DR.

RAM MANOHAR LOHIYA NATIONAL LAW UNIVERSITY

SESSION (2018-2019)

PSYCHOLOGY PROJECT

ON

TEENAGE SUICIDE: WHY IT HAPPENS AND WHAT TO DO ABOUT IT

SUBMITTED TO:
SUBMITTED BY:

Ms. Tanya Dixit Sonal Verma

Assistant Professor (Psychology) ENROLLMENT NO. 180101138

Dr. Ram Manohar Lohiya National Law University Section-B

B.A. LLB (Hons.) 1st Semester

1
2
 INTRODUCTION

Suicide is the second leading cause of death - following motor vehicle accidents
- among teenagers and young adults. On average, adolescents aged 15 to 19
years have an annual suicide rate of about 1 in 10,000 people. Among youths 12
to 16 year of age, up to 10% of boys and 20% of girls have considered suicide.
Gay and lesbian adolescents are more likely to attempt suicide than their
heterosexual peers. Suicide rates are 5 to 7 times higher among First Nations
and Inuit teens.

The teen years are an anxious and unsettling period as boys and girls face the
difficulties of transition into adulthood. It is a period in life that is often
confusing, leaving teens feeling isolated from family or peers.

About 800,000 people commit suicide worldwide every year, of these 135,000

(17%) are residents of India, a nation with 17.5% of world population. Between
1987 and 2007, the suicide rate increased from 7.9 to 10.3 per 100,000, with
higher suicide rates in southern and eastern states of India. In 2012, Tamil
nadu (12.5% of all suicides), Maharashtra (11.9%) and west Bengal (11.0%)
had the highest proportion of suicides. Among large population states, Tamil
Nadu and Kerala had the highest suicide rates per 100,000 people in 2012. The
male to female suicide ratio has been about 2:1.

Estimates for number of suicides in India vary. For example, a study published
in Lancet projected 187,000 suicides in India in 2010, while official data by the
Government of India claims 134,600 suicides in the same year.

3
 RESEARCH QUESTION

1. What is the current status of the teenage suicide among different section of
society?

2. What is the importance of psychological behaviour in teenage suicide?

3. How psychologically this problem of teenage suicide can be tackled?

4. What are the key methods to make children aware and help them to deal
with the emergence of suicidal thoughts?

OBJECTIVE

 Assessing suicidal behaviour from a psychological perspective.

 Elaborating on what are the causes and what brings in such a
behaviour that takes a hazardous toll on the victim.

Studying the impact on, not only the one who is the victim but also his close
ones.

RESEARCH METHODOLOGY
4
 Consulting secondary sources of data that includes- research papers,
journals, reports, internet, newspapers and articles.
 Qualitative analysis of data to provide insights into the problems or help
to develop ideas or hypothesis for potential research.

5
 CHAPTERISATION

WHAT IS TEENAGE SUICIDE?

Suicide is preventable and it is unacceptable that 6188 people died by suicide in

the UK in 2015 (Office of National Statistics, Suicide in the UK, 2015
registrations). Men, particularly those aged 20–29 years and those aged 40–49
years, are most at risk of suicide, but the rising rates of suicide by women and
those in the criminal justice system are extremely worrying. No civilised and
caring society should tolerate this level of despair, hopelessness and avoidable
tragedy. The early identification of suicidal thoughts and behaviour, and
effective care for those of us at risk, are crucial in ensuring people receive the
care they need and deserve. Action at an early stage is core to any strategy for
suicide prevention. Although the causes of suicide are many, understanding the
psychological processes underlying suicidal thinking and the factors that lead to
people acting on their thoughts of suicide is vital to enabling the development
and implementation of effective prevention and intervention techniques. This
includes understanding the social factors and health inequalities that lead to a
sense of hopelessness and despair, and understanding how we as individuals
make sense of and respond to challenges in our lives. Psychologists have made
significant contributions to our understanding of the interconnected nature of
the causes of suicidal behaviour. ‘Every 40 seconds a person dies by suicide
somewhere in the world and many more attempt suicides.’

Suicide and non-fatal suicidal behaviour are major public health concerns.
Suicide is the 14th leading cause of death worldwide, responsible for 1.5 per
cent of all mortality and it is the leading cause of death among young and
middle-aged men in the UK. However, despite the prevalence of suicide, it ‘…
has remained a low public health priority. Suicide prevention and research on

6
suicide have not received the financial or human investment they desperately
need.’ Suicidal behaviour refers to thoughts and behaviours related to suicide
and self-harm that don’t have a fatal outcome. These thoughts include the more
specific outcomes of suicidal ideation (an individual having thoughts about
intentionally taking their own life); suicide plan (the formulation of a specific
action by a person to end their own life) and suicide attempt (engagement in a
potentially self-injurious behaviour in which there is at least some intention of
dying as a result of the behaviour). Although suicide usually occurs in the
context of mental health conditions (e.g. depression) there are many risk factors
for suicide. Indeed, a past history of suicidal behaviour or self-harm is one of
the strongest predictors of death by suicide (Carroll et al., 2014). Self-harm is
defined as intentional self-poisoning or self-injury, irrespective of motive. As a
result, much research and clinical attention has focused on those who self-harm
as the latter is an important predictor of suicide irrespective of whether the
previous self-harm had a suicidal motive or not.

Whilst much research has been conducted to determine the causes of suicidal
behaviour, what lies behind the decision to end one’s life is not fully
understood. Nevertheless, it is well recognised that a range of complex factors
influence this behaviour. Identifying the mechanisms by which various factors
are associated with an increase in suicidal behaviour is a way of working
towards effective prevention and intervention. ‘Suicide is perhaps the cause of
death most directly affected by psychological factors because a person makes a
conscious decision to end his or her own life’. Thus, psychology is central to
understanding and preventing suicide.

7
WHAT IS MAIN REASON BEHIND RISE IN TEENAGE
SUICIDE?

Many troubling and difficult situations can make a teen consider

suicide. The same emotional states that make adults vulnerable to considering
suicide also apply to adolescents. Those with good support networks (e.g.,
among family and peers, or extracurricular sport, social, or religious
associations) are likely to have an outlet to help them deal with their feelings.
Others without such networks are more susceptible during their emotional
changes, and may feel that they're all alone in times of trouble.

Apart from the normal pressures of teen life, specific circumstances can
contribute to an adolescent's consideration of suicide. It's especially difficult
when adolescents are confronted with problems that are out of their control,
such as:

 divorce

 a new family formation (e.g., step-parents and step-siblings)

 moving to a different community

 physical or sexual abuse

 emotional neglect

 exposure to domestic violence

 alcoholism in the home

 substance abuse

Many suicides are committed by people who are depressed. Depression is a

mental health disorder. It causes chemical imbalances in the brain, which can
lead to despondency, lethargy, or general apathy towards life. Almost half of
14- and 15-year-olds have reported feeling some symptoms of depression,

8
which makes coping with the extensive stresses of adolescence all the more
difficult. Symptoms of depression in youth are often overlooked or passed off as
being typical "adolescent turmoil."

Another serious problem that can lead teens to suicide - or aid in their plans to
end their lives - is the easy access many of them have to firearms, drugs,
alcohol, and motor vehicles. For the general population, about 30% of suicides
involve firearms. Of all firearm-related deaths that occur, about 80% are
suicides.

WHAT ARE THE PYSCHOLOGICAL PERSPECTIVE ON

TEENAGE SUICIDE?

The causes of suicidal behaviour are not fully understood; however, this
behaviour clearly results from complex interaction of many different factors.
The risk of non-fatal suicidal behaviour is increased in young people, women
(who have higher rates of non-lethal suicidal behaviour than do men, although
men are more likely to die by suicide), people who are unmarried, and people
who are socially disadvantaged (eg, low income and education, or unemployed).
Although a range of risk factors for suicidal behaviour has been identified, how
or why these factors work together to increase the risk of this behaviour is not
clear. Perhaps the most widely studied risk factor for suicidal behaviour is the
presence of a previous psychiatric disorder. Findings from psychological
autopsy studies5 suggest that more than 90% of people who die by suicide have
a psychiatric disorder before their death. On balance, however, most people
with a psychiatric disorder never become suicidal (i.e., experience suicidal
thoughts, make suicide attempts, or die by suicide). For instance, less than 5%
of people admitted to hospital for treatment of an affective disorder die by
suicide;6 most people with a psychiatric disorder will not die by suicide, nor

9
will they experience suicidal behaviour. Thus, although the presence and
accumulation of psychiatric disorders are risk factors for suicidal behaviour,
they have little predictive power, and perhaps more importantly do not account
for why people try to kill themselves. For this reason, more specific markers of
suicide risk need to be identified. Psychological science is well placed to
advance the understanding of why some people attempt suicide but others do
not. Understanding of the psychological processes that underpin both suicidal
ideation and the decision to act on suicidal thoughts is particularly important,
because interventions should be targeted at addressing suicidal ideation when it
first emerges, before it progresses to a suicide attempt

Factors related to personality and individual differences are of interest because

they are fairly stable in adulthood, often have known biological bases, are
affected by the environment, and affect cognition and emotion.

HOPELESS

Although hopelessness is usually operationalised as a state factor (i.e., a factor

that varies over time), we include it in this section to emphasise that it also has
trait components (i.e., components that are relatively stable over time), and
future research should investigate the relative predictive usefulness of state
versus trait hopelessness. Hopelessness, defined as pessimism for the future, is a
strong predictor of all indices of suicidal ideation and behaviour. In a classic
study, Beck and colleagues were able to predict 91% of all suicides from
hopelessness scores in a 10-year prospective study of patients admitted to
hospital with suicidal ideation. However, findings from a 12-year prospective
Finnish study showed that when suicidal intent was compared with hopelessness
(in a sample of 224 cases of attempted suicide), hopelessness was a non-
significant predictor of suicide. More recently, in a small study of people who

10
attempted suicide, hopelessness did not significantly predict future suicide
attempts in a 4-year follow-up when past suicide-attempt history and
entrapment were included in the analysis. These more recent mixed findings
suggest that although hopelessness is important in the development of suicidal
ideation (consistent with theoretical models), other factors might be more useful
in the prediction of actual suicide attempts or deaths.

IMPULSIVITY

Although impulsivity has been studied for decades, its association with suicide
risk is not as consistent or as straightforward as originally thought, and its effect
might be less direct. Findings from many studies have shown that self-reported
impulsivity is associated with suicidal ideation, suicide attempts, and suicide
deaths. The meaning of impulsivity is confused and needs resolution, with some
studies operationalising it as novelty-seeking behaviour or having a short
attention span, whereas other researchers define it as non-planning or cognitive
impulsivity. Other research emphasises the importance of differentiation
between impulsivity as a trait versus a state construct. The evidence is also
mixed regarding whether impulsivity is associated with the medical seriousness
of the episode. Nonetheless, impulsivity should still be considered when risk of
suicide or self-harm is assessed. It might not be important in all cases of suicide
risk, but it is more likely to be evident in young people than in older people.
Impulsivity can be useful to predict repeated suicide attempts in individuals
with personality disorder. Impulsive aggression is associated with suicide
attempts. Negative urgency, defined as the degree to which a person acts rashly
when distressed, also needs further research.

11
PERFECTIONISM

Growing evidence suggests that perfectionism is associated with suicidal

ideation and suicide attempts, although few prospective clinical studies have
been done.45,46 Perfectionism can be defined in different ways and not all
types are equally associated with suicide risk. One type, socially prescribed
perfectionism (defined as the belief that other people [eg, family members] hold
unrealistically high expectations of you), is most consistently associated with
suicidal thoughts and attempts, especially when these socially determined
beliefs are internalised as self-criticism. Recent research suggests that the social
dimensions of perfectionism increase suicide risk by promoting a sense of social
disconnection, which is consistent with the integrated motivational-volitional
model and interpersonal theory of suicide. In particular, perfectionistic beliefs
can also interact with other factors (eg, negative life events, adversity, and
cognitions) to impede recovery from a suicidal episode or increase risk of
suicidal ideation and self-harm further.

The big five personality dimensions: neuroticism, extroversion, agreeableness,

openness to experience, and conscientiousness. In general terms, high levels of
neuroticism and low levels of extroversion are associated with suicidal ideation,
attempts, and completions. However, exceptions exist; in an 18-year follow-up
to patients with depression, neuroticism did not predict future suicide risk. The
combined effects of high neuroticism and low extroversion might be stronger
predictors of suicide than is neuroticism alone. The proposed interaction is
consistent with predominant theories, suggesting that people who are more
sensitive to distress (i.e., high neuroticism) and are socially disconnected are at
increased risk of suicide. The findings for openness to experience,
conscientiousness, and agreeableness are less consistent, and these constructs
have been less frequently studied.
12
OPTIMISM AND RESILIENCE

Surprisingly few attempts have been made to investigate the direct or indirect
association between trait optimism and suicidal ideation or attempts, and almost
no longitudinal studies have been published. Some evidence, however, in
college students suggests that people with high optimism have reduced risk of
suicidal ideation or attempts when confronted with severely or moderately
negative life events compared with people with low optimism. Low levels of
optimism are associated with self-harm in adolescent girls. Optimism has also
been shown to buffer the association between hopelessness and suicidal
ideation. The protective effect of optimism has also been shown in a patient
sample recruited from a primary care clinic. Although these findings are
promising, the protective effect over time is largely unknown and needs future
scrutiny. Despite research interest in resilience (defined as “qualities that enable
one to thrive in the face of adversity”), there is little evidence for its protective
effect in the context of suicide risk. Some evidence suggests a protective effect
of resilience on suicide ideation in military personnel, misusers of alcohol and
illegal drugs, and prisoners, but its effect on suicide attempts or deaths by
suicide is largely unknown. The validation of the suicide resilience inventory
might stimulate more research into this topic. In view of the scarcity of research
into protective factors, efforts have been made to identify factors that confer
resilience by buffering against suicide risk in the face of adversity. Such studies
have examined appraisals of stressful situations and self-appraisal, and their
findings suggest that positive appraisals might buffer against the development
of suicidal ideation.

13
COGNITIVE FACTORS

In an attempt to understand how and why some people’s thought processes lead
them to decide to end their lives, researchers have examined different cognitive
processes that might be deficient or dysfunctional in suicidal people. Such
research has identified several cognitive factors that seem to increase the risk of
suicidal behaviour. Cognitive rigidity For decades, clinical and theoretical
accounts have described suicidal people as being cognitively rigid or inflexible,
leading to the conclusion that suicide is the only option. Findings from studies
in which behavioural tests of cognitive rigidity are administered to suicide
attempters and clinical controls have lent support to this notion. This rigidity
was first reported in an early study by Neuringer, and has since been shown
many times with use of a range of neuropsychological measures of cognitive
rigidity or flexibility, such as tests of set-shifting (i.e., the ability to change
thinking and behaviour in response to a changing environment). Findings from
recent studies showed that this effect was not accounted for by the presence of
depression, and that cognitive rigidity prospectively predicted suicidal thinking.
Impaired decision making is also evident in suicide attempters.

RUMINATION

Rumination, which refers to repetitive focus on an individual’s own symptoms

of distress, has been linked with suicidal thoughts and attempts. A review into
the association between rumination and suicidal behaviour showed that findings
from 10 of 11 studies examining this association showed support for this link. A
distinction has been noted between brooding rumination, in which a person
dwells on his or her symptoms, and reflective pondering, in which a person
contemplates the reasons for his or her symptoms and potential solutions, with

14
brooding rumination being more strongly associated with suicidal thoughts and
attempts. Rumination has also been associated with increased symptoms of
depression, hopelessness, and impaired problem solving; an important aim for
future research is to clarify how these factors might work together to increase
the risk of suicidal behaviour.

THOUGHT SUPPRESSION

Thought suppression refers to attempts to intentionally stop thinking unwanted

thoughts. During the past 25 years, Wegner and other researchers, have reported
that thought suppression paradoxically increases the frequency of specific
unwanted thoughts, and might be a mechanism through which several forms of
psycho-pathology develop. Findings from several studies, showed that a
tendency to suppress unwanted thoughts was associated with both suicidal
ideation and attempts, and that thought suppression mediated the association
between emotion reactivity and the occurrence of self-injurious thoughts and
behaviour.

AUTOBIOGRAPHICAL MEMORY BIASES

People who engage in suicidal behaviour have a decreased ability to recall

specific autobiographical memories, which might in turn impair their ability to
imagine the future and to engage in effective problem solving, thus increasing
the likelihood of suicidal behaviour. Some evidence suggests that auto bio-
graphical memory biases result in part from previous abuse or from the presence
of an affective disorder, and as such represent a potential mechanism through
which abuse and affective disorders could lead to suicidal behaviour.

15
BELONGINGNESS AND BURDENSOMENESS

Durkheim, Shneidman, and most recently Joiner have proposed that thwarted
belongingness predisposes to the development of suicidal thoughts and
behaviour. Consistent with these theories, lack of social connectedness and
subjective perception of thwarted belongingness have been associated with
suicide ideation, and suicide attempts. A person’s perceptions that he or she is a
burden to others is an independent predictor of suicide ideation in a range of
samples, including older adults and people with chronic pain. Perceived
burdensomeness also has been shown to mediate the association between
perfectionism and suicide ideation, and to remain predictive of ideation even
after controlling for factors such as depression and hopelessness. Consistent
with the interpersonal theory of suicide, the interaction of perceived thwarted
belongingness and burdensomeness is predictive of suicide ideation, even after
controlling for depressive symptoms.

FEARLESSNESS AND PAIN INSENSITIVITY

As suicidal behaviour often includes infliction of physical pain on the body, the
association between suicide risk and both pain sensitivity or tolerance and
fearlessness about death has been examined. Although almost all research into
pain sensitivity has focused on non-suicidal self-injury, increased pain
thresholds and tolerance have been reported in suicidal adolescents. More
research is needed to establish whether changes in pain sensitivity are a cause or
result of suicide ideation or behaviour; how these changes vary as a function of
suicidal history and across the lifespan requires clarification. Research findings
suggest that suicide attempters have higher fearlessness about injury and death

16
than do non-suicidal controls, and that this difference might account for why
men are more likely to die by suicide than are women.

PROBLEM SOLVING AND COPING

That people who attempt to kill themselves have difficulties with problem
solving or coping is, perhaps, self-evident. Nevertheless, study findings have
consistently shown a link between suicidal behaviour and deficits in both
interpersonal problem solving and coping. In view of the cross-sectional nature
of most studies into this topic, however, the direction of this association is not
clear. Moreover, these associations seem to be mostly accounted for by the
presence of depression.

AGITATION

Agitation, which is often conceptualised as a state of anxious excitement or

disinhibition, has been linked with suicidal behaviour in many studies. For
instance, in a chart study of 76 patients who died by suicide during hospital
admission, 79% had severe anxiety or agitation shortly before their death.
Agitation has been hypothesised to be one potential mechanism through which
bipolar disorder, medical illness, and the prescription of certain psychiatric
medications might increase the risk of suicidal behaviour. Recent research
suggests that agitation is especially predictive of suicide attempts among people
who have high capability for suicide.

IMPLICIT ASSOCATIONS

People with a recent history of suicidal behaviour show an implicit mental

association between death and the self. Findings from research using the
implicit association test showed that this association distinguished suicide
17
attempters from distressed non-attempters presenting for emergency psychiatric
treatment (i.e., suicide attempters responded more quickly [measured in
milliseconds] when pairing stimuli related to death and self than they did when
pairing life and self), and perhaps more importantly, that this mental association
with death predicted future suicide attempts better than did prediction of future
suicide attempts by either clinicians or patients.

ATTENTIONAL BIASES

People with a recent history of suicidal behaviour show greater attention to, or
interference for, stimuli related to suicide (eg, suicide attempters take longer to
name the colour of words related to suicide than they do for neutral or negative
words), and this bias predicts future suicide attempts above and beyond other
factors, including the presence of a mood disorder and prediction of future
suicidal behaviour by either clinicians or patients. However, whether attentional
bias and implicit associations result from or are causes of suicidal thoughts
remains unclear.

FUTURE THINKING AND GOALS ADJUSTMENT

Since the 1990s, pessimism for the future (characterised by the absence of
positive future thinking, rather than the presence of negative future thinking)
has been associated with suicidal ideation and attempts. This effect of impaired
positive future thinking is independent of depression. Future research should
explore whether the association between positive future thinking and suicide
attempts changes over time, and establish whether the content of positive future
thinking affects the extent to which positive thoughts are protective. More
detailed study of imagery and flashforwards (i.e., images about acting out future

18
suicide plans or being dead) also offer promise. Personal goal pursuit defines
identity, and how people adjust when a goal becomes unattainable is known to
affect wellbeing. Indeed, evidence suggests that suicide attempters who tend not
to re-engage with new goals (in the face of existing unattainable goals) are at
increased risk of readmission to hospital after self-harm, with this association
being further affected by the extent of existing goal disengagement.

REASONS FOR LIVING

Reasons for living have been studied extensively in the prediction of suicidal
ideation and attempts, and have been incorporated into treatment protocols.
Good evidence suggests that individuals with few reasons for living are at
increased risk of suicidal thinking and attempts. Related to reasons for living, in
a 10-year follow-up study, psychiatric outpatients who had a moderate-to-strong
desire to die and little desire to live were at increased risk of suicide.

DEFEAT AND ENTRAPMENT

Defeat and entrapment have received substantial attention within social-rank

theories of depression, scientific literature about arrested flight, and most
recently in the integrated motivational-volitional model. The inability to escape
from defeating or stressful circumstances provides the setting conditions for the
emergence of suicidal thoughts. Although defeat and entrapment are well
established constructs within the psychopathology literature, their application
within suicide research offers substantial promise. Indeed, both defeat and
entrapment distinguish suicidal individuals from controls independently of
depression and hopelessness, and both predict suicidal ideation and attempts

19
over time. Entrapment has also been shown to predict repeated suicide attempts
in a 4-year period beyond traditional risk markers for suicide.

WHAT CAN BE THE STEPS TO PREVENT TEENAGE

SUICIDE?

Suicide is an important, largely preventable public health problem. The problem

is however a difficult one; as aptly expressed by Gajalakshmi et al as “a
complex array of factors such as poverty, low literacy level, unemployment,
family violence, breakdown of the joint family system, unfulfilled romantic
ideals, inter-generational conflicts, loss of job or loved one, failure of crops,
growing costs of cultivation, huge debt burden, unhappy marriages, harassment
by in-laws and husbands, dowry disputes, depression, chronic physical illness,
alcoholism/drug addiction, and easy access to means of suicide.”

In 2000, the WHO launched the multisite intervention study on suicidal

behaviours (SUPRE-MISS) which aimed to increase knowledge about suicidal
behaviours and about the effectiveness of interventions for suicide attempters in
culturally diverse places around the world.

Early detection and adequate treatment of a primary psychiatric disorder is of

paramount importance. In psychiatrically ill subjects, lithium, clozapine.
olanzapine, antidepressants, and behavioural interventions such as dialectical
behaviour therapy, DBT have been shown to have antisuicidal effects.

Since the greatest predictor of completed suicide is the presence of a previous

suicide attempt, interventions aimed at suicide attempters may be the most
effective in reducing suicide rates. Vijayakumar et al., 2011 examined the
efficacy of brief intervention and regular contact in a randomized controlled
trial in suicide attempters and found that it did reduce rates of completed suicide

20
over an 18-month period. Importantly however, the care received by the
treatment-as-usual arm in this study was below desirable standards because it
was limited to the acute management of the somatic sequelae of the suicide
attempt and did not include psychiatric or psychological assessment or
treatment.

In a psychological autopsy, 24% of suicide completers had consulted a

psychiatrist/ physician before the event and family of the victim were aware of
their suicidal intent in 68% of cases. This finding is similar to data from the
west, where two-third visited their general practitioners in the month prior to
death and 40% in the week before. This calls for adequate training of general
practitioners in detection and referral of patients with common mental disorders,
which may result in a significant decline in suicide rates. This may also have to
be culturally sensitive; the higher rate of somatic symptoms, rather than
cognitive symptoms, among depressed patients in the Indian setting, is a case in
point.

The early identification and treatment of vulnerable populations with risk

factors for suicide across the life-span is another strategy. Given the strong link
between negative life-events early in childhood and suicide risk, it is important
to identify populations that have been exposed to traumatic childhood
experiences, such as sexual/physical abuse and parental domestic violence. The
identification of such individuals requires a multidisciplinary approach with
active participation from teachers and school authorities, health professionals
and the legal system. Primary prevention strategies include promoting positive
health and instilling adaptive coping strategies among children; improving
awareness among parents, teachers and healthcare professionals regarding
child-rearing practices and early intervention for maladaptive coping styles. At
the community level, the establishment of social programs such as child and

21
family support programs and programs aimed at achieving gender and socio-
economic equality maybe prove useful.

The need for a strategy which will raise awareness and help make suicide
prevention a national priority has long been recognized. Such a national strategy
will need a comprehensive approach that encompasses the promotion,
coordination, and support of activities to be implemented across the country at
national, regional, and local levels. The program would need to be tailored for
populations at risk. For example, prevention programs aimed at children and
young adults would have to address issues related to gender inequality,
physical/sexual abuse, violence and mental illness. Strategies with empirical
evidence in western literature such as the Universal, Selective, indicated (USI)
model, ‘gatekeeper training’ and outpatient follow-up and emergency outreach
may also be relevant to India. The USI model outlines ‘universal’ preventive
strategies for the population as a whole (e.g., restricted access to lethal means),
‘selective’ strategies targeting at-risk individuals (e.g. psychiatrically ill,
homeless, socially-excluded groups) and ‘indicated prevention’ strategies
targeting suicide attempters (e.g. outpatient contact and emergency outreach).
Gatekeeper training focuses on skill development to enable community
members such as teachers, coaches and others in the community to identify
signs of depression and suicide-related behaviours among youth. It encourages
individuals to maintain a high index of suspicion and to inquire directly about
distress, persuade suicidal individuals to accept help, and serve as a link for
local referrals. Such approaches would also require a multidisciplinary team
approach involving psychiatrists, general physicians, psychiatric nurses,
psychiatric social workers, and non-governmental organizations (NGOs).

The role of the media is becoming increasingly relevant. A delicate balance

needs to be maintained between press freedom and responsibility of the press to
minimize the harm to vulnerable individuals. The role of advocacy and

22
legislature cannot be over-emphasized. Laws restricting availability of lethal
agents such as firearms have been advocated by the WHO. NGOs can play an
important role in advocacy as exemplified by the proactive stance taken by the
NGO Sneha which found that the suicide rate was highest among students who
had failed in one subject. Subsequently, the government introduced a new
scheme in 2002 wherein students who fail in one subject can rewrite their
examination within a month and can pursue their further studies without losing
an academic year.

The task of suicide prevention is daunting. Although suicide attempters are at

increased risk of completed suicide, about 10% of attempters persistently deny
suicidal intent. This group may continue to be vulnerable. Though restricting
availability of lethal means appears to be a possible solution, an early study in
India in West Bengal, where legislation was introduced to restrict sale of a
pesticide, found no reduction in the overall suicide rate, but merely a change in
the modes of suicide. The solutions to suicide prevention may prove to be more
complex than the problem of suicide itself.

23
 CONCLUSION

Although the physical availability (i.e., access) to methods of suicide affects

their use, not much is known about the psychological factors that affect

selection of one method of suicide over another. Psychological suicidology is

still dominated by research in populations in western Europe and the USA and

Canada, despite the fact that 60% of the world’s suicides occur in Asia. The

dearth of research into protective factors also needs to be addressed. Although

the development and use of psychological treatments has grown somewhat, they

are not well supported by evidence and most people who experience suicidal

thoughts and behaviours do not seek them out. The barriers to help-seeking and

the role of media (including social media) within the suicidal process also

remain poorly understood; although media guidelines for the reporting of

suicide exist, more empirical evidence about which aspects of reporting are

most dangerous is needed. Finally, psychological science has much to offer to

policy planners in the development and implementation of programmes for

suicide prevention. Promising multi component intervention developments have

been made in recent years, and further advancement is needed to combat this

devastating public health problem.

24
 SUMMARY

Reach a consensus about terminology and phenomenology in respect of all self-

injurious behaviours. More large-scale studies that test psychological models

and risk factors to predict suicide attempt and death. Incorporation of

psychological factors into national, linkage databases and psychological autopsy

studies. Improved understanding of factors that distinguish those who attempt

suicide from those who think seriously about it and those who repeatedly

attempt suicide. Integration of experimental, naturalist, clinical and non-clinical

research findings. Comprehensive testing of psychological models of suicidal

behaviour. Focus on psychological factors that protect against suicide. Better

understanding of the psychology of method selection. More psychological

science research in participants from across the lifespan, from different ethnic

backgrounds and countries.

25
 REFERENCE

 https://www.bps.org.uk/sites/bps.org.uk/files/Policy%20-%20Files/
Understanding%20and%20preventing%20suicide%20-%20a
%20psychological%20perspective.pdf

 https://www.researchgate.net/publication/
264459723_The_psychology_of_suicidal_behaviour

 https://kidshealth.org/en/parents/suicide.html

 https://www.apa.org/research/action/suicide.aspx

 https://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-
depth/teen-suicide/art-20044308

 https://www.aacap.org/AACAP/Families_and_Youth/
Facts_for_Families/FFF-Guide/Teen-Suicide-010.aspx

 https://www.studymode.com/essays/Teenage-Suicide-1340121.html

26
27