CHAPTERI

INTRODUCTION

a global tragedy.110. takrng at least 5. even though the highest rates are still found among rhe elderly (M. .Sulc~deI . l-fungary. some of these ranking high 111 respect of' s~iiclderates.000lives every year. In many countries such as Australia. i t occurs among all groups and all soclal classes. suicide has now come to rank among the top ten causes of death for individuals of all ages and among the three leading causes of death for adolescents and young adults. the global plcrure lor the last feu decades has been one of rising trends. Although there arc large lntemational variations in suicide mortality. Lstimates run cvcn to 1 2 mill~on. This has been particularly noted among the younger age groups. Netherlands and Sweden.00. In many countries. deaths due to suicide are even more than those due to road accidents. Su~cide behaviour statistics show that besides the rising number of suicides. at least twentb as Inany make one-fatal suicide attempts serious enough to require medical attent~on oAen resulting in irreversible disability. 1968) As a rcsult in a majority of countries. Japan. But the problem of suicide has not recelvcd adequate attention anywhere.because many cases go underreported due to the 1s associated stlglna S ~ l ~ c l d e a problem both in the highly industr~alizedaftluent societies of developed countries and in the poorer developing countries.

putt~ng heavy burden on their health care system. there are ~nnurnerableothers. suicide is on the rise day by day. such as fam~ly members. it has been estimated that the global level of economlc loss form su~cidalbehavior amounts to about 2. for reasons of social and emotional sufferinf. estimated to be one in every seven minutes. it being the cighth in America. to cope w t h the impact of a suicide tragedy. often for many years. colleagues and care-givers. 100 belong to the Indian subcont~nent Suicide IS now among the top ten causes of death in the country. India ranks tenth in the . 1991).suicide attenipts conir~huteto tlie major emergency hospital admissions of young a people. whose lives are en profoundly affected ( i ~ ~ that for cvery suicide and suicide attempt there are at least five persons cmmed~atelyrelated to the individual.5 percent of the total (Sathyavathi. Moreover. connnit or attempt suicide. *lends. economic burden duc to d~sease 1. su~cldeis among tlie l~rst three reasons for mortality. they may also Inany future suicides may emerge. then each year many million survivors are added lo tlie tens of millions of persons already struggling.01 Context of the Study Of the 1000 people killing themselves every day in the world. Among those aged between 16 and 53. form a pool tiom u i l ~ c h In add~tionto the many m~llionswho. Considering the service cost al for those exhibiting s u ~ c ~ dbehaviour. and lash ot' hope. In India.

1 su~cide 10. Suicide is underrep. 135 to 217 people per hundred thousand population make an attempt on their lives every year.world with the IC)C)7 estimates of 9. Nagaland and Kajasthan Among the cities of India.000 population durirlg the last per few years (Times ot.000. There 1991) w ~ t h figure of17 3 per Iakh ofpopulation.. Manipur. on an average. The statistics that we have relate to thc number of people who actually succeed in their suic~dalattempts It appears ihat in Kerala. Bangalore has highest ~. l'arnil Nadu. 'The incidence is higher in the states of Kerala. 1996). . ie. (4:I ) M The actual rate is likely to be higher as there is often under-reporting due to various social reasons. approximately 30.000 to 60. are not counted as suicide deaths.00. a rate almost three times higher than thc national average. 'Thripura. alcoholis~n and medical non-compliance . incidence ( S a t h \ a \ a ~ l l 1991 ). India.000 individuals in a year (Sathyavathi. such as accidents. Kerala stands first in surcide rates among all the states of India (Sathyavathi a Rihar is at the bottom.orted in part because of the stigma attached to it and because deaths fiom self-destructive behaviour.00. Completed suicide M > F (3:l) and attempt suicide F . the estimates ibr 1997 herng 27 suicrdes in a population of 10. West t3engal. w h ~ l e has been cons~derableincrease in the rate of su~cidein the state of Kerala. while it is lower in Jammu and Kashmir. 1998).

Morc than . Mental health dc professionals espec~allv Clinical Psycholog~sts. It is not only the persons who attempt s u ~ c ~ d c also their fam~ly but members who have to bear the pain and shame of the act hecause of the soc~alstigma attached to suicidal behaviour. religious. the major group e concerned with s u ~ c ~ dcomprises Epidemiologists. Su~c~dolog>a multi-profess~onaldiscipline devoted to the study of suicidal IS phenomenon and its prevention. According to Goldenson (1984). Statisticians. Sociologists. The practising clinician rel~eson a comprehensive clinical review of the patient and his situation. Suic~de cultural. physical and mental . A collective effort of the comniunlty is necessanJ to improve the situation. Clinicians. Psychological and has ideation or intention to commit suicide can be detected and physical aspects. S u ~ c ~ attempt by a loved one is "one of life's universal crisis". . Philosophical. Hence. the role month before the~r of the Clin~calPsvchologist is crucial in suicide prevention.iOuio of those \\lie commit suicide see their physicians within a death and man\ communicate their suicidal intent. Psychiatric Social workers and educators (health educators in schoclls and colleges). Su~cidal these aspects havc to be considered in planning the prevention. I'sychiatrists. sociological. which includes demographic and social profiles. Clinical Psychologists.can assist people in their crisis as many of' 1t5 clernents are painful and hard to face.

Mass media play an important role in suicide. 1973) In re\pect ol marital status. past histor\ and farnil! history. previous suicide attempt. schizophrenia. neurosis. 1989). r . especially more with teenage marriage. (Roy. family history of suicide. personality disorders (Miles 1977.states. low socio-economic status. widowed. for suicide i to occur it is necessary for a number of etiological variables to operate simultaneously. and those in the older age group habe h~gherrisk than younger patrents (Sathyavathi. Several other r~sli factors have heen studied in relation to suicide. (Roy 1988). poor physical and mental health.lor evaluation of risk. It is interact~ve pattern between the individual and his environment which is the critical variable leading to suicide rather than a single . Male to female ratio for completed suicide is 3 : I Studies suggest that males have appreciably higher risk than females. single than married. \eparated people have the h~gher ~ s k followed by the divorced. suicidal behaviour. Iieard 1994). affective disorders. I~C above 45 years ol'age. S L I I C rate increases as people grow older Adolescent suicide is on the rlse. poor iilterpersonal relationship (Faweett 1968). generally 40% suicides are due to alcoholism. Available research reports are not commensurate with the magnitude of suicide in the country. Most studies are retrospective and epidemiological in nature and there of is oversimpl~ficat~on the causes of suicide. (Sainbur et al 1980). Suicidologists opine that. there is lower risk. and current social and interpersonal s~tuation. (Cohen et al 1994).

high health indices. 1. it is worthwhile to study the etiological factors in Kerala which can alrnost he labelled the 'state of suicide" as per the present reports. there IS great need for well-designed. in-depth studies with persistent attention on the persons who had attempted suicides and their families.)ns of the studies reviewed and variations in the reports. Keeping in n e w the diversity of the socio-cultural background of Indians. an in-depth study is planned to explore the Psychological and Sociological factors underlying suicidal behaviour and to develop tools which inay be helpful in identifying and assist~ng those reclulrlng help.02 Need and Significance of the Study In \leu of the various limitations of the studies reported so far. which is culture-spec~tic. high suicidal rate and low per caplta income. The Indian stud~esava~lableare from states other than Kerala.but also tor rendering appropriate service to the suicide h attempters and those \ + ~ t suicidal Ideation by way of crisis intervention. to enable the researchers to get a better understanding of the phenomenon of suicide atte_mpts In the contemporap Indian set u p . Therefore. "This \vould not only pave the way for theory-building.condition. In vlc\\ of the lirnitat1. there IS a great need felt for well-designed. and the uniqueness o t Kcrala with its high i~teracy. multicentric studies with persistent attention on attempted su~cideand suicidal ideation in the Indian context. this would not only pave the way for .

for the present investigation. psycholog~calstatus a n d resources l'he various factors influencing suicidal behaviour can then be understood and appropriate manpower can be developed.theory - hullding \\ll~c. many aspects have been included. The suicidologist labelled Kerala has thc highest suic~derate in India for the last three decades. but also for developing crisis intervention service ti)r the suiclde attempters and their anxious relatives. only a few psycho-social risk factors are considered and there about the cause of suicide is over-s1mpl11'1cation . coping pattem. 111 order to be able to plan prevention strategies. In most studlcs. No etiological factors involved is available comprehensive stud! ol. it Since is important to . As such problems are on the increase in Kerala. \~Iiich contnhute to suicidal behaviour. social support systems and other socio-cultural i5cror-s. social activity. The inental llealth profess~otialsfocus attention on factors like stressful life events. The professionals and non-professionals in Kerala need to understand the risk-factors in suicidal beha\lour. The present study gives more emphasis to psychological rather than socio-cultural variables.li is cilIti. health. llke demographic and social profile. family Interaction pattern. the various to provide the inti~rmation. it 1s necessary that studies be conducted from the psycholog~calpoint O I \ it. no module is as yet a~allableto train helping professionals.\+.Therefore.ire-specific.

04 Defining of Terms The terms used in the statement of the present problem are defined below:- Aetiology 1s the study or theory of the factors that cause diseases and the method of their introduction to the host. the cause or origin of diseases or disorders (Derlands.develop one l l i e in-depth inierviews with the attempters provide valuable information which can be utilized for providing guidelines to train the professionals. suicide gestures. aetiological factors mean factors leading to suicidal behaviour.04. self-injury. suicide commynications . In the context of the present study. 1.02 Thc Suicidal Behavior (SH) generic lerin "suic~dal behavior" includes completed suicide.03 Statement of the Problem 'The prcsenr study aims at identifying the various factors likely to contribute to attempted suicide and suicidal idealon The study is entitled "Aetiological Factors in Suicidal Uehav~our' 1. nonfatal deliberate self-harm (for example suicide attempt. psychological and soc~o-demographic 1. sell-po~soning)with or without suicidal intent. 1994).

1984) .04 Suicidal Ideation (SI) Suicldal ldeatlon 1s the frequent. but which has not resulted in death.. 1.selll~nllicted. Sulc~dalattempt In the present study. or prolonged thought of those who have not attempted sulclde eper. Three broad categories of'suic~dalbehaviour are: ( I ) completed suicide.Sulc~dal attempt IS any act of self-injury consciously aiming at self- destruction-. carried out with the knowledge that it is potentially dangerous to himself. (2) suicidal in \vhich a \ v ~ l l u l .~nciuding suicide threats: and suicide ideation (Donald 1989). (Stengel and Cook 1958) Suiclde attempt includes those situations in which a person has performed an actual or seeming life-threatening behaviour with the intent ot'leopardizlng his lifel or giving the appearance of such an intent. including all deaths life-threatening act has resulted in death.04. but only nourished the tdea of surclde (Goldenson. intense.03 Suicidal Attempt (SA) '. 1. ideation "Suicidal behavior" in the present study is limited to attempt and ( 3 ) s~~lcldal and attempted suic~dc suicidal ldeat~on. refers to a non-fatal act by the individual hlmself. as reported by the casualty medical oficer who attended to the immediate medical management.04.

family's conflict. such as soclal support. in I. contributing to suicidal behaviour. C'ouiiscllors or Mental health professionals from counselling. tamily cohesion. such as independence of of famil) Ilfe. contrlbut~ng iuic~dal to behaviour .cltological risk facton To stud) thc ~ntluenceof ~~sychological factor. Ps. contributing to suicidal behaviour. LIII' is rakei~as reported by Clinical Psychologists.05 Objectives I he ohlcctives of the present study are d ~ v ~ d e d two categories as into psycholoplc'il tdctor\ dnd soclo-dcmdgraph~c factors I tic tollowing are the objectives of the psychological and soc~o- demographic r ~ s ki'ac~ors the present investigations. deadd1ct1011 ('ancer centers aiid 1.111 rile prc~eiitstudy. achievement. -1.. contributing to suicide b e h a lour 5. such as presuinptlve risk stressful lit2 events. 4. contributing to suicidal behaviour 3. such as coplng pattern. soc~alinteractton. I'sychiatris~s. such as family interaction pattern. To study the influence of psychological risk factors. intelligence. family discipline.0 study the ~nfluence psychological risk factors. To stud) the influence of psychological r ~ s kfactors. inoral behaviour. 1 2 To stud) the influence of psychological nsk factors.

The assumption led to the formulation of the major hypothesis in the present study. There will be no significant difference among the study groups with respect to psychological risk factors such as social support. number of suicidal attempts contr~but~ng suicidal behaviour. community. place of residcncc. 'To study thc influence of socio-demographic variables. relig~on. To study the influence of socio-demographic variables. past history. present living arrangement. cohesion. discipline and coping pattern on sulcidal behaviour. social mteraction. conflict. occupational status. family behaviour size contributing to suic~dai 2. durat~on01' ~llness. moral emphasis. The hypothesis for the present investigation are listed below in &o section: I Psychological Variables 1. presumptive stressful life events. family types. .1. such as age. marital status. intellectual orientation. education. income. ro The prexnt ~nvest~gat~on 1s based on the assumpt~on that some of the psychosocial and soc~o-demographicrisk factors contribute to suicidal behaviour. family interaction pattern. such as illness.famil) history. achievement. sex.

place of . 3. Personal Data Form (Prepared by the researcher) Fam~ly lnteraction Scale (Asha.II Socio-demogruphic Variables 1. There w111be no significant difference among the study groups with respect to socio-dcmo~raphic variables such as duration of illness. 3. an exploratory study was conducted on a sample of 300 subjects in the age range of 13-59 years. present arrangement and family size on suicidal behavior. (Rao & Prabhu. family types. 1987) Measurement of social support scale (Mehra. 'iherc h i l l hc no significant difference among the study groups with respect to socio-dcmoqraph~cvariables such as marital status. sex. 4. 7 -.07 Methodology in brief To establish the above hypothesis. family behaviour. The following tools were used for thts research. 1989) Coping check list. 100 patients from General hospitals and Medical College hospitals reported by the casuality medical otf'lcer to have anempted suicide. religion. (Sing et al. . 5. and communitv on suicide behaviour. 1. 100 subjects from mental health centers. 1987) Presumptive stressful life events scale. history and past history on su~cidal 1. education. restdencc. There will he no significant difference among the study groups with respect to socio-demographic variables such as age. suicide prevention clinics. 105 males and 195 females. chronic illness. and 100 controls from general population formed the three main groups for the study. counseling centers with suicidal ideation. occupation. 1989) 2.

from the same settings wlic'rc the attempters \\ere chosen but with no suicidal behaviour..I'at~ents under treatment h r suicidal attempt were interviewed after the critical per~od After. For Data were analyzed using stat~stical categorical \'ariables. information-providing documents like hosp~ral records were also consulted. even though there is a stigma attached to suicide. viz. were seen at the respective center and tools were applied personally The control group was chosen. the odds ratios and their 95% confidence interval were calculated. variance followed by Duncan's ~nultiple 1. with suicidal ideation. the continuous variables were analyzed using one-way analysis of range test. the tools were admintstered to the patlents in the ward setting The clients chosen from the non-casualty scrrlngs. in addition.establishing a rapport with the patients and family members. (2) . the investigator conducted personal interviews using the same tools. (1) prevention of suicide or suicidal behavior. package for social sciences (SPSS). From t h ~ s research investigation suicidologists may get an insight into the planning of their activities. Efforts at research would definitely pave the way for possible suicide preventive strategies. After explaining the research objectives.08 Scope of the Study Every year there is an increase in the number of cases of para-suicide brought to the hospitals.

1. Lase\. 'The problem for the present research work the nlajor hypotheses and methodology are presented in brief in aspects. These in-depth s t u d ~ c shelp in-ser\ Ice planning by mental health professionals in Kerala settings. and these training modules can help to prevent suicidal behaviour.Intervcnt~olii n dl~c'rnpcdsu~cidc. Theoret~cal chapter 11. assessment and treatment are discussed in chapter I . and auarencss programmes can be conducted fbr the potential groups. The details of . . methodology along with steps of investigation constitute chapter IV. especlall\ psychological characteristics. risk factors. Summary adconcluslon are included in chapter VI.09 Oragnization of the Report 'The report has been dev~deilInto six chapters. and (3) postvention of the bereaved fanil I \ survivors of the These findings help in understanding the magnitude of the problem of risk factors. The relevant data analys~sand interpretations of the findings are the content of chapter V. Review of related studies has been presented in chapter 111. and prevention strategies can be developed.

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