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Organisations and individuals need to be aware of the growing risk of suicide for senior employees. "It is as if! had been going downhill while I imagined I was going up. And that is really what it was. I was going up in public opinion, but to the same extent life was ebbing away from me. And now it is all done and there is only death." THE RISE OF WORKPLACE SUICIDE Words Eugene Yiga These words are from The Death of Ivan Ilyich, a 19th century novella by Russian writer Leo Tolstoy. And yet they could just as easily be from the suicide note of a corporate executive in the modern world. "Stress can be defined as the physiological and psychological response of any person seeking to adapt or adjust to internal and external pressures or demands," says psychiatrist Dr. Frans Korb. "It can lead to burnout and to psychiatric illness, including depression, anxiety, insomnia, and substance abuse." Stress can also lead to suicide, as was the case when at least 19 people took their lives at France Telecom amidst heavy job cuts in 2008 and 2009. And while Korb's recent study considered workplace depression as a whole, he believes that those in high positions attract high levels of stress. "Depression can lead to suicide if not managed adequately," he says. "And if there are not adequate programmes in place for highlevel positions, this will lead to high levels of stress, burnout, and the psychiatric disorders as above. An awareness of stress, burnout, and depression in the workplace is thus essential, together with training in stress management tools and techniques." NOT ALL STRESS IS CREATED EQUAL Sometimes the pressure to perform can inspire greater results. But when ongoing "bad stress" leaves us feeling that the demands placed upon us outweigh the practical or emotional resources we have available, the result is psychological or emotional strain. "Stressful events on their own do not necessarily lead to one attempting suicide," says counselling psychologist Tamara Zanella. "However, they can be a contributing factor in negative thinking, low mood, burnout and depression. Psychiatric, psychological and biological factors could predispose a person to suicidal behaviour, whilst stressful life events interact with such factors to increase risk. This is why suicidal behaviours are often preceded by stressful events." Zanella explains that burnout can affect every aspect of functioning and have a negative effect on both work and personal life. When there is a constant sense of powerlessness about being able to change one's circumstances, it's easy to feel frustrated, demotivated, undervalued and overwhelmed. "If left untreated there is a risk that the individual could suffer from depression," she says. "Depression is associated with an increased risk for suicide so one needs to be mindful of the impact that ongoing stress and burnout at work can have." THE OVERWHELMING FEELING OF HELPLESSNESS There are several reasons why an individual might consider suicide. Many who have survived an attempt will say that they did not necessarily want to die but felt that there was no hope of anything ever being different. They see taking their own life as the only way to end their suffering and pain. "Thoughts of suicide can be best understood as a means of transmitting a 'message' or as a need for escape," says clinical psychologist Dr. Colinda Linde. "These thoughts can be transient and dismissed from the mind, in someone who is not suffering from depression or burnout. For example, if you wake up tired after a week of deadlines and too little sleep, thinking 'I just want to lie here and sleep forever' could be seen as an urge to escape. Thoughts like these are a.common feature of being in the modern workplace. And if they are transient as well as reactive after a highstress period, they will often resolve. It is when they become a repeating theme, and when they accompany signs of depression that they become a danger." Linde explains that burnout and depression tend to develop over time, which can make their symptoms hard to detect until they are acute. Burnout often slides into depression, with the former being associated with negative mood, fatigue, and cynicism with respect to work, until these feelings and thoughts start to seep into the person's whole life. Depression shrinks a person's world. There is not much focus on meaningful activity or close relationships, and the future is seen without any hope of change. This is when the thought of a permanent escape becomes real and a person may consider suicide. "Paradoxically, the person who is seriously planning suicide is often not likely to talk about it or outwardly threaten to take their life," Linde says. "In fact, when a depressed person has made a decision to end their pain, they often appear to be in a good mood and can be quite upbeat. Their thinking is impaired to an extreme point so they can only see that this plan will end their unhappiness, but not what it will mean for those left behind. There is little rational thought or logic, and cognitive distortions can even make them believe it is for the greater good." 66 DEPRESSION CAN LEAD TO SUICIDE IF NOT MANAGED ADEQUATELY" Educating organisations on the signs of depression and burnout is the best first step. HR managers and CEOs cannot be aware of how everyone is feeling but team members are more familiar with each other's behaviour and will more likely notice if there is a sudden change or if the symptoms mentioned start becoming regular. Find a private psychologist or psychiatrist through www. therapistdirectory.co.za. The South African Depression and Anxiety Group (www.sadag.org) also has referrals, advice, and a tollfree suicide crisis line (01300 567567). IMPULSIVE DECISIONS WITH FATAL CONSEQUENCES If you suspect someone is severely burnt out, and seems depressed, it's important to pay attention to any signs that could signal suicidal thinking and planning. For example, if someone changes their behaviour in terms of social withdrawal, gives away their special possessions, or is clearly in a low and/or agitated mood for two to four weeks or more, it is important to watch and listen. "They may not directly say they are suicidal, but.comments like 'The world would be a better place without me' or regular selfdeprecation like 'I'm such an idiot' or 'I can't get anything right' may be clues that they are depressed to the point of considering escape via suicide," Linde says. "In the case of burnout, there may only be impaired performance and exhaustion, but there are thoughts and.comments that will be significant and cause for alarm. For example, if someone would like to be in an accident or have a serious health issue just to have a rest from work — and I have heard both of these many times — it is a serious signal of burnout having developed into depression." "When people work in silos it is easier for burnout and depression to creep in unnoticed, or for a crisis to cause implosion due to lack of real or perceived support," Linde says. "That's why regular catchups, even when there is high pressure and it seems like a waste to have a twominute chat, are helpful. This provides a sense of hope that there is a person who hears you, and could help when you feel stuck."