Suicide

2. “ Suicide is deliberate act of self harm with
fatal outcome and suicide attempt is an
injury with varying degrees of lethal intent.
Suicide is a complex problem with biological,
psychological, social, spiritual, economical,
political and philosophical under pinning “
W.H.O

3.  Medical model
The medical model accept that the causes
for suicidal behaviour are multiple and
complex and interacting with each other. It
includes mental disorder, physical illness,
alcohol & substance related problems,
sociological factors and biological factors

4.  The social model of suicidal behaviour
The land mark study of Emil Durkheim on
suicidal behaviour was initiated by the
observation of differences in suicidal rates
among individuals of different religious belief
system

5.  Biological factors in suicide
Genetic studies have found a strong
association between suicidal behaviour,
impulsivity and aggression. Genetic factors
may be responsible for the concordance of
suicide in some families.
Brain serotonergic system may be linked to
suicidal behaviour

6.  Psychological factors in suicide
Psychological theories of suicide explains the
suicidal behaviour as resulting from fantasies
about what would happen if they commit
suicide.
It may include wishes far revenge, power,
control, punishment or sacrifice

7.  Suicidal behavior includes three types of self-
destructive acts: completed suicide,
attempted suicide, and suicide gestures.
Thoughts and plans about suicide are called
suicide ideation.
 Suicide usually results from the interaction of
many factors, usually including depression.
 Some methods, such as guns, are more likely
to result in death, but choice of a less lethal
method does not necessarily mean that the
intent was less serious.
 Any suicide threat or suicide attempt must be
taken seriously, and help and support should
be provided.

8.  Completed suicide: An intentional act of self-
harm that results in death.
 Attempted suicide: An act of self-harm that
is intended to result in death but does not.
Frequently, suicide attempts involve at least
some ambivalence about wishing to die and
may be a cry for help.
 Suicide gesture: An act of self-harm that is
unlikely to result in death. For example,
people may scratch their wrists only
superficially or take an overdose of vitamins.

9.  Suicide is the 3rd leading cause of death
among young people, but the rate of
completed suicides is highest among men
over 70.
 People who live alone are more likely to
attempt or commit suicide.

10.  Over age 65
 Male
 Painful or disabling illness
 Living alone
 Debt or poverty
 Bereavement or loss
 Humiliation or disgrace
 Depression, especially when accompanied by psychosis or
anxiety
 Persistent sadness even when other symptoms of depression are
lessening
 A history of drug or alcohol abuse
 A history of prior suicide attempts
 A history of suicide in family members
 Traumatic childhood experiences, including physical or sexual
abuse
 Preoccupation with and talk about suicide
 Well-defined plans for suicide

11.  The choice of method is often influenced by
cultural factors and availability. Methods
jumping from a tall building, overdosing on
drugs.
 Suicide attempts most often involve drug
overdose and self-poisoning. Violent
methods, such as shooting and hanging,

12. 1. People who talk about suicide won’t really
do it.
2. Anyone who tries to kill him/herself must
be crazy.
3. If a person is determined to kill
him/herself, nothing is going to stop
him/her
4. Talking about suicide may give some one
the idea
5. Suicide is hereditary.

13.  Suicide among youth
The majority of suicidal children and
adolescent have clinical depressive illness
like anxiety disorder, ADHD, bipolar illness
(mania depression)

14. Warning signs of suicide in children
Verbal clues – saying things like
 I shouldn’t be here
 I am going to run away
 I wish I were dead
 I am going to kill myself
 I want to see what it feels like it die
 I wish I could disappear forever

15.  Behavioral clues
 Talking or joking about suicide
 Giving away possessions
 Pre occupation with, jumping form high places,
running into traffic
 Obsession with guns, knives....
 Previous suicidal thoughts/attempts

16.  Social isolation & loneliness, especially
among widowers
 Physical isolation: many old people live alone
 The accumulation of losses, such as friends,
physical & mental abilities, social status and
health
 Talk about suicide, e.g. I won’t be a burden
on my family much longer
 Statement of hope/help/worthlessness
 Suddenly happier
 Unusual visiting (saying good byes)
 Refusal to follow doctor

17. 1. School gate keeper training
2. General suicide education
3. Screening programs
4. Peer support programme
5. Crisis centers & hotlines

18.  Although some attempted or completed suicides
come as a shock even to family members and
friends, many people give clear warnings. Any
suicide threat or suicide attempt should be
regarded as a plea for help and must be taken
seriously. If the threat or attempt is ignored, a
life may be lost.
 If a person is threatening or has already
attempted suicide, the police should be
contacted immediately so that emergency
services can arrive as soon as possible. Until help
arrives, the person should be spoken to in a
calm, supportive manner.
 A doctor may hospitalize people who have
threatened or attempted suicide. Even if they do
not agree to hospitalization.

19.  Any suicidal act has a marked emotional effect on
all involved. Family, friends, and doctors may feel
guilt, shame, and remorse at not having
prevented the suicide. They may also feel anger
toward the person.
 Sometimes a grief counselor or a self-help group,
such as Survivors of Suicide, can help family and
friends deal with their feelings of guilt and
sorrow. The primary care doctor or local mental
health services (for example, at the county or
state level)
 The effect of attempted suicide is similar.
However, family members and friends have the
opportunity to resolve their feelings by
responding appropriately to the person's cry for
help.

20. 1. Remaining calm so that your judgement are
not affecting
2. Being supportive by focusing on positive
qualities of the person
3. Identifying the loss which is causing the
excessive stress
4. Focusing on the problem to deal with the
immediate crisis to prevent suicide from
occurring
5. Don’t get into debate/ arguments
6. Suggest feasible options & don’t give direct
advice

21.  Highest no. of family suicides are reported
from Kerala.
 The no. of suicides in Kerala has come down
as evidenced from the following figures
 2002-9810
 2003-9438
 2004-9053
 2005-9244
 2006-9026
 2007-8962
 2008-8321

22.  States with high rates
 Pondicherry = 48.6/100,000
 A & N islands = 38.5
 Daman Diu Haveli = 29.6
 Kerala = 26.3
 Karnataka = 21.62
 States with low rates
 Bihar = 1.0
 J & K = 1.9
 U.P = 2.1
 Uttarakhand = 2.6

24.  Addiction means a person has no control over
whether he or she uses a drug or drinks.
Someone who's addicted to cocaine has grown
so used to the drug that he or she has to have
it. Addiction can be physical, psychological, or
both.
 The difference between substance abuse and
addiction is very slight. Substance abuse means
using an illegal substance or using a legal
substance in the wrong way. Addiction begins
as abuse, or using a substance like marijuana or
cocaine. One can abuse a drug (or alcohol)
without having an addiction.

25.  A pattern of pathological use; e.g.
inability to reduce or stop use,
intoxication almost throughout the day or
nearly everyday for at least a month, and
episodes of overdose.
 Impairment in social or occupational
functioning; e.g. fights, loss of friends,
absence from work, loss of job, legal
difficulties

26.  Tolerance: the need for increased amount
of drug to achieve the desired effect.
or
 Withdrawal: physical symptoms after
cessation or reduction in the use of a
particular substance

27.  Being physically addicted means a person's
body actually becomes dependent on a
particular substance (even smoking is
physically addictive). It also means building
tolerance to that substance, so that a
person needs a larger dose than ever
before to get the same effects. Someone
who is physically addicted and stops using a
substance like drugs, alcohol, or cigarettes
may experience withdrawal symptoms.
Common symptoms of withdrawal are
diarrhea, shaking, and generally feeling
awful.

28.  Psychological addiction happens when the
cravings for a drug are psychological or
emotional. People who are psychologically
addicted feel overcome by the desire to have a
drug. They may lie or steal to get it.
 A person crosses the line between abuse and
addiction when he or she is no longer trying the
drug to have fun or get high, but has come to
depend on it. His or her whole life centers
around the need for the drug. An addicted
person — whether it's a physical or
psychological addiction or both — no longer
feels like there is a choice in taking a
substance.

29.  The most obvious sign of an addiction is the
need to have a particular drug or substance.
However, many other signs can suggest a
possible addiction, such as changes in mood
or weight loss or gain. (These also are signs
of other conditions, too, though, such as
depression or eating disorders.)

30.  use of drugs or alcohol as a way to forget problems or to
relax
 withdrawal or keeping secrets from family and friends
 loss of interest in activities that used to be important
 problems with schoolwork, such as slipping grades or
absences
 changes in friendships, such as hanging out only with
friends who use drugs
 spending a lot of time figuring out how to get drugs
 stealing or selling belongings to be able to afford drugs
 failed attempts to stop taking drugs or drinking
 anxiety, anger, or depression
 mood swings

31.  changes in sleeping habits
 feeling shaky or sick when trying to stop
 needing to take more of the substance
to get the same effect
 changes in eating habits, including
weight loss or gain

32.  A strong desire or sense of compulsion to
take the substance ( craving)
 Difficulty in controlling substance taking
behavior in terms of its onset, termination
and levels of use ( loss of control)
 A physiological withdrawal state when the
substance use is ceased or reduced (
withdrawal symptom)

33.  Increased tolerance level
 Progressive neglect of alternative
pleasurable activities or interests due to
use of psychoactive substance use (
salience)
 Persistent use despite clear evidence of
overtly harmful consequences

34.  Most addiction treatments are designed
to simply reduce or remove alcohol or
drug use - they focus on getting
addicted people to change their lifestyle
and even their core life values as a way
of preventing return of the problems

35. Multimodal in nature
 Immediate intervention – acute
intoxication, overdose, detoxification
 Short term management- brief
counseling, motivation enhancement,
general rehabilitation
 Long term management – after care

36.  During detoxification, or detox, healthcare
practitioners physically stabilize an
addicted person and get alcohol or other
drugs out of his or her system, a necessary
prerequisite to treatment.
 Most addicted people must work hard to
protect their recovery. They need to
participate in therapy or support groups
and to call upon others - friends or family
members - for support

38.  Aftercare - the system of support for a
recovering person once intensive treatment
is over - is essential for continued
recovery. People can get this support
through programs at work or in the
community. They need help maintaining the
skills that will help them to deal with
craving for alcohol and other drugs and to
avoid the triggers that set off cravings.

39.  Relapse education Model ( Daley)
 Understanding the relapse process
 Identifying and handling high risk
situations
 Identifying and handling urges or cravings
 Identifying and handling social pressure
 Anger management
 Handling boredom and managing leisure
time
 Stopping actual relapse

40.  If you think you're addicted to drugs or
alcohol, recognizing that you have a problem is
the first step in getting help.
 A lot of people think they can kick the problem
on their own, but that doesn't work for most
people.
 Find someone you trust to talk to. It may help
to talk to a friend or someone your own age at
first, but a supportive and understanding adult
is your best option for getting help.
 If one can't talk to their parents, he/she
might want to approach a counselor, relative,
doctor, favorite teacher, or religious leader.

41.  Unfortunately, overcoming addiction is not
easy.
 Quitting drugs or drinking is probably going
to be one of the hardest things ever done.
 It's not a sign of weakness if one need
professional help from a trained drug
counselor or therapist.
 Most people who try to kick a drug or
alcohol problem need professional assistance
or a treatment program to do so.

42.  Once you start a treatment program, try these tips to make the road to
recovery less bumpy:
 Tell friends about the decision to stop using drugs. true friends will
respect decision. This might mean that you need to find a new group of
friends who will be 100% supportive.
 Ask friends or family to be available when one need them. need to
call someone in the middle of the night just to talk. accept the help of
family and friends offer.
 Accept invitations only to events that you know won't involve drugs or
alcohol. Going to the movies is probably safe, but you may want to skip a
Friday night party until you're feeling more secure. Plan activities that
don't involve drugs. Go to the movies.
 Have a plan about what you'll do if you find yourself in a place with
drugs or alcohol. The temptation will be there sometimes, but if you
know how you're going to handle it, you'll be OK. Establish a plan with
your parents or siblings so that if you call home using a code, they'll know
that your call is a signal you need a ride out of there.
 Remind yourself that having an addiction doesn't make one bad or
weak. If you fall back into old patterns (backslide) a bit, talk to an adult
as soon as possible. There's nothing to be ashamed about, but it's
important to get help soon so that all of the hard work you put into your
recovery is not lost.

43.  Recovering from a drug or alcohol addiction doesn't
end with a 6-week treatment program.
 It's a lifelong process. Many people find that joining
a support group can help them stay clean.
 one will meet people who have gone through the
same experiences, and he 'll be able to participate in
real-life discussions about drugs that one won't hear
in one’s school's health class.
 Many people find that helping others is also the best
way to help themselves..
 If one do have a relapse, recognizing the problem as
soon as possible is critical
 have a relapse, don't ever be afraid to ask for help!
