to try the bar he used to go.
She found him dirty, drunk, and helpless. After moments of struggle, he later disclosed this to his girlfriend and asked her to go away because he lost hope of marrying her.
He had also bought rat poison, which he wanted to take to end his life.
Fortunately, his girlfriend called his brother, and together, they took him to a counselor for help.
In addition to job loss, people with chronic illnesses, those with a history of substance abuse, a history of attempted suicide may be triggered by a minor issue to get suicidal.
Bullying at school, personality problems, domestic violence and physical abuse are situations that could be hard for some people to cope with and in most cases end up committing suicide.
Who is at risk?
While there is a well-established link between suicide and mental disorders (such as depression and drug abuse disorders), many suicides happen impulsively in moments of crisis.
Vulnerable groups who experience discrimination such as refugees and migrants, indigenous people, gay persons, and prisoners may also be suicidal.
Incurable diseases like cancer or HIV might lead someone to contemplate suicide.
Jolly Namuli, 28, says she thought about ending her life when she was diagnosed with HIV.
She had been advised by her new boyfriend to do blood testing before they could settle down together.
After finding out, her boyfriend left her and she did not know what to do or who to run to.
She went home and swallowed an over-doze of anti-depressants and went to bed, hoping she would die.
“I wanted to die but the tablets did not work. When I woke up, I kept wondering what would kill me fast but could not figure it out,” she says. Fortunately, her friend called her and she opened up.
Signs and symptoms
As mentioned earlier, suicide is not a stand-alone action, but rather a series of events and it may start with the victim having long sleepless nights, eating habit changes, anger, aggression, and being easily agitated.
Victims may also engage in reckless behaviour like: excessive alcohol or drug consumption, avoiding social interactions with others, expressing rage or intentions to seek revenge.
One might also hear voices, feel empty and alone, misuse of money, get easily offended, have negative performance at work, and so many other symptoms.
Namuli says: “It is like someone was whispering to me telling me that it is safer while dead than live and go through pain, after all there is no cure. I was hopeless.”
Managing the thoughts
Suicide is a psychiatric emergency, and so, in case one has such thoughts they need immediate attention from a medical person or psychiatric help.
If the person has attempted to commit suicide, he or she must be put in a very safe place under strict observation, with no access to any tools to prevent the person from hurting himself.
They should be taken for therapy immediately, for the cause to be addressed.
Olong says: “If the cause of the suicidal thought is not addressed, the person is likely to have another attempt and this time they could end their life.
“It is important that the caregiver or the family look out for signs of withdrawal, extreme wishes of death, and involve a medical person or police if you have no support to take the patient to hospital or rehabilitation centre.”
Once at the rehab, the therapist will do a comprehensive assessment of the person’s behaviour and involve them in talk therapy once they are able to talk about the cause of the suicidal thoughts.
With the help of counseling and proper medication, depending on the cause, the therapist must help the victim to solve the problem or he will repeat the attempt.
For Musiime’s case, it took him six weeks of talk therapy and he was able to get back to his feet. He returned to his job and agreed to work till the money was cleared.
Once in a while, he would go back to the therapist for review and more sessions.
When Namuli shared her pain with a friend, she took her to Uganda Cares, an organisation that offers free counseling and treatment to HIV patients.
She has been receiving counseling and treatment from here. But even after counseling, she says she still struggles with suicidal thoughts.
“Every time I cross the road, I hope a car knocks me and I die instantly. But then I remember maybe it is not yet my time,” Namuli says.
She is still undergoing counseling and hopes to get better.
Lutafa says depending on the cause, if talk therapy is not enough to successfully lower risk, medication may be prescribed to ease symptoms.
Treating these symptoms can help reduce or eliminate suicidal thoughts.
Anti-depressants, antipsychotic medications and anti-anxiety medications may be prescribed.
In addition to talk therapy and medication, suicide risk can sometimes be reduced by simply adopting certain healthy habits such as avoiding alcohol and drugs, exercising regularly, enough sleep and avoiding isolation.
Suicides are a preventable public health concern. There are a number of measures that can be taken to prevent suicide and suicide attempts.
Raising awareness among people is very essential in preventing suicide.
Every parent and caregiver should foster socio-emotional life skills in adolescents; limit access to the means of suicide (e.g. pesticides, firearms, certain medications); early identify, assess, manage and follow up on anyone who is affected by suicidal behaviours.
What the Bible says
There are several suicidal examples in the Bible such as King Saul and his armor-bearer, Samson, Abimelech, Judas Iscariot, and many others.
However, Exodus 20:13 says: “You shall not kill.” This commandment does not limit other people’s lives but also self.
Olong advises people that no matter the situation, they should choose faith over fear. The Lord has promised us that He will always be with us (Isaiah 41: 10).
In all difficult situations, He is always with us; you are never alone.
Some people choose suicide because they do not feel loved, but God loves us so much that He even did not withhold His Son who died on the Cross for our sins.
He actually has better plans for us, so we need to hold onto our faith.
It is never the will of God to end our lives because He came so that we may live in abundance (John 10:10).
Therefore, God cannot inspire someone to kill themselves. However, there are incidents where God’s people have taken their lives.
We cannot judge them because only God has the right to judge. He judges the motive of the heart. “There is no condemnation for those who are in Christ” (Romans 8:1).