‘Men are more likely to commit suicide than women’

Dr Dimeji Ayoade is a clinical psychiatrist at a private hospital in Lagos. In this interview with TOBI AWODIPE, he talks about risk factors that cause depression, which can lead to suicide

What really is depression?
Depression is a mood disorder. It is not the normal sadness. People can feel sad from time to time without being called depressed. We say someone is depressed when this feeling of sadness is prolonged with no basis. When the sadness is persistent and go beyond the normal duration, we refer to it as a depressive state.

How do you determine depression?
There are several symptoms we see in patients to know this. The number of symptoms the patients exhibit will help us categorise into different levels of severity. Depression can be mild, moderate or severe, depending the symptoms the patient has. To make a diagnosis however, there are three major symptoms and there are minor symptoms. The first is mood, persistent sad mood. Once a person is consistently sad for about two weeks, this is a major red flag.

Another major symptom is loss of interest in usual, daily pleasurable activities. The third is reduced level of energy and this usually relates to their usual daily activities. Most depressed people complain and get tired easily.

These are some of the ways the major symptoms manifest. Other minor symptoms include poor sleeping habits, constant thinking of negative thoughts, poor appetite and sudden weight loss. The married ones can find themselves lacking interest in sexual activities. It can go as far as causing irregular menstruation for women some can even have total cessation of their menstrual flow and loss of self esteem.

At this point of total hopelessness, thoughts of suicide and wishing death for themselves might begin to creep in. Suicide isn’t a day thing. Most victims have planned it for a while and usually drop hints that go unnoticed.

Can depression be prevented?
This is hard to say because a lot of things go into this. Depression, like all mental illness is interplay of the genetic makeup of that individual with the environment. Most mental illnesses like depression, schizophrenia and mania have been studied extensively and the particular cause hasn’t been identified, but genetics has a major role to play. Most people with depression usually have a parent or family member that suffered it and studies have shown that the heritability stands at 80 per cent.
A depressed or mentally ill mother can have several children and just one would inherit it or none at all and a grandchild would inherit it. However, adverse life incidences can be associated with depression, but usually they have to be genetically pre-disposed first.

Awareness is a major key in preventing depression and common as it is, it is the least diagnosed. When people started to experience hallucinations or talking strangely, they should go to the hospital. Nigerians hardly seek help for things like sadness and tend to trivialise it, afraid to be labeled a weakling.

Does religion play a role in preventing diagnosis?
Yes and No. When depression is still very mild, it can be handled by trained mental health nurses at a primary health care, as there is no need to start drugs yet. Also, an individual getting help from natural support systems around him might just be enough to help the patient at that point.

Pastors can be helpful when it is very mild, but when it increases and they start giving spiritual connotations to the condition, they prevent the patient from seeking help. Most people that commit suicide usually talk about it. Sometimes jokingly but we must not take it lightly and there is need to seek medical help immediately.

What factors can drive an individual to commit suicide?
There are a million and one reason and no two victims have the same reason. However, there are several risk factors of suicide, which include gender.

According to our studies, men are more likely to commit suicide than women. Women are more likely to engage in self-harm, for example, slashing their wrists or ingesting poison. Old age, marital problems, unemployment, hardship, poverty, inability to cope with life issues and mental state disorders, especially schizophrenia are other great risk factors that can make an individual to commit suicide.

It will surprise you to know that many people that commit suicide are usually receiving treatment already. They get started on medications and have increased energy levels, but because the root cause is still there, they still go ahead to kill themselves. Some even overdose on their medication. Other factors include chronic illnesses like epilepsy, leprosy, cardiac failure, renal failure and so on.

In the patients you have seen, on the average, how often is suicide linked to health conditions or mental illnesses?
Honestly, most people that have attempted suicide and failed have done so based on adverse life conditions or change in fortune. For the ones that have gone through with it, we sadly cannot ask them what pushed them to the act.

Some counseled ones have given poverty, being caught cheating in an exam hall, having issues with baby daddies or relatives and unemployment as the reasons they attempted suicide.

How can family or loved ones help a depressed individual?
Harnessing social support is the first step. It can go a long way in helping the individual. When it becomes more severe, then you can seek help. Find out how the person is doing, show love and care, help to solve their issues, help them cope with stress before they degenerate. If necessary, place the individual on suicide watch or use a CCTV to monitor them before getting professional help.

There is a lot of shame and stigma still associated with mental health in Nigeria. How can this be overcome?
It usually stems from ignorance. Aggressive campaigns were carried out to reduce the AID/HIV stigma but sadly, nothing is being done regarding mental health. People believe mentally ill patients can never be normal again. They believe it is not treatable. They believe mentally ill patients are violent (which is not true). Because of this stigma, mentally ill patients are less likely to seek help, because they don’t want to be stigmatised, they don’t want to be laughed at or called insane.

A lot of people don’t seek help until it is too late. Mental health needs a lot of advocacy, government needs to raise more awareness about it, because awareness is still limited to just the big cities alone. Mentally ill patients can do anything they wish once they’re properly treated, once they receive treatment, you would be preventing a lot of suicide cases like we are having these days.