All these questions often leave those who have been left behind more frustrated, and with even more questions.

One thing is certain: any suicide is devastating. However, refraining from talking about or trying to understand the event would also be equally devastating.

The World Health Organization (WHO) reports that one person commits suicide every 40 seconds in the world, which translates into approximately 800,000 deaths by suicide each year. WHO also states, "Suicide occurs throughout the lifespan and is the second leading cause of death among 15-29 year olds globally."

According to a 2015 WHO report, three suicide deaths occur per 100,000 individuals in Indonesia. However, it is difficult to gauge the real figure due to potential underreporting, which may be linked to the social stigma surrounding death by suicide and mental illness. Death by suicide, especially in Indonesia, is still considered taboo and “sinful”. The major religions in Indonesia say that suicide is a sin. The stigma can be so strong that, following the suicide of a relative, a family might report the death as anything but suicide.

Trying to brush the issue aside will not change anything. Change will come from doing the opposite: The more we talk about suicide to try and understand it, the more we become aware of the need to make mental healthcare accessible, the more we can prevent suicide.

Risk factors

Suicide is a complex issue that is rarely attributed to a single factor or event. Studies have shown that a combination of biological, psychological and social factors is associated with an individual's increased vulnerability to suicide.

There are risk factors that can be changed, such as substance abuse, yet there are also risk factors that cannot be changed, like a family history of suicide or the sudden death of a loved one. It is important to underline that these risk factors might not directly lead to suicide. For instance, having mental health issues does not directly cause someone to commit suicide, but could be a likely cause in combination with other factors.

The risk factors of suicide include:

• Mental health issues (e.g., depression, anxiety, bipolar disorder) and/or substance abuse (drugs and/or alcohol)
• Feelings of hopelessness
• Past suicide attempt(s)
• Family conflicts or domestic violence, including child abuse
• Family history of suicide
• Social isolation (feeling isolated or cut off from others) and geographical isolation (physically distant from one's social support system and/or living in a remote area).
• Gender: males are at a statistically higher risk of suicide than females. In Indonesia, the male-to-female suicide ratio is 4.5 to 1.6).
• Personal loss and/or stressful life events (e.g., loss of a loved one, financial loss, the end of a relationship, life transitions, an abusive relationship, conflict, school exams)
• Impulsive or aggressive tendencies (e.g., acting on impulse without thinking things thorough)
• Cultural/religious beliefs that view suicide as an honorable solution to a personal or professional quandary (such as the ritual seppuku historically performed by samurai)
• Local suicide epidemics (also called "suicide contagion", when one suicide in a community leads to multiple suicides or suicide attempts)
• Physical illness
• Easy access to lethal methods and means of committing suicide
• Unwillingness to seek help, possibly due to the stigma of mental health, substance abuse or suicide and suicidal thoughts

Protective factors

It is also important to recognize and understand the protective factors against suicide. Protective factors help protect individuals from suicidal thoughts and prevent suicide attempts.

These protective factors include:

• Willingness to seek help
• Easy access to and awareness of effective clinical support for psychological, physical and substance abuse problems
• Family and community support (feeling connected to individuals, family, community and social institutions)
• Adaptive problem-solving and conflict resolution skills; nonaggressive approach to managing disagreements
• Strong sense of purpose and meaning in life
• Belief in cultural/religious teachings that disapprove of suicide and encourage the life instinct or the survival instinct
• Good,  continuing support from medical and mental health treatment or relationships with medical and mental health professionals

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Emilita Krisanti "Santi" Cornain is a clinical psychologist at the International Wellbeing Center who is trained in cognitive behavior therapy, and often combines mindfulness and solution-focused strategies in her practice. Santi completed her undergraduate degree in psychology through the double-degree program at the University of Indonesia and the University of Queensland, Australia; she holds a clinical psychology doctorate from Australia's Griffith University. Outside of work, Santi can be found playing with her energetic toddler, reading novels or searching for the next best vegetarian dish in town.