ABSTRACT

Corresponding Author:
Dr. Shivananda Manohar,
Senior Resident, Department of Psychiatry,
JSS Medical College and Hospital,
JSS Academy for Higher Education,
Mysore, Karnataka, India.
E-mail: drshivman@gmail.com

ABSTRACT

BACKGROUND

In India, the number of suicides and attempted suicides have increased significantly. Moreover, the suicide attempt rates are found to be higher than rates for completed suicides. Therefore, present study aimed to investigate the socio-demographic characteristics and suicide data on attempted suicides.

MATERIALS AND METHODS

75 cases of attempted suicide individuals admitted to MVJ Medical College and Research Hospital, when declared medically/surgically stable and referred to Psychiatry Department, were recruited for the study. Detailed interview with the patient was conducted and information obtained was compiled in a specially designed proforma.

RESULTS

Majority of the subjects were aged less than 30 years (77.3%), females (66.7%), married (56%), educated only up to high school or less (70.7%), were Hindus (90.7%) and from nuclear family (73.3%). Housewives (30.7%) and farmers (21.35%) were the common occupational groups. Significant past and family history of suicidal behaviour, psychiatric and physical illness was present. Most attempts took place at patient’s house (78.7%). Organophosphorus compound poisoning was the most common method of attempt (38.7%) with interpersonal problems in the family (38.7%) as the most common precipitating factor.

CONCLUSION

In conclusion young adults, females with low socio-economic and educational status, having significant past and family history of suicidal behaviour and psychiatric illnesses were at increased risk of suicide attempt. High intent among suicide attempters was associated with high hopelessness score and presence of current psychiatric illness. Also, high hopelessness score was associated with presence of current psychiatric illness.

KEY WORDS

Suicide Attempt, Suicide Risk Factors, Hopelessness.

BACKGROUND

Suicide and suicide attempts are serious public health problem in developed countries.^1,2 Suicide is the most common among several mental health problems, which leads to death in all age groups in majority of countries.³ Furthermore, the attempted suicides are 10 - 40 times more frequent than completed suicide. In 2002, the world health organisation found 877,000 deaths were due to suicide (Geneva). The recent Indian epidemiologic studies found more than one lakh persons lost their lives by committing suicide during the year 2008. Furthermore, the studies in Sikkim reported the highest rate of suicide (48.2) followed by Pondicherry (46.9) and suicide rate in Andhra Pradesh was 17.4 in 2008 (National Crime Records Bureau, 2008).⁴

DISCUSSION

In the present study we obtained the data on socio-demographic and suicide attempt profile of study subjects, among them oral consumption of organophosphorus compound and marital status was found to be an important factor for suicide attempt. Furthermore, Beck’s Hopelessness Scale was found to be higher scale; however, there was no significant association observed in our population. In our study, majority of the suicide attempters were below 25 years of age (54%). The data obtained in our sample was consistent with few earlier studies conducted in Pondicherry population,¹⁶ Chennai population,¹⁷ Kerala population¹³ and Ludhiana population.¹⁸ These findings emphasise the need to target this age group for suicide risk assessment and management. Studies conducted in western populations have revealed that the female’s suicide attempters are more predominant than the male subjects.¹⁹ Similar findings were observed in our study populations. In contradictory to this, majority of Indian studies showed the male preponderance.²⁰ The high rate among females might be explained on the basis of psychological and socio-cultural reasons such as inadequate opportunities to express emotional conflicts and low social status of a woman in a family.

Most of our studied population was educated only up to high school or less 70.7%. Similar results were observed in other studies conducted in different populations.^13,21 However, the other study conducted by Indian population was observed that the majority of attempters were educated beyond matriculation (75%).¹⁰ Majority of subjects were employed and only 16% of the sample was unemployed and this finding is similar to most of other Indian studies^10,22 and differing from many western studies.²³ Among females about 62% of them were either housewives or unemployed, who did not have a regular job with income. So, very low rate of suicide attempts was noted among professionals. Overall most people in our sample were married (56%) compared to people who were single, separated or widowed. These findings were in agreement with most of Indian studies.^10,11,20 However, study from Denmark reported cohabiting or single marital status was a significant risk factor for suicide.¹⁵ Being separated or divorced was noted to be significantly associated with a suicidal act in another study.²⁴

Positive family history of psychiatric illnesses, suicide and attempted suicide was found in significant number of attempters in our study. This was in agreement with most other studies, which studied this relationship in India and abroad.^25,26 In our study a high rate of 58.7% with axis I disorder during the attempt was noted, even higher rates had been shown in many western studies and a few Indian studies.²⁷ While some Indian studies showed rates similar to ours,^10,16 there were others which had very low rate of psychiatric illnesses in suicide attempters.^11,17 Possible reason for this variation could be due to differing geographic, cultural and economic background and also because of the fact that these studies were conducted across different timeline using different diagnostic/ classificatory systems.

In our study, significantly high suicide intent was seen in attempters with a high hopelessness score. There was statistically significant increase in the hopelessness score of attempters with a current psychiatric axis 1 diagnosis compared to those without any current psychiatric axis 1 diagnosis. Thus, our study showed that there was significant association between suicide intent, hopelessness and psychiatric diagnosis. Hopelessness is one of the core features in a depressed person. As depression and other mood disorders were the common psychiatric comorbidity in our patients, it is no surprise that there was high hopelessness score among these individuals compared to those patients with no significant psychiatric comorbidity. Attempters with a psychiatric diagnosis and high degree of hopelessness are more likely to have undergone more number of stressful life events in the preceding months or year. These patients had wrongly concluded that there was no possible solution to their problems and decided suicide to be the only way out from their untenable situation. Hence, it is likely that these persons aspired to have their act to end in a complete suicide. This high intentionality is expressed in their cognition, planning and the method chosen.

CONCLUSION

In conclusion, young adults, females with low socio-economic and educational status, having significant past and family history of suicidal behaviour and psychiatric illnesses were at increased risk of suicide attempt. High intent among suicide attempters was associated with high hopelessness score and presence of current psychiatric illness. Also, high hopelessness score was associated with presence of current psychiatric illness. However, further studies are warranted with large number of sample size to confirm our results.