Suicide Prevention in Nigeria – How to Manage Low Mood and Depression

‘Very often when people say “I am tired of life” or “There is no point in living”, they are brushed off, or are given examples of other persons who have been in worse difficulties. Neither of these responses helps the suicidal person’. WHO

The causative issues for low mood and depression are quite common all over the world, but there are other issues I have identified peculiar to the Nigerian environment. In this article I will be discussing the common causes of low mood and depression prevalent in our society.

The rate of Depression, suicidal ideation and drug addiction is on the increase in Nigeria at the moment, this seems to be a ‘chain reaction’ triggered by a host of other factors which include, poverty, unemployment, harmful cultural practices , ‘social media factors ‘and  untreated mental health illness ;schizophrenia, bipolar disorder,etc. 

Social Media pressures

 When we were growing up, there was no social media, I call it the good old days, for social activities we spent more time outdoors, and we made use of indoor and outdoor sport facilities.

I grew up in a university environment where I didn’t have to belong to an elite sports club to make use of a gym, basketball court or lawn tennis court. I had the privilege of having a gym where we contributed only a token, although the gym was filled with males doing body building, it was a bit difficult for me to use the gym sometimes as I could be the only female in the gym and felt outnumbered, but I didn’t let that deter me, because I understood the benefits of physical exercise to my wellbeing, and overall health.

Social media has its own advantages and disadvantages, and it could be addictive as well; these days’ young people are influenced by it and so engrossed in having approval through ‘followership’, likes etc they tend to neglect what matters most which is their mental health and wellbeing. Some people have gone into depression when their friends do not like their posts.

The human body was created to function in harmony, when any part is suffering, it affects our productivity. For some of the suicide cases that have occurred recently, the victims made a post about it on social media before the act or while doing the act.

For us to understand how to deal with low mood and depression, we need to know the trigger factors and causes to enable us seek help in good time .Knowing the root cause is essential to identifying ways to solve the problem.

Common causes of low mood and depression

• 1- Bereavement
• 2- Lack of self-worth and feeling of inadequacy
• 3- Relationship break down like divorce, separation etc
• 4- Poverty- Unemployment
• 5- Minor illness and Major diseases
• 6- Natural disasters
• 7- Tribal Conflicts /Wars
• 8- Poor grades or exam failure
• 9- Toxic workplace
• 10- Hectic lifestyle
• 11- Excessive overworking
• 12- Domestic Violence
• 13- Sexual Abuse
• 14- Social Media addiction
• 15- Lack of sleep
• 16- Underlying mental health illness
• 17- Infertility
• 18- Prescribed Medication
• 19- Drug addiction /Abuse
• 20- Issues with finding a life partner/Late marriage

How do we maintain our mental health?

There are several ways we could maintain our emotional health and help reduce low mood and depression

According to the WHO, Depression is a common mental disorder, characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks. 

In addition, people with depression normally have several of the following: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.

Depression is treatable, with talking therapies or antidepressant medication or a combination of these. Depression is the most common diagnosis in completed suicide. Everyone feels

Depressed, sad, lonely and unstable from time to time, but usually those feelings pass. However,

When the feelings are persistent and disrupt a person’s usual normal life, they cease to be

Depressive feelings and the condition becomes a depressive illness.

Some of the common symptoms of depression are:

• feeling sad during most of the day, every day;
• losing interest in usual activities;
• losing weight (when not dieting) or gaining weight;
• sleeping too much or too little or waking too early;
• feeling tired and weak all the time;
• feeling worthless, guilty or hopeless;
• feeling irritable and restless all the time;
• having difficulty in concentrating, making decisions or remembering things;
• having repeated thoughts of death and suicide.

Life Stressors

The majority of those who commit suicide have experienced a number of stressful life events in the three months prior to suicide, such as:

• Interpersonal problems – e.g. quarrels with spouses, family, friends, lovers;
• Rejection – e.g. separation from family and friends;
• Loss events – e.g. financial loss, bereavement;
• Work and financial problems – e.g. job loss, retirement, financial difficulties;
• Changes in society – e.g. rapid political and economic changes;
• Various other stressors such as shame and the threat of being found guilty.

To understand what leads people to committing suicide, we need to understand the state of mind of a suicidal person.

THE STATE OF MIND OF SUICIDAL PERSONS

Three features in particular are characteristic of the state of mind of suicidal patients:

1. Ambivalence: 

Most people have mixed feelings about committing suicide. The wish to live and the wish to die wage a see-saw battle in the suicidal individual. There is an urge to get away from the pain of living and an undercurrent of the desire to live. Many suicidal persons do not really want to die – it is just that they are unhappy with life. If support is given and the wish to live is increased, the suicidal risk is decreased.

1. Impulsivity:

 Suicide is also an impulsive act. Like any other impulse, the impulse to commit suicide is transient and lasts for a few minutes or hours. It is usually triggered by negative day-to-day events. By defusing such crises and by playing for time, the health worker can help to reduce the suicide wish.

1. Rigidity:

When people are suicidal, their thinking, feelings and actions are constricted. They constantly think about suicide and are unable to perceive other ways out of the problem. They think drastically. A majority of suicidal people communicate their suicidal thoughts and intentions. They often send out signals and make statements about “wanting to die”, “feeling useless”, and so on. All those pleas for help must not be ignored. Whatever the problems, the feelings and thoughts of the suicidal person tends to be the same all round the world.

HOW TO REACH OUT TO THE SUICIDAL PERSON

Very often when people say “I am tired of life” or “There is no point in living”, they are brushed off, or are given examples of other persons who have been in worse difficulties. Neither of these responses helps the suicidal person. The initial contact with the suicidal person is very important. Often the contact occurs in a busy clinic, home or public place where it may be difficult to have a private conversation.

• Feelings Thoughts
• Sad, depressed “I wish I were dead”
• Lonely “I can’t do anything”
• Helpless “I can’t take it anymore”
• Hopeless “I am a loser and a burden”
• Worthless “Others will be happier without me”

1. The first step is to find a suitable place where a quiet conversation can be held in reasonable privacy.
2. The next step is to allocate the necessary time. Suicidal persons usually need more time to unburden themselves and one must be mentally prepared to give them time.
3. The most important task is then to listen to them effectively. “To reach out and listen is itself a major step in reducing the level of suicidal despair”.

The aim is to bridge the gap created by mistrust, despair and loss of hope and give the

person the hope that things could change for the better.

How to communicate

• Listen attentively, be calm.
• Understand the person’s feelings (empathize).
• Give non-verbal messages of acceptance and respect.
• Express respect for the person’s opinions and values.
• Talk honestly and genuinely.
• Show your concern, care and warmth.
• Focus on the person’s feelings.

How not to communicate

• Interrupt too often.
• Become shocked or emotional.
• Convey that you are busy.
• Be patronizing.
• Make intrusive or unclear remarks.
• Ask loaded questions.

A calm, open, caring, accepting and non-judgemental approach is required to facilitate communication.

HOW TO MANAGE A SUICIDAL PERSON

Low risk

The person has had some suicidal thoughts, such as “I can’t go on”, “I wish I were dead”, but has not made any plans.

Action needed

• Offer emotional support.
• Work through the suicidal feelings. The more openly person talks of loss, isolation and worthlessness, the less his or her emotional turmoil becomes. When the emotional turmoil subsides, the person is likely to be reflective. This process of reflection is crucial, as nobody except that individual can revoke the decision to die and make a decision to live.
• Focus on the person’s positive strengths by getting him or her to talk of how earlier problems have been resolved without resorting to suicide.
• Refer the person to a mental health professional or a doctor.
• Meet at regular intervals and maintain ongoing contact. All these questions must be asked with care, concern and compassion

Medium risk

The person has suicidal thoughts and plans, but has no plans to commit suicide immediately.

Action needed

• Offer emotional support, work through the person’s suicidal feelings and focus on positive strengths. In addition, continue with the steps below.
• Use the ambivalence. The health worker should focus on the ambivalence felt by the suicidal person so that gradually the wish to live is strengthened.
• Explore alternatives to suicide. The health worker should try to explore the various alternatives to suicide even though they may not be ideal solutions, in the hope that the person will consider at least one of them.
• Make a contract. Extract a promise from the suicidal person that he or she will not commit suicide without contacting the health care staff; for a specific period.
• Refer the person to a psychiatrist, counsellor or doctor, and make an appointment as soon as possible.
• Contact the family, friends and colleagues, and enlist their support.

High risk

The person has a definite plan, has the means to do it, and plans to do it immediately.

Action needed

• Stay with the person. Never leave the person alone.
• Gently talk to the person and remove the pills, knife, gun, insecticide, etc. (distance the

means of suicide).

• Make a contract.
• Contact a mental health professional or doctor immediately and arrange for an ambulance and hospitalization.
• Inform the family and enlist its support.

REFERRING A SUICIDAL PERSON

Refer when the person has:

• Psychiatric illness;
• A history of previous suicide attempt;
• A family history of suicide, alcoholism or mental illness;
• Physical ill-health;
• No social support.

If we can identify the level of risk of suicide an individual has, we will be better placed to manage the suicidal thoughts before they get carried out.

Established mental health illnesses need to be managed medically, sometimes with pharmacological or non pharmacological therapy.

Non- pharmacological therapy includes- Cognitive behavioural therapy, befriending services, yoga/exercise, talking therapy etc.

Pharmacological therapy includes the use of medication like anti-depressants, mood stabilisers, anxiolytics, prescribed by a qualified medical/healthcare professional. Such medication also have side effects so adequate management is needed and if when considering stopping, the dose is tapered off gradually to prevent withdrawal symptoms which could make the patient’s condition worse at the end of the day.

 

References:

• Preventing Suicide –A resource for Primary Health care workers, Mental and Behavioural Disorders, Department of Mental Health. World Health Organization
• Geneva2000
• For primary care workers who would like to develop toolkits on projects or suicide prevention, Please access full resource guide from WHO form the link below 
• WHO Materia (here)