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 Table of Contents  
DEBATE/PERSPECTIVE/VIEWPOINT
Year : 2017  |  Volume : 33  |  Issue : 2  |  Page : 139-141

Prevention of suicide


Institute of Mental Health, University of Health Sciences, Rohtak, Haryana, India

Date of Web Publication30-Jun-2017

Correspondence Address:
Rajiv Gupta
Institute of Mental Health, University of Health Sciences, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_35_17

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  Abstract 

Suicide is a major public health problem in India, probably even bigger than in the West. Suicidal behavior is the best conceptualized as a multifaceted complex problem involving social factors and mental illnesses. Broadly, there are two approaches to suicide prevention; population preventive strategies and high-risk preventive strategies. Population preventive strategies include reducing availability of means for suicide, education of primary care physicians, influencing media portrayal of suicidal behavior, education of the public, telephone helplines, and addressing economic issues associated with suicidal behavior. High-risk preventive strategy includes identifying individuals with high risk of committing suicide, intensively treating mental illness if present, and providing psychosocial support. Thus, prevention requires a multipronged effort with collaboration from various sectors including mental health professionals, social justice department, and macroeconomic policy makers.

Keywords: High risk prevention, population preventive strategy, prevention, suicide


How to cite this article:
Gupta R, Jain N. Prevention of suicide. Indian J Soc Psychiatry 2017;33:139-41

How to cite this URL:
Gupta R, Jain N. Prevention of suicide. Indian J Soc Psychiatry [serial online] 2017 [cited 2019 Aug 24];33:139-41. Available from: http://www.indjsp.org/text.asp?2017/33/2/139/209183

Suicide is a public health problem of increasing magnitude. The WHO reported that over one million deaths worldwide are due to suicide and each death impacts at least six other people.[1] In India, data available in the public domain from the National Crimes Record Bureau show that the reported suicide rate was 14.9 and 15.4 suicides per 100,000 population in 2001 and 2010, respectively. Homemakers accounted for the highest proportion of suicide deaths over the decade. Distribution of the reasons for suicide remained almost constant overtime; most suicides (33.7%) were due to personal/social reasons, followed by health at 24.3% and unknown reasons at 16.4%. Nationally, poison/overdose with drugs/pesticides was the leading means of suicide through the decade.[2]

Two large epidemiological verbal autopsy studies in rural Tamil Nadu reveal that the annual suicide rate is six to nine times the official rate. If these figures are extrapolated, it suggests that there are at least half a million suicides in India every year.[3] Suicide thus is a major public health problem in India, probably even bigger than in the West.

Although suicide is a deeply personal and an individual act, suicidal behavior is determined by a number of individual and social factors and is best conceptualized as a multifaceted complex problem. Many social factors such as poverty, domestic violence, divorce, dowry, love affairs, cancellation or the inability to get married, illegitimate pregnancy, and extramarital affairs play a crucial role. Recently, farmer suicides across the country have highlighted the problem and espoused governmental concern.

Mental illnesses are known to be strongly associated with suicide. Diagnosable mental illnesses, especially depression, are very common in persons who attempt suicide. Similarly, alcohol abuse is significantly associated with suicide. In spite of enough scientific evidence associating treatable mental illnesses with suicide, the access to psychiatric care remains poor in the country and this confounds the problem. The recent Mental Healthcare Bill of India which has been passed by the parliament,[4] has decriminalized suicide. It has made the government duty bound to provide care, treatment, and rehabilitation to a person who has attempted suicide due to severe stress. This is a welcome step and might strengthen the suicide prevention strategies which are almost nonexistent due to poor resources both in terms of trained workforce and budgetary allocations.

The response to the vexed problem of suicide prevention has mostly been pessimistic among health professionals, probably “because of the almost complete absence of randomized controlled trials demonstrating the effectiveness of specific treatments.”[5] However, this pessimism is largely unfounded and multiple reports of effective intervention are surfacing. For instance, the WHO reports that low-cost brief intervention may be an important part of suicide prevention programs for underresourced low- and middle-income countries.[6] The regulation of paraquat in South Korea in 2011–2012 was associated with a reduction in pesticide suicide.[7]

Broadly, from the perspective of prevention of health problems in general, two approaches of suicide prevention can be distinguished: first, population preventive strategies, which aim to decrease risk in the population as a whole, and second, high-risk preventive strategies, in which specific groups that are at increased risk, are targeted.

Population preventive strategies that are frequently employed include the following:

  • Reducing availability of means for suicide: For instance reducing the availability of lethal pesticides, firearm control laws, etc
  • Education of primary care physicians: Includes increasing awareness about the problem and training them in brief interventions
  • Influencing media portrayal of suicidal behavior: Reducing sensationalism and increasing the amount of educational material when news items pertaining to suicide are reported
  • Education of the public about mental illness and its treatment: Educational approaches in schools, namely, teaching about the facts of suicide, developing educational modules in life skills, and problem-solving and training teachers
  • Befriending agencies and telephone helplines
  • Addressing the economic factors associated with suicidal behavior: This is a policy matter which requires political will, resources and can have far-reaching impact.


The population-based preventive strategies described above are general in nature. One should keep in mind that these strategies need to be modified as per the requirements of individual communities.


  High-Risk Group strategy Top


Another strategy aimed at preventing suicide targets the high-risk groups. There are a variety of different high-risk groups such as patients with mental illnesses including substance abuse, elderly people, high-risk occupational groups, and prisoners. We would focus our discussion on patients with mental illnesses.

Common psychiatric diagnoses associated with suicide are depression, alcohol abuse, and schizophrenia. The most pragmatic approach is to provide effective treatment for these patients. Identifying risk factors for suicide are a commonly employed method, but one should be aware that suicide characteristics culled from the population-based studies might or might not be applicable to individuals. The following risk factors have been known to be associated with suicide:

  • Previous attempts
  • Social isolation
  • Older age
  • Depressive disorder and other psychiatric disorders
  • Alcohol/other substance problems
  • Chronic painful illness
  • Epilepsy
  • Personality disorders
  • Unemployment
  • Homelessness.


Of the above, history of previous attempts is a particularly important marker of possibility of further attempts at suicide. A careful evaluation aimed at understanding the following is very important when assessing a patient with a suicide attempt:

  1. What were the patient's intentions while harming himself? Factors suggesting high-suicidal intent include
    • Act carried out in isolation
    • Act timed so that intervention or help seemed unlikely
    • Precautions taken to avoid discovery
    • Preparations made in anticipation of death like signing will
    • Communicating intent to others
    • Leaving a note
  2. Do they intend to die now?
  3. What are their current problems?
  4. Is there a psychiatric disorder?
  5. What are helpful resources available?


The answers to these questions would provide inputs regarding impending risk and possible interventions to mitigate this risk.

Risk management plan for such patients includes following:

Hospitalization: The management in the ward includes taking precautions such as 24 h supervision, supervised medications, keeping sharp objects out of patient's reach, and providing opportunity to communicate suicidal ideas to medical staff.

Treatment of underlying psychiatric disorder, if any.

Once the risk is lowered, the patient might need intensive psychosocial interventions and rehabilitation plan to meet the current challenging circumstances the patient finds himself in.

One particular period of high risk of suicide is immediately after discharge from hospital and continuity of care becomes very important.


  Conclusion Top


The problem of suicide is a multifaceted problem which would require multipronged efforts with collaboration from various sectors. Suicide is increasingly being recognised as a medico-social problem, and a public health approach to suicide is gaining momentum. Hopefully, suicide prevention in the traditional mental health sector will be boosted by macroeconomic policies, social justice measures, and legal reforms.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Preventing Suicide: A Resource for Media Professionals. Geneva: WHO; 2008.  Back to cited text no. 1
    
2.
Dandona R, Bertozzi-Villa A, Kumar GA, Dandona L. Lessons from a decade of suicide surveillance in India: Who, why and how? Int J Epidemiol 2016. pii: Dyw113.  Back to cited text no. 2
    
3.
Vijaykumar L. Suicide and its prevention: The urgent need in India. Indian J Psychiatry 2007;49:81-4.  Back to cited text no. 3
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4.
Mental Health Care Bill; 2016. Available from: http://www.prsindia.org/uploads/media/MentalHealth/MentalhealthcareaspassedbyRS.pdf. [Last cited on 2017 Apr 16].  Back to cited text no. 4
    
5.
Goldney RD. Suicide prevention: A pragmatic review of recent studies. Crisis 2005;26:128-40.  Back to cited text no. 5
[PUBMED]    
6.
Fleischmann A, Bertolote JM, Wasserman D, De Leo D, Bolhari J, Botega NJ, et al. Effectiveness of brief intervention and contact for suicide attempters: A randomized controlled trial in five countries. Bull World Health Organ 2008;86:703-9.  Back to cited text no. 6
[PUBMED]    
7.
Cha ES, Chang SS, Gunnell D, Eddleston M, Khang YH, Lee WJ. Impact of paraquat regulation on suicide in South Korea. Int J Epidemiol 2016;45:470-9.  Back to cited text no. 7
[PUBMED]    




 

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