lecture note

1. Suicide
& Attempted Suicide

2.  Suicidal behaviour includes completed suicide
and attempted suicide or
parasuicide, Deliberate self - harm, deliberate
self -injury and self-poisoning.
The intent and purpose in these various acts may vary:
 altruistic suicide as a sacrifice for a cause;
 deliberate, premeditated act in a state of deep
depression;
 impulsive acts in response to stress
 communicate distress (cry for help
 manipulate others
 cause guilt
 punish others.
 Freud- the forces that operate to preserve life (Eros) are in conflict
with those that operate for self-destruction or death (Thanatos)
In complex ways physical, psychological, spiritual and socio-
economical factors may tilt the balance one way or the other.

3. FEATURES SUICIDE PARASUICIDE
AREA WEST JAFFNA WEST JAFFNA
Sex Males Males Females Equal
Age Old 15-34 yrs. Young 15-34 yrs.
Marital status Divorced
Single, Widowed
Unmarried Single, Divorced
(Marital )
Unmarried . Love marriage,
Marital conflict
Social class Lower (10%) Middle (25%) Lower Lower
Socio-Economic Unemployment
retirement
Socio-economic Stress Unemployment Poverty hunger
s.e. stress
War Less Less ? ? more
Family-
Broken home, Death
Common
Grief
Grief Common Grief
Personality Normal Psychopathy
Psychiatric illness 90% of Total
70% Depression
Alcoholism
17% Depression + Grief,
Alcoholism stress
Situational stress
Personality dis.
Reactive
Depression
Alcoholism
Depression + Grief
Alcoholism stress
Physical illness Chronic pain Terminal
or chronic illness
Ca, HT, Asthma
Intent + Setting Premeditated High intent
Hopelessness
Pessimism
Some never Intended to
die
Impulsive
Low Intent Manipulation
"Message "
"Crisis"
High intent
Crisis
Method - culture
(fashion)
availability /
media
Violent Agrochem
Alary 
Self poisoning drugs Agrochem
Drugs
 Alary
Previous Attempts + (50%) +

5. Suicide

6. Suicide rate in Jaffna (1980-1989)
0
5
10
15
20
25
30
35
40
45
50
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
Year
SuicideRate
Males
Females
Total

7. Management of Suicidal Patients Assessment
1. 60% of patients communicate - take seriously
2. Frustration or Depression - Inquire about suicidal ideas.
 Evaluate risk (see box) and intent
 Suicidal Intent -
 Depth of depression- worthlessness, hopelessness, attitude towards future, guilt, suicidal
ruminations, previous attempts
 If attempted- check circumstances surrounding act.
 Premeditation, Planning, Last acts (will , note etc.)
 Timing - Isolation, Intervention (possible?), Concealment,
 Patient knowledge about toxicity, Method employed, attitude to survival .
 Psychiatric Diagnosis ?
 Treat Depression vigorously with ECT, anti depressants (risk of overdose),
 Alcoholism
 Other - schizophrenia, personality disorder, medical illness
 Identify Problems - Current Stress
 Crisis intervention/ management- problem solving methods,
 counselling, Create Hope, refer to Aid agencies, activate family + social support
 Logotherapy for Despair
 Decide on Admission
 Risk - High risk group, close fit to epidemiological characteristics of suicide
 High intent
 Previous attempts
 Acute crisis / severe depression
 If Yes- Admit (KUO, precautions etc.)
 If No - Relatives’ supervision

8. Suicide Risk- Evaluation
Variable High Risk Low Risk
Demographic and
social profile
Sex Male Female
Marital status Divorced or widowed •Married
Employment Unemployed Employed
Interpersonal relationship •Conflictual •Stable
Family background Chaotic or Conflictual •Stable
Health- Physical •Chronic illness •Good health
♦Hypochondriac ♦Feels healthy
♦Excessive substance intake ♦Low substance use
Mental •Severe depression •Mild depression
•Psychosis •Neurosis
•Severe personality disorder •Normal personality
•Substance abuse •Social drinker
•Hopelessness •Optimism

9. Suicide Risk- Evaluation cont.
Suicidal activity
Suicidal ideation ♦ Frequent, intense, prolonged ♦ Infrequent, low intensity, transient
Suicide attempt ♦ Multiple attempts ♦ First attempt
♦ Planned ♦ Impulsive
♦ Rescue unlikely ♦ Rescue inevitable
♦ Unambiguous wish to die ♦ Primary wish for change
♦ Communication internalized (self-
blame)
♦ Communication externalized (anger)
♦ Method lethal and available ♦ Method of low lethality or not readily
available
Resources
Personal  Poor achievement  Good achievement
 Poor insight  Insightful
 Affect unavailable or poorly controlled  Affect available and appropriately
controlled
Social ♦ Poor rapport ♦ Good rapport
♦ Socially isolated ♦ Socially integrated
♦ Unresponsive family ♦ Concerned family
Variable High Risk Low Risk

10. Suicide Risk- Evaluation cont.
Suicidal activity
Suicidal ideation ♦ Frequent, intense, prolonged ♦ Infrequent, low intensity, transient
Suicide attempt ♦ Multiple attempts ♦ First attempt
♦ Planned ♦ Impulsive
♦ Rescue unlikely ♦ Rescue inevitable
♦ Unambiguous wish to die ♦ Primary wish for change
♦ Communication internalized (self-
blame)
♦ Communication externalized (anger)
♦ Method lethal and available ♦ Method of low lethality or not readily
available
Resources
Personal  Poor achievement  Good achievement
 Poor insight  Insightful
 Affect unavailable or poorly controlled  Affect available and appropriately
controlled
Social ♦ Poor rapport ♦ Good rapport
♦ Socially isolated ♦ Socially integrated
♦ Unresponsive family ♦ Concerned family
Variable High Risk Low Risk