Beruflich Dokumente
Kultur Dokumente
Dec 3 2014
Introduction
Historical perspective
Global & Indian scenario
Etiology
Risk factors
Protective factors
Common methods
Stages
Warning signs
Treatment
Prevention
Recommendations 12/03/14 2
Suicide – defined as an act with a fatal outcome
that is deliberately initiated and performed by the
person in the knowledge or expectation of its fatal
outcome.
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Derived from Latin word
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The story of suicide is probably as old as that of man
himself
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In ancient Athens, a person who committed suicide
without the approval of the state was denied the
honours of a normal burial
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ISLAM: suicide is PROHIBITED
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Hinduism:
When Lord Sri Ram died, there was an epidemic of
suicide in his kingdom, Ayodhya
‘he who takes his own life will enter the sunless
areas covered by impenetrable darkness after
death’
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Vedas - permit suicide for religious reasons
consider that the best sacrifice was that of one's own
life - ‘sallekhana’
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More than 8,00,000 people die by suicide every year
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Suicide worldwide was estimated to represent 1.8% of
the total global burden of disease in 1998
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Tenth leading cause of death worldwide
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Suicide belt – (25 per 100,000) Scandinavia,
Switzerland, Germany, Austria, eastern European
countries (Belarus, Estonia, Lithuania, and the
Russian Federation) and Japan
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India ranks 43rd in descending order of rates of suicide
with a rate of 10.6/100,000 reported in 2009
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According to NCRB : In 1989- 8.47/100,000
population/year
1999 – 11.21
2006 – 10.5
Under-reporting
• Pondicherry, Andaman & Nicobar Islands –
30/100,000
suicide
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Egoistic - This type of suicide occurs when the degree of
social integration is low
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Psychological Factors
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Biological Factors
Serotonergic system: low concentration of
5-HIAA (metabolite of serotonin)
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Gender differences- Men 4 times > Women
Exceptions – India and China , ratio is 1.3:1
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Religion- degree of orthodoxy and integration
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Climate – no significant variation
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• Mental illness- 90- 95% have a diagnosed mental
disorder
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Depression
Schizophrenia
Addiction disorder Early parental
Family history loss
& past history of Isolation
suicidality Unemployment
Dysregulated Acute life
serotonergic system events
Older age
Male sex
Vulnerable
periods
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Strong connections to family and community support
Skills in problem solving, conflict resolution, and non-
violent 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
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Pesticide poisoning(30%)
Hanging
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Firearms
Drug overdose
Fatal injuries
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Exsanguinations
Suffocation
Drowning
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STAGES OF SUICIDE
Ideation
Intervention
Threatening
Attempting
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Parasuicide : injures themselves by self
mutilation but 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 syndrome)
Anniversary suicide: persons take their lives on
the day a member of their family did
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IPC S. 309 Attempt to Commit Suicide
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Suicide in adolescents:
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Gathering of lethal weapons
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“I can't go on anymore"
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"My parents won't have to worry about me anymore"
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Treatment of suicide attempters
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Psychosocial treatment
a) Problem-solving
b) Psychotherapy
c) Distress-tolerance skills
d) Outreach
e) Provision of emergency cards
f) Family therapy
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Pharmacological treatment
c) Lithium
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1) Assessment- ( SAD PERSON’S scale – high specificity
but low sensitivity so not used anymore)
2) Treatment:
Population strategies
High-risk strategies
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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
6. Gender-related legislation and action
7. Introducing alcohol policies
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Interventions at institutional and organizational
levels:
1. Establishing sentinel centres and developing an
information system
2. Training of personnel working in high risk settings
3. Establishing crisis intervention and counselling centres
and telephone hotlines
4. Increase in specific clinical training programmes for lay
counsellors
5. Redesigning the curriculum for medical and nursing
personnel
6. Intervention programmes for high schools
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High-risk strategies
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3. Suicide attempters
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Key Gatekeepers
o Primary health care providers
o Mental health care providers
o Emergency health care providers
o Teachers and other school staff
o Community leaders
o Police officers and other first responders
o Military officers
o Social welfare workers
o Spiritual and religious leaders
o Traditional healers
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In the WHO Mental Health Action Plan 2013-2020 - the
global target of reducing the suicide rate in countries
by 10% by 2020.
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Model for developing countries in public health
low IMR
MMR
High life expectancy
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Evidenced by high suicide rates
32/100,000 population/ year
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Public awareness
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Foundations providing services in prevention of suicide
Prerana group- Mumbai
Maithri -Ernakulam
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When someone is suicidal , he or she will always
remain suicidal
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Talking about suicide is a bad idea and can be
interpreted as encouragement
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Only people with mental disorders are suicidal
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Most suicides happen suddenly without warning
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Someone who is suicidal is determined to die
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People who talks about suicide do not
mean to do it
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Kaplan & Sadock’s Synopsis of Psychiatry (10 th edi)
New Oxford Textbook of Psychiatry ; Michael Gelder, Nancy Andreasen
(2nd edition)
Community Mental Health in India; B. Chavan, Nithin Gupta
Essentials of Psychiatry; Jerald Kay, Allan Tasman
A hand book on Suicide Prevention Strategies, KRISIS
World Health Organization. World Health Report 2001. Mental health:
New understanding, new hope. Geneva
S.Manoranjitham;Towards a National Strategy to Reduce Suicide in
India; The National Medical Journal of India vol. 18, no. 3, 2005
Aaron R, Joseph A, Abraham S, Muliyil J, George K, Prasad ; Suicides in
young people in rural southern India Lancet; 2004;363:1117–18
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