Warning: This article contains references to suicide, self-harm and domestic abuse. The first time she attempted suicide, Ms Sandy (not her real name) was in Secondary 3 and had tried to end her life by swallowing a household cleaning product. At 15, she was reeling from a family conflict that had spilled into her school life, leaving her feeling "really humiliated" and with nowhere to turn."I felt like I wanted to have some place to dig a hole and just hide and not come out anymore," said Ms Sandy, now a 51-year-old freelance educator. "After drinking (the cleaner), I was sick and vomited, and my parents thought I was sick because of food poisoning."She continued to experience suicide ideation every now and then – and then in her 30s, she fell to new depths of depression while dealing with a divorce and financial stresses from her family. She hit rock bottom when a colleague of hers died in a workplace accident.After noticing her irregular sleeping and binge eating patterns, it was her sister who "verbally slapped" her out of it. "My sister came to me one day and said: 'What are you trying to do with your life? Is this really what you want to do?' When she asked that, I just broke down and cried," said Ms Sandy, visibly choking up as she recalled the incident."I felt during that period of time (that) life was a blur. Everything was misty and foggy to me."She spoke on condition of anonymity given that stigma surrounding suicide still exists today. While awareness around mental health has grown in recent years, many who have struggled with suicidal ideation said the silence and shame are still daunting.Last September, a first-of-its-kind study in Singapore released by the Institute of Mental Health (IMH) found that suicide is rarely the result of a single cause. Instead, it's often a convergence of factors including mental illness, physical health issues and relationship breakdown. The study, titled Seeking Answers: A Psychological Autopsy of Exploring and Analysing Risk Factors (SPEARS), also found that on average, four warning signs emerged in the week before a person died by suicide. In response to CNA TODAY's queries, Associate Professor Mythily Subramaniam, principal investigator of the study and assistant chairman of the institute's Medical Board for Research, said the study provided insights into the complexity of suicide in Singapore, particularly the role of interpersonal, social and clinical factors.The study also underscored gaps in recognition both at the individual and caregiver level. For example, suicide loss survivors – individuals who had lost loved ones to suicide – said they were unaware of warning signs or unsure how to respond when a loved one expressed suicidal thoughts. Survivors of both suicide attempts and suicide loss told CNA TODAY that while those warning signs were familiar, they were only part of the picture of how overwhelming everyday situations can escalate to a point of an individual wanting to end their life.The journey back from crisis was rarely linear, said those who had lived it and the caregivers and mental health professionals who have worked with persons dealing with suicidal ideation. More importantly, it's a process that they hope no one has to face alone.LIVING WITH WANTING TO DIE Individuals who have considered ending their life told CNA TODAY that rather than singular triggers, it was an accumulation of pain over time that made it hard to imagine any other way out – much of it rooted in circumstances beyond their control.The imprints of the mental, emotional and physical abuse from Ms Adoncia Ng's now-estranged mother led her to struggle with suicidal thoughts as early as 14 years old. At her lowest points, when she felt life was meaningless, she would self-harm by hitting her head against the wall or scratching her arms whenever she argued with her mother. "It seemed almost like my vision had a grey tint. Everything was in greyscale, everything was so gloomy," said Ms Ng, now 30 and a business development and strategy manager. "I was very sad all the time. I would be crying and not know why I'm crying. My heart would ache."