“Resilience” in Suicide Prevention and Intervention: Food for Thought!

“Death” is inevitable, but this painful irreparable loss remains a harsh reality for the affected families especially so when a young life is lost; the cause maybe either accidental reckless driving or a deliberate self-attempt! A life that never got an opportunity to bloom! In such a scenario, who should be labelled as the defaulters? For example, despite there being a hue and cry for the recent alarming and exponential increase in the number of suicides in a city known for shaping careers (to be read as Kota), efforts have unfortunately not shown a desirable outcome. What is being done to prevent these extreme steps undertaken by the youth? The issue appears to have been taken up by the government, politicians, parents, coaching centers, health professionals, and a number of steps are being reported to prevent such future incidents. The media is also active in interviewing stakeholders and reporting the refusal of parents to let the child drop out from pursuing a challenging career (as per the observations and advice from coaching experts). Though the government has taken certain measures, the rising figures attest to the apparent inadequate efficacy of implementation of steps like anti-hanging fans, anti-suicide nets, close monitoring for any signs of depression, etc. Nevertheless, the discussion on this specific issue is beyond the scope and not within the remit of this Editorial.

There has probably never been an ever more appropriate and crucial time for child (and adolescent) mental health professionals to step in and analyze the scenario in order to act in a critical and responsible manner. Unfortunately, on examination of the existing literature, focus has centered mainly on examining the issue of suicidality in adults and elderly, with scant attention to suicides in adolescents. This skewed focus carries significance in the perspective of the WHO data estimate (2000-2019), which states that suicides in adolescents are the 4th leading cause of death in this group. ¹

As authors of this Editorial, we would like to simultaneously reiterate and clarify that our concern is not purely focused on the youth related “Kota suicides,” but it is related to a much wider and more general concern for a particular vulnerable population, that is, adolescents, especially those who are in the decision-making phase of their career. The aspect of “decision-making” usually starts around Grade/Year/Class 10 (or 9) when they have to make a choice regarding the stream and simultaneously handle the invariable non-verbally/verbally communicated aspirations and expectations of their parents. This aspect may persist or resolve in higher classes depending upon the alignment of the individual’s interest, performance, peer group affinity, etc.

Young minds tend to shape the future of the society and the world that we live in! Considering the fact that the adolescent period is both prone to, and laden with, inner turmoil (due to physical and psychological changes) along with environmental stressors, one needs to understand the associated significant factors where one can possibly intervene. In fact, “adolescence” has also been identified as the most vulnerable phase regarding the age of onset for mental illnesses. The environmental and contextual factors are undeniably relevant for preventive efforts but insufficient to change the painful destiny!

Since suicide is a recognized worldwide public health problem, the following are its established risk factors among adolescents: bullying, loneliness and anxiety, tobacco and alcohol use, and weak family and social relationships and protective factors being support from family, school, and society.^2-4 Despite recognition of important familial and environmental factors, various search engines contrastingly yielded lacunae of literature related to any systematic intervention program. This leads onto the corollary that efforts till date targeted at dealing with suicidal behavior have somehow been developed by primarily examining the situational factors.

Suicide is a complex phenomenon and dealing with “IT” is a “complex necessity.” Since moral values, religion, and environment tend to give both suicidal behavior and suicide a cultural context and specificity, we probably need to formulate our own “suicide prevention program”; on the lines of those available in countries like the USA, UK, Australia, New Zealand, etc. But, till date what role have mental health professionals played in these efforts? Should we not take it as a wakeup call to urgently plan, generate evidence, design, and execute evidence-based prevention plans?

One can take the Bronfenbrenner model as the theoretical framework for understanding causal pathways and interventions and try to understand why few young minds have poor tolerance for stress and the various levels of the surrounding environment tend to shape the process. In this context, if other stakeholders like educationists and policy makers make efforts to bring changes in the system and the surrounding environment in order to reduce the competitive pressure, it would be a laudable effort indeed. However, our expectations for other stakeholders to take the lead may not be a justified stance as we will probably be in dereliction of our “duty of care.”

The trend of rising suicides (see Para 2 of this editorial) is a testimony to indicate that adolescents and youth of “today” are probably not resilient enough! This begets the following questions in one’s mind: Why is each following generation less equipped than the previous one to take on hard work? Why most of the youngsters look for easy options or shortcuts? Why our grandparents or even parents are sturdier for any psychological/physical hardships? Ongoing advancements in technology have made life easier. Adolescents, in principle, are tech savvy and if one has to carry out a project, a Google search or ChatGPT would provide all answers. So, rather than talking to several seniors, paying a visit to library, soliciting help from library staff in learning to locate books/journals, one just needs to spend an hour or two holed up in front of a laptop. This leads onto a decreased need to socialize, decreased use of one’s organizational ability, and potential introduction (or increase) of complexities in relationships.

Resilience is closely associated with parent-child relationship.^5,6 Among other factors, parent child relationship has been more frequently linked with adolescent suicidal behavior, as reported in a 52 country Global School-based Health Survey ⁷ . Despite regional variations, different dimensions like understanding of their problems, monitoring activities (both academic and leisure time), and respecting their privacy were linked with suicidal behaviors of adolescents. ⁷

In the current scenario, though the tendency is to focus on the current parent–child (read as “adolescent”) relationship, the parental pressures, and unrealistic expectations, would it not be better to focus on building the child’s resilience since one’s formative years! Our argument needs to be seen in the perspective of how the Indian society has undergone changes over the last few decades, ⁸ thereby impacting upon how parenting during formative years has changed! Disintegrating families (shift from joint to nuclear setups) and working parents have become a norm. In itself though it is not negative, but the extra income and the absence of support induce a situation where the child is indulged in and gets used to getting work done easily with helpers around to carry out various tasks. It is a moot point as to how many situations do the parents’ voluntarily create for instilling the “7Cs (competence, confidence, connection, character, contribution, coping, and control) of resilience” as identified by Dr Kenneth Ginsburg!

A recent report by UNICEF ⁹ on “parenting adolescents” emphasizes on raising awareness about the importance of equipping parents to provide with the support and competencies they need for positive parenting. Hence, it is imperative to develop resource material-based psychological interventions in order to equip parents with the following objectives viz. to integrate the 7Cs in their parenting and ensure the feeling of being uncritically accepted by the child.

In essence, critical junctures and platforms need to be identified early on in children’s lives so as to build their resilience and make them strong to take on life-related pressures. This acts as an effective foundation in order to reduce the suicidal risk in adolescence and youth. The period of adolescence is full of challenges, risks, and adventures, but how adolescents can build resilience to cope with environmental stressors and show their potential depends significantly upon the parenting and early phase of life. Thus, the family (read as mainly “parents”), and their parenting (including their involvement and support) may influence the trajectory of whether the child becomes an angry, hostile, lonely, depressed adolescent OR an enthusiastic, focused, socially adept, and confident adolescent ready to face and take on the challenges of life!