Special Articles / Esther Kala, J.O. Jeryda Gnanajane Eljo / Scientific Writing and Publishing in Social Work
Suicide is the process of purposely ending one’s own life. Suicide is often committed out of misery, or endorsed to some underlying mental disorder which includes depression, bipolar disorder, schizophrenia, alcoholism and drug abuse. Suicidal behavior is any deliberate action with potentially life-threatening consequences. Suicide attempts that do not result in death are much more common than accomplished suicides. Many of these suicide attempts are carried out in a way that to be rescued. These attempts often represent a desperate cry for help. The method of suicide may be nonviolent, such as consuming poison or overdose. Relatives of people who seriously attempt or complete suicide often blame their own self or become very angry, seeing the attempt. Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to her or his community. (WHO, 2011).
The descriptive study on Mental Health of Suicide attempters aims to understand the level of mental health of the suicide attempters in a psychiatric hospital in Tiruchirappalli. Self prepared questionnaire was used to collect the socio-demographic data and Mental Health Inventory developed by Jagdish & Srivastava (1983) was used to understand the level of mental health among the suicide attempters. The universe of the present study consists of respondents who came to the psychiatric hospital in Tiruchirappalli for treatment between the months May 2011 to June 2001. Data was collected from 106 respondents by adopting census method. The finding of the study reveals that more than half of the respondents (53.8%) have low level of positive self evaluation, more than half of the respondents (51.9%) have low level of perception of reality, more than half of the respondents (53.8%) have low level of integration of personality, more than half of the respondents (55.7%) have low level of autonomy, majority of the respondents (58.5%) have low level of group oriented attitudes, more than half of the respondents (56.6%) have low level of environmental mastery, more than half of the respondents (54.7%) have low level of overall mental health.
Key Words: Mental Health, suicide, attempters
The word suicide was used first by Sir Thomas Brown in his Religio Modici in 1642 and subsequently by Walter Charleton in 1651. Suicide (Latin suicidium, from suicaedere, “to kill oneself”) is the act of a human being intentionally causing his or her own death. Suicide is the eighth leading cause of death in males and the 16th leading cause of death in females. The higher incidence of completed suicides in males versus females is consistent across the life span. Suicide is the third leading cause of death for people of 10-24 years of age. In United States, boys 10-14 years of age commit suicide twice as often as their female peers. Teenage boys of 15-19 years of age complete suicide five times as often as girls their age, and men of 20-24 years of age commit suicide 10 times as often as women their age. Teen suicide statistics for youths of 15-19 years of age indicate that from 1950-1990, the incidence of suicides increased by 300% and from 1990-2003, the rate decreased by 35%. However, from 2000-2006, the rate of suicide has gradually increased, both in 10-24 years and in 25-64 years of age groups. While the rate of murder-suicide remains low at 0.0001%, the devastation it creates makes it a concerning public-health issue. (Edwards et al., 2011)
Symptoms for Suicide Behaviour
The following are some of symptoms for suicidal behaviour. They are talking about wanting to die or to kill one, looking for a way to kill oneself, such as searching online or buying a gun, talking about feeling hopeless or having no reason to live, talking about feeling trapped or in unbearable pain, talking about being a burden to others, increasing the use of alcohol or drugs, acting anxious or agitated; behaving recklessly, sleeping too little or too much, withdrawing or feeling isolated, showing rage or talking about seeking revenge, displaying extreme mood swings. (National Prevention Suicide Lifeline,2013)
Suicidal Methods in India
Suicidal method is any means by which persons purposely kill their own self. In India the usual means of committing suicide are hanging, poisoning- by consuming pesticide, rat poison, poisonous herbs, jumping in front of the train and self immolation.
According to Radhakrishnan and Andrade 2012
In India, during 2009 consumption of a poison (33.6%), hanging (31.5%), self immolation (9.2%), and drowning (6.1%) were the commonest modes of suicide. Jumping from buildings accounted for 1.5%. This pattern is recapitulated in the NCRB 2010 report. The use of plant poisons as a means of suicide attempt is more common in India.
Statistics About Suicide in India
Pereira I. (25th June 2013) in an article from “The Hindu” stated the statistics by the National Crime Records Bureau that …
India saw 1,35,445 people committed suicide in the country last year, of which 79,773 were men and 40,715 were women who have taken the extreme step. The rate of suicide last year stands at 11.2 cases for a population of I lakh. As per rounded off figures provided by the NCRB, on an average, 15 suicides an hour or 371 suicides a day had taken place. When scrutinized further, it reveals 242 male and 129 female suicides a day. Tamil Nadu tops the list with 16,927 suicides, followed by Maharashtra with 16,112 suicides, West Bengal 3rd and Andhra Pradesh following it with 14,328 suicides. The 28 States together accounted for 1,32,667 cases and the seven Union Territories together for 2,778 suicides. In the administrative division of Lakshadweep, only one person committed suicide. In Delhi UT, it was 1,899. Among the cities of the country, Chennai topped with 2,183 cases. The rate of suicide at the administrative division of Puducherry was the highest in the country, 36.8 for every 1 lakh persons. With a population close to 15 lakh as per estimated mid-year population, 541 persons committed suicide in Puducherry in 2012. Sikkim follows with a rate of 29.1 per cent and Tamil Nadu 3rd with a rate of 24.9 closely followed by Kerala with 24.3. The national average stands at 11.2. 9 (The Hindu, 2013)
Psychologists have mentioned the following characteristics as attributes of a mentally healthy person. A mentally healthy person is free from internal conflicts; he is not at ‘war’ with himself. He is well-adjusted, i.e. he is able to get along well with others. He accepts criticism and is not easily upset. He searches for identity. He has a strong sense of self-esteem. He knows himself: his needs, problems and goals (this is known as self-actualization).He has good self-control balances rationality and emotionality. He faces problems and tries to solve them intelligently, i.e. coping with stress and anxiety. (Park, 2001)
Review of Literature
Bhatia et al., (2000) conducted a study on “Psychosocial Profile of Suicide Ideators, Attempters and Completers in India”. The study aims to determine the psychological profile of suicide ideators, attempters and completers in a tertiary care teaching hospital. A total of 260 suicidal ideators, 58 attempters and 55 completers were studied. The majority of ideators, attempters and completers were 26-35 years of age, males (except attempters who were predominantly females), married, literate up to high school, employed (ideators) or housewives (attempters and completers). The suicide ideators, attempters and completers who had a past history of attempt were 6.9%, 24.1 % and 18.2% respectively. Family history of attempted suicide or completed suicide was also common among patients suffering from depression. In suicidal ideators, mixed anxiety and depressive disorder was the most common psychiatric diagnosis followed by major depression and schizophrenia. Among suicide attempters, adjustment disorder with depression was the most common diagnosis. The most common method of suicide attempt was organ phosphorus compound intake whereas in suicide completers, the most common method in use was hanging. The patients with suicidal ideation or attempt need careful evaluation, early intervention and long term follow up.
Gouda (2008) conducted a study on “Factors related to attempted suicide in Davanagere”. The main aim of the study is to study the socio-demographic factors, methods and reasons for suicidal attempts. Cross-sectional study was used. The study was conducted in Bapuji and C.G. Hospitals attached to J.J.M. Medical College, Davanagere. A total of 540 suicidal attempters admitted to emergency wards. A pretested proforma was administered to the subjects relating the factors responsible for the attempt. The data thus obtained was compiled and analyzed. Statistical Analysis: Proportions, Z -test and Chi-square test. In this study, 61.3% were males and 38.7% were females. Peak occurrence of suicidal attempts was found in the second and third decades (15-29 years). Hindus constituted about 94.6% of the total suicidal attempters. Almost half (52.2%) of the subjects had education below or up to matriculation and 83% of them were from the lower (classes IV and V) socio-economic groups. Agriculturists, housewives and unskilled workers represented 75% of the total subjects. Fifty-five percent of the subjects were from nuclear families and most (62.4%) of them were married; frequent mode of attempting suicides was by organo-phosphorus compounds (66.3%) followed by over dosage of tablets (17.8%). Common cause was family problem (27.2%) followed by illness.
Materials and Methods
Aim and Objectives
The researcher has used descriptive research design to describe the socio- demographic characteristic of the respondents, to find out the reasons for suicide attempt and to know the level of mental health of the suicide attempters. It also attempts to test the relationships and associations of variables upon which hypotheses were formed. Hence for this research, descriptive design has adopted.
Tools of Data Collection
The researcher used Mental Health Inventory framed by. Jagdish & Srivastava (1983) which contains six dimensions of mental health such as positive self-evaluation, perception of reality, integration of personality, autonomy, group oriented attitudes and environmental mastery. The reliability of the inventory was determined by ‘split-half method’ and it was found to be 0.73
The researcher made a visit to the psychiatric hospital in Tiruchirappalli and discussed with the psychiatrist about the feasibility of conducting research and to seek the permission to collect the data from the hospital.
Universe and Sample
The present study was conducted at a leading psychiatric hospital in Tiruchirappalli. The universe of the study consists of respondents, who came to the hospital with the history of suicidal attempt during the period May 2011 to June 2011. Census method was adopted and data was collected from 106 respondents who visited the hospital during the above said period.
Statistical Analysis of Data
The data collected were carefully analyzed and processed. Statistical test such as chi square, ‘t’ test and ‘F’ test was used to find out the difference between the variables and among the variables respectively. Karl Pearson’s co-efficient of correlation was used to find out the relationship between the variables and various dimensions of mental health and meaningful inferences were drawn based on the hypotheses framed between variables.
Findings of the Study
The general profile of the study Population
The study used heterogeneous respondents who have visited the psychiatric clinic for their treatment. Among the respondents the female respondents (57.5%) are little more than the male adolescents. As the majority population of India is of Hindu (79.2%) religious groups the same reflected in this study. Even though the rural population dominates (42.5%) the sample group, nearly (79.2%) percentage of the respondents hailed from nuclear family. It is indeed surprising to find that nearly one third (28.3%) of the respondents has attempted suicide with in a period of three months. But in the case of their family members (70.8%) have no history of suicidal attempts and nearly one-fourth of the respondents (23.6%) are above the age group of 40 years. Love failure (24.5%) leads to the main cause to attempt suicide.
Table No.1 reveals that more than half of the respondents (53.8%) have low level of positive self evaluation which shows that suicide attempters have poor self-confidence, self-acceptance, self-identity, lack of worthlessness and realization of one’s potentialities. Palmer (2004) support this finding as in his study as Self-esteem was significantly decreased by suicide ideation and suicide attempt history. More than half of the respondents (51.9%) have low level of perception of reality. It is inferred that respondents are not oriented in reality and have excessive fantasy about their life. More than half of the respondents (53.8%) have low level of integration of personality, it is inferred that suicide attempters have imbalance of psychic forces, inability to understand and concentrate at work and decreased interest in several attitudes and not mingling and sharing.
More than half of the respondents (55.7%) have low level of autonomy, it is inferred that lack of internal developing standards for one’s action and dependence on others for their development. Majority of the respondents (58.5%) have low level of group oriented attitudes which shows that respondents are not able to spend time with others for recreation and not working with others.
More than half of the respondents (56.6%) have low level of environmental mastery which shows that respondents are unable to take responsibilities and capacity for adjustment and not able to meet situational requirement. More than half of the respondents (54.7%) have low level of overall mental health. It is inferred that even though respondents received family support and counseling after suicidal attempt, their mental health is not good because they are always thinking about the problems and are depressed.
There is a significant difference between the male and female respondents with regard to mental health in the dimension of positive self evaluation. The mean scores reveals that the male respondents perceive high level of positive self evaluation than those of the female. There is no significant difference between the male and female of the respondents with regard to mental health in the dimensions of perception of reality, integration of personality, autonomy, group oriented attitudes, environmental mastery and overall mental health.
There is a significant difference between family history of suicide of the respondents with regard to mental health in the dimensions of positive self evaluation and overall mental health. There is no significant difference between family history of suicide of the respondents with regard to mental health in the dimensions of perception of reality, integration of personality, autonomy, group oriented attitudes and environmental master
It is inferred from the table that there is no significant difference among the various occupation of the respondents (self-employed, private sector, govt. sector, coolie, agriculture, not working) with regard to mental health in the dimensions of positive self evaluation, perception of reality, integration of personality, autonomy, group oriented attitudes, environmental mastery and level of overall mental health of the suicide attempters. .
The above table shows that there is a significant association between the age of the respondents and in only one dimension of mental health namely integration of personality. There is no significant association between the age of the respondents and various dimensions of mental health namely positive self evaluation, perception of reality, autonomy, group oriented activities, environment mastery and overall mental health
In Table No.5 there exist a positive significant relationship between positive self evaluation and integration of personality and overall mental health at 0.05 level of significance. There also a negative significant relationship between positive self evaluation and autonomy at 0.05 level of significance. There is no positive significant relationship between positive self evaluation and perception of reality and also there is no negative significant relationship between positive self evaluation and group oriented attitudes and environmental mastery.
There exists a positive significant relationship between perception of reality and overall mental health at 0.05 level of significance. There is no positive significant relationship between perception of reality and group oriented attitudes and environmental mastery. There is no negative significant relationship between perception of reality and integration of personality and autonomy.
There is a positive significant relationship between integration of personality and overall mental health at 0.05 level of significance. There is a negative significant relationship between integration of personality and autonomy at 0.05 level of significance. There also exist no positive significant relationship between integration of personality and environmental mastery and there is no negative significant relationship between integration of personality and group oriented attitudes.
There is a positive significant relationship between autonomy and group oriented attitudes at 0.05 level of significance. There is no positive significant relationship between autonomy and environmental mastery and overall mental health.
There exists a positive significant relationship between group oriented attitudes and overall mental health at 0.05 level of significance. There is no positive significant relationship between group oriented attitudes and environmental mastery.
There exist a positive significant relationship between environmental mastery and overall mental health at 0.05 level of significance.
Persons with previous history of suicidal attempt due to personal failure, recent loss, substance abuse, family violence and lack of communication, the family members must be give extra care and affection and also should be provided counseling with the help of Social Worker. If someone says, “I want to kill him” or “I’m going to commit suicide,” take the statements seriously and immediately seek the help of a trusted adult, such as a teacher, parent, counselor, priest and lifeline. Psychotherapy should be given to the suicide attempters, as it helps the patient to develop skills to deal with stress, frustration, improve the patient’s interpersonal relationships within the family, peers and restrict the patient’s access to potentially lethal means of suicide. Cognitive Behavior Therapy helps the suicide attempters to change their thinking patterns, maladaptive behaviours and to develop positive thoughts (Stanley, et al 2010).An important tool for successful management of the suicidal person is an individualized emergency plan to diffuse tension in case of stressful events and thus interrupt the chain of events leading to suicidal behavior. Pharmacotherapy should be given by the Psychiatrist to the repeated suicidal attempters or a depressive patient in order to avoid further suicidal attempt and strengthen their mental health. Humanizing communication within the family is helpful to the suicidal attempters to share their problems, get solution and also divert or engage their mind in pleasant activities. Suicidal attempters should have close clinical monitoring during antidepressant treatment because the risk of a reattempt is highest in the first few months after a suicide attempt. Mental health intervention is one of the most vital aspects of treatment for suicide attempters ( Adoga, 2012). Hotline services also help the suicidal thought person to avoid suicidal attempt. Suicide attempters should be able to cope with the problem, so life skills education should be taught by the teachers or parents or social workers. Counselors and therapists can provide emotional support and can help suicide attempters to build their own coping skills for dealing with problems. Crisis Oriented Intervention should be given by the counselor or therapist in order to overcome from the depressed situation for the suicide attempters. School intervention programs are useful for the teens which give support and education about the risk factors, symptoms and ways to manage suicidal thoughts in themselves.
It is clear from the study that suicide and mental health are interrelated. When a person has any mental illness or poor mental health then there are more possibilities to commit or attempt suicide. In this study various dimension of mental health like positive self evaluation, perception of reality, integration of personality, autonomy, group oriented activities and environmental mastery is used to understand the level of mental health of suicide attempters. The result shows that most of the suicide attempters have low level of mental health. Hence the Social worker, Psychologist, Psychiatrist should intervene with suicide attempters in order to enhance their mental health and prevent them from suicide attempts.
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