IJCRR

IJCRR - 6(18), September, 2014

Pages: 29-34

Date of Publication: 21-Sep-2014

STUDY OF PSYCHIATRIC CO-MORBIDITY AND ASSOCIATED PSYCHOSOCIAL STRESS IN ATTEMPTED SUICIDE PATIENTS

Author: R. Tara, G. V. Ramana Rao

Category:

Abstract:Introduction: The prevalence rates of suicides are on the raise in the developing countries particularly among farmers, students and the marginalized sections of the society. This imposes great psychological stress to the bereaved families and great economic loss to the nation. Objective: To study the demographic profile and other related details like psychiatric co morbidity, psychosocial stress preceding the event, of attempted suicides in a rural setting. Material and Methods: This cross sectional study was conducted at the General Hospital attached to GSL Medical College, Rajahmundry, Andhra Pradesh, India. The sample size was 60. Data collection was done by predesigned proforma and health parameters are assessed using the standard research tools like Mini International Neuropsychiatric Interview plus (MINI), The presumptive stressful life event scale etc. Results: In this study out of 60 cases of attempted suicides 44 (73.3%) subjects belong to the age group between 15-35 years, 36(60%) are of female gender, 31 (53%) were educated,32(55%) are unskilled workers, 16(26.7%) belong to lower middle class,48(80%) belong to nuclear family, 41(68%)of them consumed organophosphorous poison to kill themselves, 31(55%) of them suffered from psychiatric illness before the attempt,42(73%)had significant life events in the past one year. Conclusion: Majority of the subjects who attempted suicides are young in age, belong to lower socioeconomic status, unskilled workers, had psychiatric co morbidity, illiterates, of rural origin, and the most common mode of the attempt being consumption of organophosphorous poison.

Keywords: Attempted suicide patients, Psychiatric co-morbidity, and psychosocial stress

Full Text:

INTRODUCTION
Death due to suicide ranks among the first few causes of mortality at present. This causes serious psychiatric morbidity among family members of the diseased person. It is considered as an important human tragedy from the national economic perspective as well. In the last half a century, suicide rates have increased by about 60%.1 Nearly one million people commit suicide worldwide every year (i.e. One suicide every 40 seconds) compared to approximately 400000 suicides every year, a decade earlier. Suicide is among the ten leading causes of death for all ages in most of the countries (WHO)2 . The term ‘attempted suicide’ encompasses a wide variety of self destructive behaviors ranging from serious, life threatening acts to relatively minor gestures primarily aimed at attracting attention. This ambiguity about the criterion has led to dissatisfaction with the term, and a number of alternatives have been proposed including deliberate self poisoning and self injury,3 non-fatal deliberate self harm or deliberate self harm,4 parasuicide.5 Psychiatric co morbidities in suicide attempters have been the interest of many researchers. Literature has recorded association of psychiatric and personality disorders in such cases, both in the West and in India. Prevalence rates of psychiatric disorders in suicide attempters have ranged from 11.6%6 to 93%7 .Prevalence rates of co morbid psychiatric disorders in suicide attempters have ranged from 7%8

to 82%.9 Risk for suicidal behavior differs markedly among individuals; factors such as socio-demographic differences, personality traits, and psychiatric disorders all contribute to individual differences in risk. The question of whether various risk factors contribute independently to suicidal behavior or whether some risk factors are confounded with more basic individual differences has not been thoroughly investigated but is highly relevant from the standpoint of risk assessment and prevention. AIM 1. To study the demographic profile and other related details of attempted suicides in a rural setting. 2. To assess the presence of psychiatric co morbidity. 3. To assess the increasing psychosocial stress preceding the event, that could be contributive to the event. 4. To assess any associated physical symptoms preceding the event. MATERIAL and METHODS Type of study: The current study is a cross sectional descriptive, inferential and hospital based study. Source of data: Sample for the current study are patients who had attempted suicide and were referred to the Psychiatric services at the GSL Hospital during the period December, 2012 to July, 2013. Method of collection of data: Sampling method: From the above sources, all consecutive cases attending out-patient Department of Psychiatry, who fulfilled the inclusion criteria and did not get excluded, were selected for the current study. Ethical Considerations: The study was approved by the institutional ethics committee and written informed consent was taken from the parents or caregivers of the child. Tools used for assessment: 1. An Intake Pro forma to record socio-demographic features and details of suicide attempts. 2. Socio- Economic sale by O.P.Aggarwal 3. Physical symptoms scale by Kapur. 4. Family and Social Integration Schedule - Venkoba Rao (1989) 5. The presumptive stressful life event scale. (Singh, G, et al 1983). 6. Mini International Neuropsychiatric Interview plus, English Version 5.0.0. RESULTS All the statistics were performed by using SPSS 16.0 trial version and MS Excel 2007. The descriptive statics were presented in the form of mean ± standard deviation and percentages. Chi-square test is performed to find association between categorical study variables. P < 0.05 was considered as statistically significant. DISCUSSION This study has provided information about the relationship of attempted suicide to a number of factors such as age, sex, marital status, employment status, educational background, method and circumstances led to attempt, motivation, and psychiatric diagnosis and stress associated with suicide attempters. Sociodemographic features Age (Fig 1): Peak occurrence of suicides was in the age groups of 15-35 the youngest and oldest being 16 and 66 years respectively. This finding coincides with the observations made by Srivatsava et al(2004)6 and Haw et al(2009)10. Rao (1965)11 noted that majority of individuals were in age range between 15- 25 years in both sexes. Gender (Fig 2): Female preponderance of 60% in the sample is in conformation with other studies on attempted suicide observed by Srivatsava et al (2004) 6 and Oquendo (2007)12 Contrary to the above male preponderance was seen in the studies of Rao(1965)11. Religion(Fig 4): It is very difficult to make any observations from the religious prospective as 85% Indian population are Hindus, which coincides with studies observed by Kumar et al(1995)13 and Joseph Raj et al(2000)14 . Education (Fig 5): Majority of the suicide attempters in the present study had only primary education. This is contrary to the study observed by Chandrasekaran et al8. (Table-1) Different domiciliary background could be the reason for this observation.

Socioeconomic status (Fig 7):
The observation made in the present study that maximum number of suicide attempters belong to low socioeconomic sta-tus, which is in accordance with the findings observed by Chandrasekaran et al (2003)8.(Table-2), Haw et al(2001)10.

Stressful life events (Fig 16): In the present study 73.3% of the subjects suffered from stressful events in past 1 year and only 26.7% suffered from stress in lifetime events, which coincides with studies from Srivatsava etal (2004) 6 , Chowdhary et al(2007)18.

CONCLUSIONS
 • Majority of the suicide attempters were young and below 35 years of age. Women (73%) outnumbered Men in the study. More number (53%) of the subjects had education below or up to 10th Standard, (Fig 5). Most of the suicide attempters were married (75%). (55%) constituted unskilled labour by occupation (Fig 6), and (26%) belong to low-middle socioeconomic status, (Fig 7). All of the suicide attempters were from rural background.80% of the subjects belongs to nuclear families, (Fig 8).

• Oral agents were used for attempting suicide in all fifty one patients of our study sample. The most common method of self harm was consumption of organophosphorous compounds (41patients) followed by drug over dose (10 patients). Majority of the subjects made an impulsive suicide attempt which constitutes 70% of the sample which may be another cause for the use of pesticides commonly for attempting suicide in this region (Fig 10). Lack of restriction for procurement of these compounds and easy availability may be the reason for the preference to use these agents for attempting suicide.

• Stressful life events seemed to play an important role for attempting suicide of which 73% experienced in first one year and 26% constituted life time events (Fig 16).

• 55% of the suicide attempters suffered from a psychiatric disorder and major depressive episode (28%) and alcohol dependence (13%) were found to be most common diagnosed disorders (Fig 15).

• Only 22% of the subjects had left suicide note (Fig 11).This may be indirectly attributed to low literacy and rural domicile for majority of the patients.

• 80% of the subjects were guilty of their suicidal behaviour after survival from the suicidal attempt, (Fig 13).

• 75% of the suicide attempts were performed in solitude. Solitude may be considered as one of the risk factors for suicidal behaviour, (Fig 14).

ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

References:

1. Upreti DK. When life becomes a burden. Deccan Herald 2007; Nov 11:9 (col. 1).

2. World Health Organization. Suicide report, 1993: Geneva: World HealthOrganization.

3. Kessel N. self-poisoning. BMJ 1965; 2:1265-70, 1336-40.

4. Morgan HG, burns-cox CJ, Pocock, H, Pottle S. Deliberate self-harm. Clinical and socio-economic characteristics of 368 patients. Br j psychiatr 1975, 127:645-78.

5. Kreitman N, Smith P, Tan ES. Attempted suicide in social networks. Br j prev Soc Med 1969; 23:116-23.

6. Srivastava MK, Sahoo RN, Ghotekar LH, Dutta S, Danabalan M, Dutta TK, Das AK: Risk factors associated with attempted suicide: A case control study Indian J psychiatry 2004,46(1)33-8

7. Latha KS, Bhat SM, D’ Souza P suicide attempters is a general hospital unit in India. Their socio-demographic and clinical profile emphasis on cross cultural aspects. Acta psychiatr scand 1996, 94:26-30.

8. Chandrasekaran R, Gnanaseelan J, sahai A, swaminathan RP, Perme B. psychiatric and personality disorders in survivors following their first suicide attempt. Indian J psychiatry 2003;45(2);45-8

9. Gregory R. Grief and loss among Eskimos attempting suicide in western Alaska. Am J psychiatry 1994; 151:1815-6.

10. Haw C, Hawton K, Houston K, Townsend E. psychiatric and personality disorders in deliberate self-harm patients. Br J psychiatry 2001; 178; 48-54.

11. Rao VA. Attempted suicide: an analysis of one hundred and fourteen medical admissions into the Erskine hospital, Madurai, Indian J psychiatry 1965,VII(4):253-64

12. Oquendo MA, Bongiovi-Garcia ME, Galfalvy H, Goldberg PH, Grunebaum MF, burke AK et al. sex differences in clinical predictors of suicidal acts after major depression: a prospective study. Am J Psychiatry 2007;164;134-41.

13. Kumar PNS, kuruvilla K, Dutta S, john G. Jayaseelan. Psychological aspects of attempted suicide: study from a medical intensive care unit. Indian J Psychological Medicine. 1995; 18(2):32-42

14. Joseph raj MA, kumaraiah V, Bhide AV, social and clinical factors related to deliberate self-harm. NIMHANS J. 2000; 18(1and 2):3-18.

15. Harriss L, Hawton K, Zahl D. value of measuring suicidal intent in the assessment of people attending hospital following self-poisoning or self-injury. Br J Psychiatry 2005; 186:60-6.

16. Ponnudurai R, jeyakar J, Saraswathy M. Attempted suicides in Madras. Indian J psychiatry 1986; 28(1):59-62.

17. Suominen K, Henriksson M, Suokas J, Isometsa E, Ostamo A, Lonnqvist J. Mental disorders and co-morbidity in attempted suicide. Acta psychiatr scand 1996;94: 234-40.

18. Chowdhary AN, Banerjee S, Brahma A, Biswas MK. Pesticide poisoning in nonfatal, deliberate self-harm: a public health issue. Indian j psychiatry 2007; 49(2):117-20.