Elderly suicide in Singapore: risk factors and cultural context

¶ … suicide among elderly is increasing in Singapore?

The UN World Health Organization, cases of suicide affect about a million people per year. The organization also states that, self-directed violence can be shown in two different ways: through suicidal tendencies and committing acts of violence against oneself, such as mutilation (de Souza Minayo & Cavalcante). Singapore, which is predominantly Asian, has a culture inspired by that of India, China and the Malayan Archipelago. The country\'s major ethnic groups are the Indian, Chinese and Malay. These groups believe that the elderly will be taken care of in terms of finance, health care and residence by their offspring. Multigenerational families that live together enables them to easily transfer services, money and affect. However, this method of living also leads to tension, and people expecting undue assistance. The elderly get no more support as provided in the Asian culture if they live away from their children, or if they choose to have a separate home, even if it is close to that of their children. It is as a result of this kind of physical isolation that they become vulnerable to social segregation (Wong & Verbrugge, 2008). This paper gives an analysis of the suicide cases in Singapore. It centres on a comprehensive literature review as well as a survey. The paper includes learnings and inferences from the literature and the survey.

Literature Review

Suicide among the elderly is multidetermined and complicated. The complexity of these cases make it difficult to prevent them However, it also gives many opportunities for people to intervene, which if used together may at one point lead to less suicide cases among the elderly. It is undeniable that more research on factors that cause older adults to be vulnerable to suicide have been designated to enhance our capability to give help to the group to people that need it most. It is also very clear that conducting research to help the elderly people at risk is of great importance (Conwell, 2014).

i. Chronic Pain

It is very common for people of older age to suffer from chronic pain. This is one of the factors that put them at risk of suicide. In fact, people with chronic pain seem to have twice or more chances of dying through suicide as compared to the overall population. A centre for pain located in the United States has calculated 23/100.000 cases of successful suicides among the patients under their care. This number is 2 to 3 times greater compared to the overall population. It has been discovered that cases of suicide among chronic pain patients is based on the kind of pain they may be suffering from, the duration, intensity as well as the insomnia level as a result (Kiriakidis, 2015).

ii. Suicide and men

The rate of suicide has a stronger link with attitudes among men. The divergence in correlation strengths between elderly females\' and males\' attitudes to their economic and general status in the society is great. Among men, the link between the suicide cases among the elderly and the exit age from work is greater that of women. The greater link between males and suicide is as a result of the fact that they care more about their career accomplishments and socioeconomic contributions. It is also due to the greater expectations that their families and the society have of them. It has been found that the rates of suicide among elderly males is linked to family belonging issues, more greatly than the rates among females (Yurvev, Sisak, Varnik, & Varnik, 2010).

iii. An Ageing Society

Denmark, Norway and Sweden have great similarities in terms of culture, language and history. In the modern world, the three countries are economically successful. The three countries are dominated by Protestant Christians. However, lately, this faith is slowly becoming insignificant among people, and is being replaced with materialism. The health and vigour of the youth are fancied, giving less regard to the elderly, who are not as productive as they previously were. This lack of regard for the elderly is also as a result of industrialisation. The youth move from their rural homes to urban centres to work, separating the customary family organization and separating generations. The society is in a good position to prevent suicide among its citizens in spite of their age. Nonetheless, in practice, the attitudes of people towards elderly people has changed and still continue to change. In the 1700s, the suicide rate among the elderly people took the highest proportion in Sweden, and to this date, it still takes the greatest percentage. However, most efforts to prevent suicide are centred on the younger population (Wasserman & Ringskog, 2001).

iv. Depression According to the studies conducted on suicide cases among elderly people, including the idea, attempt and successful completion, there is a link between suicide and depression. In the West, cases of suicide are more dominant among elderly people than among other ages. Furthermore, even though there are less attempts of suicide by elderly people, they are still more successful in the completion of these attempts than those among other ages. Predictably, the most dominant cause of suicide among the elderly, as diagnosed, is depression. These attempts are usually highly premeditated, planned and greatly thought about. They are not impulsive. They are done using lethal means that reduce the chances of being saved, such as substances and guns (Kiriakidis, 2015).

1. Isolation

The study assessed two kinds of isolation, social isolation (absence of social links) and physical isolation (results from living alone). The duration of time that a subject had been exposed to living alone was used as a measure for physical isolation. The average for physical isolation was 10.7 years (mode 5, median 5.5). There was a large range; two of subjects faced physical isolation for over 20 years while one of them faced it for 3 months. During the interviews, 3 participants said they unlawfully sublet their rooms in order to have a roommate. However they had little contact and therefore it was same as residing alone. In general, majority of the participants were aware of issues related to solo-dwelling.

The level of contact that the individuals had with friends and family was used as a measure for social isolation. Eleven subjects (58%) had no children and 2 others (10%) revealed that their children were not on speaking terms with them. Only six participants (32%) in the sample had good relations with their kids. On friendships, nine participants (47%) stated that they had limited number of friends. They were however not ready for new ones. Eight (42%) had active friendship links and were willing to make new friends (Wong & Verbrugge, 2008).

1. External Opinion

80% of the respondents in the survey believed mental illness and depression were the main causes of the suicide. It is important to note that 55% of the respondents were Indians. The causes of mental isolation or depression ranged from societal issues to family reasons. The number of issues tackled by respondents was in accordance to issues written in journals by means of literature research. Also 35% of the respondents sensed that suicide among elderly in Singapore was on the increase, especially in the recent years. Although almost all the respondents agreed on the increasing trends causes of suicide, none of saw it as a solution for the difficulties faced by individuals (95% of the respondents were 30 years and below).

1. Social Connectedness

A large number of risk factor studies show that social disconnectedness is the fourth key driver of suicide among the elderly. There are numerous literatures on how social connections affect health and negative results of social disconnections, comprising those among the elderly (Conwell, 2014). Therefore, the minor drivers of reduced suicide rates among the elderly that permits research at an individual level include:

1. Interventions to improve and increase both social networks and supports, including using psychosocial means such as problem-solving and interpersonal therapies.

1. Other interventions involving addressing family dysfunction together with person\'s adaptation to challenges related to age.

Discussion and Analysis

It is not be probable to stop or prevent all suicide. But, we can all aid in reducing the risks of suicide. Suicide Prevention Education can be subdivided into three groups (Chia & Hock, 2010):

1. Education of individuals who may be in contact with a suicidal individual (e.g. social workers, counsellors, teachers, healthcare workers and police officers) on ways of identify individual at risk.

1. Training of mental health workers on ways of assessing suicide risk and ways of managing patients.

1. Education and training of the public. The media plays a vital role here. Singapore\'s media is habitually very cautious when it comes to reporting suicide news. They do this with good intentions; they are trying to avoid sensationalizing suicide, \'teach\' individuals ways of committing suicide or precipitating copy-cat suicides by describing methods. However, under-reporting creates the impression that the activity is not common and it is therefore not an in Singapore. Moving forward, a balanced method is needed to create public awareness and to train them about suicide and where or how they can look for help if needed.

Treatment of Depression

Carefully planned tactics for treating the depressed are needed. The strategies used in the cases where the elderlies are being treated must be tailored closely to meet their needs. Those aged 65 and above undergoing first phases of depression, had a median interval ranging between the first communication on the issue and the actual act and it was one month. This finding focuses further consideration on the significance of very quick delivery of sufficient depression treatment, involving regular medical checks together with social support. This is particularly so because of the effect of antidepressants - particularly the most current drugs - becomes useful only after lengthy periods of treatment, while throughout the beginning phases of treatment the anxiety level increases. This increase in anxiety may, in a dejected individual who has formerly entertained suicidal ideas, prompt intense suicidal feelings. The individual may also experience complete hopelessness, be overwhelmed with nervousness and, finally, choose to commit suicide as a way out. Evidently, using antidepressant drugs alone is inadequate. Treating depression in the old, same as other groups, requires reinforced psychological treatment strategies together with social support (Wasserman & Ringskog, 2001).

Conclusion and Recommendation

The ability of elder Singaporeans\' to live on their own comes from their \"agency\" in conquering the barriers of society to their achievement of their goals. The abilities they gain include a wide variety of remedies to unique and daily problems. These allow them to age successfully, both in social and physical segregation with little or no external help. Living in solitude, for an elderly Singaporean, is easy. The findings of this study show the personal and sociocultural factors perpetuating and leading to their social and physical segregation. People living alone gain skills to help counter loneliness and acquire the services they need. This is as a result of several factors. As Singaporeans grows older, there will be an increase in the population of elderly people that wish to live in solitude. Children will leave their homes to work and live abroad. Additionally, there will be reduced fertility, leading to more elderly people than children. Children will be unable to offer their parents finances and time. It is important that the government of Singapore considers the changes in elderly people\'s living arrangements and offer better support to those who live alone. Even though there is need for public policy to handle some of the matters, advocating policy to elderly people cannot solve all of them. Considerations of policy need to be organized by including the elderly in the decisions for them to be part of the changes made in their environment (Wong & Verbrugge, 2008).