The Psychopathology and the Sociodemographic Determinants of Attempted Suicide Patients

1. Corresponding Author 2. Amit Gupta (MD. Psychiatry) Associate Professor, Department of Psychiatry Adesh Institute of Medical sciences & Research, Bhatinda. 3. Department of Microbiology Adesh Institute of Medical sciences & Research Bhatinda.

Abstract

Background: Suicide and suicidal behaviour are known since the birth of humanity. Unfortunately, it is not possible to predict suicidal behaviour with certainty. Suicide is common, but there scanty data on this topic from India.

Materials and Methods: A cross sectional study was performed for a period of 1 year in a medical college and research center in North India.

Results: A majority of the samples were males (61%), 70% were less than 30 years of age, 57% were married, 25% werehousewives and had high school education. The most common method of suicide was self poisoning (69%), followed by burning, hanging, getting electrocuted and getting run over by trains. The most common psychiatric illness which was found was affective disorder (57%). Depressive disorder (46%) constituted a major category of the affective disorders.

Conclusion: Awareness programmes and preventive measures should be undertaken and a proper psychiatric referral system should be built up to reduce the incidence of suicides.

Depressive Disorder, Suicidal Behavior, Self Injury

Introduction
Attempted suicide, both fatal and non fatal, is a challenging public health issue. Although many terms like deliberate self poisoning and self injury (1), para suicide (2), nonfatal self deliberate harm (3) and pseudo suicide (4) are used, the term ‘attempted suicide’ continues to have widespread use.

Suicide and suicidal behaviour are known since the birth of humanity. While humanity has triumphed over several diseases that cause suffering and loss of lives, suicidal behaviour still continues to lead to the loss of precious lives. In India, about 100,000 persons commit suicide every year, contributing to about 10% of the suicides in the world (5). Suicide is among the top 10 causes of death in India and among the top 3 causes of death in those between 16 and 35 years of age (6).

Attempted suicide is regarded by many as an irrefutable evidence of a psychiatric disorder. Harrington and Cross were the first to question this. Various studies have found varying degrees of psychopathology in the suicide attempters. Among the psychiatric disorders, mood disorders are the ones which are most commonly associated with suicide attempts. As there is a lack of data in Punjab regarding the psychopathology in suicide attempters, we aimed to conduct this study.

Material and Methods

This study was conducted in a medical college in the Malwa region of Punjab, in North India, from January 2010 to December 2010. After getting permission from the institutional ethics committee, the cases who were kept under observation were interviewed. The inclusion criteria of a case with a suicide attempt, was a patient who reported to the causality department with a suicide attempt and was later shifted to the hospital, to the patient services. Those cases who attempted suicide and received treatment outside, were later shifted to the hospital, to the Psychiatry department forfurther management. Those patients who were not willing and who had initially admitted a suicide attempt but had later denied it, were not included in the study.

A total of 100 patients were studied. Whenever possible and as advised, these subjects were shifted to the Psychiatry ward or were called for follow up to the Psychiatry O.P.D. An informed consent was taken from the family members after explaining the purpose of the study to them. The general descriptive and demographic data and the psychiatric history were recorded by holding a semi structured interview. The present status examination was carried out with the help of a structured proforma which was developed by Wing et al. The psychiatry diagnosis of the probands were made according to I.C.D. (10).

Results

Of the 100 patients, 61 were males and 39 were females. A majority of the samples belonged to the less than 30 years age group (70%), had an urban residence (68.9%), were married (57%), had a high school education (55%) and belonged to joint families (53%)., The samples included 25% housewives, 15% students, , 10% business men, 9% farmers and 9% unemployed people. The most common method of suicide was poisoning (69%), followed by burning (13%), hanging (6%), stabbing (4%), jumping from heights (3%), getting electrocuted (2%) and getting run over by trains (1%). A majority of the suicide attempters were suffering from mood disorders (57%). Depression was found in 46% subjects, out of which 30% had severe depressive episodes, 9% had recurrent depression, 6% had bipolar illness with currently depressive episodes and 1% had dysthymia. In addition, 4% of the subjects had bipolar illness (currently manic), 5% had bipolar illness (currently mixed), 2% had manic episodes and 2% had psychotic symptoms which were associated with affective disorders. All the19 cases of substance dependence were exclusively males (31.1%). There were 3 cases of schizophrenia and delusional disorder. Otherswere 1 male with a personality disorder,1 female with an organic mental disorder and 1 female with an adjustment disorder, with a depressed mood. Epilepsy was present in 2 cases. One of these was also diagnosed as an affective disorder, a manic episode without psychotic features. Co morbidity of the affective disorder with substance dependence was present in 2 cases. There was a F32.2 severe depressive episode without psychotic features with F19.2 multiple drug dependence in one case. The other proband with co morbidity had a F31.1 bipolar affective disorder (currently manic) with F19.2 multiple drug dependence. Previous suicide attempts were present in 22 cases. Of these, 10 had made a single suicide attempt and 12 had made multiple suicide attempts(Table/Fig 1)(Table/Fig 2)(Table/Fig 3)(Table/Fig 4)(Table/Fig 5)(Table/Fig 6)(Table/Fig 7)(Table/Fig 8)(Table/Fig 9)(Table/Fig 10).

Discussion

The present study was carried out with an aim to evaluate the psychopathology in the suicide attempters. The demographic factors which were associated with attempted suicide were also studied. Our previous study was conducted to evaluate the psychiatricmorbidity and the socio-demographic determinants of self harm. The difference between attempted suicide and self harm is that, the intention in self harm is to gain attention but not to end the life. The injury in self harm is not life threatening, whereas in suicide, the intention is to kill oneself, with a fatal outcome. The purpose in suicide is to escape from life, whereas the purpose in self harm is to express anger, push oneself, generate normal feelings and to distract oneself.

In this study, males outnumbered the females (61% v/s 39%), which correlated with the findings of other studies (7),(8),(9),(10). The mean age of the sample was found to be 26.98 +8.13 years, which corroborated with the findings of other studies (7),(11),(12). There were more people from the urban areas as compared to those from the rural areas (69% v/s 31%).The reason for this could be that this study was conducted in a referral hospital in an urban city. Housewives constituted the largest occupational group (64% female suicide attempters), followed by skilled workers (29.5%), businessmen (16.4% of male probands) and farmers (9%), which was accordance with the findings of other studies (9),(10),(13). Unemployment was an important factor which contributed to the suicidal behaviour (14). As marriage is an important cultural factor in India, most of the suicidal attempters were married, which was similar to the findings of other studies (7),(10),(11),(12),(15). A majorityof the cases had high school education, which was consistent with the findings of 2 Indian studies (9),(15). Self poisoning was the most commonly adopted method for attempting suicide, which was also supported by the findings of other Indian studies (8),(10),(19).This may be due to the easy availability of insecticides and pesticides in every home. In particular, pesticide self poisoning is now considered by the WHO to be the commonest method of committing suicide (16),(17), but it is rarely seen in the western countries (18). Among the psychiatric disorders, affective disorders were the commonest (57%), which was supported by the findings of Indian (7),(10),(14),(19) as well as western studies (20),(21),(22),(23)(24)(25). 19 subjects had substance dependence. Some studies (10),(21) had reported a higher percentage of substance dependence, while some had reported the reverse (22). The variations in the findings of these studies and of the present study are probably due to the differences in the diagnostic criteria which were used by the various researchers.

LIMITATIONS
Our study was a hospital based study where a majority of the patents got admitted from the urban population. Most of the cases of suicidal attempts were not referred for psychiatric assessment and many of the family members didnt want to disclose the true facts because of the possible legislative actions. The findings of the present study may not be applicable to other regions. So, the findings of our study should be interpreted in this background.

Conclusion

The findings and the interpretations on the patients in our study were confined to the hospital patients only, which is the tip of the iceberg. So, population based studies should be promoted.

DOI and Others

JCDR/2011/1510