The document explores the complexities of suicide, defining it as a self-inflicted death often stemming from mental illness, despair, and societal pressures. It highlights the prevalence of suicidal ideation, particularly among youth, and examines factors influencing suicidal thoughts and behaviors, such as family dynamics and access to resources. Additionally, it discusses the role of media in shaping perceptions of suicide and the need for crisis intervention and mental health support in vulnerable populations.

1. UNDERSTANDING
S U I C I D E
“Hope now,-not health,nor cheerfulness,
Since they can come and go again,
As often one brief hour witnesses,-
Just Hope has Gone forever.”
-EDWARD THOMAS
Muskan Hossain
Oindrila Gupta
Anandi Bhattacharya
Zeeyan Islam

2. INTRODUCTION
We have all felt it, we have all meant it, we have all wanted the pain, the
utter misery, the sheer helplessness to end. We have always at some point
thought that death is easier than life.
But the reality is that most of us have survived thanks to our instinct to
life ( eros). Suicide a topic painful in itself but a necessity to be addressed
is something which is out there in the world conjuring up reasons and
experiences to end one’s own lifeand how to do it is a plethora of choices
from which each individual can choose. But then again is suicide really
the only option we have got?
Is the world really turning into such a place where ending one’s life is
better than seeking for help? Let’s find out.

3. Defining Suicide
One would not expect it to be easy to define or classify suicide and it is not.
Death by one’s own hand is far too much a final gathering of unknown
motives, complex psychologies and uncertain circumstance-for the definition
of suicide to stay locked within the categories chipped out by scientists or
philosophers.
Suicide is defined by Disease Control and Prevention (an agency of the United
States Public Health Service) as a “death from injury,poisoning, or suffocation
where there is evidence (explicit or implicit ) that the injury was self inflicted
and that the decedent intended to kill himself/herself.”
World Health Organization provides an even simpler definition, “a suicidal act
with a fatal outcome” where suicidal act is defined as “self injury with varying
degrees of lethal intent”

4. Suicide Notes- an obvious starting point- often
promise more than they deliver. It would seem that
nothing could be closer to the truth of suicide than
letters left behind; but this is not the case; our
expectations of how we think people should feel and
act facing their own deaths are greater than the
reality of what they do and why they do. 4000 years
ago, an Egyptian wrote out of despair a poem-now
in Berlin Museum, is thought by British Psychiatrist
Chris Thomas to be the first suicide note extant and
he believes it reflects the ruminations of a deeply
depressed, probabaly psychotic mind. Many suicide
notes are short and may give only an explicit
warning to those who are likely to find the bodies:
“BE CAREFUL.Cyanide gas in the bathroom”, Do
not enter. Call Paramedics”. The reasons given for
suicide are often vague and allude to cumulitive pain
and weariness- “I could not bear it any longer, “I am
tired of living”, There is no point in going on”-
without going into further details.

5. Suicidal Ideation
SUICIDE is the anchor point on a continuum of suicidal thoughts and behaviour. This
continuum is one that ranges from risk taking behaviours at one end, extends through
different degrees and types of suicidal thinking and ends with suicide attempts and
suicide. Suicidal Ideation which is to say thinking about suicide is more amenable to
inquiry and measurement. In an early community based study of suicidal thinking and
behaviours, University of Cambridge, psychiatrist Gene Paykel and his colleagues
interviewed more than 7000 people in Connecticut. The results gave a public face to what
had been very private thoughts. More than 10% said that at some point in their lives, they
had felt that “life is not worth living”. 1 out of 20 people had thought about taking his/her
life, seriously. 1 person in 100 had attempted suicide. Two other studies of American High
school students reported that more than 50% of New York high school students reported
that they had “thought of killing themselves” and 20% of Oregon high school students
described a history of suicidal thinking of varying degrees of severity.

7. Suicidal Ideation in Young Children and Why are Parents Unaware About Them?
Cynthia Pfeffer, a child Psychiatrist at Cornell University,
finds that more than 10% of a sample of “normal” school
children with no history of psychiatric illness report
suicidal impulses, One of the children in her study, a 10
year old girl described her thinking painfully:
“I often think of killing myself. It started when i was almost
hit by a car. Now, i want to kill myself. I think of stabbing
myself with knife. When Mom yells at me, I think she
doesn't love me. I worry a lot about my family. Mom is
always depressed and sometimes she says she will die soon.
My brother becomes very angry, often for no reason. He
tried to kill himself last year and had to go to hospital.
Mom was also in hospital once, I worry a lot about my
family. I worry that if something happens to them, no one
will take care of me. I feel sad about this.”
● Parents Seriously underestimates
the extent of depression in their
children.
● It is difficult for parents to believe
that young children are in such
pain as to wish to die, yet many
children are.
● They are unaware about mental
health and also believes that
mental health can only affect older
people and not young children.
● They label “odd” behaviours of
children as attention seeking
tactics.
● They believe that “with time it will
automatically go away”
● Children don't want to disclose
their feelings to their family
because they often feel that their
parents will not understand them.

8. The Borders between thinking, acting, and fatal
action are more tenuous, uncertain, and dangerous
than any of us would like to believe; this Robert
Lowell captured well in his final verses of
“Suicide”:
“Do I deserve Credit
For not having tried Suicide-
Or am i afraid
The exotic act
Will make me blunder,
Not knowing error
Is remedied by practice,
as our first home-photographs,
Headless, half-headed, tilting
Extinguished by flashbulb?”

9. SUICIDE INTENT SCALE
A Suicide Attempt Scale was Developed by Aaron T. Beck and his colleagues at the University of
Pennsylvania for use with patients who attempt suicide but survive, It provides an idea regarding intent
and suicide planning.

10. Psychology and Psychopathology of Suicide
Difficulties in life merely precipitate a suicide, they do not cause it.
Acute Psychiatric Illness is the single most common and dangerous trigger
of suicide. There are many reasons to believe that stressful events might
bring on or worsen a psychiatric illness. If the underlying psychiatric illness
or biological predisposition is severe enough such events may well play a
role in suicide as well.
(for most cases these come in play together; although always these reasons
together donot contribute to suicide; exceptions always prevail)
The awareness of the damage done by severe mental illness- to the
individual and himself and to others- and fears that it may return again
play a decisive role in many suicides. Those patients with Schizophrenia
who are more educated and who demonstrate greater insight into the
nature of their illness are more likely to kill themselves. There is a terror of
becoming a chronic patient - terrible loss of dreams and inescapable
damage done to friends, family and self.
Negative Life Events X Stress (burn out stage) X
Psychiatric Illness X Precipitating Factor = Suicide

11. NEUROBIOLOGICAL PATHWAYS
LINKED TO SUICIDE RISK

12. Freud’s Theory
Karl
Menninger’s Theory
Suicide represents aggression
turned inward against an
introjected, ambivalently
cathected
love object. Freud doubted
that there would be a suicide
without an earlier repressed
desire
to kill someone else.
In "Man against
Himself", conceived of suicide as inverted
homicide because of a patient’s anger toward
another person. This retroflexed murder is either
turned inward or used as an excuse for
punishment. He also described a self-directed
death instinct (Freud’s concept of Thanatos)
plus three components of hostility in suicide: the
wish to kill, the wish to be killed, and the
wish to die.
Recent
Theories
The suicidal patients most likely to act
out suicidal fantasies may have lost a
love object or received a narcissistic
injury, may experience overwhelming
affects like rage and guilt, or may
identify with a suicide victim.
The most frequently discussed
personality traits associated
with suicide are impulsivity, aggression,
pessimism, and negative affectivity,
which all seem to increase the risk for
suicide.
Karl Menninger

13. MIND OF A SUICIDAL PERSON
● Their thinking is paralyzed.
● Their options appear spare or nonexistent.
● Their mood is despairing.
● Hopelessness permeates their entire mental
domain.
● The future cannot be separated from the
present and the present is painful beyond
solace. (comprehension)
● People seem to be able to bear or tolerate
depression as long as there is the belief that
things will improve. If that belief cracks or
disappears, suicide becomes the option of
choice.
Sense of Unmanageable events +
Hopelessness + Invasive negativity about
future = warning signs of suicide

14. The Statistics
Suicide is responsible for more
deaths than malaria, breast cancer,
war or even homicide, according to
WHO.
As per World Health Organisation’s
report in 2016, India had the highest
suicide rate in the South-East Asian
region.
India’s suicide rate (16.5) was higher
than the rate of its geographic region
(13.4) and the rate of its income group
(11.4).

15. ● Globally 800,000 people die from suicide
every year – that’s twice the number from
homicide.
● 1.4% of global deaths in 2017 were from
suicide. In some countries, this share is as
high as 5%.
● Globally, the suicide rate for men is twice
as high as for women. In many countries
this ratio is even higher.
● Suicide rates from firearms are
particularly high in the US – 60% of
deaths from firearms result from suicide.
● Self-poisoning from pesticides have had a
large toll, particularly in low-to-middle
income countries. Bans on some pesticides
have been effective in reducing suicide
rates.

16. The Media Presentation of Suicide
An important aspect of the presentation of suicide in the media is that it usually oversimplifies the
causes, attributing the act to factors such as financial catastrophes, broken relationships, or academic
failure (e.g. in examinations). The most common and dominating factor leading to suicide, mental
illness, is often overlooked. The impact of the media on suicidal behaviour seems to be most likely
when a particular method of suicide is specified, especially in graphic detail, when the story is
reported or portrayed dramatically and prominently along with visual representations of the
recently deceased, and when suicides of celebrities are reported.
Chester Bennington Ernest Hemingway
Sushant Singh Rajput
Jiah Khan

17. WHY DID WE ADD THE SEGMENT ON NEWS?
BECAUSE UNFORTUNATELY CERTAIN ASPECTS OF NEWS COVERGAE CAN
PROMOTE SUICIDE CONTAGION. What are they?
● Presenting Simplistic explanations for suicide.
● Engaging in repetitive,ongoing or excessive reporting of suicide in the news
● Presenting pictures of the site of Suicide
● Providing sensational coverage of suicide
● Reporting “how-to” descriptions of suicide
● Glorifying suicide or persons who commit suicide can be triggering for some people at
risk.

18. Evidence suggests that suicide rates
can increase following the suicide
of a prominent celebrity or peer,
sometimes known as suicide
contagion. A study reported a 10%
increase in U.S. suicides in the
months following the suicide of
comedian Robin Williams, who
died in August 2014. It was found
that the data supported an
increased number of suicides
resulting from media accounts of
suicide that romanticize or
dramatize or sensationalize the
description of suicidal deaths.
A study conducted in Hong Kong in
2017 found that the age, gender, and
method of the suicides were largely
reported correctly (> 70%) but
accounts of risk factors were seldom
accurate (< 46%). Specifically, suicide
risk factors such as being unemployed,
having a history of suicide attempts,
and lacking social support were
misreported by over 70% of the
articles.
Robin WIlliams

19. Case Study: Sylvia Plath
Sylvia Plath was one of the most renowned poets in America in the twentieth century. Although she only lived a life
spanning 30 years, she composed innumerable poems and short stories. However, she only wrote one novel in her
lifetime, The Bell Jar. She was diagnosed with depression when she was 20 years old. Although she was not diagnosed
with bipolar disorder, it is suspected that she experienced hypomanic episodes during the course of her depression. The
following are brief details of the factors that may have contributed to her diagnosis, the multiple tries to end her life, and
her final suicide attempt, at which she succeeded.
Plath’s first ‘medically documented’ attempt: overdose on pills in mother’s cellar; Aug 1953
Possible precipitating factor/s: Vexation due to repeatedly being denied a meeting with Welsh poet Dylan Thomas, whom
she claimed to ‘love more than life itself’; Denied admission to Harvard Writing Seminar
Plath’s second attempt: drove her car over the side of the road into the river, Jun 1962
Possible precipitating factor/s: Miscarriage of second pregnancy; An episode of domestic violence prior to miscarriage
Plath’s third and final attempt: died of carbon monoxide poisoning as a result of putting her head far into the gas oven;
Feb 1963
Possible precipitating factor/s: prolonged depressive episode lasting for over 6 months, marked by constant agitation,
suicidal thoughts, inability to cope with daily life, weight loss;

20. Dying
Is an art, like everything else.
I do it exceptionally well.
I do it so it feels like hell.
I do it so it feels real.
I guess you could say I’ve a call.
(from Sylvia Plath’s poem, “Lady Lazarus”)

21. ANALYSIS OF SYLVIA PLATH’S CASE AND CRISIS INTERVENTION WHICH SHOULD HAVE BEEN DONE
● Father was authoritarian.
● Father died when she was 8 years old.
● Being denied a meeting with Welsh poet Dylan Thomas, whom she claimed to love.
● Denied admission to Harvard Writing Seminar
● Was depressed and tried suiciding at the age of 19..
● Marriage was having problems because of her husband’s infidelity and plath’s
mental illness.
● Miscarriage during second pregnancy.
● Reports of domestic violence.
● Second attempt of suicide.
● Her husband left her for another woman.
● She was left with two children to care for alone.
● Third suicide attempt lead to her deaath.
Sylvia Plath, five years before her suicide described the seeping, constricting side of
her depression: “I have been and am battling depression “, she wrote in her journal.
“I am now flooded with despair,almost hysteria, as if i were smothering. As if a great
muscular owl were sitting on my chest, its talons clenching and constricting my
heart.”
What could help her?
● Her husband who
knew about her
mental illness but did
not help her in
getting proper
treatment.
● Her poems and work
clearly stated about
her mental illness
and suicidal attempts
yet no one (friends,
family,colleagues,
followers) understood
her cry for help.
● Before death she had
written series of letter
to a
friend(psychiatrist).

22. 1ST CASE OF STUDENT SUICIDE IN INDIA DUE TO COVID’19 EDUCATION CRISIS
The case occurred in Kerala ( India) and was reported on June 2 ( The Hindu, 2020).
An educationally gifted 15 year old girl in Grade X ( awarded by her school for her
academic brilliance ) committed suicide because she was unable to attend online
classes or watch television lessons because she had no access to a smartphone!
Her father was a day labourer but had not earned any money for two months due to
lockdown and the family was in extreme financial poverty. Acc. to media reports, she
was worried that her academic performance would be affected because she was not
being able to do the lessons for quite a long time. Also, any sort of accessibility seemed
futile due to her family’s condition. Thus, becoming depressed she took her own life.
Though, there are other student suicides which have been reported ( Thakur and Jain,
2020), still this was the first case where the main reason for suicide was due to lack of
acess to technology and also due to the extreme economic problems which led to the
fragile state of the girl’s mind.

23. DEEPER ANALYSIS OF THE CASE AND CRISIS INTERVENTION
ANALYSIS:
● Online learning modules and technology
are not available for all.
● Mental health of such students who don’t
have access to online learning is of great
concern. ( Sahu, 2020)
● Jotting down the main crisis situations for
the above mentioned girl’s case:
1. Due to lack of accessibility to online
education, doubts related to her own
ability as a good academic student started
to creep in.
2. Economic problems added to the already
fragile state of the girl’s mind
3. Not being able to talk or express her
situations thinking that no one would
care led to depression and ultimately to
suicide.
CRISIS INTERVENTION:
● Those running academic institutions must be
made aware of how many student’s families
are vulnerable and can’t afford education
online.
● The girl was academically intelligent in this
case, but in case of those with lesser
academic ability must have some sort of
mentorship under an educator whom they
can contact via telephone.
● Alternate methods such as recording of
videos, making presentations and documents
can be used.
● Talking to one’s peers about the situation
and the peer alerting the academic staff and
the family is also a major intervention
strategy that could possibly reduce further
cases like this.

24. Suicide among Mental Health Practitioners
A high suicide rate among psychiatrists (58 to 65/100,000 compared with that of the general
population, 11/100,000) has been reported by the following: Freeman, Blachly et al
Their reasons are no different than the general population
although they are more emotionally and mentally
exhausted as they are on the verge of burnout.
The cases they see on the daily basis are heavy and
emotional which leaves an impact on them.
Researchers find that the best way to cope are:
● Self care. Taking time from their work is hard but a
necessary step when things get overwhelming.
● Seeking treatment and therapies themselves.
● A self help group among colleagues weekly helps in
sharing problems.

25. Signs Someone is contemplating Suicide
(There is always a sign, a cry of plea which we often miss)
1. Severe sadness or moodiness: suddenly crying or becoming angry, having
“emotional breakdowns”
2. Hopelessness: Not doing their usual work or their professional work or doing
with little to no interest.
3. Severe Sleep Problems
4. Sudden calmness: Suddenly becoming calm after a period of depression or
moodiness can be a sign that the person has made a decision to end their life.
5. Making preparations: This might include visiting friends and family members,
giving away personal possessions, making a will, putting out huge amount food
for their pets. Some people will write a note before taking their own life. Some
will buy a firearm or other means like poison.
6. Talking about Suicide Indirectly: Something like “if i go away will you miss me?”
or “What if i was never born?”
7. Sudden loss or any traumatic event.
8. Withdrawal and wanting to stay alone.
9. Suddenly into substance use or increased substance use.

26. IT IS BETTER TO BE SAFE THAN TO BE SORRY.
PRECAUTION IS BEST BECAUSE THERE IS NO CURE.
LISTEN TO YOUR CHILDREN,PARENTS , FRIENDS AND YOUR DEAR AND NEAR ONES.
GUILT LIVES FOREVER.

27. PREVENTION OF SUICIDE
Psychological first Aid for Suicide: Save the person physically at any cost.

28. The National Depressive and Manic-Depressive Association, Chicago, makes the following specific
recommendations to family members and friends who believe someone they know is in danger of
committing suicde:
1. Don’t Leave the person alone until you are sure they are hands of competent professionals.
2. Take your friend or family members seriously.
3. Stay Calm but don’t underact.
4. Involve other people. Don’t try to handle the crisis alone or jeopardize your own health or safety.
5. Contact the person’s psychiatrist, therapist, crisis intervention team, or others who are trained to
help.
6. Express Concern.
7. Listen attentively. Maintain eye contact. Use body language such as moving close to the person
or holding his or hand, if it is appropriate.
8. Acknowledge the person’s feelings. Be Empathetic, not judgemental. Do not relieve the person of
responsibility for his or her actions.
9. Reassure. Stress that suicide is a permanent solution to temporary problems. Provide hope.
Remind your friend or family member that there is help and things will get better.
10. Don’t promise confidentiality. You may need to speak to your loved one’s doctor in order to
protect the person. Don’t make promises that would endanger your loved one’s life.

29. AS PARENTS AND TEACHERS HOW CAN WE SAVE OUR CHILDREN FROM REACHING A POINT OF
SUICIDAL IDEATION?
1. If we ourselves are going through any mental illness we must seek immediate help because children
understand our mood and miseries more than we think so.
2. We must create a safe space with the children so they can tell us all their worries without apprehension.
3. We must never judge them for even of their smallest of problems instead give them an empathetic hearing.
4. Surround them with love and nurture and always keep a healthy communication.
5. Make them realise that their life is above all the material aspects like studies,money etc.

30. Crisis
Intervention
Of Suicide
If living alone they must be
brought back to family or
any care facility.
Make them realise that
suicide is a temporary
solution.
Let them talk to you and
try exhausting them off
their energy.
Call their doctor/therapist
immediately; usually
medicines are given to calm
them down.
Try using body language
like holding them or
hugging them if possible.
If the person is in a
isolated place call the
police for help.
Be empathetic and try
instilling hope in them.
Call or Inform anyhow a family
member/friend/anyone near to
be physically present with the
person.

31. Pharmacotherapy Ideation and of Suicidal
Behaviour
1. ANTIDEPRESSANTS
2. MOOD STABILIZERS
3. ANTIPSYCHOTIC DRUGS
4. BENZODIAZEPINES
Psychotherapeutic Approaches to
Suicidal Ideation and Behaviour
1. Cognitive-behavioural Therapies
2. Problem-solving Therapy
3. Cognitive Therapy
4. Outreach and Intensive
Therapies
General Hospital Management of
Suicide Ajtempters
1. IMMEDIATE MEDICAL
CARE
2. PSYCHIATRIC
ASSESSMENT
3. Psychiatric Inpatient
Treatment
4. Outpatient and
Community-based Care
Suicide Prevention in Schools
A. PSYCHO-EDUCATIONAL
PROGRAMMES (for
teachers,
parents,counsellors)
B. Identification of “Warning
Signs”
C. Teaching How to Respond
to the Suicidal Students
D. Destigmatization and
Encouraging Help-seeking
E. DIRECT CASE-FINDING
OR SCREENING
F. ACTIVE
INTERVENTIONS
Suicide Awareness Via Media
1. When a death by suicide
comes to news they could
bring a psychologist who
would talk about how to
understand signs and how to
help the person at risk.
2. Provide resources like suicide
helpline numbers.

32. “Suicide is an epidemic,
Signs of depression go overlooked
So if you’re depressed
Then you need to book a therapy session
Talk about your depression
And let a professional hear it”
-Bo Burnham

33. ASSOCIATED TERMS WITH SUICIDE
Parasuicidal Behavior
Parasuicide is a term introduced to
describe patients who injure themselves by
self-mutilation (e.g., cutting the skin), but
who usually do not wish to die. Studies
show that about 4 percent of all patients in
psychiatric hospitals have cut
themselves; the female-to-male ratio is
almost 3 to 1. Most persons who cut
themselves claim to experience no pain
and give reasons for this behavior such as
anger at themselves or others, relief of
tension. Most are classified as having
personality disorders and are significantly
more introverted, neurotic, and hostile
than controls.
Euthanasia and Assisted Suicide
Euthanasia and physician-assisted suicide refer to
deliberate action taken with the intention of ending a
life, in order to relieve persistent suffering.
Euthanasia: A doctor is allowed by law to end a person’s
life by a painless means, as long as the patient and their
family agree.
Assisted suicide: A doctor assists a patient to commit
suicide if they request it.
“Intentionally helping a person commit suicide by
providing drugs for self-administration, at that person’s
voluntary and competent request.”
Voluntary: When euthanasia is conducted with consent.
Non-voluntary: When euthanasia is conducted on a
person who is unable to consent due to their current
health condition.

35. ● We need to continue to research suicide and non-fatal suicidal behaviour, addressing both risk and protective
factors.
● We need to develop and implement awareness campaigns, with the aim of increasing awareness of suicidal
behaviours in the community, incorporating evidence on both risk and protective factors.
● We need to target our efforts not only to reduce risk factors but also to strengthen protective factor, especially
in childhood and adolescence.
● We need to train health care professionals to better understand evidence-based risk and protective factors
associated with suicidal behaviour.
● We need to combine primary, secondary and tertiary prevention.
● We need to increase use of and adherence to treatments shown to be effective in treating diverse conditions;
and to prioritise research into effectiveness of treatments aimed at reducing self-harm and suicide risk.
● We need to increase the availability of mental health resources and to reduce barriers to accessing care.
● We need to disseminate research evidence about suicide prevention to policy makers at international, national
and local levels.
● We need to reduce stigma and promote mental health literacy among the general population and health care
professionals.
● We need to reach people who don't seek help, and hence don't receive treatment when they are in need of it.
● We need to ensure sustained funding for suicide research and prevention.
● We need to influence governments to develop suicide prevention strategies for all countries and to support the
implementation of those strategies that have been demonstrated to save lives.
P
R
I
O
R
I
T
I
E
S

36. SUICIDE HELPLINE NUMBERS IN INDIA
● iCall (TISS)- 9152987821
● Jeevan Aastha Helpline :1800 233 3330
● AASRA : 09820466726
● COOJ Mental Health Foundation : 0832-2252525
● VANDRAVELA FOUNDATION: 18602662345 and
+91-9999666555
● KIRAN MENTAL HEALTH ( GOVT ) - 18005990019
● FORTIS STRESS HELPLINE : +91-8376804102

37. BOOKS ON SUICIDE AND CRISIS
INTERVNETION

38. CONCLUSION
“If to do were as easy as to say then chapels would be churches and poor men’s cottages will be
prince’s palaces” - Merchant of Venice, Shakespeare.
The importance of this quote is that when a person is really pushed to that limit where the end and
going over the edge seems the easiest thing to do, then in most cases words of wisdom or advice seem
futile.
However, with that being said it also does not mean that we shouldn’t give that effort to save someone
from ending their precious life. Times, specially during this Covid situation have worsened. If not
Covid, then some fungus, some natural calamity, political aggression etc are also rearing up their ugly
heads, but does that mean that it is the end of the world? Rather, I should ask, even if it is the end of
the world, is there really not a single reason why you want to stay alive?
And if the answer to the above question is Yes, then don’t just only seek help immediately but also
remember and acknowledge the fact, that suicide is easy, but survival is difficult! And it has always
been so.

39. Take a step back because you don’t know which
person,which book, which song oe which quote might save
you.
Talk To Someone.
Value Your life
Love Life
And if you are alive today then feel as if that is the highlight
of the day.
THANK YOU
TAKE CARE AND STAY SAFE