When the mind gives up….

Prevalence.  Transient suicidal ideation is seen in most of the normal people. According to survey by World Health Organization (W H O) in 1983, around 2,400 persons commit suicide every day....

Prevalence.  Transient suicidal ideation is seen in most of the normal people. According to survey by World Health Organization (W H O) in 1983, around 2,400 persons commit suicide every day. Most recent figures from 21 countries show annual average suicide rate varying from 7.1 to 33.9 per lac population above 15 years of age. Hungary, Sweden, Denmark, Austria and Germany are the leading countries as so far of suicide is concerned the lowest number of suicide being in Chile and Ireland.
In India, 150 to 200 people commit suicide every day. The average prevalence of suicide is about 10 per lac of population. The ratio of attempted suicide to suicide is 8-10: 1 .
Suicide rates increase with age, and on average are 50 times greater in males than in females but the rate of attempted suicide are maximum in adult females. Suicide is the second most common cause of death among adolescents and youth.

The main causes of suicide can be classified as:
a) Genetic: There is an increased incidence of suicide in relatives of those who have committed it and the concordance for suicide in monozygotic twins may be as high as 18 %.The role of genetic factors is also proved by the association of suicide with increased familial incidence of psychiatric illness (Depression, Schizophrenia, Alcoholism, etc.).
b) Mental Illness: Depression, Alcoholism, Schizophrenia, Personality Disorder, Drug abuse, etc., are the leading causes of suicide.
c) Physical Illness: There is an increased prevalence of suicidal ideation in patients suffering from viral fevour, hepatitis, kidney failure, multilating injuries, cancer, etc.In epileptics; the risk is 4 times more. The intake of drugs like phenothiazines (anti-schizophrenic), barbiturates and oral contraceptives make one more prone to suicide.
d) Psychological Mechanisms: Freud believed that suicide was aggression turned inward against a loved person with whom the individual had identified.
e) Situational: The escape from unbearable situation is a dominant theme in children's suicide and suicidal attempts.

Durkheim described 3 different social categories of suicide:
i)Egoistic: Due to loss of integration leads to a sense of isolation and morbid individualism,
ii)Altruistic: As seen in war, Army men dying for the country,
iii) Anomic: When there is disturbance in the balance of the individual's aspiration on the hand and the values of society on the other.

2) Common Risk Factors in Suicide:

History of previous suicide attempts.
Family history of affective illness, suicide and alcohol dependence.
Personal factors such as bereavements or other losses.
Advanced age, particularly in males.
Marital status: widowed, divorced or separated.
Living alone, poor social ties.
Unemployment, retired.

Associated Illnesses and Conditions
Chronic, painfull, physical illnesses.
Psychiatric illnesses, particularly depression.
Personality Disorders-antisocial,
 Drug dependence
Insomnia, Anorexia and sexual impairment.
Sudden Unaccountable well being in a depressed patient.
Social Stresses.
Mental Status
Suicidal ruminations
Guilt feelings
Feelings of worthlessness and hopelessness
Loss of Self-esteem
Agitation and restlessness
Planning and preparations
Verbal expression of suicidal intent
Suicide notes and warnings
Precautions against discovery and failure of suicidal attempt
Methods adopted- violent methods indicate greater risk
Preparation for the final exit: execution of will, settlement of pending affairs.
Procurement and possession of lethal agents.
3) Management: Once suicide is committed, it is obviously no longer treatable. The management of suicide, therefore, lies in preventing the act at suicide prevention centers, crisis intervention centers (both of them are not available as yet on a large scale in India), Psychiatric emergency services, medical emergency services, social welfare centers or even at home of the patient.
Some important steps for preventing suicide include:
i) Take all the suicidal threats, Gestures and /or attempts seriously and notify a psychiatrist or a mental health professional.
ii) Psychiatrist (or a mental health professional) should quantify the seriousness of the situation – a proper risk assessment – and take remedial precautionary measures. Inspect physical surroundings and remove all means of committing suicide, such as sharp objects,ropes,drugs,fire arms,etc. Also, search the patient thoroughly; surveillance, depending on the severity of risk.
iii) Acute psychiatric emergency interview.
iv) Counseling and guidance.
To deal with the desire to attempt suicide, and to deal with on-going life stressors, and teaching coping skills and interpersonal skills.
v)Treatment of the psychiatric disorder(s) with medication, Psychotherapy and /or ECT.
 Author is Associate Prof. Psychiatry.Govt.Medical College,Sgr.

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