Category Archives: suicide awareness

12 Facts About Depression and South Asian Mental Health

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South Asia is a broad region that includes close to 2 billion people. Encompassing India, Pakistan, Bangladesh, Nepal, Afghanistan, Sri Lanka, Bhutan, and the Maldives, South Asia is huge.

South Asia is a suicide-dense area but with only a handful of peer-reviewed studies assessing the relationship between depression and suicidal behavior.

South Asia represents approximately one-quarter (over 23%) of the global population. Depression affects close to 90 million people in South Asia. The World Health Organization (WHO) estimates that almost one-third of people suffering from clinical depression worldwide live in South Asia, making the region home to a large majority of the world’s depressed.

Suicide is a global public health issue (World Health Organization, 2021). WHO estimated that suicide isthe fourth-leading cause of death worldwide among 15–30- year-olds. It is the result of a complex interaction between several risk factors which may include biological, personal, social, psychological, cultural, and environmental factors, but psychiatric disorders are one of the most crucial risk factors (WHO, 2014; Arafat and Kabir, 2017). Depression numbers are probably underreported in South Asian communities because of years of stigma about mental disorders.

About 90% of people who die by suicide experience some form of psychiatric illness. Among psychiatric disorders, clinical depression is the most common risk factor for suicides.

Mental illness is taboo in many South Asian communities. Discussing mental health in South Asia has yet to be socially normalized. South Asian religious and cultural influences often do not consider mental health a medical issue, referring to it as shameful and even a “superstitious belief.”

A 2010 study by the mental health campaign Time to Change (www. time-to-change-UK.org) found that South Asians rarely discuss mental health because of the risk the subject poses to their reputation, family, and status.

South Asian languages do not have a word for depression. There is dukkha (universal suffering); pagal (derogatory word, crazy); and shikasta (broken). Many South Asians are unable to express the specific condition of depression in their language. As a result, they often downplay it as part of “life’s ups and downs.” This language limitation and difficulty describing symptoms also makes diagnoses and treatment difficult.

Depression is a major contributor to other global health problems. Medical experts have found a correlation between the symptoms of depression and the perpetuation of chronic illness, such as cardiovascular disease. Depression exacerbates other health conditions.

Postpartum depression in South Asian women is often undiagnosed and unrecognized. The gender of the baby, domestic violence, secrecy, and poverty are all factors that put new mothers at a higher risk for postpartum depression. The stigma surrounding mental health prevents new mothers from receiving mental health care or support during after pregnancy.

Bangladesh, Sri Lanka, and Indonesia are three countries who have recently emphasized mental health as a “top priority” in public health. In 2021, WHO lauded their work and the important step it takes towards normalizing and treating depression and mental illness, as illness.

Non-government organizations (NGOs) have had a positive impact on mental health care. In countries where the government is not willing or able to make mental health a priority, NGOs are providing crucial support to people suffering from mental health issues. NGOs in South Asia have expanded their community-based programs and are providing specialized mental health services. For example, in the Maldives, a number of NGOs are offering rehabilitation, life-skills training, educationsl information, and resilience-building to citizens. These efforts have begun to increase the access South Asians have to mental health care with decreased stigma.

Mental disorders are bad for work and family life. People with major depression struggle to take care of their family, complete self-care tasks, pay bills, and be productive in the work place. Although poverty rates in South Asia are declining, the region accounted for nearly half of the world’s “multidimensionally poor” in 2017. Providing mental health care to South Asians may be a major step in helping to eradicate poverty within the region.

According to the World Bank, strong mental health is a contributing factor to not only the wealth of nations but to increased quality of living and productivity for families and individuals.

Read more about this:  South Asian Mental Health

***Call 911 if you or someone you know is in immediate danger or go to the nearest emergency room.
988 Suicide & Crisis Lifeline
Call or text 988; Llame al 988 (para ayuda en español)
Use Lifeline Chat on the web.
The Lifeline provides 24-hour, confidential support to anyone in suicidal crisis or emotional distress. Call or text 988 to connect with a trained crisis counselor.
New: If you are worried about a friend’s social media updates, you can contact safety teams at the social media company. They will reach out to connect the person with the help they need.

5 Important Facts About Suicide

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When I was completing my doctorate, the Clinical Director of my program committed suicide. For a bunch of psychologists committed to being healers, it was an incredibly painful experience. We yearn to lessen suffering.  It was the first large memorial service I ever attended where suicide was openly discussed. As a society, the stigma and secrecy around suicide have not been helpful.

5 Important Facts About Suicide

    1. Language matters. It is not appropriate to say that somebody committed suicide. Committed suicide is a phrase that comes from the days where it was actually considered a crime or sin. Died by or from suicide is more accurate. Some media corporations have started using more appropriate language around this topic.
    2. Talking about suicide is crucial. Asking about somebody’s suicidal thoughts will not make them suicidal. In fact the opposite is true; not giving somebody space to talk about it can be dangerous.
    3. Stop the taboo. Suicide falls within the top 10 causes of death in the United States, and in the top five within certain age ranges. We used to refer to cancer as the C word, now we have more research, treatment plans, and family support. Making suicide a taboo topic discourages individuals and their families from seeking help.
    4. Three phrases that are never helpful:
      At least their pain is over. They are in a better place. They seemed to have everything.
      Alternatively, people sometimes feel like they have nothing to say or offer, so they avoid the person and / or their family. If you want to help, be solidly present. That includes being available for 3:00 AM phone calls, helping with daily tasks, and being a loving presence. 
    5. Implying that suicide is selfish is completely inaccurate. Individuals who feel suicidal are in incredible pain

My colleague and officemate, Dr. David Jobes, one of the world’s most eminent researchers on suicidology runs the Suicide Prevention Lab, in Washington, DC. For information, see https://sites.google.com/site/cuajsplab/home

Call or text 988 to reach the 988 Lifeline.

988lifeline: Big News in Mental Health

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In two days, states will roll out 988 as the new National Suicide Prevention Lifeline number, similar to how people can call 911 for emergencies. When calling, the individual will be connected to a trained mental health professional.

All phone service providers will be required to connect callers who dial 988 to the lifeline starting July 16. The existing lifeline uses a 10-digit number, 1-800-273-8255. This important change has been in the works for years, and many mental health professionals say it will help expand much-needed services and make them more accessible to people seeking help.

At the same time, it is important to note that the mental health industry has been overwhelmed, especially in the past two years. With a surge in phone calls, availability of resources is crucial. Another area of concern is ongoing financing. Congress has allocated one time funding; after that it is up to individual states.

Some Myths about suicide
Myth 1: Talking about suicide increases the chance a person will act on it.
Fact: Talking about suicide may reduce, rather than increase, suicidal ideation. It improves mental health-related outcomes and the likelihood that the person would seek treatment. Opening this conversation helps people find an alternative view of their existing circumstances.

Myth 2: People who talk about suicide are just seeking attention.
Fact: People who die from suicide have often told someone about not wanting to live anymore or they do not see the future. It’s always important to take seriously anybody who talks about feeling suicidal.

Myth 3: Suicide can’t be prevented.
Fact: Suicide is preventable but unpredictable. Most people who contemplate suicide, often experience intense emotional pain, hopelessness and have a negative view of life or their futures. Suicide is a product of genes, mental health illnesses and environmental risk factors.

Myth 4: People who take their own lives are selfish, cowards or weak.
Fact: People do not die of suicide by choice. Often, people who die of suicide experience significant emotional pain and find it difficult to consider different views or see a way out of their situation.

Myth 5: Barriers to bridges, safe firearm storage, and other actions to reduce access to lethal methods of suicide don’t work.
Fact: Limiting access to lethal means, such as firearms, is one of the simplest strategies to decrease the chances of suicide. Many suicide attempts are a result of impulsive decisions. Therefore, separating someone from a lethal means could provide a person some time to think before doing harm to themselves.

Myth 6: Suicide always occurs without warning.
Fact: There are almost always warning signs before a suicide attempt.

Here are a few common signs:

  • Talking about suicide — making statements such as “I’m going to kill myself,” “I wish I were dead” or “I wish I hadn’t been born.”
  • Withdrawing from social contact and wanting to be left alone.
  • Having mood swings, such as being emotionally high one day and deeply discouraged the next.
  • Being preoccupied with death, dying or violence.
  • Feeling trapped or hopeless about a situation.
  • Increasing use of alcohol or drugs.
  • Changing normal routine, including eating or sleeping patterns.
  • Doing risky or self-destructive things.
  • Giving away belongings or getting affairs in order when there is no other logical explanation for doing this.
  • Saying goodbye to people as if they won’t be seen again.

Myth 7: Talk therapy and medications don’t work.
Fact: Treatment can and does work. One of the best ways to prevent suicide is by getting treatment for mental illnesses and learning ways to cope with problems and emotional pain.

See also this, post on how to speak to friends and family about depression.

Causes of Mortality in US Teens and Children

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In 2020, firearm-related injuries became the leading cause of death for children and teens, an age group defined as ranging from 1-19 years. From 2019 to 2020, the relative increase in the rate of firearm-related deaths of all types (suicide, homicide, and unintentional) among children and adolescents was 29.5%, a significant uptick.

In addition, drug overdose and unintentional poisoning increased by 83.6% from 2019 to 2020 among children and adolescents, becoming the third leading cause of death in that age group. Motor vehicle accidents remained the second cause of death.

Although the USA suicide rate dropped overall from 2019 to 2020, there were increases among young adults/teens that affected different demographic groups differently.

According to a study published in the Journal of the American Medical Association (JAMA Psychiatry) that examined racial differences in suicide in 2020, suicide mortality among Black young people doubled. The evidence pointed to the pandemic having a heavy impact on Black Americans in significant areas including more hospitalizations, deaths and bereavement, job loss, and housing instability.

(Stats: New England Journal of Medicine: NEJM,May 19, 2022; JAMA, psychiatry; December 2020 ). 

The Late Night Call

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For many of us in psychology/mental health, when the phone rings or a text pings late night, there is an immediate frisson of worry and concern. It’s a cold shiver in your spine. Bad news is going down. I work with a lot of young people, teens through 30s, and I am readily accessible most of the time. No one abuses this. When people call you late at night, it’s usually not to say hello.

One of my mentors is a top authority in suicide research in the world. When I asked him, as a doctoral student, why he got into this painful area where he has done so much to help, he said we pursue what we fear. It might seem counterintuitive but there is no greater courage than facing the fears we have by helping others with theirs.

I started my own company several years ago after being Clinical Director elsewhere because I believe that mental health is for all. It is often excluded for many people because of financial constraints, stigma, lack of cultural competence, lack of hours to actually go see someone, and a potentially ‘authoritative’ relationship that is anathema to many.

I will tell you this.
NO doctor or therapist can do anything without their team. The team is: found or biological family or parents, other medical providers, friends and social supports of the person that you are working for and with, chosen spiritual beliefs, community, teachers (as burdened as they are are, they are very often the person that young people turn to), genuine Internet connections, ancestry/culture, companion animals, and fostering self-compassion relentlessly.

We are always so shocked and horrified to hear about someone taking their life. But when most ask people how they’re doing, they expect to hear ‘fine’.

We need to facilitate conversation where somebody can say they feel absolutely lousy. It’s been a terrible day. Right now, people at your job, your neighborhood, your home, feel absolutely lousy.  They don’t know what to do. We need dialogue about mental health so it becomes a natural thing.

It takes a village, the most trite and true statement.

Men and mental health

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In my practice, the majority of my clients are male. Overall, three times as many men as women die by suicide, according to a World Health Organization (WHO) comprehensive report from 2018. The American Foundation for Suicide Prevention also cited 2018 data, similarly noting that in that year alone, men died by suicide three and a half times more often than women in the United States.

Mental Health America, a community-based nonprofit, collected data suggesting that more than 6 million men in the U.S. experience symptoms of depression each year, and more than 3 million experience an anxiety disorder. Despite these figures, the National Institute of Mental Health (NIMH) reported that men are much less likely than women to have received formal mental health support.

In a study from Canada, published in the Community Mental Health Journal, in 2016, more than one-third of the participants in the study admitted to holding stigmatizing beliefs about mental health issues in men. Significantly more male than female respondents said that they would feel embarrassed about seeking formal treatment for depression.

BIPOC men face additional challenges when it comes to looking after their mental health. According to the American Psychological Association (APA), in the U.S., Black and Latinx men are six times more likely to be murdered than their white peers. Indigenous American men are the demographic most likely to attempt suicide in this country and Black men are most likely to experience incarceration, based on statistics gathered by the American Psychological Association. The consequences of these disparities on the mental health of people of color and of diverse ethnic and racial backgrounds is exponentially challenging.

Depression symptoms often manifest differently in men than women, perhaps based on these disparities. Some men with depression hide their emotions, and may seem to be angry, irritable, or aggressive, while many women may seem overtly sad or express sadness verbally.

For men, some symptoms of depression are physiological, such as a racing heart, digestive issues, muscle tension, bodily aches and pains, or headaches, and men are more likely to see their doctor about physical symptoms than emotional symptoms. Additionally, self-medicating with alcohol and other substances can be a common symptom of depression among men and that this can exacerbate mental health problems and increase the risk of developing other health conditions.

It is not easy for men to be open with others about mental health struggles. In fact, many of the male patients that I see have never spoken about their struggles until they come to my office, often not until they have experienced dire difficulties. Often, their pain is palpable.

As a mental health community, and as a society, we have to teach men to not mask their emotions. Instead, we need to encourage men to speak up, not man up. Talking saves lives; let’s normalize mental health.
(statistics from the American Psychological Association and NIMH). 


Covid-19 Crisis depression General strategies for self-care suicide awareness No Comments

At Embolden Psychology, we have put forth a number of recommendations for managing feelings like stress, boredom, anxiety, depression, fear, and loneliness during social distancing, including:

Shifting the mental framing of social distancing- believing that one is “safe at home” versus “stuck at home” can have a profound effect on sense of agency, and reduce feelings of helplessness and fear. Agency matters.

Maintaining remote social contact with friends and colleagues can help limit feelings of loneliness. Text, FaceTime, call.

Enjoying simple physical comforts, like a hot shower, sipping a hot beverage, cuddling a companion animal, or wrapping oneself in a blanket may reduce feelings of loneliness.

Please spend time outdoors. Our bodies cannot store vitamin D, and we need this essential nutrient for mental health and wellness. Whether it’s taking a walk down your street or sitting on your deck, sunlight is essential.

Keeping to routines. Go to bed at the same time, wake up at the same time, as much as possible. Make sure you eat at regular time intervals. Keeping to a schedule helps maintain mental health.

Resources that rock:
1. SAMHSA Disaster Distress Helpline: 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters–call 800.985.5990
2. 7 Cups: A free online text chat service that connects individuals with a trained listener for emotional support and counseling – visit: www.7cups.com
3. National Suicide Prevention Lifeline: Those who are experiencing suicidal thought and impulses can call 800.273.8255 or text HOME to 741741 for support

Indigenous Americans, youth, and mental health.

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Indigenous/tribal communities face significant behavioral health challenges and disparities. For Indigenous Americans, multiple factors influence health outcomes, including historical trauma and a range of social, policy, and economic conditions such as poverty, under-employment, lack of access to health care, lower educational attainment, housing problems, and violence.

These disparities have important consequences. Suicide is the second leading cause of death among Native American youth ages 8 to 24. Also, while there is general awareness that Native Americans experience higher rates of alcohol and substance use, the scope of these behavioral health problems is not fully understood.

With 564 federally recognized American Indian and Alaska Native (AI/AN, is the designation currently used by the Census Bureau) tribes, 100 state recognized tribes, and over 200 languages, there is a great need for the development of mental health programs aimed at AI/ANs that center culture as a dominant aspect of treatment. The deficit in culturally relevant treatment programs aimed at Indigenous Americans people living with mental illness is glaring. These communities cope with intergenerational trauma which has a historical context, occurring when exposure to trauma takes place in an earlier generation and continues to affect subsequent generations. The stress of intergenerational trauma contributes to the erosion of family structure, tribal structure and even spiritual ties. It can affect one’s identity, relationship skills, personal behavior, transmission of traditions and values, and attitudes and beliefs about the future. The stress of these traumas combined with the complex and ongoing mistreatment of AI/AN citizens contributes to the rates of mental illness in AI/AN communities and can manifest in a high rate of substance abuse disorder, PTSD, anxiety and depression.

Additional stressors such as a lack of access to health insurance, pervasive poverty and unemployment, and higher suicide rates exacerbate these issues.

I have compiled this list of resources for indigenous clients. Please note that the hours of availability may have changed, but they are all in service at the present time.

Mental Health Resources For Native And Indigenous Communities:
–  Indigenous Story Studio creates illustrations, posters, videos, and comic books on health and social issues for youth.

–  Suicide prevention.
–  National Alliance on Mental Illness.
–  One Sky Center: The American Indian/Alaska Native National Resource Center for Health, Education, and Research; mission is to improve prevention and treatment of mental health and substance use problems and services among Native people.
–  WeRNative: a comprehensive health resource for Native youth by Native youth, promoting holistic health and positive growth in local communities.
–  Ask Auntie: similar to an advice column – type in your question and it will pull up similar ones; if none answer what you’re asking, Auntie Amanda will write up an answer and notify you when it is posted.
–  StrongHearts Native Helpline: The StrongHearts Native Helpline (1-844-762-8483) is a confidential and anonymous culturally-appropriate domestic violence and dating violence helpline for Native Americans, available every day from 7 a.m. to 10 p.m. CT.

Suicide prevention month

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September is suicide prevention month.

That doesn’t just mean check on your friends. Although that is important.
It means:
promote universal healthcare. Because most people cannot afford mental health.

  • it means understanding that suicide is the third most likely cause of death, for ages 15 to 45, universally.
  • it means understanding that the pandemic has caused depression and despair to grow exponentially, combined with financial hardship, lack of mental health and medical care, and social isolation.
  • It means destigmatizing mental disorders.
  • It requires an active stance. Because it’s not going away, and eventually it will be in your face, from friends, family, colleagues, and loved ones. Even people who attempt suicide and survive, often have residual grave harm to their psyche and body. This is a public health issue.

Suicide Prevention Hotline
Additional Resources from the CDC

How to help a loved one who is having mental health problems

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We all go through tough times and people help us through them. Other times we have been worried about other people’s mental health. Whether they are a friend, family member, significant other, neighbor, or colleague, there are many ways to support somebody you care about.

1 in 6 people experienced a common mental health problem such as anxiety or depression in the past week.

Talking about mental health
If you are worried about someone it can be difficult to know what to do. When you are aware there is an issue, it is important not to wait. One of the saddest components of depression is that it is immobilizing. You can simultaneously know that you desperately need help, and have absolutely no energy or desire to seek it.

Waiting and hoping others will come to you for help might lose valuable time in getting them support. Openly talking with someone is often the first step to take when you know they are going through a hard time. This way you can find out what is troubling them and what you can do to help.

Eight tips for talking about mental health:

  1. Set time aside with no distractions. It is important to provide an open and non-judgemental space.
  2. Let them share as much or as little as they want to. Let them lead the discussion at their own pace. Don’t put pressure on them to tell you anything they aren’t ready to talk about. Talking can take a lot of trust and courage. You might be the first person they have been able to talk to about this.
  3. Don’t try to diagnose or second guess their feelings. You probably aren’t a medical expert and, while you may be happy to talk and offer support, you aren’t a trained counsellor. Try not to make assumptions about what is wrong or jump in too quickly with your own diagnosis or solutions.
  4. Keep questions open ended. Say “Why don’t you tell me how you are feeling?” rather than “I can see you are feeling very low”. Try to keep your language neutral. Give the person time to answer and try not to grill them with too many questions.
  5. Talk about wellbeing. Exercise, having a healthy diet and taking a break can help protect mental health and sustain wellbeing. Talk about ways of de-stressing and ask if they find anything helpful.
  6. Listen carefully to what they tell you. Repeat what they have said back to them to ensure you have understood it. You don’t have to agree with what they are saying, but by showing you understand how they feel, you are letting them know you respect their feelings.
  7. Offer them help in seeking professional support and provide information on ways to do this.
  8. Know your limits. If you believe they are in immediate danger or they have incurred injuries that need medical attention, you need to take action to make sure they are safe. More details on dealing in a crisis can be found below.

How do I respond in a crisis?

People with mental health problems sometimes experience a crisis, such as breaking down in tears, having a panic attack, feeling suicidal, or experiencing a different sense of reality (dissociation). This may include even losing a sense of time and place. You may feel a sense of crisis too, in response, but it’s important to stay calm yourself.

There are some general strategies that you can use to help:

    • Listen without making judgements and concentrate on their needs in that moment.
    • Ask them what would help them.
    • Reassure and help point them to practical information or resources.
    • Avoid confrontation.
    • Ask if there is someone they would like you to contact.
    • Encourage them to seek appropriate professional help.
    • If they have hurt themselves, make sure they get the first aid they need.

Seeing, hearing or believing things that no-one else does can be the symptom of a mental health problem. It can be frightening and upsetting. Gently remind the person who you are and why you are there. Under extreme stress, people can dissociate. Don’t reinforce or dismiss their experiences, but acknowledge how the symptoms are making them feel.

How do I respond if someone is suicidal?
If someone tells you they are feeling suicidal or can’t go on, or if you suspect they are thinking of taking their own life, it is very important to encourage them to get help.

National Suicide Prevention Lifeline
Hours: Available 24 hours. Languages: English and Spanish
1-800-273-8255



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Dr. Hoorie Siddique

Embolden Psychology
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Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

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