Indian Write-Ups

Not a single human being exists who has not experienced thoughts of suicide in life time. The thought may fluctuate depending on the prevailing situation (circumstances), the mental state of the person and family background. Recently an unsurge of suicidal ideation and attempts have been noticed in the pre-adolescent and adolescent age group, apart from adult population.

Suicide has been an age old phenomena, which has affected attention of people from all spheres of life. It affects people from all religions, cultures and socioeconomic status. It has not spared the rich nor the poor, those who are affected/ not affected by illness.

Earlier in 1930’s, the attention was drawn to the possibility that attempted suicide and completed suicide represent different phenomena. Following this lead it was eventually established that it probably is a sequence. One merging into another i.e. persons attempting suicide eventually do complete suicide though variation may occur. Recent statistics will confirm that more number of people (probably 10 to 20 times more) attempt suicide than those who complete it. Attempted suicide is more obviously a symptom of other problems than it is a precursor every year.

An approximate percentile break-up of suicidal rate can be as follows:

• 70% include alcoholism, depressive phase of affective disorder.

This phase in usually associated with completed suicide.

• 5% include psychotic illness including schizophrenia.
• 1% include neurotic illness including hysteria.
• 14% fall in undiagnosed or unspecified psychiatric illness.

The prevalence of suicide among patients who are medically ill and in terminal stages (such as malignancy) is quite less. These illnesses are rarely associated with suicide that physicians do not usually consider suicide as possible outcome.

Predictors of Suicide

• Complete suicide is more than 3 times common in men than women.
• Highest incidence after age 40 years.
• About 50% to 80% of people who commit suicide communicate suicidal intent. This refutes the predictor of eventually completed suicide. Attempted suicide is more often associated with hysteria, anti-social personality, sexual problems and various other paraphernalia. Thus attempted suicide is an equally important psychiatric phenomena as is the occurrence of complete suicide.

Suicide (Sui = self; cide = murder or self harm) can be defined as – the intentional taking of one’s own life in a culturally non endorsed manner while attempted suicide (parasuicide, pseudocide, non fatal deliberate self harm) is defined as any act of self damage carried out with the apparent intention of self destruction, however half hearted, vague and in effective.

75% of suiciders consult their doctors within four weeks of the act. A prompt intervention at this juncture may save their lives.

Attempters of suicide outnumber the completers of the same.10% of attempters will eventually become completers.

Parasuiciders are 30 to 40 times more common than suicide and in the first year carry a subsequent risk of suicide (100 times that of general population). The risk remains elevated for next 10 years. A general practitioner with a list of 2500 may expect a suicide every 3 to 6 years and 5 to 6 parasuicides than those who talk about death they won’t do it.

• Females have high number of suicide attempters
• Certain percent of attempters complete suicide (about 10%)
• High percent of completed suicides are preceded by attempts.

Antecedent Circumstances As Predictors

Among alcoholics who commit suicide; following factors are thought to be aggravating:

• Loss of affectional relationships
• Divorce
• Separation of spouse
• Death of spouse
• Bereavement involving death of relatives or close friend.

During preceding years 25% of suicides have loss of affection relationship. These affectional losses could be due to:

• Alcohol abuse / alcoholism
• Drug abuse
• Difficulty in living with chronically ill people.

Other common antecedents considered important to suicide, includes:

• Heavy drinking
• Friction with spouse / lover
• Job troubles
• Divorce, separation
• Financial difficulties
• Drinking just prior to suicide
• Feeling of disgrace.