|LETTER TO EDITOR
|Year : 2017 | Volume
| Issue : 3 | Page : 280-281
Psychosocial intervention in a case of attempted suicide
Sujoy Ray, Sheena Varughese, Anvar Sadath
Department of Psychiatry, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
|Date of Web Publication||14-Sep-2017|
Department of Psychiatry, St. John's Medical College and Hospital, Bengaluru - 560 008, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ray S, Varughese S, Sadath A. Psychosocial intervention in a case of attempted suicide. Indian J Soc Psychiatry 2017;33:280-1
A 22-year-old premorbidly well-adjusted female student, from a Hindu Brahmin background, presented with a suicide attempt of low intentionality and high lethality in the background of a recent relationship break-up. She had been in a relationship with a boy from the same gotra and had kept this as a secret from her family. This relationship continued for a few years during the course of which she had sexual intercourse with him. She also underwent a pseudo-marriage ceremony with the boy that was not legalized. Later, she came to know that the boy had already got engaged. Apparently, she disclosed this to her brother, but the family did not agree to her having a relationship with the boy as they were both from the same gotra. The patient felt guilty for having lost her virginity and at the same time felt helpless for not being able to disclose this to her father who had recently survived a heart attack.
As a response, she took around forty tablets of antihypertensive medication. After appropriate medical treatment, she was referred for inpatient psychiatric care. Significant findings included nonpervasive low mood, death wishes, poor emotional warmth and attachment between family members, diffuse boundaries in the family, authoritarian leadership of the father, and high criticality from the parents. Initially, high-risk anti-suicide measures were instituted as a part of crisis intervention.
During the inpatient treatment in the hospital, she continued to be at a high risk for suicide and felt that she needed to hear out the boy's version. The parents had been handling the situation ineffectively by not allowing her to have any means of contact with him. Our team worked at multiple levels to deal with the critical situation. Initially, individual sessions were conducted with the patient that focused on establishing rapport and forming a therapeutic relationship. We organized a few family meetings with the patient and her parents to enhance family communication and reach a mutual consensus on the patient's relationship with the boy. Patient's insistence to meet the boy was initially resisted by her family members as they thought that she would abscond with him. Initially, it was challenging for the team as the patient's parents were rigid and unwilling to make any negotiations for the marriage within the gotra. However, after a couple of family meetings, a few consensuses were arrived at, i.e. the boy and his parents could be called to the hospital for discussion and if both of them still insisted to continue in the relationship, they could marry but needed to live separately. After initial telephonic conversations with the boy, he came with his father and another joint meeting was held. The matters regarding the relationship were solved by a mutual discussion between both the parties. It was reiterated to the patient by the boy that the relationship needed to be finished. Although it was a trauma, the patient managed to overcome the crisis situation with supportive work from the team and family members. During the course of the treatment, understanding between the patient and her family members was improved. Once the risk of self-harm and the patient's preoccupation with the relationship reduced significantly, she was discharged.
Psychological interventions such as cognitive or dialectical behavioral therapy for treating suicidal behavior have been extensively evaluated and reported to be useful in scientific literature. A meta-analysis evaluated the efficacy of various psychosocial interventions on repeated suicide attempts and concluded that only cognitive behavioral therapy has beneficial effects on them. A recent study reported that psychosocial assessment and referrals were useful in reducing the risk of deliberate self-harm. But many such cases reported are associated with a major depressive episode or personality factors in combination with psychosocial adversities., The interventions for self-harm resulting from economic adversities have also been evaluated. However, in this case, the suicide attempt occurred in response to a broken romantic relationship in the background of a pathological family environment and in the absence of any personality factors, depressive disorder, or financial stressors. The psychosocial interventions for such cases are scant in literature. In this case, we used simple intervention techniques such as liaison work with the patient, the boy, and their families, facilitating telephonic conversations and family meetings to openly discuss the relationship issues and supportive work with the patient during her crisis situation. We applied brief family intervention techniques to enhance better understanding and communication between the patient and her family members. The decision to involve the boy in the family meeting was critical to clarify many doubts regarding their relationship and future plans. Though the patient felt that she had been deceived by the boy, she did not seek any legal help as she was worried about her father's health status and family reputation. During a follow-up visit, she came with her family members and discussed her future plans with us and was found to have recovered from the relationship trauma.
This case report also highlights how sensitive and critical the issue of marriage within the same gotra in Indian communities is. The parents strongly believed that marriage within the same gotra is a sin and that such a relationship would bring disgrace and dishonor to their family. Their resistance against same gotra marriage was based on religious and custom-related beliefs rather than any anticipated genetic deformities.
Consent had been taken from the patient and her brother for this manuscript and at no point any personal or identifying information has been revealed.
Financial support and sponsorship
Conflict of interest
There are no conflicts of interest.
| References|| |
Rudd MD, Bryan CJ, Wertenberger EG, Peterson AL, Young-McCaughan S, Mintz J, et al.
Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: Results of a randomized clinical trial with 2-year follow-up. Am J Psychiatry 2015;172:441-9.
van der Sande R, Buskens E, Allart E, van der Graaf Y, van Engeland H. Psychosocial intervention following suicide attempt: A systematic review of treatment interventions. Acta Psychiatr Scand 1997;96:43-50.
Carroll R, Metcalfe C, Steeg S, Davies NM, Cooper J, Kapur N, et al.
Psychosocial assessment of self-harm patients and risk of repeat presentation: An instrumental variable analysis using time of hospital presentation. PLoS One 2016;11:e0149713.
Brown GK, Ten Have T, Henriques GR, Xie SX, Hollander JE, Beck AT. Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. JAMA 2005;294:563-70.
Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, et al.
Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006;63:757-66.
Barnes MC, Gunnell D, Davies R, Hawton K, Kapur N, Potokar J, et al.
Understanding vulnerability to self-harm in times of economic hardship and austerity: A qualitative study. BMJ Open 2016;6:e010131.