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She grappled with trauma of her father's suicide for more than a decade

Looking back now, Ms Jacqueline Pak said there were signs that her father was suicidal.

He had lost his job in a shipyard a few years before his death, and stayed home most of the time. Withdrawing into himself, he spoke little in the last year of his life.

At night, when the teenager came out of her room to go to the bathroom, she would see her father sitting alone in the dark, just staring into space.

"We just assumed he was just going through a bad period of his life," said Ms Pak, who is now 42 and the head of corporate affairs in a boutique consultancy firm.

"I grew up knowing him as a caring father who took care of the family. But I think in the years leading up to his suicide, his behaviour changed... It was so gradual that we didn't think it was any cause for alarm."

At that time, Ms Pak's mother was a housewife, who took on babysitting jobs at home to earn some income. She has a younger brother.

Ms Pak is one of 25 suicide survivors who are participating in a new study by the Institute of Mental Health (IMH) aimed at gaining a deeper understanding of the factors that can lead to suicide.

It is the institute's first psychological autopsy, essentially an examination of the state of mind, to determine what the deceased person might have been thinking about, and what was going on in their lives, before they decided to take their own lives, said Associate Professor Mythily Subramaniam, assistant chairman of IMH's medical board (research).

"Perhaps if we identify the main factors, we could then do something to prevent some of these suicides," she added.

Ms Pak and 24 other individuals who have suffered losses to suicide have been recruited to shed light on the state of mind of their loved ones.

Though their trauma is not part of the study, no suicide survivor is spared.

For more than a decade after her father died some 25 years ago, Ms Pak struggled with the trauma of his death.

The 17-year-old blamed herself for it.

Though she seemed fine on the outside, graduating with good grades to land a good job, inside, she was crumbling.

"I tried to call helplines. I tried to reach out to seniors in school, friends, teachers, counsellors, I spoke to several different ones from different organisations, but I felt I was not being understood," she said.

At 26, she went to work in Australia to get away from it all but spiralled downwards.

"I stopped getting out of bed. I stopped eating because I didn't see a point in living," she said.

Her then boyfriend dragged her to a psychiatrist.

"I saw one doctor and I broke down because all he did was tell me that it was normal to feel this way, that I wasn't to be blamed. It was all I needed to hear," said Ms Pak, who learnt she was suffering from depression and post-traumatic stress disorder.

"That one doctor that I saw changed my life and after that, I sought treatment, I was diligent in my sessions, my therapies, and I found peace and I found reason to continue living."

Ms Pak hopes that by taking part in this study and doing this interview, she can contribute to suicide prevention efforts as well as help fight the stigma around suicide and mental health.

However, it has been challenging finding willing participants for the study, said Prof Mythily.

The researchers initially wanted to wrap up the study by March 2023 with 150 suicide survivors, but as they are far from that target, they are extending this study by another year, hoping that more will come forward.

The study has not been easy for the researchers.

"When I do these interviews, some of them stay with me for a very long time. Whether you like it or not, you cannot distance yourself completely from the person who is being described," said Prof Mythily.

She added that an in-depth analysis will be done after all the data is collected.

So far, the issues have not been different from what she has seen in other studies done overseas.

"Typically, three or four factors tend to be associated with suicides - financial stress, interpersonal relationships breaking down, having a chronic pain condition or chronic distress due to a medical condition, and association with mental illness.

"We would need a larger sample size to see the emergence of any patterns that could be unique to Singapore," she said.

Anyone keen to take part in the study can write to imhresearch@imh.com.sg

Institute of Mental HealthSUICIDESMental Health