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Let’s talk about suicide
30 October 2014

This article was drawn from research done by a multi-disciplinary team from HCA comprising Advanced Practice Nurse Kahvidah Mayganathan, Medical Social Worker Venus Ther, and Resident Physician Dr Dennis Dignadice.

Meet John.

John (not his real name) was 58 years old. He lived alone. He suffered from nose cancer, which had metastasised to his brain. Extreme pain and breathlessness kept him awake through long nights. He faced the loss of his vision.

John asked us to help to end his life peacefully. He told us an invisible monk was his guide. He completed suicide soon after and was found dead at the void deck of his block.

The relative risk of suicide in patients with advanced illness is twice that of the general population.

Having been diagnosed with terminal illness, what control could one have over his pain, his body, his life? When would the suffering come to an end? Would ending his life be his only means to some measure of control? It’s no wonder that symptoms of severe depression in those with advanced illness rise to 77%.

For home care patients, there’s an even greater risk – simply because they have easy lethal access. Furthermore, a large percentage of them stay alone.

“Every time we leave the home of a patient with these ideations, it feels like a risk leaving him alone,” said Advanced Practice Nurse Kahvidah Mayganathan.

Patients with advanced illness cope with an inordinate amount of these risk factors. Identifying these is fundamental.

They fall into three broad categories: physical, psychological, and cognitive.

Physically, there’s debilitating pain, immobility and physical deterioration. Cognitive symptoms like delirium distort reality. Depression, which is notoriously difficult to diagnose, multiplies the risk of suicide 25 times greater than within the general population, while hopelessness is a strong indicator of completed suicide. Financial problems was also found to be a common factor among patients who had completed suicide.

How do we support our patients in the face of these risk factors?

Support needs to work holistically to increase protective factors while addressing risk factors – shifting the see-saw towards life, rather than death. Control, too, is a vital antidote to lethal hopelessness.

Pain and other physical symptoms needs to be managed, while alternative care options can help patients retain a greater autonomy, empowering them. Medications such as antipsychotics and antidepressants address cognitive risk factors and depression.

Meanwhile, counselling enables patients to readjust and tap into internal resources to develop the control to achieve realistic goals. Family connections should be facilitated, while social support through day hospice placement can help patients understand what helps others cope.


What about those left behind?

Suicide survivors, both caregivers and healthcare professionals, often overestimate their role in contributing to the suicide. To make matters worse, they become socially isolated because of social stigma and difficulties opening up.

For nurses, there’s an additional dimension – does feeling grief and bitterness compromise professionalism?

Suicide bereavement support groups, books, therapy have been found to be particularly useful as sources of support. For healthcare professionals in particular, suicide prevention education is crucial. Staff should feel comfortable enough to express their feelings with colleagues during bereavement, group meetings and debrief sessions.

We care for the psychological welfare of our patients, in addition to their physical condition. Find out more about the team’s research, or our other services, by emailing us at communications@hcahospicecare.org.sg.