The Nigeria media was awash in the past week with news of the suicide of a woman in Ekpoma, Edo State who apparently committed suicide because of lack of a cure for her diabetic state. It is sad to say that suicide is not an unusual occurrence in individuals with diabetes. Diabetes is one of the most psychologically and behaviourally demanding chronic medical illnesses, in part because an estimated 95% of diabetes management is carried out by the individuals with diabetes themselves. This treatise will therefore look at the remote and immediate causes of suicide in individuals with diabetes and advice on early recognition of suicidal ideation in people with diabetes by both the person with diabetes and their caregivers.
Continue reading after the cut....
Diabetes is known to exert a profound toll on not only the quality of life but also the emotional health of those with it. Research conducted using the Beck Hopelessness scale showed that individuals with diabetes had high scores in the Loss of motivation arm and Loss of Future Expectations arm, which two factors are related to suicide attempts. People with diabetes are also known to score higher on the Suicide Score Scale.
It is pertinent at the outset to say a word about risk factors. A risk factor is a condition that places an individual at risk of developing a health related problem. These factors can either be inherited or acquired from the environment. It may be identified as a single measurement (e.g. a physical feature such as weight), a disease (e.g. Hypertension) or a lifestyle characteristics (e.g. smoking).
What then are the risk factors that make individuals with diabetes prone to suicide? First is the use of multiple medications, the more inconvenient the therapy the individual with diabetes is on, as exemplified with use of multiple medications, the higher the Hopelessness score and the higher the risk of suicide attempts. Age greater than fifty years is another risk factor. As the individual with diabetes advances in age and age related joint pains and locomotion problems supervenes, leading to reduced physical and social functioning, then suicide risk becomes higher.
There is a two way relationship between diabetes and depression; people with diabetes are prone to depression while those with depression are also prone to developing diabetes. Diabetes can exact an enormous toll on the psyche of people living with the condition. Depression is a serious chronic medical condition that affects thought, feelings, and the ability to function in everyday life. Apart from affecting the quality of life, it is known that depression in people with diabetes is associated with poor blood sugar control, poor self management and untimely death.
Though suicide cannot be predicted, examination of an individual’s risk factors is an essential aspect of the suicide assessment that can help to gauge the level of risk. Other risk factors for suicide include mood disorders, lack of social support, unemployment, family history of suicide, family conflict including domestic violence, hopelessness, and low self-esteem among many others.
Intentional over dosage of insulin and drugs of the sulfonylurea family are the commonest methods of suicide in those with diabetes. Over dosage of these drugs lead to profound reduction in the blood glucose level with severe brain damage, coma and eventual death or when death does not occur, severe mental incapacitation ensues. If such an individual is not discovered within six hours of the overdose, then the outcome may be fatal. It is thus imperative to be careful in prescribing anti-diabetic medications in the person with diabetes and concomitant depression. Prompt use of counseling services is also helpful in the depressed person with diabetes to prevent progression of active depression to an active plan to end life. The potential to use lifesaving anti-diabetic medications to cause their own demise in the person with diabetes on such medications must be promptly recognized and treated.
It is said that those contemplating suicide do not always advertise their plans; though some may do, it thus behooves the caregiver to recognize the warning symptoms and risk factors for suicide in the person under their care. Diabetes, even when poorly controlled is not the end of the world.
-Dr Olubiyi Adesina [Consultant Diabetologist]
fbadesina@gmail.com, 08034712568
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