This document provides information on starting a survivors group to prevent suicide. It discusses epidemiology of suicide, risk factors, warning signs, methods used, and management strategies. The key points are: 1) Suicide is a major public health issue, with over 100,000 deaths annually in India. 2) Risk factors include depression, substance abuse, family history, and access to lethal means. 3) Warning signs can be verbal, behavioral, or situational clues of suicidal ideation. 4) Prevention involves identifying at-risk individuals, ensuring their safety, helping them connect to resources, staying connected over time.

1. HOW TO START A SURVIVORS
GROUP-PREVENTING SUICIDE
P. SELVARAJ
HEAD OF THE DEPARTMENT
DEPARTMENT OF PSYCHIATRIC
NURSING
SHANMUGA COLLEGE OF NURSING
SALEM-10

2. EPIDEMIOLOGY
 Statistics show that annually more than
1,00,000 people commit suicide in
India.
 In the year 2009, 14,424 people in the
state of Tamil Nadu committted
suicide, of which Chennai accounts for
1412.
 Suicide resulted in 842,000 deaths
globally in 2013-10th leading cause of

3.  0.5% to 1.4% of people die by suicide, about
12 per 100,000 persons per year. Three
quarters of suicides globally occur in
the developed world.
 Rates of completed suicides are generally
higher in men than in women,
 There are an estimated 10 to 20 million non-
fatal attempted suicides every year
 ratio of attempted suicide to completed
suicide is 10-20: 1 .
 In India the highest suicide rate is in the age
group of 18-30 years.
 suicide in India are reported from
Pondicherry, west Bengal, Chennai, and
Bangalore

4. DEFINITION
Suicide
 sui-self,
 cide-murder
it can be defined as the intentional
taking of one’s own life in a
culturally non-endorsed manner.
Type of deliberated self harm (DSH)

5. ATTEMPTED SUICIDE
defined as any act of self damage
carried out with the apparent intention
of self destruction, however half
hearted, vague and ineffective.
Otherwise-parasuicide, pseudocide,
nonfatal deliberat self harm.
2-10 % of all person who attempt
suicide, eventually complete suicide in
the next 10 years.

6. SUICIDE GESTURE
person performing the action
never intends to die by the act.
However some of these persons
may accidently die during the act.
Attempted suicide is more
common in women while
complete suicide is 2-4 times
commoner in men.

7. ASSISTED SUICIDE
 when one individual helps another bring
about their own death indirectly
 This is in contrast to euthanasia

8. SUICIDAL IDEATION
 It is thoughts of ending one's life but not
taking any active efforts to do so

 vague, fleeting thoughts about wanting to die

9. ETIOLOGY
 loved and accepted
 loneliness, alienation, worthlessness,
helplessness, and hopelessness,
 intense feelings of anxiety, depression, and
anger or hostility directed toward the self
 If no one is available to talk to or listen to such
feelings of insecurity or inadequacy, a suicide
attempt may occur in an effort to seek help or
end an emotional conflict

10. 1. GENETIC FACTORS
 concordance rate of 18% in monozygotic
twins.
 Biochemical factors- low levels of 5-HIAA((a
metabolite of serotonin normally found in
spinal fluid)

11. 2. SOCIOLOGIC THEORIES
 society as an influencing factor on suicide rates
1. Egoistic suicide
suicide by individuals who are not
strongly integrated into any social group
(eg, a divorced male, who has no children and
who lives alone, commits suicide).

12. 2. Altruistic suicide
suicide by persons who believe
sacrificing their lives will benefit society.
For example, a fireman
a suicide bomber
3. Anomic suicide
suicide that occurs when an individual has
difficulty relating to others, adapting to a world
of overwhelming stressors, or adjusting to
expected normal social behavior
(eg, a college student

13. 3. PSYCHOLOGICAL FACTORS
 failures in examination.
 Failure in love.
 Dowry difficulties,
 marital difficulties,
 illegitimate pregnancy,
 family dispute ,
 loss of a loved object by death or others means,
 occupational and financial difficulties and
 social isolation.

14. 4. PHYSICAL DISORDERS
 Patients with incurable or painful physical
disorders,like cancer and aids , offen commit
suicide
 5. Depression
 Major depression , depression secondary to
serious physical illness, reactive depression.
 6. Alcoholism and drug dependence

15.  7. Others
 1. A reunion wish or fantasy
 A way to end one’s feelings of
hopelessness and helplessness
 A cry for help
 An attempt to “save face” or seek a release
to a better life

16. RISK FACTOR FOR SUICIDE
1. Age: >50. Adolescents are also at high risk.
2.Gender: Males are at higher risk than females.
3. Martial status: Single, divorced, and widowed
persons than married persons.
4. Socioeconomic status: Individuals in the
highest and lowest socioeconomic classes
than those in the middle classes.
5. Occupation: Professional health-care
personnel and business executives are at
highest risk.

17. 6.Previous suicide attempt
7. Mental disorders—particularly mood disorders
such as depression and bipolar disorder-
presence of guilt, agitation, nihilistic ideations,
worthlessness, hypochondriacal delusions
8. Co-occurring mental and alcohol and
substance abuse disorders
9 Family history of suicide
10. Hopelessness

18. 11. Impulsive and/or aggressive tendencies
12 Barriers to accessing mental health treatment
13.Relational, social, work, or financial loss
14.Physical illness
15.Easy access to lethal methods, especially
guns
16 Unwillingness to seek help because of stigma
attached to mental and substance abuse
disorders and/or suicidal thoughts

19. 17.Influence of significant people—family
members, celebrities, peers who have died by
18. Cultural and religious beliefs—for instance,
the belief that suicide is a noble resolution of
a personal dilemma
19 Local epidemics of suicide that have a
contagious influence
20 Isolation, a feeling of being cut off from other
people

20. INDIVIDUAL AT RISK FOR SELF DESTRUCTIVE
BEHAVIOUR
1. Verbal suicidal clues
talking about death,
making comments that significant others would be
“better off without” the person,
asking questions about lethal dosages of drugs.
2. Behavioral suicidal clues
writing love notes,
directing angry messages at a significant other
who has rejected the person,
giving away personal items,
or taking out a large life-insurance policy.

21. 3.Situational suicidal clues
describe events or situations that present
themselves either around or within the person,
unexpected death of a loved one,
divorce,
job failure,
diagnosis of a malignant tumor.

22. METHODS USED
 Ingestion of poisons ( about35%)
 Hanging ( about 23%)
 Drowning (about 9%)
 Jumping in front of a train (about 4%)
 Burning (about 12%)
 Weapon or machine (about 1%)

23. COMMON MISCONCEPTIONS ABOUT SUICIDE
Misconceptions Facts
People who talk about
suicide do not commit
suicide. Suicide happens
without warning.
Eight out of 10 people
who kill themselves have
given definite clues and
warnings about their
suicidal intentions.
You cannot stop a suicidal
person. He or she is fully
intent on dying.
Most suicidal people
are very ambivalent
about their feelings
regarding living or

24. Misconceptions Facts
Once a person is suicidal,
he or she is suicidal
forever
People who want to kill
themselves are only
suicidal for a limited time
Improvement after severe
depression means that the
suicidal risk is over.
Most suicides occur
within about 3 months
after the beginning of
“improvement,”
Suicide is inherited, or
“runs in families.”
Suicide is not inherited. It
is an individual matter
and can be prevented.

25. Misconceptions Facts
All suicidal individuals
are mentally ill, and
suicide is the act of a
psychotic person
Although suicidal persons
are extremely unhappy,
they are not necessarily
psychotic or otherwise
mentally ill.
Suicidal threats and
gestures should be
considered manipulative
or attention-seeking
behavior and should not
be taken seriously
All suicidal behavior must
be approached with the
gravity of the potential act
in mind.

26. Misconceptions Facts
People usually commit
suicide by taking an
overdose of drugs.
Gunshot wounds are the
leading cause of death
among suicide victims
If an individual has
attempted suicide, he or
she will not do it again.
Between 50% and 80%
of all people who
ultimately kill themselves
have a history of a
previous attempt

27. Misconceptions Facts
Suicide occurs mainly in
the poor/rich.
Suicide occurs in all
groups of society.
You are either the suicidal
type or you are not and
that is it.
It could happen to
anybody.

28. COMMON THEMES IN SUICIDE
1.It is a crisis that causes intense suffering and
felling of hopelessness and helplessness.
2.There is a conflict between survival and
unbearable stress.
3.There is a narrowing of the person’s perceived
options
4.There is a wish to escape ( it is an escape
rather than a going-towards)
5.There is often a wish to punish self or punish
significant others with guilt.

29. MANAGEMENT
 suicide prevention centres,
 crisis intervention centres,
 psychiatric emergency services,
 medical emergency services,
 social welfare centres or
 even at home.

30. ASSESSMENT AID
IS PATH WARM
 I- Ideation
 S -Substance abuse
 P- Purposelessness
 A- Anxiety
 T- Trapped
 H -Hopelessness
 W -Withdrawal
 A- Anger
 R- Recklessness
 M- Mood changes

31. SUICIDE PREVENTION
 Suicide is a complex public health issue
and requires coordination and
cooperation among
 healthcare providers,
 individuals and family members,
 treatment services and
 other critical stakeholders.

32. RISK IDENTIFICATION
 Talking about wanting to die or wanting to kill
themselves
 Talking about feeling empty, hopeless, or
having no reason to live
 Making a plan or looking for a way to kill
themselves, such as searching online,
stockpiling pills, or buying a gun
 Talking about great guilt or shame

33.  Talking about feeling trapped or feeling that
there are no solutions
 Feeling unbearable pain (emotional pain or
physical pain)
 Talking about being a burden to others
 Using alcohol or drugs more often
 Acting anxious or agitated
 Withdrawing from family and friends

34.  Changing eating and/or sleeping habits
 Showing rage or talking about seeking
revenge
 Taking great risks that could lead to death,
such as driving extremely fast
 Talking or thinking about death often
 Displaying extreme mood swings, suddenly
changing from very sad to very calm or happy
 Giving away important possessions
 Saying goodbye to friends and family
 Putting affairs in order, making a will

35. IF YOU KNOW SOMEONE IN CRISIS
What can I do for myself or someone else?
Sneha Suicide Prevention Centre
Hot line :91.44.24640050
E-Mail : help@snehaindia.org
 What does Sneha Offer?
Sneha extends emotional support to the
depressed, desperate and suicidal when they
feel there is no one to turn to. They need
someone with whom they can share their pain
and misery in confidence; someone who would
listen, understand and accept them

36. WHERE CAN I GO FOR MORE INFORMATION ON
SUICIDE PREVENTION?
 National Suicide Prevention Lifeline : 1–800–
273–TALK (8255), confidential help 24-
hours-a-day.
 Help for Mental Illnesses: National Institute of
Mental Health web
page www.nimh.nih.gov/findhelp

37. 5 ACTION STEPS
 Ask: “Are you thinking about killing yourself
 Keep them safe: Reducing a suicidal
person’s access to highly lethal items or
places is an important part of suicide
prevention.
 Be there: Listen carefully and learn what the
individual is thinking and feeling. Findings
suggest acknowledging and talking about
suicide

38.  Help them connect: Save the National
Suicide Prevention Lifeline’s number in your
phone so it’s there when you need it: 1-800-
8255 (TALK).
 Stay Connected: Staying in touch after a
crisis or after being discharged from care
can make a difference.

39. FAMILY AND FRIENDS
 Take any hint of suicide seriously.
 Do not keep secrets. If a suicidal person says,
“Promise you won’t tell anyone,” do not make
that promise.
 Be a good listener
 Many people find it awkward to put into words
how another person’s life is important for their
own wellbeing,

40.  Express concern for individuals who
express thoughts about committing suicide.
 Familiarize yourself with suicide
intervention sources, such as mental health
centers and suicide hotlines.
 Restrict access to firearms or other means
of selfharm.

41. SELF-HELP-GROUP
 SURVIVORS AFTER SUICIDE - A SELF-
HELP GROUP
helps people come to terms with their grief and
pain in their own way and move forward in
their lives positively and productively.
 The SAS programme consists of 8 weekly
group meetings of 2 hours each. The group is
made up of 10 to 15 people who have lost
someone to suicide and understand the pain
involved.

42. NURSING INTERVENTIONS
 primary prevention
is to identify and eliminate factors that ause or
contribute to the development of an illness or
disorder that could lead to suicide.
primary prevention focuses on providing a
support system, promoting the development of
positive coping skills, and educatingc the
person about his rehabilitation.

43.  Secondary prevention
 involves attempts to identify and treat
physical or emotional disorders in the early
stages before they become disturbing to an
individual.
 Secondary prevention such as individual
therapy or couple therapy

44.  Tertiary prevention
 is used to reduce residual disability after an
illness. For example, a residential treatment
center, a halfway house, or a rehabilitation
center may be used to treat a recovering
alcoholic client who previously attempted
suicide and is recovering from severe
depression but needs the supervision and
support of others to avoid a relapse

45. CLINICAL PEARL
 Be direct. Talk openly and matter-of-factly
about suicide. Listen actively and encourage
expression of feelings, including anger.
Accept the client’s feelings in a
nonjudgmental manner