by Edwin Quinabo
Suicides are preventable, unlike an incurable disease – this is what health experts say people should know first and foremost about this public health crisis.
Experts say knowing these two myths alone can help to save lives. The first myth: suicides are committed only by people with a history of mental illness. The reality: there are life stressors that also have been documented to influence suicide among those who’ve never suffered from clinical mental illness. The second myth, people commit suicide unexpectedly without giving it much thought. The reality: there are warning signs, but most don’t know what they are and must be better informed.
September is National Suicide Prevention Awareness Month and public health educators say it’s a good time to be educated on suicide that could save the life of a loved one in your life. While talking openly about suicide is uncomfortable and difficult, it’s also the most meaningful attempt to saving a life, experts say.
Just how common is suicide in the U.S.?
Suicide is the 10th-leading cause of death in the United States, overall. Statistics show it is the second-leading cause of death between the ages of 10 and 34, and nearly 5% of Americans 18 and over have had serious thoughts about suicide over the course of a year, according to the National Institute of Mental Health.
According to the Centers for Disease Control and Prevention suicide rates increased approximately 36% between 2000–2021. Suicide was responsible for 48,183 deaths in 2021, which is about one death every 11 minutes. The number of people who think about or attempt suicide is even higher. In 2021, an estimated 12.3 million American adults seriously thought about suicide, 3.5 million planned a suicide attempt, and 1.7 million attempted suicide.
According to the Hawaii State Department of Health, data from 2016 shows suicide in Hawaii is the most common cause of fatal injuries among residents, outpacing car crashes, homicide, poisoning and drowning. It’s estimated that one suicide is committed every two days in Hawaii.
Within the Filipino community, higher rates of suicide have been reported among immigrants because of uncertainty of their legal status and added pressures of assimilation.
Suicide in Hawaii as well as throughout the country could be characterized as a silent epidemic, a silent crisis. Not many are talking about it due to the taboo associated with suicide. Because of the stigma behind suicides, it’s believed suicides are underreported, and that the problem could be more widespread than it already is.
Suicide rates among Asian Americans (5.24 deaths per 100,000) are lower than the national average. But Asian immigrants are at higher risk of suicide, according to the National Latino and Asian American Study, a first-ever study conducted on the mental health of Asian Americans.
Within the Asian ethnic group, Filipino Americans have the lowest rate of suicide (3.5 per 100,000) while Japanese Americans have the highest rate (9.1 per 100,000), followed by Chinese Americans (8.3 per 100,000).
Mabel, Kalihi, said “Suicide is a very private issue and I’m willing to comment under strict confidentiality because it involves my daughter. I cannot go into detail, but I will comment because this might help people in our community.
“In 2015, my son came to me saying he had a deep secret involving my daughter. He looked very nervous and choked up when telling me this. He said I must promise him not to tell my daughter. He said my daughter confided in him that she wanted to kill herself. I was devastated from hearing this. I cried and couldn’t believe what I was hearing. He told me her reasons, which I cannot say here. But I can tell you what we did in response to this secret.
“Immediately, I had to tell my husband and we had to come up with a plan as a family. The first week, my son was to be our go to person to monitor how serious she was about suicide. The plan was for one week of very cautious monitoring then we would reassess this situation after the week was up. But that didn’t last a day.
“The next day after hearing this news my husband and I approached our daughter delicately. She’s in her 20s and still lives with us. After work her normal routine is to go to her room. After about an hour we both went to her room to talk about it. We still remember that day vividly. It was an outpouring of emotion, sadness, understanding and joy that she hadn’t acted on it. Suicide, she confessed, was something she’d thought about for years. But we were clueless to the signs.
“We knew we needed professional help because it was serious. We got help. At first, she saw a psychiatrist who put her on medication. After about a year, she switched to a psychologist who she sees regularly. The dosage of her meds went down and she’s doing a lot better. Suicide is something today we will talk about as a family periodically. But it’s still our family’s secret.
“What I can say to look out for is when personal trauma happens like a death of someone close and if it coincides with other serious trauma happening about the same time, these traumas collectively can be the beginning of serious suicidal ideation especially if your child is naturally sensitive. Pay close attention to how your children deal with personal traumas. Not everyone responds to trauma the same, even if these traumas are as natural occurrences in life to most people,” Mabel said.
“I am so thankful to God that she reached out to my son initially. That saved her life. And it saved us from what would have been a lifetime of grieving if she had committed suicide. Thank you, Jesus.”
Mabel said she’s been looking into the topic on her own and found out suicide ideation is more common among millennials than most people think. She said in her findings, that the millennial generation is far more open to seeking mental health counseling far more commonly than those in her generation, Gen X. “This is good that the younger generation is getting the help they need,” Mabel said.
Dr. Mariel Eusebio told the Filipino Chronicle she has a cousin who is diagnosed with major depressive disorder. She said her battle began after her father’s death due to cancer. They were both 18 years old and roommates in college when this started.
“I vividly remember arriving home from school and finding her in a corner of our room – bawling and ‘hearing voices’ in her head. When I asked her what these voices told her, she said, ‘They told me to take my life away.’ That night, I did not sleep as I watched her closely and made sure she would not do anything to hurt herself. It was challenging for us, especially for her mother and sister. After informing her mom, she immediately took a leave of absence from work in Saudi Arabia. She took the earliest flight to the Philippines and then decided to admit my cousin to a mental health facility,” Dr. Eusebio said.
She adds it’s difficult to have a family member with mental illness together with suicidal ideation. “It takes a toll not only on the person but also on the people around her. The family’s continuous effort, patience, and care must always be present. The family must always be on our toes due to this threat to life. As a relative, it breaks my heart to see my cousin struggle through this and fight her battles each day. The most significant contribution I could give is my love and endless support for my cousin.”
While people may not want to talk about suicide openly in public if it involves a family member or someone close to them, experts say most are open to talk about it on a personal level with those who they love.
Dr. Eusebio said, “Since me and my sister come from a broken family, we are left with each other for support, especially with topics like suicide. We openly talk about suicide; as Christians, we are reinforced that this is an act we will not do. If we are ever placed in that situation, we will try our best to support each other and remind ourselves that this is an act we would never and should not do.”
Rae Ann Benitez, Honolulu, said she doesn’t know of anyone personally who’s had suicide ideation. “I haven’t had any conversation about suicide, but I feel like I’m comfortable enough to open up about it if I have to.”
She said if she found out that someone who she knows has suicide ideation, she would offer her time and would ask her if she’s comfortable talking about it with her or if there’s anyone that she would want to talk to and be more comfortable with.
Similarly, Dr. Eusebio said she would invite the person thinking about suicide to talk about his thoughts. “First, I would ask about his plans if he has any suicide plans already. Next is to give reassurance that I am available if he needs someone to talk to. Then, I would tell him that life may be difficult and cause us to fall sometimes, but he is not alone. We all have our struggles and battles. I would encourage him to seek professional help from a doctor and a therapist.”
But like Mabel, experts say most people just don’t know if someone is thinking about suicide because they are unaware of what could trigger suicidal thoughts.
Risk Factors for Suicide
The Centers for Disease Control and Prevention (CDC) says suicide is rarely caused by a single circumstance or event and lists a range of factors — at the individual, relationship, community, and societal levels — that can increase risk.
Individual Risk Factors
These personal factors contribute to risk:
*Previous suicide attempt
*History of depression and other mental illnesses
*Serious illness such as chronic pain
*Job/financial problems or loss
*Impulsive or aggressive tendencies
*Current or prior history of adverse childhood experiences
*Sense of hopelessness
*Violence victimization and/or perpetration
Relationship Risk Factors
These harmful or hurtful experiences within relationships contribute to risk:
*Family/loved one’s history of suicide
*Loss of relationships
*High conflict or violent relationships
Community Risk Factors
These challenging issues within a person’s community contribute to risk:
*Lack of access to healthcare
*Suicide cluster in the community
*Stress of acculturation
Societal Risk Factors
These cultural and environmental factors within the larger society contribute to risk:
*Stigma associated with help-seeking and mental illness
*Easy access to lethal means of suicide among people at risk
*Unsafe media portrayals of suicide
The National Suicide Prevention (NSP) says there are warning signs people thinking of suicide exhibit. The NSP wants to convey that people who commit suicide don’t want to die; what they really want is to end their pain. These individuals are suffering deeply; they feel helpless and hopeless.
Here are signs to look for:
*Preparing for death: suddenly updating wills, giving away cherished belongings, saying goodbye
*Talking about suicide — for example, making statements such as “I’m going to kill myself,” “I wish I were dead” or “I wish I hadn’t been born”
*Getting the means to take your own life, such as buying a gun or stockpiling pills
*Withdrawing from social contact and wanting to be left alone
*Having mood swings, such as being emotionally high one day and deeply discouraged the next
*Being preoccupied with death, dying or violence
*Feeling trapped or hopeless about a situation
*Increasing use of alcohol or drugs
*Changing normal routine, including eating or sleeping patterns
*Doing risky or self-destructive things, such as using drugs or driving recklessly
*Giving away belongings or getting affairs in order when there’s no other logical explanation for doing this
*Saying goodbye to people as if they won’t be seen again
Mental health experts say it’s never out of place to ask someone if he or she is thinking of committing suicide when warning signs are present.
Reducing risk for suicide
While Mabel’s daughter continues her counseling sessions, she said her family has gotten closer. They have more regular family outings. They’ve worked on communicating and connecting at a deeper level. They got a family pet. “Most important is that we always tell each other that we’re here to support each other, no matter what,” Mabel said.
The CDC says building tighter family and community bonds helps to reduce risks of suicide. When people feel that they are needed and know how their loss would greatly impact those around them, this becomes a powerful deterrent against suicide, the CDC says. It also says learning effective coping and problem-solving skills are important factors that reduce suicidal tendencies.
Dr. Eusebio believes the rates of suicide are on the rise because society has evolved in such a way that places many expectations and stress on individuals – especially the youth. “Additionally, as the number of divorce rates also increases, the number of children from broken families is also growing, which leads to the loss of their primary support system,” she said.
Dr. Eusebio said she had never thought of committing suicide. “Due to life’s challenges at an early age, this has molded me to become independent and strong-minded. I have learned to have a firm and goal-directed vision.”
Mabel said she thinks most parents in her generation don’t think of suicide as something that could happen in their own family. “It’s something that our parents never talked about with us. And growing up, I never had those thoughts. But every generation is different. My hope is that every parent has a serious talk about suicide. You just never know what’s in the mind of your children.”
Contact the 988 Suicide and Crisis Lifeline if you are experiencing mental health-related distress or are worried about a loved one who may need crisis support. Call or text 988. Chat at 988lifeline.org. Connect with a trained crisis counselor. 988 is confidential, free, and available 24/7/365.
The Hawaii State Department of Health’s Adult Mental Health Division (AMHD) has a statewide ACCESS line program. On Oahu callers can reach the Crisis Line by dialing 832-3100. Neighbor island residents may call toll-free at 1-800-753-6879.
If there is an urgent threat, it’s recommended to call 911.
If you’re feeling suicidal, but you aren’t immediately thinking of hurting yourself:
Reach out to a close friend or loved one — even though it may be hard to talk about your feelings. Contact a minister, spiritual leader or someone in your faith community. Make an appointment with your doctor.
Seeing a mental health professional when suicide ideation occurs is lifesaving. Professionals can help people deal with healthy coping strategies and emotional management. They can help the at-risk individual with techniques to get through life stressors.
Mental health professionals say, “Remember, acute suicidal feelings are temporary. Take one step at a time and don’t act impulsively.”
by Edwin Quinabo