Wednesday, 27 July 2011

Epidemiology of suicides: Watch out for definite traits to prevent suicides, say psychiatrists

Syed Akbar
Hyderabad: Suicides and suicidal tendencies leave behind definite traits, which can be of great help to curb the increasing menace in young population, point out city researchers. Andhra Pradesh accounts for 11 per
cent of suicide deaths in the country.
Those who should be watched for suicidal tendencies are people with psychiatric disorders including depression and schizophrenia, mood disorders, personality disorders particularly of anti-social or narcissistic type, alcohol abuse, and painful or chronic medical conditions. People on certain medicines, which create suicidal tendencies, should also be kept under observation and should not be left alone.
"Watch out for warnings or clues such as giving property away," suggests senior psychiatrist Dr MS Reddy of Asha Hospital. According to him, there's no single cause for suicide. One should observe for casual factors. "Those with feelings of hopelessness, definite suicide plan, a recent suicide attempt
and severe depression should not be left alone as it is unsafe for the patient," he warns.
People with suicidal tendencies not only give out warning signs but also follow a definite pattern in the methods they adopt to end their lives. Men, for instance, prefer hanging and insecticide poisoning, while women go in for self-immolation and hanging in case they want to end their life. Two-thirds of people in the State, both men and women, who commit suicide prefer hanging and insecticide poisoning.
Dr Reddy and his team from Asha Hospital carried out a research study on the epidemiology of suicide in India, with focus on Andhra Pradesh. The study pointed out that earlier, older men formed the largest chunk of suicide cases but now the trend has reversed with more young people ending lives.
With the number of suicidal deaths increasing, Andhra Pradesh is now responsible for more than 11 per cent of suicides reported in the country. The researchers used patient care record forms of all medical emergencies in Hyderabad and other parts of the State, and found that 72 per cent of men, who committed suicide, either hanged themselves or consumed insect poisons. A little over 40 per cent of women committed suicide by self- immolation or hanging.
"Around 37.8 per cent of people, who commit suicide, are below 30 years of age. The percentage of suicides committed by those below 44 years is 71 per cent. About 60 per cent of suicides may not have occurred if proper intervention was undertaken," Dr Reddy said.
According to the study published in the latest issue of Indian Journal of Psychological Medicine, a majority of those committing suicide suffer from depression or other emotional disorders. Over 7.5 per cent of Indians face some sort of emotional disorder. Out of every three cases of suicide reported every 15 minutes in India, one is committed by a youth in  the age group of 15-29 years.
"Suicide is complex with psychological, social, biological, cultural and environmental factors involved. The largest number of victims were found in the age group of 21-30 years. Majority of the victims were mentally sound, married and were from rural background," he told this correspondent.
He said suicidal note was detected in five per cent of cases. Suicidal tendency and alcohol intake could not be encountered in most of the cases. Financial burden in 37 per cent and marital disharmony in 35 per cent were some of the main reasons for the suicide.
Long-term follow-up of people who have been hospitalised for severe depression show a suicide risk of up to 13 per cent. People with severe depression are 20 times more likely and people with bipolar disorder are 15 times more likely to die from suicide than members of the general population.
The data on suicide cases collected by Dr Reddy revealed that a majority of the victims were mentally sound, married and were from rural background. Victims were mostly drawn from low socio-economic status (48 per cent). Less educated or illiterates were usually the victims.
Stating that all major psychiatric disorders carry an increased risk of suicide, he said 90 per cent of suicides can be traced to depression linked either to bipolar disorder, major depressive disorder, schizophrenia or personality disorders, particularly borderline personality disorder.
Around five per cent of schizophrenics will commit suicide during their lifetimes, usually near the illness onset. Risk factors for suicide among people with schizophrenia include a history of previous suicide attempts, the degree of illness severity, post-psychotic depression, social isolation, and male gender.
Referring to mood disorders, Dr Reddy said depressed people with agitation, severe insomnia, anxiety symptoms, and anxiety disorders are particularly at risk. Eating disorder like anorexia nervosa is also linked to suicide as such people are 40 times more prone to suicides than normal people.
Alcohol abuse has also emerged as one of the important factors for suicidal tendencies. It has been observed that many of the suicide victims were under influence of alcohol.
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Box item
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* Suicides are no longer the domain of the elderly. More youngsters are
ending their lives for a number of reasons.

* Methods of suicide differ from gender to gender and region to region. But
the common factors or warning signs remain mostly the same. Psychiatrists
suggest that people should watch out for suicidal tendencies or warning signs
in their near and dear ones, so that timely intervention can save their lives.

* Some common methods of suicide are cutting wrist, hanging, electrocution,
jumping from buildings, jumping into water bodies, sleeping across railway
tracks, burning and poisoning.

* If you notice your close one with suicidal ideation, take him to a
psychiatrist.

* Be careful with certain anti-depressant drugs. They may create or increase
suicidal tendencies. When such drugs are prescribed by doctor, ensure that
the patient is not left alone in the room. Keep a watch on him or her.

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