![SUICIDE IN INDIA
India ranks 43rd in descending order of rates of suicide with a rate of
10.6/100,000 reported in 2009
About one-third of suicides over the world happen in India.
Seven of the 12 surveyed states recorded suicide rates higher than
the national average [Assam (11.1), Chhattisgarh, Gujarat and
Kerala (22.4 each), Madhya Pradesh (11.9), Tamil Nadu (23.4) and
West Bengal (15.5)].
Suicide rates were the lowest in Uttar Pradesh (1.7) and Manipur
(2.0) [ interpreted with caution considering the role of under
reporting and other contextual factors ]
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Suicide
- 1. 1
- 2. 2 DR.ASHWATHI.J FINAL YEAR PSYCHIATRY POSTGRADUATE SSIMS & RC DAVANGERE
- 3. Some myths Talking about suicide is a bad idea and can be interpreted as encouragement Given the widespread stigma around suicide, most people who are contemplating suicide do not know who to speak to. Rather than encouraging suicidal behaviour, talking openly can give an individual other options or the time to rethink his/her decision, thereby preventing suicide. 3
- 4. Some myths Only people with mental disorders are suicidal Suicidal behaviour indicates deep unhappiness but not necessarily mental disorder however 90% of them are found to have mental disorders as reported by WHO survey. 4
- 5. Some myths Most suicides happen suddenly without warning The majority of suicides have been preceded by warning signs, whether verbal or behavioural. Of course there are some suicides that occur without warning 5
- 6. Some myths Someone who is suicidal is determined to die On the contrary, suicidal people are often ambivalent about living or dying Someone may act impulsively by drinking pesticides, and die a few days later, even though they would have liked to live on 6
- 7. Some myths People who talks about suicide do not mean to do it People who talk about suicide may be reaching out for help or support to discuss their difficulties / issues bothering them. 7
- 8. CONTENTS Definition of suicide Related terms Historical background Global burden and suicide in India Etiology Risk factors Protective factors Common methods of suicide Suicide process model Treatment Prevention Laws related to suicide References 8
- 9. DEFINITION OF SUICIDE Derived from Latin language sui = oneself , cidium = killing A fatal act of self-injury undertaken with more or less conscious self-destructive intent, however vague and ambiguous. 9
- 10. RELATED TERMS SUICIDE ATTEMPT : self- injurious behaviour with a nonfatal outcome accompanied by explicit or implicit evidence that the person intended to die. SUICIDAL INTENT : subjective expectation and desire for a self- destructive act to end in death. SUICIDAL IDEATION : thought of serving as the agent of one’s own death; seriousness vary depending upon the specificity of suicidal plans and the degree of suicidal intent. DELIBERATE SELF-HARM : will ful self-inflicting of painful, destructive, or injurious acts without intent to die. 10
- 11. RELATED TERMS (contd) PARASUICIDAL BEHAVIOUR : describe patients who injure themselves by self-mutilation but who usually do not wish to die. CYBER-SUICIDE : suicide pact made between individuals who meet on the internet COPYCAT SUICIDE : a suicide within a peer group/publicized suicide can serve as a model for next suicide in absence of sufficient protective factors (Werther effect) ANNIVERSARY SUICIDE: persons take their lives on the day a member of their family did 11
- 12. ADD-ONS 12
- 13. HISTORICAL BACKGROUND The story of suicide is probably as old as that of man himself. Suicide has variously been glorified, bemoaned and even condemned. Ancient Athens - a person who committed suicide without the approval of the state was denied the honours of a normal burial. Ancient Greece & Rome - suicide was deemed to be an acceptable method to deal with military defeat. ISLAM: suicide is prohibited CHRISTIANITY: suicide is considered a sin In 19th-century, in Europe, the act of suicide shifted from being viewed as caused by sin to being caused by insanity. 13
- 14. HISTORICAL BACKGROUND (contd) Hinduism: When Lord Sri Ram died, there was an epidemic of suicide in his kingdom, Ayodhya The Bhagavad Gita - condemns suicide Upanishads, the Holy Scriptures - condemn suicide ‘he who takes his own life will enter the sunless areas covered by impenetrable darkness after death’ Vedas - permit suicide for religious reasons consider that the best sacrifice was that of one's own life - ‘sallekhana’ 14
- 15. GLOBAL BURDEN Primary emergency for mental health professional Major public health problem Over 8,00,000 people die by suicide and more than 20 million attempt suicide each year. Every 40 seconds a person dies by suicide somewhere on the globe. Every 15 seconds someone will attempt to take his or her own life. Globally, suicides account for 52% and 71% of all violent deaths in men and women respectively. 15th leading cause of death. Second leading cause of death in young people (15-29 years) globally after traffic accidents. 15
- 16. SUICIDE IN INDIA India ranks 43rd in descending order of rates of suicide with a rate of 10.6/100,000 reported in 2009 About one-third of suicides over the world happen in India. Seven of the 12 surveyed states recorded suicide rates higher than the national average [Assam (11.1), Chhattisgarh, Gujarat and Kerala (22.4 each), Madhya Pradesh (11.9), Tamil Nadu (23.4) and West Bengal (15.5)]. Suicide rates were the lowest in Uttar Pradesh (1.7) and Manipur (2.0) [ interpreted with caution considering the role of under reporting and other contextual factors ] 16
- 17. ADD-ONS 17
- 18. ETIOLOGY Sociological factors Psychological factors Biological factors Genetic factors 18
- 19. SOCIOLOGICAL FACTORS EMILE DURKHEIM’S CONCEPT OF SUICIDE (French sociologist) – described 4 basic types of suicide: 19 Applies to persons whose integration into society is disturbed so that they cannot follow customary norms of behaviour. Anomie explains why a drastic change in economic situation makes persons more vulnerable than they were before their change in fortune. Applies to those who are not strongly integrated into any social group. The lack of family integration explains why unmarried persons are more vulnerable to suicide than married ones and why couples with children are the best protected group ANOMIC SUICIDE ALTRUISTIC SUICIDE EGOISTIC SUICIDE FATALISTIC SUICIDE a result of strict rules in a society which have proved decisive for the destiny of an individual (the suicide of a person held as a slave) Applies to those susceptible to suicide stemming from their excessive integration into a group, with suicide being the outgrowth of the integration (soldier who sacrifices his life in battle)
- 20. PSYCHOLOGICAL FACTORS Freud’s theory: 1) In his paper ‘Mourning and Melancholia’ – self-destructive behaviour in depression represents aggression directed against a part of the self that has incorporated a loss or rejection of a love object. 2) Freud doubted that there would be a suicide without an earlier repressed desire to kill someone else. Menninger’s theory: 1) In Man against Himself, described suicide as inverted homicide because of a person’s anger toward another person; this retroflexed murder is either turned inward or used as a excuse for punishment. Aaron Beck : hopelessness – most accurate indicators of long-term suicidal risk. 20
- 21. BIOLOGICAL FACTORS Diminished serotonin plays a role in suicidal behaviour. Low concentrations of 5-HIAA in CSF predict future suicidal behaviour. Recent studies report some changes in the noradrenergic system of suicide victims 21
- 22. GENETIC FACTORS Polymorphism in the TPH1 gene on chromosome 11 – associated with an increased risk of suicidal behaviour. Polymorphism in the serotonin transporter gene is associated with impulsive-aggressive personality traits. 22
- 23. RISK FACTORS - SOCIO-DEMOGRAPHIC VARIABLES 23
- 25. PROTECTIVE FACTORS Strong connections to family and community support Skills in problem solving, conflict resolution, and nonviolent handling of disputes Personal, social, cultural and religious beliefs that discourage suicide and support self-preservation Restricted access to means of suicide Seeking help and easy access to quality care for mental and physical illnesses 25
- 26. COMMON METHODS OF SUICIDE 26
- 27. SUICIDE PROCESS MODEL RISK AND PROTECTIVE FACTORS (genetic, social, psychological and biological) SITUATIONAL FACTORS (recent stressors, availability and lethality of methods) INTENT TO COMMIT SUICIDE SUICIDE ATTEMPTDEATH OR SURVIVALAFTER EFFECTS 27
- 28. TREATMENT Most suicides among psychiatric patients are preventable, because evidence indicates that inadequate assessment or treatment is often associated with suicide. Evaluation for suicide potential involves: 1) A complete psychiatric history 2) A thorough examination of the patient’s mental state 3) An inquiry about depressive symptoms, suicidal thoughts, intents, plans and attempts. Usage of scales to assess the risk of suicide 1) SAD PERSONS Scale (low sensitivity and high specificity) 2) Manchester Self-Harm Rule (MSHR) scale ( low specificity and high sensitivity) 28
- 29. TREATMENT (contd) Treatment of suicide attempters: ❖ For every completed case of suicide there are about 20 non fatal attempts ❖ Repetition – 15-25% within a year ❖ Poor problem solving skills – most commonly seen. ❖ Psychosocial therapy – mainstay of treatment. ❖ Pharmacological treatment to treat the associated psychiatric conditions 29
- 30. TREATMENT (contd) A lack of future plans, giving away property, making a will and having recently experienced a loss – imply an increased risk of suicide. INPATIENT VERSUS OUTPATIENT TREATMENT : whether to hospitalize a patient with suicidal ideation is the most important clinical decision to be made. INDICATIONS FOR HOSPITALIZATION : 1) Absence of strong social support 2) History of impulsive behaviour 3) A suicidal plan of action 30
- 31. TREATMENT (contd) Outpatient treatment may be more beneficial than hospitalization in patients with chronic suicidal ideation and / or self-injury without prior medically serious attempts, if a safe and supportive living situation is available Psychosocial treatment a) Problem-solving b) Psychotherapy – individual and group therapy. c) Distress-tolerance skills d) Family therapy Pharmacological treatment a) Antidepressants b) Antipsychotics combined with other therapies c) Mood stabilizers 31
- 32. PREVENTION General principles ✓ Population strategies ✓ High-risk strategies 32
- 33. PREVENTION (contd) Population strategies Intervention at community level: 1. Increasing public awareness 2. Campaign to reduce stigma 3. Guidelines for the mass media 4. Regulating formulations, packaging and sale of pesticides 5. Regulation of over-the-counter medication 33
- 34. PREVENTION (contd) Interventions at institutional and organizational levels: i. Establishing sentinel centres and developing an information system ii. Training of personnel working in high risk settings iii. Establishing crisis intervention and counselling centres and telephone hotlines iv. Increase in specific clinical training programmes for lay counsellors v. Redesigning the curriculum for medical and nursing personnel vi. Intervention programmes for high schools 34
- 35. PREVENTION (contd) High-risk strategies Patients with psychiatric disorder 1) Risk identification 2) Preventive strategies- active treatment of underlying condition and psychological therapy Elderly people- care and support High-risk occupational groups- all these groups have easy access to methods of suicide – removing the access Prisoners- Ensuring that prison cells are safe in terms of absence of structures favourable for suicide 35
- 36. ADDITIONAL POINTS The Section 309 in the Indian Penal Code lays down the punishment for attempted suicide. 309 IPC - Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with simple imprisonment for a term which may extend to one year or with fine, or with both. Attempted suicide was decriminalized with the passage of the Mental Healthcare Bill. The relevant provision of the Mental Healthcare Act, 2017 states, "Notwithstanding anything contained in section 309 of the Indian Penal Code any person who attempts to commit suicide shall be presumed, unless proved otherwise, to have severe stress and shall not be tried and punished under the said Code.“ The act commenced in July 2018. 36
- 37. 37 Theme of 2019 : WORKING TOGETHER TO PREVENT SUICIDE
- 38. CONCLUSION 38
- 39. REFERENCES New Oxford textbook of Psychiatry Kaplan & Sadock’s Synopsis of Psychiatry Kaplan & Sadock’s – COMPREHENSIVE TEXTBOOK OF PSYCHIATRY National Mental Health Survey 2015-16 Gazette of India Google search 39
- 40. 40 THANK YOU ☺