SUICIDE: is the result of an act of self harm deliberately initiated and performed in the full knowledge or expectation of its Fatal Outcome. Suicidal acts with nonfatal outcome are labeled by WHO as "Attempted Suicide”. Derived from Latin word ,sui = oneself , cidium = a killing Primary emergency for mental health professional Major public health problem More than 8,00,000 people die by suicide every year Estimated annual mortality is 14·5 deaths per 1,00,000 people Around one person every 40 seconds 75% of suicides occur in low- and middle-income countries Tenth leading cause of death worldwide It is the second leading cause of death in 15-29 year olds globally suicide belt – (25 per 100,000) Scandinavia, Switzerland, Germany, Austria, eastern European countries (Belarus, Estonia, Lithuania, and the Russian Federation) and Japan Prime suicide site of the world – Golden Gate Bridge in San Francisco Japan- reported to have highest number of cases Every year, more than 1,00,000 people commit suicide in our country. There are various causes of suicides like professional/career problems, sense of isolation, abuse, violence, family problems, mental disorders, addiction to alcohol, financial loss, chronic pain etc According to NCRB: A total of 1,39,123 suicides were reported in the country during 2019 showing an increase of 3.4% in comparison to 2018 and the rate of suicides has increased by 0.2% Scerotonergic system: low concentration of HIAA (metabolite of serotonin) Non adrenergic system: stress-diathesis model HPA axis: Dexamethasone suppression test- non-suppressors Genetic: Molecular biology – polymorphism in TPH gene (tryptophan hydroxylase enzyme) 2019 over 2018. Gender differences- Men 4 times > Women Exceptions – India and China , ratio is 1.3:1 Age- Increase with age men peak age- after 45 years women – 55years Physical health- loss of motility, Disfigurement, chronic intractable pain , patients on hemodialysis alcohol related illnesses Mental illness Previous h/o suicidal attempt H/O Substance abuse Marital status Social isolation Trouble coping with recent losses, death, divorce, moving, break-ups, 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' themes in writing, art, music lyrics, etc. — Sudden changes in personality or attitude, appearance, chemical use, or school behavior.Problem-solving b) Psychotherapy c) Distress-tolerance skills d) Outreach e) Provision of emergency cards f)Antidepressants- fluoxetine, should be always combined with other therapies b) Neuroleptics- flupenthixol 20mg for 6 months c) Lithium Family therapy

2. HEADINGS
• Introduction
• HISTORICAL PERSPECTIVE
• Global & Indian scenario
• Etiology
• Risk factors
• Protective factors
• Common methods
• Stages
• Warning signs
• Treatment
• Prevention

3. INTRODUCTION
• SUICIDE:
– is the result of an act of self harm
– deliberately initiated and
– performed in the full knowledge or expectation of its Fatal Outcome.
• Suicidal acts with nonfatal outcome are labeled by WHO as "Attempted Suicide”.
• Derived from Latin word ,sui = oneself , cidium = a killing
• Primary emergency for mental health professional
• Major public health problem

4. HISTORICAL PERSPECTIVE
• HISTORY-WORLD
• Finds a mention in the ancient treatises of all cultures
– New testament- Judas hanged himself after betraying Christ
– Christian church declared suicide as a form of murder as early as 6th century
– Zoroastrian philosophers call it a crime
– Early Greeks considered it acceptable
– Romans were against suicide
– Judaism considers it sinful
– Considered a moral and heroic act in certain situations (hara-kiri by Japanese samurais)
– Islam condemns it

5. HISTORY-INDIA
• In hindu mythology, death of Lord Rama led to mass suicides in Ayodhya
• Some parts of vedas emphasized suicide as a ritual
• Upanishads however have condemned it
• After war of Mahabharata, Yudhishtira thought of committing suicide
• Indian culture accepted suicide by certain groups- widows, terminally ill and aged at
holy places
• Sallekhana (devotee ending life by gradual starvation) in Jainism
• Sati and Johar practise was widely prevalent

6. HISTORY (CONTD.)
• Term ‘suicide’ was first used by Sir Thomas Browne in 1642 in his book Religio Medici
• Derived from ‘SUI’ (of oneself) and ‘CAEDES’ (murder)
• First scientific attempt started in 1763 with the work of Merian who emphasized that
suicide is a disease, not a sin or a crime
• In 1905, R Gaupp (psychiatrist) indicated that there were some peculiar and unique
personality traits among people committing suicide

7. GLOBAL SCENARIO
• More than 8,00,000 people die by suicide every year
• Estimated annual mortality is 14·5 deaths per
• 1,00,000 people
• Around one person every 40 seconds
• 75% of suicides occur in low- and middle-income countries
• Tenth leading cause of death worldwide
• It is the second leading cause of death in 15-29 year olds globally
• suicide belt – (25 per 100,000) Scandinavia, Switzerland, Germany, Austria, eastern European countries (Belarus, Estonia,
Lithuania, and the Russian Federation) and Japan
• Prime suicide site of the world – Golden Gate Bridge in San Francisco
• Japan- reported to have highest number of cases

9. INDIAN SCENARIO
• Every year, more than 1,00,000 people commit suicide in our country. There are various
causes of suicides like professional/career problems, sense of isolation, abuse,
violence, family problems, mental disorders, addiction to alcohol, financial loss, chronic
pain etc
• According to NCRB:
• A total of 1,39,123 suicides were reported in the country during 2019 showing an
increase of 3.4% in comparison to 2018 and the rate of suicides has increased by 0.2%
during 2019 over 2018.

10. STATE/UT WISE MAJOR PERCENTAGE
SHARE OF SUICIDES IN STATES DURING
2019

13. TIME OF SUICIDE:
• Most common during: Daytime (8 A.M.-5 P.M.) (Chavan BS et al, 2008)
• Second most common time: Early morning (Chavan BS et al, 2008)
• Other study reported equal incidence: Between day and night (Mohanty S et al,
2007)

14. ETIOLOGY
• Sociological Factors
• Durkheim’s Theory: Emile Durkheim ( French Sociologist 0
• Suicide – egoistic, 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

15. BIOLOGICAL FACTOR
• Scerotonergic system: low concentration of HIAA (metabolite of serotonin)
• Non adrenergic system: stress-diathesis model
• HPA axis: Dexamethasone suppression test- non-suppressors
• Genetic:
• Molecular biology – polymorphism in TPH gene
• (tryptophan hydroxylase enzyme)

16. RISK FACTOR
• Gender differences- Men 4 times > Women Exceptions – India and China , ratio is 1.3:1
• Age- Increase with age
• men peak age- after 45 years women – 55years
• Physical health- loss of motility, Disfigurement, chronic intractable pain , patients on
hemodialysis alcohol related illnesses
• Mental illness
• Previous h/o suicidal attempt
• H/O Substance abuse
• Marital status
• Social isolation

17. BIOLOGICAL ,PSYCHOSOCIAL ,DEMOGRAPHIC FACTOR
Depression
,Schizophrenia Addiction
disorder Family history &
past history of suicidality
Dysregulated
serotonergic system
Older age Male sex
Vulnerable periods
Early parental
loss,Isolation
Unemployment
Acute life events

18. BIOPSYCHOSOCIAL MODEL
(KINDERMAN, 2005)
Suicidal
behaviou
r
Mental
health
disorder
Psychologica
l processes
Events
Environmen
t
Biology
How do you
think/feel about
the past,
present and the
future?

19. PROTECTIVE FACTOR
• 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

20. COMMON METHODS OF SUICIDE
• Pesticide poisoning(30%)
• Hanging
• Firearms
• Drug overdose
• Fatal injuries
• Exsanguinations
• Suffocation
• Drowning

21. STAGES OF SUICIDE
STAGES OF
SUICIDE:
Ideation Threatening Attempting
Intervention

22. TERMINOLOGIES
• — Parasuicide : injures themselves by self mutilation but do not wish to die
• — Cyber-suicide : suicide pact made between individuals who meet on the internet
• — Copycat suicide : a suicide within a peer group/publicized suicide can serve as a
model for next suicide in absence of sufficient protective factors (Werther syndrome)
• — Anniversary suicide: persons take their lives on the day a member of their family
did

23. WARNING SIGNS
• — Trouble coping with recent losses, death, divorce, moving, break-ups, 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' themes in writing, art,
music lyrics, etc.
• — Sudden changes in personality or attitude, appearance, chemical use, or school
behavior.

24. TREATMENT
• Treatment of suicide attempters
• every completed case of suicide there are about 20 non fatal attempts
• Repetition – 15-25% within a year
• Poor problem solving skills

25. PSYCHOSOCIAL TREATMENT
• a) Problem-solving
• b) Psychotherapy
• c) Distress-tolerance skills
• d) Outreach
• e) Provision of emergency cards
• f) Family therapy

26. PHARMACOLOGICAL TREATMENT
• a) Antidepressants- fluoxetine, should be always combined with other therapies
• b) Neuroleptics- flupenthixol 20mg for 6 months
• c) Lithium

27. MANAGEMENT IN CLINICAL PRACTICE
• 1) Assessment- ( SAD PERSON’S scale – high specificity but low sensitivity so not
used anymore)
• 2) Treatment:
• a) Psychiatric disorders to be treated
• b) Community therapy- problem solving and outreach
• c) Adolescents – family therapy, group therapy

28. PREVENTION
• Strategies to reduce domestic violence provide poverty relief and improve treatment of mental and
physical disorders (Maselko J et al, 2008).
• Greater emphasis on educating the general public regarding the policies and services available for
suicide prevention.
– As the majority of the general population and all the subjects with attempted suicide were not aware of any
community and support services for the prevention of suicide (Manoranjitham S et al, 2007).
• Strategies involving restriction of access
– to common methods of suicide and need of specific measure at the probable time of crisis by government
agencies.
• School-based interventions involving
– crisis management, self-esteem enhancement and the development of coping skills and carrier counseling.
•
• In a multicentre study (India as one of the centre) by Fleischmann A et al (2008) reported that brief
intervention and contact (BIC) in the form of patient education and follow up than the usual mode of
treatment only
– Significantly effective method for prevention of suicides in suicide attempter. This is also a low cost method.

29. THANK YOU…