Discussion about suicide is complex, but shouldn't stop.

Trigger warning: This article involves discussion on the topic of suicide.

• “Ignorance is bliss?

  
  This is a statement I would wholeheartedly disagree concerning suicide and suicide prevention. Unfortunately, the stigma of suicide is still prevalent. For example, in Singapore:
  

  Nationwide study by SMU shows that 8 in 10 believe in the existence of stigma associated with suicide in Singapore

  
  By the SMU Corporate Communications team

  
  Singapore, 18 April 2024 (Thursday) – A new study by Singapore Management University showed that there remains a stigmatic attitude towards suicide compared to two years ago. 1 in 3 Singaporeans would do something to help someone who is suicidal, yet 7 in 10 said they are fearful that they might exacerbate the situation by making the suicidal person feel worse. This year’s nationwide study was a follow-up to the original, “Save.Me”, conducted in 2022 and showed no shift in these perceptions amongst Singaporeans.
  

  Key Findings of practical impact:

  1. The stigma associated with suicide remains high

  • 8 in 10 believe in the existence of stigma associated with suicide in Singapore.
    

  2. False beliefs in suicide prevail

  • 8 in 10 think that when someone does talk about suicide, that person could take his life. This may be highly significant in society’s resistance towards the conversation surrounding suicide, as resistant then as it is today.

  • From 2022, there is a rise in those believing that most suicides happen suddenly without warning and that a person dying by suicide was one who was unwilling to seek help.
    

  3. Fear of exacerbating the situation for someone who is suicidal

  • Similar to 2022, more than 70 per cent say it is their fear of making the suicidal person worse, their lack of ability to do anything, and their lack of knowledge.
    

  4. A well-educated individual may not necessarily have greater knowledge of suicide

  • Just as in 2022, education exerts no significant effect on knowledge of suicide.

  • There is only a marginal rise in knowledge of suicide with more years of education.

  • When asked for the top reason for their low knowledge levels, those people with more intimate connections to suicide (from immediate family to relatives) chose “No outreach or education”, the same as in 2022. Those more removed from suicide (friends to unrelated or nobody) chose “No personal connection”.
    

  5. Instinctive reactions at the news of suicide include grief, anger and guilt

  • The most instinctive emotion across survey respondents at the time of a suicide incident was “Confusion / Shock / Disbelief”, with those with immediate family connections choosing most of or all the above including grief, anger and guilt.
    

  6. The public perceives a suicide prevention strategy as being critical

  • 9 in 10 (90.2 per cent) believe that suicide can be prevented, a borderline significant dip from 91.9 per cent in 2022, and that Singapore needs a suicide prevention strategy.

  • The older an individual, the more he does not believe suicide can be predicted.

  • More than 70 per cent of survey respondents aged below 21 years old believe suicide can be predicted.

  https://news.smu.edu.sg/news/2024/04/18/stigma-suicide-still-strong-2022

• Discussion around Suicidality is complex, and research on how to do so is ongoing.

  
  The American Psychological Association defines suicidality as “the risk of suicide, usually indicated by suicidal ideation or intent, especially as evident in the presence of a well-elaborated suicidal plan.” It can also be defined to include suicidal thoughts, plans, gestures, or attempts.
  
  It is also difficult to discuss, as we do not want to increase the risk of suicide.

  
  “I am afraid of making the matter worse.”
  “I don’t know how to handle if he/she says I want to kill myself.”

  
  There is research that suggests that poor handling of the discussion of suicidality does increase the risk of suicide.

Two sides of the same coin? The association between suicide stigma and suicide normalisation

Aims

Evidence suggests that suicide stigma (i.e. negative attitudes towards persons affected by suicide/suicidality) and suicide normalisation (i.e. liberal attitudes towards suicide) are both associated with increased suicide risk. Despite conceptual similarities and potential interaction, suicide stigma and suicide normalisation have usually been investigated separately. We used cross-sectional data from a community sample to test the association between suicide stigma and suicide normalisation as well as to identify their respective determinants and consequences.

Results

Suicide stigma and suicide normalisation were inversely associated so that higher suicide stigma scores were linked to lower suicide normalisation. More suicide stigma was associated with reduced intentions to seeking professional help, increased willingness to seek help from family and friends and lower odds to experience current suicidality, however the association between suicide stigma and intentions to seek professional help diminished after controlling for confounding variables. Increased suicide normalisation was linked to reduced intentions to seek help from professionals or family and friends, as well as higher odds to experience current suicidality, even after controlling for confounding variables.

Conclusion

Our findings suggest that interventions to reduce public suicide stigma are at risk to unintentionally increase suicide normalisation, which appears to be a key barrier to seeking help for suicidality. Future research should therefore identify strategies to improve attitudes towards persons affected by suicidality that avoid normalisation, i.e. do not convey the message of suicide as an acceptable solution for difficult life situations. One strategy with great potential to safely reduce public suicide sigma could be interventions that stimulate interpersonal contact with affected persons sharing their recovery story.


Oexle, N., Valacchi, D., Grübel, P., Becker, T., & Rüsch, N. (2022). Two sides of the same coin? The association between suicide stigma and suicide normalisation. Epidemiology and Psychiatric Sciences, 31. https://doi.org/10.1017/s2045796022000610

• Guidelines for discussing suicide
  
  These are my thoughts, which may not represent the general community:

  • Avoid sensationalising/ normalising suicide, regardless of the number of deaths by suicide or the closeness of the suicide to you that has occurred.

  • Avoid presenting suicide as a potential solution, no matter how hopeless the situation may seem.

  • Avoid discussions on the explicit details such as the method, individual, and circumstances involved in the suicide, but find out enough so that you can potentially stop the attempt.

  • Do provide information on available resources and encourage help-seeking.

  • More discussion on personal stories of coping with and recovering from suicidality.

  • Attend appropriate trainings, such as Caring for Life’s programme to help you further.

  

  CFL LIFE Training is a 4-hour, half-day program designed to help participants identify signs of suicidal thoughts and effectively engage with individuals who may be struggling. The training also emphasizes connecting them to community resources for suicide intervention.
  

  The program highlights the importance of creating a safe environment for conversations, encouraging open dialogue to address the topic of suicide.
  
  “Being able to calmly talk to him and even respect his thoughts of suicide and understand why he wanted to die made him feel not rejected. Then I was able to identify the problems that caused him to lose hope in living, map out a realistic plan to help overcome each of these problems and make him feel it could actually be done, which made him think of living again.”
  

  Dr Alex Su, CFL Advisor

  Clinical Director (Care Transformation), Chief (Recovery Care), Senior Consultant
  
  https://caringforlifesg.org/how-to-spot-suicide-ideations-and-prevent-a-suicide-attempt/

• Suicide prevention is an ongoing journey, so don’t stop.