Suicide prevention is possible: A perception after suicide attempt

Suicide research in India: An overview of four decades

BACKGROUND

Suicide is a global phenomenon and a major public health concern and 'it is possibly preventable if it is well understood'.

AIM

The article is an attempt to understand 'suicide in India' with the existing literature and the lacuna for the four decades.

METHODS

The information is collected from 270 articles on suicide research in India, published in various electronic data bases and different official sites as surprisingly the nation is with highest suicide mortality rate among all regional countries.

RESULTS

The review shows an increase in the number of articles on suicide in India over the period of time. Though the suicide mortality rate in India is significantly high, the number of intervention studies remains very minimal. India's understanding about 'the concept' remains questionable as the data from different sources for the same time period shows a huge disparity. Sex, age, socio-economic status, substance abuse, mental illness, medical illness, psychological and environmental stressors etc make individuals vulnerable to end their lives.

CONCLUSION

Appropriate official documentation and more qualitative studies would help in understanding the phenomena better. Intervention studies and policy level changes are the need of the hour to save the nation from the dangerous 'iceberg of suicide'.

Suicide by psychiatric patients: Nature of risk, risk categorisation and preventability

This study considers risk factors associated with suicide by psychiatric patients, the perceived risk at last contact and risk categorisation and reflects upon the potential for prevention. Information regarding 63 consecutive suicides known to mental health services in Wolverhampton, UK, over a 15-year period was collected as part of an audit using a semi-structured questionnaire covering sociodemographic and clinical risk factors, along with information about preventability. A complex mixture of historical, enduring and current risk factors was observed. In addition to common risk factors, a considerable proportion had histories of multiple co-morbid psychiatric (52.5%) and physical diagnoses (27.6%) and psychiatric admission (70.5%). Common suicide methods included hanging (36.5%) and poisoning (36.5%). Most suicides occurred in the post-discharge months up to around two years (75.8%). Although a range of psychopathologies and suicidal cognitions were observed at the last clinical contact, the immediate suicide risk was considered low (46.2%) or not present (38.5%) in the majority of cases. Clinicians suggested various factors that could have made suicides less likely. Clinical assessment can identify risk factors, but categorisation may not be indicative of the outcome. A focus on modifiable factors, with support for psychosocial and clinical issues, may assist with prevention.

Perception and Attitude toward Mental Illness in Antenatal Mothers in Rural Population of Southern India: A Cross-Sectional Study

Background:

Mental health disorders globally are on a rise due to various reasons. Gender differences have been one of the reasons. Pregnancy is a stressful event in mothers and it can either exacerbate preexisting mental illness or can give rise to other mental health disorders. Studies have shown that women residing in rural areas are at higher risk of developing mental health problems. Mental health problems have detrimental effects in post-partum period. Most of the complications can be prevented if psychiatric symptoms are detected in early part of pregnancy and if women are aware of these symptoms.

Aim:

To find the awareness, attitude and perception towards mental illness in antenatal mothers residing in rural area of India.

Setting and Design:

It's a descriptive cross sectional study conducted at primary health care centers.

Methods and Materials:

Total of 300 antenatal mothers attending primary health care centers were recruited into the study after a written informed consent was obtained.

Statistical Analysis:

Basic socio demographic data were collected and a semi structured questionnaire was designed. The participants were interviewed according to the questionnaire. Data collected was analyzed using SPSS software.

Results and Conclusion:

The mean age of the study participants was 24+5. Of the 300 study participants more than 90% were unaware that mental illness can occur during pregnancy and only around 07% could agree say that it can occur in pregnancy. There is poor awareness of mental health problems amongst pregnant women residing in rural part of southern India. The reasons for the same are lack of awareness, low levels of education, lower socio economic status, cultural beliefs and practices, lack of mental health services and stigma associated with mental illness. There is no routine screening for mental health problems during antenatal visits. If done otherwise could bring down adverse maternal outcome.

Lifetime suicide intent, executive function and insight in schizophrenia and schizoaffective disorders

OBJECTIVES

Lack of insight and neurocognitive deficits are often seen in schizophrenia patients. While there are several studies investigating the relationship between suicidal ideation, executive function and insight, there are relatively fewer investigating the triangular relationship between suicide intent, insight and cognitive competence in schizophrenia. The aim of our study was to address this issue.

METHODS

One hundred seventy five subjects with DSM-IV TR diagnoses of schizophrenia or schizoaffective disorder were enrolled and the diagnosis was established using the Hindi version of the Diagnostic Interview for Genetic Studies and other available information in consultation with a Board certified senior Psychiatrist. All the subjects were interviewed on Beck’s cognitive insight scale and tested on the Trail Making Test. All the subjects who had lifetime history of suicide attempt were interviewed on Pierce’s suicide intent scale.

RESULTS

Ever attempters scored significantly higher on Beck’s cognitive insight scale (p = 0.012) and outperformed non-attempters on Trail Making Test A and B (p = 0.026 and p = 0.012 respectively), indicating better executive functions in the former. However among ever attempters, significant relationship was not found between executive functions, insight and severity of suicide intent.

CONCLUSION

Our study suggests that good insight and better executive functioning may be significantly correlated with suicide attempts at some time during the course of illness. Patients with schizophrenia should be evaluated for potential suicidality once denial, neurocognitive deficits and other factors associated with poor insight abate.

Correlates of Process of Suicide Attempt and Perception of Its Prevention

Objective: Suicide attempt may follow a process right from the inception of the first information about ‎suicide until the act itself. This study was conducted to determine the relationship between ‎perception of suicide prevention with the process of suicide attempt and demographic ‎variables following a suicidal attempt.‎ Method: In this hospital based cross-sectional study, 168 consecutive admitted participants with a ‎suicide attempt were screened, and 109 who met the study criteria were recruited to ‎participate in this study before discharge. They were assessed using the socio-demographic ‎and clinical proforma designed for this study as well as by the Pierce Suicide Intent Scale. To ‎assess the process of suicide attempt and perception of suicide prevention, a 17- item ‎questionnaire was developed and used after rigorous literature search. The Cronbach's ‎alpha coefficient value of this questionnaire found to be 0.84 in the reliability analysis.‎ Results: Media was the first source of information, and the majority had short duration of ‎preoccupation and interval between making the decision and the actual attempt and the ‎control of emotion during the attempt. A significant positive correlation was observed ‎between the source of the first information and age (p<01), reason for the method used and ‎economic status (p<01), duration since the first information and family history of suicide (p<01). Psychiatric diagnosis had a statistically significant association with the method used (p<01), duration of preoccupation (p<01), preparedness (p<01) and emotional state during ‎the attempt (p<01). A statistically significant negative correlation was found between the ‎source of the first information and education (p<01), any psychiatric diagnosis and duration ‎since the first death wish (p<01). On the score of perception about suicide prevention, a ‎significant group difference was observed for marital status, occupation, medical diagnosis, ‎opinion about an attempt, duration since the decision to attempt, and emotional control ‎during the attempt.‎ Conclusion: Based on the findings, it can be concluded that perception of suicide prevention may vary ‎with the process of suicide attempts and demographic characteristics.‎.

Mysore study: A study of suicide notes

BACKGROUND

Suicide is one of the leading causes of preventable deaths. Recent data suggest South India as one of the regions with highest suicide rates in the world. In 2013, 134,799 people committed suicide in India according to the statistics released by the National Crime Records Bureau. Suicide note is one of the most important sources to understand suicide, which may be beneficial in suicide prevention. Studies on suicidal notes from this part of the world are sparse.

OBJECTIVE

The aim was to study the themes in suicide notes that might be useful in prevention strategies.

MATERIALS AND METHODS

A descriptive study of all suicide notes of those individuals who committed suicide between 2010 and 2013 available with Police Department, Mysore district was obtained and analyzed.

RESULTS

A total of 22 suicide note were available. A majority of suicide note was in age group of 16-40 years (86%) and most were men (59%). All suicide notes were handwritten, the majority (70%) in regional language Kannada. Length of notes varied from just few words to few pages. Contents of suicide notes included apology/shame/guilt (80%), love for those left behind (55%) and instruction regarding practical affairs (23%). Most have blamed none for the act (50%). 23% mentioned that they are committing suicide to prove their innocence. 32% mentioned a last wish.

CONCLUSION

The majority of suicidal note contained "guilt" which is a strong indicator of possible depression in deceased. Creating awareness about suicide among public and ensuring access to professionals trained in suicide prevention is need of the hour in this part of the world.

The Lifekeeper Memory Quilt: evaluation of a suicide postvention program

The Lifekeeper Memory Quilt Project, implemented by the Salvation Army (Suicide Prevention-Bereavement Support Services) in Australia in 2008, aimed to provide support for those bereaved by suicide and to create greater public awareness of suicide. To evaluate participants' satisfaction with this project, 82 bereaved individuals completed surveys and 30 completed an interview. Results indicated that the Quilt was helpful in assisting participants in their bereavement. The Quilt project gave participants an opportunity to reflect on the life of their loved one and provided a space for them to grieve without fear of negative social reactions.

Assistência hospitalar na tentativa de suicídio

Este artigo discute pontos relevantes que podem colaborar no sucesso da assistência hospitalar direcionada à pessoa com intenção suicida. O risco de suicídio aumenta de acordo com o número de tentativas e também está associado a intervalos de tempo menores entre essas tentativas. Assim, o acolhimento à pessoa com tentativa de suicídio durante a assistência hospitalar é fundamental, pois se realizado com segurança, prontidão e qualidade é possível determinar a aceitação e a adesão do paciente ao tratamento. Essas ações devem estar direcionadas ao cuidado integral prestado à tríade – paciente/família/equipe de profissionais de saúde e da área social. Existem fatores cruciais no alcance da qualidade assistencial que estão atrelados às condições para favorecer a adesão ao tratamento e a criação de uma equipe multidisciplinar com competência de utilizar uma combinação de fatores biológicos, psicológicos e intervenções sociais por meio de educação continuada.

Do newspaper reports of suicides comply with standard suicide reporting guidelines? A study from Bangalore, India

BACKGROUND

Several countries have prescribed standard guidelines for media professionals on suicide reporting. However, the implementation of these guidelines has been varied. Suicide rates in South Asia are one of the highest in the world, and it is known that media guidelines for suicide reporting are not followed adequately. However, there are no published reports available from this region.

AIM

This study aimed at assessing newspaper reports of suicide for quality of reporting based on standard reporting guidelines and to study differences between English and vernacular (Kannada) newspapers in Bangalore, South India.

METHODS

A total of 341 newspaper reports of suicide from 550 newspapers (3 English and 3 Kannada) over 3 months were systematically assessed for compliance with reporting guidelines. Each report was evaluated on 2 domains and 36 parameters. Data were analyzed for frequency of inappropriate reporting and patterns compared between vernacular and English newspapers.

RESULTS

In all, 87% of the reports were those of completed suicide. Non-compliant reporting - method of suicide was reported in 89% and 32% of reports were in prominent pages of the newspaper, 95% mentioned gender, 90% reported the name, 80% reported age and suicide location, 75% reported life events related to suicide, 70% reported occupation, 69% had headline explicity on suicide and 61% reported monocausality. Only 16% reported mental disorder related to suicide, and less than 3% included information on suicide prevention and helplines. Vernacular papers showed significantly better compliance in 16 of the 20 areas. However, protective characteristics were better reported in English newspapers.

CONCLUSION

Majority of reports on suicides in newspapers from Bangalore did not comply with standard guidelines of reporting. There is a strong need to evolve local guidelines and mechanisms for ensuring responsible reporting which have important implications in prevention of suicide.

Suttur study: An epidemiological study of psychiatric disorders in south Indian rural population

BACKGROUND

Based on review of literature World Health Organization (WHO) Global Burden of Disease Study has estimated that psychiatric disorders are among the most burdensome, around the globe and has suggested general population surveys for future research. This study aims to estimate the prevalence of psychiatric disorders and study their association with various socioeconomic variables.

MATERIALS AND METHODS

This was an exploratory study where a door-to-door survey of the entire population residing in a South Indian village was done (n = 3033). Mini international neuropsychiatric interview kid (MINI) or MINI plus were administered to all the subjects according to the age group.

RESULTS

It was found that 24.40% of the subjects were suffering from one or more diagnosable psychiatric disorder. Prevalence of depressive disorders was found to be 14.82% and of anxiety disorders was 4%. Alcohol dependence syndrome was diagnosed in 3.95% of the population. Prevalence of dementia in subjects above 60 years was found to be 10%.

CONCLUSION

Our study is among the very few epidemiological studies with respect to methodological design which does not use screening questionnaires and evaluates each subject with detailed administration of MINI. It concluded that one among four were suffering from a psychiatric disorder. Improving the training of undergraduate medical and nursing students is likely to play a significant role in addressing the increasing psychiatric morbidities.

Nursing students' attitude towards suicide attempters: A study from rural part of Northern India

Context:

Majority of health professionals have unfavorable attitudes towards patients presenting with self-harm, which further compromises their willingness and outcome of care.

Aims:

To assess the nursing students’ attitudes toward suicide attempters.

Settings and Design:

Cross-sectional study was conducted in two nursing colleges of north India.

Material and Methods:

Three hundred and eight nursing students were recruited through total enumeration method from May to June 2012. ‘Suicide opinion questionnaire’ was administered to assess their attitudes towards suicide attempters.

Statistical Analysis Used:

Descriptive statistics was employed with Statistical Package for Social Sciences version 14.0 for Windows.

Results:

Majority were single females, from urban locality, with the mean age of 20 years. Only minority had previous exposure to suicide prevention programs and management of such cases. Majority of students agreed for mental illness, disturbed family life, and depression as major push to attempt suicide. They held favorable attitude for half of the attitudinal statement, but they were uncertain for rest half of the statements.

Conclusions:

They generally had favorable attitude towards suicide attempters. Their uncertain response highlights the need for enhancing educational exposure of nursing students and new staff at the earliest opportunity, to carve their favorable attitude towards patients presenting with self-harm.

Nursing students' attitude toward suicide prevention

BACKGROUND

Preventing suicide depends upon different health professionals' knowledge regarding suicide, attitude toward suicide attempters, skills to assess and manage suicidal risk.

OBJECTIVES

This study was aimed to assess the attitude of nursing students toward suicide prevention.

MATERIALS AND METHODS

308 nursing students were recruited from the two institutions through total enumeration method. Attitude toward suicide prevention scale was administered. Study design was cross-sectional.

RESULTS

Majority were single females, from urban locality, who were pursuing BSc Nursing with the mean age of 20 years. Only minority had previous exposure to suicide prevention programs or workshops. Nearly half of the subjects had positive attitude toward working with suicidal patients. Again half of the subjects considered unemployment and poverty as main causes of suicide and were quite hopeless about it and they also perceived that most of the suicidal people would not reveal their suicidal plans to others.

CONCLUSIONS

Merely half of the students had positive attitude toward working with suicidal patients. Hence, there is strong need to organize more educational and training programs on suicide prevention so that these budding health professionals could be more equipped and trained to manage these suicidal patients.