Social strategies for recognizing suicidal signs and preventing homicide and domestic violence

How can you identify and help someone who is suicidal? This task is not easy because even those who are directly contemplating suicide rarely talk about their feelings. However, research shows that up to 75% of those who are directly contemplating suicide have repeatedly, however subtly, communicated their intentions. They may exhibit sudden behavioral changes and become more anxious and withdrawn than usual. They may ask about the afterlife, talk about suicidal thoughts about "others," abandon cherished possessions because they "will never need them again," make a will, pay insurance premiums, and/or organize their personal affairs meticulously. Such actions are cries for help. The best response is as follows: Listen to and encourage the agonizing person to talk about his or her feelings. Always take the suicide threat seriously. Take proactive steps to leave or have someone else stay with the agonizing person until after the crisis. Beware of sudden "change of heart," as the underlying issues may still exist. If possible, seek professional assistance from a doctor, psychologist, clinic, hospital, chaplain, or suicide crisis center. Traditional views hold that homicide-the killing of one person by another-is a legal matter, not a topic discussed in health guidelines. Regardless of one's perspective, it's undeniable that people can die from illness, just as they can die from violence. Evidence suggests that nearly 60% of those murdered each year have connections to or know the perpetrator. Because so many killers are driven to crime by relatives or acquaintances, homicide and other forms of violence are seen as health and law enforcement issues. Homicide is the ninth leading cause of death for men, and men are three times more likely to die from it than women. It is the cause with the largest gender disparity in mortality among the top ten leading causes of death for men. Unemployment, stress, racism, social isolation, despair, drug and alcohol abuse, and the inability to get along with others can breed harmful behavior and uncontrollable rage. Some experts believe that in socioeconomically disadvantaged groups, men are more likely to vent their anger on others rather than themselves, and homicide often replaces suicide. Approximately half of all homicides are related to alcohol use, and about 10% are related to illicit drugs. All forms of domestic violence-from spousal arguments to child abuse-are a major contributor to homicide deaths. According to research, over one million children suffer severe abuse each year-physical, gender-based, and emotional-from parents, guardians, or other adults. Between 2,000 and 5,000 of these children die from their abuse. By the 1960s, all U.S. states had enacted laws to protect children from abuse and discrimination, and doctors began to understand what unprovoked beatings, bruises, burns, streaks, swelling, missing teeth, and fractures truly meant in young patients. It was clear that child abuse wasn't just a crime occurring among blue-collar workers; it also occurred among the educated, those living in luxury homes, and the wealthy. However, child abuse is not the most common form of domestic violence. Severe violence between adults is even more prevalent. It is estimated that two million women are severely beaten by their husbands, ex-husbands, or lovers each year. Often, it is the woman who initiates the attack on her husband/lover. Few incidents evoke the same intense outrage as those between intimate partners. Spousal murders are often caused by romantic love triangles or extramarital affairs. In many cases, murder is a way to resolve divorce for those who cannot find other ways to escape unhealthy relationships. Domestic violence can also be a cause of violence outside the home. Experts studying victim-criminal relationships note that many killers often have prior convictions for non-lethal violence sufficient to attract the attention of police and healthcare workers. Homicide prevention requires reducing risk factors in the environment and improving interpersonal relationships. Access to light weapons is particularly dangerous in families where domestic violence is prevalent. Victims of violence must learn through counseling how to get along with their spouse/lover, improve family relationships, resolve anger, eliminate resentment, and break free from the shadow of child/spousal abuse. For society, homicide prevention requires providing family crisis prevention programs, establishing child care facilities, designing structurally safe environments, promoting neighborly relations, providing counseling to parents and children to handle their stressful situations with minimal violence, and fostering a societal attitude that views homicide as a normal educational lesson. In short, as the medical model shifts from the biomedical model to the bio-social-psychomedical model, health issues are not just about disease itself; they also involve the inner workings of our lives, our environment, and the lifestyles we choose. Modern medicine and health sciences should not be limited to the scope of biology and technology, but should further explore the social and economic causes of diseases. Accidents, suicide, and homicide cannot be classified as diseases, yet they are the leading causes of harm to young men. If we are to conquer these "final calamities" of youth, public health and health sciences must study these three situations as important factors threatening human health and propose corresponding countermeasures.