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Suicide ppt


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suicide - a public health problem
history, global scenario, Indian scenario, etiology, risk factors. protective factors, suicide in adolescents, treatment, prevention, recommendations

Published in: Health & Medicine
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Suicide ppt

  1. 1. PRESENTER: Dr. Suhasini K. Dec 3 2014
  2. 2. Introduction Historical perspective Global & Indian scenario Etiology Risk factors Protective factors Common methods Stages Warning signs Treatment Prevention Recommendations 12/03/14 2
  3. 3.  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 12/03/14 3
  4. 4. Derived from Latin word sui = oneself , cidium = a killing Primary emergency for mental health professional Major public health problem 12/03/14 4
  5. 5. The story of suicide is probably as old as that of man himself Suicide has variously been glorified, romanticized, bemoaned, and even condemned 12/03/14 5
  6. 6. 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 12/03/14 6
  7. 7. ISLAM: suicide is PROHIBITED CHRISTIANITY: suicide is considered a sin In 19th-century in Europe the act of suicide shifted from being viewed as caused by sin to being caused by insanity. 12/03/14 7
  8. 8. 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’ 12/03/14 8
  9. 9. Vedas - permit 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 12/03/14 9
  10. 10. 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 12/03/14 10
  11. 11. Suicide worldwide was estimated to represent 1.8% of the total global burden of disease in 1998  By 2020 - projected to be 2.4% 12/03/14 11
  12. 12. Tenth leading cause of death worldwide It is the second leading cause of death in 15-29 year-olds globally 12/03/14 12
  13. 13. 12/03/14 13
  14. 14. 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 12/03/14 14
  15. 15. India ranks 43rd in descending order of rates of suicide with a rate of 10.6/100,000 reported in 2009 About one-third of suicides over the world happen in India According to 2012 WHO data – males -25.8/100,000population/year females- 16.4/100,000 12/03/14 15
  16. 16. According to NCRB : In 1989- 8.47/100,000 population/year 1999 – 11.21 2006 – 10.5 Under-reporting • Pondicherry, Andaman & Nicobar Islands – 30/100,000 • Kerala, Sikkim, Tripura, Karnataka also have reported high rates of suicide 12/03/14 16
  17. 17. Sociological Factors  Durkheim’s Theory: Emile Durkheim ( French Sociologist ) suicide 12/03/14 17
  18. 18. 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 12/03/14 18
  19. 19. Psychological Factors  Freud’s theory: “ Mourning and Melancholia” Menninger’s theory: suicide as inverted homicide 12/03/14 19
  20. 20. Biological Factors Serotonergic system: low concentration of 5-HIAA (metabolite of serotonin) Nonadrenergic system: stress-diathesis model HPA axis: Dexamethasone suppression test- non-suppressors ( suicide is more common in groups with low cholesterol levels) 12/03/14 20
  21. 21. Genetic factors Molecular biology – polymorphism in TPH gene (tryptophan hydroxylase enzyme) 12/03/14 21
  22. 22. 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 Race- Two out of every three suicides are White males 12/03/14 22
  23. 23. Religion- degree of orthodoxy and integration Marital status- lessens the risk Occupation- higher social status greater the risk unemployed > employed Physician suicides - physicians particularly females are at greater risk 12/03/14 23
  24. 24. 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 12/03/14 24
  25. 25. • 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% 12/03/14 25
  26. 26. Depression Schizophrenia Addiction disorder Family history & past history of suicidality Dysregulated serotonergic system Early parental loss Isolation Unemployment Acute life events Older age Male sex Vulnerable periods 12/03/14 26
  27. 27. 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 12/03/14 27
  28. 28. Pesticide poisoning(30%)  Hanging 12/03/14 28
  29. 29. Firearms Drug overdose Fatal injuries 12/03/14 29
  30. 30. Exsanguinations  Suffocation Drowning 12/03/14 30
  31. 31. STAGES OF SUICIDE Ideation Threatening Attempting 12/03/14 31 Intervention
  32. 32. 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 12/03/14 32
  33. 33. IPC S. 309 Attempt to Commit Suicide S.306 Abetment of Suicide • S.305 Abetment in Special Cases 12/03/14 33
  34. 34. Suicide in adolescents: Highly vulnerable group Living in violent & abusive environment Lack of support network They are usually successive in their attempt to suicide Male : female ratio almost equal 12/03/14 34
  35. 35.  Causes- mental illness school difficulties broken romance separation rejection physical/ sexual abuse Children –bullying /being bullied (NOTE: Direct questioning about suicidal thoughts is necessary) 12/03/14 35
  36. 36. 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). 12/03/14 36
  37. 37. 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. 12/03/14 37
  38. 38. “I can't go on anymore" "I wish I was never born" "I wish I were dead" "I won't need this anymore" 12/03/14 38
  39. 39. "My parents won't have to worry about me anymore" “Everyone would be better off if I was dead” “Nobody cares if I live or die” 12/03/14 39
  40. 40. Treatment of suicide attempters For every completed case of suicide there are about 20 non fatal attempts Repetition – 15-25% within a year Poor problem solving skills 12/03/14 40
  41. 41. Psychosocial treatment a)Problem-solving b)Psychotherapy c)Distress-tolerance skills d)Outreach e)Provision of emergency cards f) Family therapy 12/03/14 41
  42. 42. Pharmacological treatment a)Antidepressants- fluoxetine, should be always combined with other therapies b)Neuroleptics- flupenthixol 20mg for 6 months c)Lithium 12/03/14 42
  43. 43. 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 12/03/14 43
  44. 44. 12/03/14 44
  45. 45. General principles Population strategies High-risk strategies 12/03/14 45
  46. 46. Population strategies Intervention at community level: 1. Increasing public awareness 2. Campaign to reduce stigma 3. Guidelines for the mass media 4. Regulating formulations, packaging and sale of pesticides 5. Regulation of over-the-counter medication 6. Gender-related legislation and action 7. Introducing alcohol policies 12/03/14 46
  47. 47. Interventions at institutional and organizational levels: 1. Establishing sentinel centres and developing an information system 2. Training of personnel working in high risk settings 3. Establishing crisis intervention and counselling centres and telephone hotlines 4. Increase in specific clinical training programmes for lay counsellors 5. Redesigning the curriculum for medical and nursing personnel 6. Intervention programmes for high schools 12/03/14 47
  48. 48. High-risk strategies 1. Patients with psychiatric disorder a) Risk identification b) Preventive strategies- active treatment of individuals and psychological therapy 2. Elderly people- care and support 12/03/14 48
  49. 49. 3. Suicide attempters 4. High-risk occupational groups- all these groups have easy access to methods of suicide – removing the access 5. Prisoners- young males held at remand Ensuring that prison cells are safe in terms of absence of structures favorable for suicide 12/03/14 49
  50. 50. 12/03/14 50
  51. 51.  Key Gatekeepers o Primary health care providers o Mental health care providers o Emergency health care providers o Teachers and other school staff o Community leaders o Police officers and other first responders o Military officers o Social welfare workers o Spiritual and religious leaders o Traditional healers 12/03/14 51
  52. 52. 12/03/14 52
  53. 53. 12/03/14 53
  54. 54. In the WHO Mental Health Action Plan 2013-2020 - the global target of reducing the suicide rate in countries by 10% by 2020. WHO’s Mental Health Gap Action Programme, launched in 2008, includes suicide prevention as a priority and provides evidence-based technical guidance to expand service provision in countries 12/03/14 54
  55. 55. 12/03/14 55
  56. 56. Model for developing countries in public health low IMR MMR High life expectancy Marched forward in physical health, neglected mental health 12/03/14 56
  57. 57. Evidenced by high suicide rates 32/100,000 population/ year KRISIS (Kerala Integrated Scheme for Intervention in Suicide)- launched in 2004 In 2008- 26/100,000 population/yr 12/03/14 57
  58. 58. Public awareness Integration of mental health and general health in suicide prevention approaches At MBBS level – making it a compulsory subject of study and a examination paper 12/03/14 58
  59. 59. Foundations providing services in prevention of suicide Prerana group- Mumbai Sneha NGO – Chennai based Maithri -Ernakulam 12/03/14 59
  60. 60. When someone is suicidal , he or she will always remain suicidal Heightened suicide risk is often short-term and situation-specific. While suicidal thoughts may return, they are not permanent and individual with previously suicidal thoughts and attempts can go on to live a long life 12/03/14 60
  61. 61. Talking about suicide is a bad idea and can be interpreted as encouragement Given the widespread stigma around suicide, most people who are contemplating suicide do not know who to speak to. Rather than encouraging suicidal behaviour, talking openly can give an individual other options or the time to rethink his/her decision, thereby preventing suicide. 12/03/14 61
  62. 62. Only people with mental disorders are suicidal Suicidal behaviour indicates deep unhappiness but not necessarily mental disorder. 12/03/14 62
  63. 63. Most suicides happen suddenly without warning The majority of suicides have been preceded by warning signs, whether verbal or behavioural.  Of course there are some suicides that occur without warning 12/03/14 63
  64. 64. Someone who is suicidal is determined to die On the contrary, suicidal people are often ambivalent about living or dying  Someone may act impulsively by drinking pesticides, and die a few days later, even though they would have liked to live on 12/03/14 64
  65. 65. People who talks about suicide do not mean to do it People who talk about suicide may be reaching out for help or support 12/03/14 65
  66. 66. 12/03/14 66
  67. 67. 12/03/14 67
  68. 68.  Kaplan & Sadock’s Synopsis of Psychiatry (10th edi)  New Oxford Textbook of Psychiatry ; Michael Gelder, Nancy Andreasen (2nd edition)  Community Mental Health in India; B. Chavan, Nithin Gupta  Essentials of Psychiatry; Jerald Kay, Allan Tasman  A hand book on Suicide Prevention Strategies, KRISIS  World Health Organization. World Health Report 2001. Mental health: New understanding, new hope. Geneva  S.Manoranjitham;Towards a National Strategy to Reduce Suicide in India; The National Medical Journal of India vol. 18, no. 3, 2005  Aaron R, Joseph A, Abraham S, Muliyil J, George K, Prasad ; Suicides in young people in rural southern India Lancet; 2004;363:1117–18 12/03/14 68
  69. 69. 12/03/14 69