PERSONAL LOSSES PUT WOMEN AT GREATER RISK OF SUICIDE
Although many effective treatments exist for depression and suicide, suicide in women remains a much under-recognised, under-diagnosed and under-treated problem. In the United States, it is estimated that a woman successfully commits suicide every 90 minutes, while a suicide attempt takes place every 78 seconds. Accurate figures for suicide rates in South Africa are not available, but it is likely that the US suicide rate of 4.4 per 100 000 is even higher in South Africa. A disturbing increase in the incidence of suicide has been noticed over the past forty years, particularly among younger women. The suicide rate amongst women aged between 40 and 54 has doubled since 1950, while the rate for younger girls aged between 10 and 14 years has almost tripled since 1980.
Dr Charl Els, a Psychiatrist from Bloemfontein says “what I find very alarming is the intentional misclassifications of cause of death we often hear of. Alcohol abuse, people who are treated for serious medical illnesses, and not taking their medications, and cases where the exact cause of an accident could not be determined, would normally fall in this group. The actual figures for suicide are probably much higher than the figures we read about in the literature.”
Women attempt suicide twice as often as men, although men complete suicide at a rate four times higher than that of women. The higher rate of attempted suicide in women is attributed to the elevated incidence of mood disorders, such as major depression and dysthymia. In addition, hormonal changes in menopause also put women at risk to suffer from depression and related disorders. It is estimated that during the postpartum period following childbirth, between as many as 60 – 80 percent of women experience transient depression, while up to 15 percent develop clinical depression. Many women suffering from manic depressive illness experience their first episode during this postpartum period.
A Psychiatrist from Pietersburg, Dr Stoffel Grobler feels that “in my experience postpartum depression is grossly underdiagnosed by the treating physicians. All health care professionals should be more sensitive to the early detection of symptoms, and should especially look for depressive symptoms lasting longer than two to three weeks after delivery.”
The precipitating life events for women who attempt suicide tend to be interpersonal losses or crises in significant social or family relationships. Suicide is more common among women who are single, or have recently separated, divorced or widowed.
Dr Ian Westmore, a psychiatrist from Bloemfontein, feels that the presence of a concomitant physical disease, especially chronic diseases e.g. cancer, seems to increase the suicide risk. It also seems to be higher when there is comorbid substance or medication abuse. However, women are more likely than men to make use of stronger social support structures, resulting in higher suicide completion rates among men. Women are more likely to feel that their relationships are deterrents to committing suicide and to seek psychiatric and medical intervention.
“The degree to which women experience empowerment is not equal to that experienced by males”, says Tertia Spangenberg, a clinical psychologist from Bloemfontein. “In many females we see that the perception still exists that they are ‘culturally and socially’ inferior. This could play a role in making them more susceptible to developing a mood disorder.”
Although it may not always be possible to prevent suicide, suicidal ideation and impulses can be significantly reduced when health care providers, family and friends recognise and understand the factors that impact on suicide. Hopelessness has been identified as a major predictor of suicide: most patients do not want to die, they see death as a way to end pain and anguish. Many such deaths could be avoided if individuals were prompted to receive psychopharmacological therapy in a supportive and encouraging environment. Most suicides are preventable if the psychiatric disorders responsible for clinical disorders and impulsivity are detected early on, and treated appropriately. Antidepressants, including selective serotonin re-uptake inhibitors (SSRIs) are particularly effective in the treatment of depression and selected eating-and obsessive-compulsive disorders. The relative safety of the drugs reduces the hazards of overdose seen with older antidepressant drugs.
Access to help is a major factor in reducing the risk of suicide. Lack of access to help and support at a time of despair may result in panic, anger and impulsive acts