SUICIDE

FRAIZA J. SALI, RN,MPA

HISTORICAL PESPECTIVE
THE STORY OF SUICIDE IS PROBABLY AS OLD AS THAT OF MAN HIMSELF.
SUICIDE HAS VARIOUSLY BEEN GLORIFIED, ROMANTICIZED, BEMOANED, AND EVEN CONDEMNED.
IN ANCIENT ATHENS, A PERSON WHO COMMITTED SUICIDE WITHOUT THE APPROVAL OF THE STATE WAS DENIED THE HONOURS OF A
NORMAL BURIAL.

IN ANCIENT GREECE & ROME SUICIDE WAS DEEMED TO BE AN ACCEPTABLE METHOD TO DEAL WITH MILITARY DEFEAT.
ISLAM: SUICIDE IS PROHIBITED.
CHRISITIANITY: SUICIDE IS CONSIDERED A SIN.
IN 19 CENTURY IN EUROPE THE ACT OF SUICIDE SHIFTED FROM BEING VIEWED AS CAUSED BY SIN TO BEING CAUSED BY INSANITY.
TH
HINDUISM:
WHEN LORD SRI RAM DIED, THERE WAS AN EPIDEMIC OF SUICIDE IN HIS KINGDOM, AYODHYA
THE BHAGAVAD GITA- CONDEMNS SUICIDE
UPANISHADS, THE HOLY SCRIPTURES- CONDEMN SUICIDE ‘‘HE WHO TAKES HIS OWN LIFE WILL ENTER THE SUNLESS
AREAS COVERED BY IMPENETRABLE DARKNESS AFTER DEATH’’.

VEDAS- PERMITS SUICIDE FOR RELIGIOUS REASONS CONSIDER THAT THE BEST SACRIFICE WAS THAT OF ONE’S OWN
LIFE- “SALLEKHANA”

SATI, WHERE A WOMAN IMMOLATED HERSELF ON THE PYRE OF HER HUSBAND RATHER THAN LIVE THE LIFE OF A WIDOW.
INTRODUCTION
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.

IT’S A COMPLEX PHENOMENON

INSURMOUNTABLE DISPARITY BETWEEN EXPECTATIONS AND OUTCOMES, REAL OR IMAGINED –
TREMENDOUS PRESSURE ON MIND, BLINDING ITS LOGIC, FORCING IT A CONCLUSION OF ESCAPE
DERIVED FROM LATIN WORD

SUI = ONESELF, CIDIUM = A KILLING

PRIMARY EMERGENCY FOR MENTAL HEALTH PROFESSIONAL

MAJOR PUBLIC HEALTH PROBLEM

GLOBAL SCENARIO
MORE THAN 800,000 PEOPLE DIE BY SUICIDE EVERY YEAR.
ESTIMATED ANNUAL MORTALITY IS 14-15 DEATHS PER 100,000 PEOPLE.
AROUND ONE PERSON EVERY 40 SECONDS.
75% OF SUICIDES OCCUR IN LOW AND MIDDLE INCOME COUNTRIES.
SUICIDE WORLDWIDE WAS ESTIMATED TO REPRESENT 1.8% OF THE TOTAL GLOBAL BURDEN OF DISEASE IN 1998.
BY 2020- PROJECTED TO BE 2.4%
TENTH LEADING CAUSE OF DEATH WORLDWIDE.
IT IS THE SECOND LEADING CAUSE OF DEATH IN 15-29 YEARS OLDS GLOBALLY.
SOCIOLOGICAL FACTORS

DURKHEIM’S THOERY:
EMILE DURKHEIM (FRENCH SOCIOLOGIST) Egoistic

Suicide
Altruistic

Anomic
EGOISTIC- THIS TYPE OF SUICIDE OCCURS WHEN THE DEGREE OF SOCIAL INTEGRATION IS LOW.
ALTRUISTIC- DEGREE OF SOCIAL INTEGRATION TOO HIGH
ANOMIC- INTEGRATION INTO SOCIETY IS DISTURBED.
PSYCHOLOGICAL FACTORS

• FREUD’S THEORY: “MOURNING AND MELANCHOLIA”

• MENNINGER’S THEORY: SUICIDE AS INVERTED HOMICIDE
BIOLOGICAL FACTORS

• SEROTONERGIC SYSTEM: LOW CONCENTRATION OF 5 HIAA (METABOLIC SEROTONIN)

• NONADRENERGIC SYSTEM: STRESS DIATHESIS MODEL
• HPA AXIS: DEXAMETHASONE SUPPRESSION TEST-NON SUPPRESSORS
• (SUICIDE IS MORE COMMON IN GROUPS WITH LOW CHOLESTEROL LEVELS)
GENETIC FACTORS

• MOLECULAR BIOLOGY- POLYMORPHISM IN TPH GENE (TRYPTOPHAN HYDROXYLASE ENZYME)

RISK FACTORS
GENDER DIFFERENCES- MEN 4 TIMES > WOMEN EXCEPTIONS- INDIA AND CHINA , RATIO IS 3:1
AGE – INCREASE WITH AGE
• MEN PEAK AGE- AFTER 45 YEARS
• WOMEN- 55 YEARS
RACE- TWO OUT OF EVERY THREE SUICIDES ARE WHITE MALES
RELIGION- DEGREE OF ORTHODOXY AND INTEGRATION
MARITAL STATUS- LESSENS THE RISK
OCCUPATION- HIGHER SOCIAL STATUS GREATER THE RISK UNEMPLOYED > EMPLOYED
PHYSICIANS SUICIDES- PHYSICIANS PARTICULARLY FEMALES ARE AT GREATER RISK
• CLIMATE –NO SIGNIFICANT VARIATION
• PHYSICAL HEALTH- LOSS OF MOTILITY
DISFIGUREMENT
CHRONIC INTRACTABLE PAIN
PATIENTS ON HEMODIALYSIS
ALCOHOL RELATED ILLNESSES

• DRUGS: RESERPINE, CORTICOSTEROIDS, ANTI-CANCER AGENTS

• MENTAL ILLNESS- 90-95% HAVE A DIAGNOSED MENTAL DISORDER
• PSYCHIATRIC PATIENTS- DEPRESSIVE DISORDER – 80%
• ALCOHOL RELATED DISORDERS – 4-60%
• SCHIZOPHRENIC DISORDER- 3-10%
• PERSONALITY DISORDER- 5-44%
• ORGANIC MENTAL DISORDER- 2-7%
PROTECTIVE FACTORS
• 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
COMMON METHODS OF SUICIDE
PESTICIDE POISONING (30%)
HANGING
FIREARMS
DRUG OVERDOSE
FATAL INJURIES
EXANGUINATIONS
SUFFOCATION
DROWNING
STAGES OF SUICIDE

1. IDEATION
2. THREATENING
3. ATTEMPTING
WARNING SIGNS
TROUBLE COPING WITH RECENT LOSSES, DEATH, DIVORCE, BREAK-UPS AND ETC.
FEELINGS OF HOPELESSNESS AND DESPAIR
MAKING FINAL ARRANGEMENTS: WRITING A WILL OR EULOGY, OR TAKING CARE OF DETAILS (I.E. CLOSING A BANK
ACCOUNT)

GATHERING OF LETHAL WEAPONS

GIVING AWAY PRIZED POSSESSIONS
PREOCCUPATION WITH DEATH SUCH AS DEATH AND/OR “DARK” IN WRITING ART, MUSIC LYRICS, ETC.
SUDDEN CHANGES IN PERSONALITY OR ATTITUDE, APPEARANCE, CHEMICAL USE, OR SCHOOL BEHAVIOR.
VERBAL WARNING SIGNS

“I CAN’T GO ON ANYMORE”

“I WISH I WAS NEVER BORN”
“I WISH I WERE DEAD”
“I WON’T NEED THIS ANYMORE”
TREATMENT

FOR EVERY COMPLETED CASE OF SUICIDE THERE ARE ABOUT 20 NON FATAL ATTEMPTS

REPETITION – 15-25% WITHIN A YEAR

POOR PROBLEM SOLVING SKILLS

PSYCHOSOCIAL TREATMENT
PROBLEM-SOLVING
PSYCHOTHERAPY
DISTRESS-TOLERANCE SKILLS
OUTREACH
PROVISION OF EMERGENCY CARDS
FAMILY THERAPY
PHARMACOLOGICAL TREATMENT

ANTIDEPRESSANTS – FLUOXETINE, SHOULD BE ALWAYS COMBINED WITH OTHERS THERAPIES

NEUROLEPTICS – FLUPENTHIXOL 20MG FOR 6 MONTHS
LITHIUM
MANAGEMENT IN CLINICAL PRACTICE
ASSESSMENT ( SAD PERSON’S SCALE – HIGH SPECIFICITY BUT LOW SENSITIVITY SO NOT USED
ANYMORE

TREATMENT :

a) PSYCHIATRIC DISORDERS TO BE TREATED

b) COMMUNITY THERAPY - PROBLEM SOLVING AND OUTREACH
c) ADOLESCENTS – FAMILY THERAPY, GROUP THERAPY