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Indian Journal of Community Medicine

Suicidal Attempts Reported at a Medical College Hospital in Tamil Nadu

Author(s): M. Logaraj, N. Ethirajan, J.W. Felix, F.W. Roseline

Vol. 30, No. 4 (2005-10 - 2005-12)

Introduction:

Intentional self killing in the form of attempted and successful suicide is on the rise globally in the recent decades. In the last four decades suicide rates have been inceasing and currently it is one of the three leading cause of death among the age group of 15-44 (in both sexes). Suicide attempts are upt to 20 times more frequent than completed suicide11. It presents as one of the serious social and public health problems. Its prevention is still a challenging job to the public health authorities and other health care providers. India ranks 10th with a sucidal rate of 9.74 per 100,000 population2. The present study was conducted with the objectives of describing socio-demographic variables, preferred methods of suicidal attempts and seasonal variations in sucidal attempts.

Materials and Methods:

A retrospective study was carried out at Rajah Muthiah Medical College Hospital which is a university teaching institution in Tamilnadu. Medical rerods of 817 cases of attempted suicide reported in the hospital for a period of 5 years between January 1997 and December 2001 were included in the study. The data on variables such as age, sex, marital status, and time of committing suicide, methods of suicidal attempts, place and outcome were analysed from the case sheets. Chi-square statistics was used in finding out the association and making inferences.

Results:

In both males and females, more number of reported suicidal attempts were found in the age group of 15-29 yrs. (65.85%) followed by 30-44 yrs age group (21.54%). Through there was no significant statistical difference between the proportion of suicidal attempts among males and females, chi-square test revealed the association between the age groups and number of suicidal attempts. Age specific rates showed that in female patients the attempted suicidal rates decreased as the age advanced whereas in males the rate increased as the age increased.

The proportion of married and unmarried among a male patients were 40.48% and 59.52% respectively and in female patients it was 55.72% and 44.28% respectively. The difference was statistically significant. Higher number of attempts were reported among the married female patients and unmarried male patients.

In both males and females, Organophosphorous poisoning 207(25.4%) was the most commonly used method for suicide. The other methods used were Rodenticides poisoning 129 (15.79%), Native plant poisoning (Oleander and Abrus precatorious) 127 (15.58%), Drugs over dose (Sedatives and Psychotropic) 92 (11.29%), Suicidal burns 85(10.43%) and Hanging 77 (9.45%). Organophosphorous poisoning, suicidal burns and native plant poisoning were common among females. Organophosphorous, Rodenticides and Sedatives and Psychotropic drug over dose were more common among males.

The time of committing suicide was available only for 711 patients and it showed that 35.44% of patients attempted suicide between 12 noon and 6.00 pm and another 34.6% attempted between 6.01 pm and 12 am. In the month distribution, more number of suicidal attempts had occured in the month of February 90(11.02%) and March 83 (10.16%). The number of attempted suicide were highest during spring 224(27.42%) and lowest during winter 170 (20.81%).

Out of 817 cases of attempted suicide, the outcome was fatal 145 (17.86%) cases. In this study, as the age increases the number of fatal outcomes also increases and it is statistically significant. Among the different methods of suicidal attempts, fatal outcomes were commonly reported for Suicidal burns 39(45.9%) and Organophosphorous poisoning 59(28.5%)

Discussion:

Retrospective analysis of records of 817 cases revealed that the Organophosphorous poisoning (25.4%) was the commonest mode of suicidal attempts followed by Rodenticides (15.79%) and Native poisoning (15.54%). Similar observations have been reported by recent studies as well were Organophosphorous was the most common method of attempted suicide3,4. In the present study, most of the cases were from rural areas with agricultural backgound with easy accessibility to Organophosphorous and native plant poisoning. Marzuk et al 19925 reported that the availability of a particular method played very important role in the method of choice when they were impulsive in nature. Easy availabity and lack of safety precaution during storage at home make Organophosphorous agents as the first choice in the present study. Thus restriction of the ready availbility of such methods by ensuring the safety at home, by educating the farmers may prevent greater number of suicidal attempts.

The commonest age groups in attempted suicide were 15-29 years followed by 30-44 years. Similar findings were obeserved by Ponnudurai6. Even though there was no sex difference in the number of suicidal attempts, reported suicidal attempts were more common in young females which was similar to the finding reported by Sharma7. In contrast many studies in India showed male preponderance6,8. Higher number of unmarried in the present study has been supported by other investigators also6,8.

In this study, more number of suicidal attempts had occured from 12 noon to midnight. Similar finding have been reported by Satyavathy and Ponnudurai9,10. Choosing night time for committing suicide was noted, may be to escape from the attention of others. In this study more number of suicidal attempts had occurred in the month of Feb and March. Gopal Sharma11 has reported maximum number of suicidal attempts during April. Also, more number of suicidal attempts had occurred during spring and summer seasons.

The proportion of fatal suicidal attempts was 17.86%. P.N. Suresh Kumar reported 10% in this study4. In the present study 82% of the attempted suicides were non-fatal. A good proportion of these cases may attempt to commit suicide again as reported by Suresh Kumar4. 24% had history of previous attempts respectively. This shows that there is a need for strengthening the counseling of the cases of the attempted suicide and their families in the hospital to prevent further attempts. As compared to the feasibility of detecting people at risk in the community and providing counseling, it is relatively easy to prevent further attempts by concentrating on those who get admitted with the history of suicidal attempts. Further, this will be one of the cost effective measures of identifying people at risk and intervention.

References:

  1. World Health Organization (WHO) Reports (2000): International suicide statistics.
  2. Govt. of India 1994 Accidental deaths and suicides in India, New Delhi: National Crime Record Bureau, Ministry of Home Affairs.
  3. Ponnudurai, R., Patnaik, A., Sathyanathan, R and Suban, K. . A study on Venues of suicide. Indian Journal of Psychiatry, 1997 : 39. 34-36.
  4. Suresh Kumar P.N. A descriptive analysis of methods adopted, suicide intent and causes of attempted suicide. Indian journal of psychological medicine, 2000, 23(1) 47- 55.
  5. Marzuk, P.M., Leon A.C., Tardiff, K., Moran, E.B., Stajic, M and Man, J.J. The effect of access to legal methods of injury on suicide rates. Archives of general Psychiatry, 1992; 49, 451- 458.
  6. Ponnudurai, R., Jayakar, J. and Saraswathy, M : Attempted suicides in Madras. Indian journal of psychiatry. 1986; 28: 59-62.
  7. Sharma R.C. Attemped suicide in Himachal Pradesh. Indian Journal of Psychiatry, 1998 ; 40 (1), 50-54.
  8. Gupta, S.C. and Singh, H. Psychiatric illness in attempters. Indian journal of Psychiatry 1981; 23, 69-74.
  9. Satyavathy, K and Murthy Rao, D.L. N. A study of suicide in Bangalore. Transaction of All India institute of mental health. 1962; 3:5-25.
  10. Ponnudurai R, Jayakar J. Attempted suicide in Madras. Indian Journal of Psychiatry. 1980; 22, 203-205.
  11. Gopal Sharma P, Anand. B. Suicides in Warangal District: Season and suicide. Indian Journal of Psychological Medicine, 2000; 23 (2), 33-6.

Deptt. of Community Medicine, Rajah Muthiah Medical College, Annamalai University, Tamil Nadu.

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