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DISSERTATION ON

TO IDENTIFY THE RISK FACTORS ASSOCIATED WITH ATTEMPTED SUICIDE AMONG SUICIDE ATTEMPTERS AT RAJIV

GANDHI GOVERNMENT GENERAL HOSPITAL, CHENNAI - 03 M.SC (NURSING) DEGREE EXAMINATION

BRANCH – V MENTAL HEALTH NURSING

COLLEGE OF NURSING

MADRAS MEDICAL COLLEGE, CHENNAI – 03.

A dissertation submitted to

THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI – 600 032.

In partial fulfillment of the requirement for the degree of MASTER OF SCIENCE IN NURSING

JULY 2011

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CERTIFICATE

This is to certify that this dissertation titled, “A STUDY TO IDENTIFY THE RISK FACTORS ASSOCIATED WITH ATTEMPTED SUICIDE AMONG SUICIDE ATTEMPTERS at RAJIVGANDHI GOVERNMENT GENERAL HOSPITAL, CHENNAI - 03” is a bonafide work done by Ms.M.ABIRAMI, College of Nursing, Madras Medical College, Chennai – 03, submitted to the Tamilnadu Dr.M.G.R. Medical University, Chennai in partial fulfillment of the university rules and regulations towards the award of the degree of Master of Science in Nursing, Branch V, Mental Health Nursing under our guidance and supervision during the academic period from 2009 – 2011.

Dr.Mrs.P. MANGALA GOWRI, M.Sc (N), Ph.D.,

Principal,

College of Nursing, Madras Medical College, Chennai – 03.

DEAN

Madras Medical College, Chennai – 03.

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DISSERTATION ON

TO IDENTIFY THE RISK FACTORS ASSOCIATED WITH ATTEMPTED SUICIDE AMONG SUICIDE ATTEMPTERS AT RAJIVGANDHI GOVERNMENT GENERAL HOSPITAL,

CHENNAI - 03

Approved by Dissertation committee on………..

Professor in Nursing Research______________

Dr.Mrs.P.Mangala Gowri, M.Sc (N), Ph.D., Principal,

College of Nursing, Madras Medical College, Chennai – 03.

Professor in Clinical Speciality_____________

Mrs. M.Vijayakumari, M.Sc (N),

Lecturer, Department of Mental Health Nursing,

College of Nursing, Madras Medical College, Chennai – 03.

Medical Expert_____________

Prof. Dr.C.Rajendiran M.D., Director

Poison Control Training and Research Centre RajivGandhi Government General Hospital Chennai - 03

A dissertation submitted to

THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI – 600 032.

in partial fulfillment of the requirement for the degree of MASTER OF SCIENCE IN NURSING

JULY 2011

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ACKNOWLEDGMENT

Gratitude calls never expressed in words but only to deep perceptions, which make words to flow from one’s inner heart.

I thank GOD the ALMIGHTY for the abundant blessing showered on me which helped me to complete the study successfully.

I would like to convey my sincere thanks to my madam Dr.Mrs.

P.Mangalagowri, M.Sc (N) Ph.D., Principal, College of Nursing, Madras Medical College, and Chennai – 3, only because of her I learnt the nooks and corners of nursing research and I abide her for all the valuable suggestions and untiring encouragement in the field of nursing research.

I am thankful to Prof.Dr.J.Mohanasundaram, MD, DNB, Ph.D., former Dean, Madras Medical College, Chennai – 600 003 who permitted me to conduct the study.

I wish to express my special and sincere heartfelt thanks to Prof.Dr.C.Rajendiran, M.D., Director, Poison Control Training and Research Centre, RajivGandhi Government General Hospital , Chennai -03 for accepting my request for conducting the study in the Poison Control Training and Research Centre RajivGandhi Government General Hospital

I extend my gratitude to Mrs.R.Vijayakumari , M.Sc (N),., M.Phil., Lecturer, in Mental Health Nursing, College of Nursing, Madras Medical College, Chennai – 600 003 for the continuous guidance, encouragement, motivation and heart loving care support for the successful completion of the study

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My heartfelt thanks to Prof.Dr.R.Sathyanathan, M.D., DPM., MPH (USA), former Director, Institute of Mental Health, Kilpauk, Chennai – 10, for granting permission to conduct the study and his valuable suggestions and guidance.

I deem it a great privilege to express my sincere gratitude and deep sense of indebtedness to my esteemed teacher Mrs.N.Jaya,M.A., MSc(N),Ph.D., for her encouragement and positive motivation guidance in pursuing the study.

I extend my thanks to all Assistant Professors and Staff Nurses attached to Poison Control Training and Research Centre for their fullest co-operation for the successful completion of this study.

I am thankful to Mr.Anand computer operator, Poison Control Training and Research Centre for his timely help in providing statistics.

I wish to express my gratitude to all faculty members of College of Nursing, Madras Medical College, Chennai-3 for their valuable suggestions in conducting this study.

I acknowledge my sincere thanks to Mr.A.Venkatesan, M.Sc., PGDCA, Lecturer in Statistics for his valuable suggestions and guidance in the statistical analysis

I am thankful to Mr.Ravi, M.A., MILS., Librarian, College of Nursing Madras Medical College, Chennai – 3, and also to the librarians of Institute of Mental Health and Tamil Nadu Dr.M.G.R.

Medical University for their co-operation in collecting the related literature for this study.

My earliest gratitude to all my subjects who have participated in my study for their support and kind co-operation to complete my study successfully.

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I extend my immense love and gratitude to my dear parents and brother for their loving support, earnest prayers, which enabled me to move forward during difficult situations in completion of the study.

I extend my special thanks to all my friends who gave me support and immeasurable suggestions throughout the study.

I extend my sincere thanks to all the Mental Health specialists for their valuable suggestions and providing content validity to precede my study.

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INDEX

S.No Title Page No

1. Introduction

1.1. Need for the study

1.2. Statement of the Problem 1.3. Objectives

1.4. Operational Definition 1.5. Assumption

1.6. Hypothesis 1.7. Delimitation

        1 ‐ 12 

2. Review of literature

2.1. Review of related studies 2.2. Conceptual frame work

13 ‐  23 

3. Research Methodology 3.1. Research Approach 3.2. Research Design 3.3. Variables

3.4. Setting of the study 3.5. Population

3.6. Sample 3.7. Sample Size

3.8. Sampling Technique

3.9. Criteria for selection of sample

3.10. Development and description of tools 3.11. Scoring techniques

 

 

 

 

 

24 ‐ 30 

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3.12. Content Validity 3.13. Pilot Study

3.14. Reliability of the tool 3.15. Data Collection Procedure 3.16. Plan for data analysis

3.17. Protection of human subjects

4. Data analysis and interpretation

31 ‐ 47 

5. Discussion

48 ‐ 53 

6. Summary and conclusion 6.1. Summary

6.2. Findings of the study 6.3. Conclusion

6.4. Implication of the study 6.5. Recommendations

6.6. Suggestion for future research 6.7. Limitations

      54 ‐ 58 

  Bibliography   

  Appendices   

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LIST OF TABLES

TABLE  NO 

TITLE  PAGE 

NO  1. INCIDENCE AND RATE OF SUICIDAL DEATHS IN INDIA

(2005-2009)

2. STATISTICS OF SUICIDE ATTEMPTERS AT GGH FROM

2007 TO 2010

3. THE DEMOGRAPHIC INFORMATION OF SUICIDE

ATTEMPTERS

32 

4. THE PERSONAL INFORMATION OF SUICIDE

ATTEMPTERS FROM THE PRE- DESIGNED PERFORMA

33 

5. LEVEL OF CRISIS (LIFE CHANGE EVENTS) 35 

6. CORRELATION BETWEEN LEVEL OF RISK FACTOR AND MENTAL HEALTH STATUS

38 

7. ASSOCIATION BETWEEN TYPE OF FAMILY AND MENTAL

HEALTH

39 

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LIST OF FIGURE

FIGURE NO

TITLE PAGE NO

1. WORLD MAP OF SUICIDE RATES 2009

2. AGE AND GENDER WISE PROFILES OF THOSE WHO

DIED BY SUICIDE IN INDIA (YEAR: 2006)

3. OCCUPATIONAL PROFILES OF THOSE WHO DIED BY

SUICIDE IN INDIA (YEAR: 2006)

4. MODIFIED BETTY NEUMAN’S SYSTEM MODEL 23 

5. PERSONAL HABITS OF THE SUICIDE ATTEMPTERS 34 

6. ANALYSIS OF RISK FACTORS ASSOCIATED WITH

ATTEMPTED SUICIDE AMONG SUICIDE ATTEMPTERS 36  7. MENTAL WELL BEING OF THE SUICIDE ATTEMPTERS 37 

8. ASSOCIATION BETWEEN LEVEL OF RISK FACTORS AND AGE OF

SUICIDE ATTEMPTERS

40 

9. ASSOCIATION BETWEEN LEVEL OF RISK FACTORS AND OCCUPATION STATUS OF SUICIDE ATTEMPTED

41 

10. ASSOCIATION BETWEEN OCCUPATION STATUS AND

MENTAL HELATH STATUS 42 

11. ASSOCIATION BETWEEN MARITAL STATUS AND LEVEL OF RISK FACTORS

43 

12. ASSOCIATION BETWEEN WORKING HOURS AND LEVEL

OF RISK FACTORS 44 

13. ASSOCIATION BETWEEN PROBLEMS AND LEVEL OF MENTAL HEALTH STATUS

45 

14. ASSOCIATION BETWEEN MARITAL STATUS AND LEVEL

OF MENTAL HEALTH 46 

15. ASSOCIATION BETWEEN WORKING HOURS AND LEVEL

OF MENTAL HEALTH 47 

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LIST OF A PPENDICES

APPENDIX  NO 

TITLE 

1. STUDY TOOL

• DEMOGRAPHIC VARIABLES/ PRE DESIGNED PERFORMA

• MILLER AND RAHE RECENT LIFE CHANGE EVENT LIST

• THE WARWICK-EDINBURGH MENTAL WELL-BEING SCALE

2. INFORM CONSENT

3. LETTER SEEKING PERMISSION FOR CONDUCTING THE

STUDY

4. CERTIFICATE OF CONTENT VALIDITY

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ABSTRACT

The study titled “Identify the risk factors associated with attempted suicide among suicide attempters”, was conducted with the following objectives:

1. To describe the socio demographic characteristics of suicide attempters

2. To identify the risk factors associated with attempted suicide among suicide attempters

3. To assess the mental health of the suicide attempters

4. To correlate the risk factors of attempted suicide and mental health of suicide attempters

5. To associate the risk factors of attempted suicide and mental health of suicide attempters with selected demographic variables

Retrospective descriptive design was adopted for this study, 100 suicide attempters admitted in the Poison Control Training and Research Centre and Medical wards at RajivGandhi Government Hospital, Chennai – 03, was selected over a period of 4 weeks during the month of December based on the sampling criteria.

Data was collected using semi- structured interview schedule with the following tools:

• Demographic variables/ pre designed performa

• Miller and Rahe recent life change event list

• The Warwick-Edinburgh Mental Well-being Scale

The analysis of this study was exercised by using mean, standard deviation, Pearson’s correlation, and Pearson. Chi Square test.

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The main findings of this study were:

Among the study subjects (56%) were from the age group of 31 – 40 yrs.

Higher proportion of the samples (65% )of them were males Majority of the study subject (78.0%) were married.

Among the study subjects (47.0%) were educated up to high school level.

Among the study subjects (41.0%) were earning more than 5000 rupees/ month.

More than half of the study subjects (56%) were from rural community.

Among the study subjects nearly (39%) had the habit of both smoking and alcoholism

There was a negative correlation between the risk factors and mental health of the suicide attempters

Among the study subjects nearly (67%) of them had high level of crisis

People at younger age group were at higher risk for suicidal attempt More than half of the study samples (56%) were mentally unhealthy There was significant association between unemployment and risk

factors

There was significant association between the younger age and risk factors

There was significant association between unemployment and the mental health status

Findings of this study revealed that the risk factors of suicidal attempt were younger age, unemployment, being single, living in nuclear family, and stressful life events including problems in home

and family. Psychiatric nurses need to take pro-active roles in managing the suicidal intent and ideation at the earliest to minimize

the risk of attempting suicide

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CHAPTER I INTRODUCTION

Suicide is the word rooted its meaning from many languages. In Latin “sui” (genitive) of oneself + English –cide, and in Sanskrit “sva”

means oneself. Many of the Anthropologists remark that, the term suicide was first used in the year 1647. The father of psychoanalytical theory Sigmund Freud states, “Suicide as the murder turned 180 degrees”.

Suicide is a global public health problem (Cutcliffe, 2006). The majority of suicides (85%) in the world occur in low and middle income countries (Krug, Dahlborg, Mercy, Zwi, & Lozano, 2007).Suicide is among the three leading causes of death among those aged 15-44 years in some countries, and the second leading cause of death in the 10-24 years age group; these figures do not include suicide attempts which are up to 20 times more frequent than completed suicide.

World Health Organization stated suicide as the world’s 13th leading cause of death. Suicide is a deeply personal and individual act; suicidal behaviour is determined by a number of factors. These can be classified under the terms of predisposing factors and precipitating factors. Predisposing factors are internal determinants operating at the level of the individual. These include dynamics such as personality traits, bonds with family and society, biological and genetic factors etc.Every year, almost one million people die from

Suicide- The state of cry for help

Suicide victims are not trying to end their life

- they are trying to end the pain!

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suicide; a "global" mortality rate of 16 per 100,000, or one death every 40 seconds.

In the last 45 years suicide rates have increased by 60%

worldwide. Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020.Although traditionally suicide rates have been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries. (National Bureau Of Crime Records 2009).

It is estimated that over 100,000 people die by suicide in India every year. India alone contributes to more than 10% of suicides in the world. The suicide rate in India has been increasing steadily and has reached 10.5 (per 100,000 of population) in 2006 registering a 67% increase over the value of 1980. In the year 2006, 12,381 people in the state of Tamil Nadu committed suicide, of which Chennai accounts for 2427.Majority of suicides, occur among men and in younger age groups (Vijayakumar 2007). Despite the gravity of the problem, information about the causes and risk factors is insufficient.. Suicide attempts can be up to 10-40 times more frequent than completed suicide (Schmidtke et al., 2006). It can then be estimated that there are at least five million suicide attempts each year and hence suicide attempts are a major public and mental health concern in India.

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(National Bureau of Crime Records 2009) FIG 1: WORLD MAP OF SUICIDE RATES

2009

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Table 1 Incidence and Rate of suicidal deaths in India (2005-2009)

Year Suicide Incidence Male Female Total

Estimated Mid-year Population (in lakhs)

Suicide Rate (per 100,000)

2005 69332 41085 110417 10506 10.5 2006 70221 40630 110851 10682 10.5 2007 72651 41046 113697 10856 10.7 2008 72916 40998 113914 11028 10.8 2009 75702 42410 118112 11198 11.2

(SNEHA SUICIDE PREVENTION CENTRE)

FACTS ABOUT SUICIDE:

The suicidal intent and behaviour comprises of three forms of self destructive acts they are:

Completed suicide

Attempted suicide

Suicidal gestures.

The ideas thoughts and further plans about suicide are called as suicidal ideation.

Suicide usually results from the interaction of many factors, usually including depression. Some methods, such as guns, are more likely to result in death, but choice of a less lethal method does not necessarily mean that the intent was less serious. Any suicide threat or suicide attempt must be taken seriously, and help and support should be provided. Telephone and email hot lines are available for people who are considering suicide.

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Suicidal behavior has two dimensions. The first dimension is the degree of medical lethality or damage resulting from the suicide attempt. The second dimension relates to suicidal intent and measures the degree of preparation, the desire to die versus the desire to live, and the chances of discovery. The clinical profiles of suicide attempters and completers overlap. Suicide "attempters"

who survive very lethal attempts, which are known as failed suicides, have the same clinical and psychosocial profile as suicide

"completers

A suicidal person may not ask for help, but that does not mean that help isn’t wanted. Most people who commit suicide doesn’t want to die they just want to stop hurting. Suicide prevention starts with recognizing the warning signs and taking them seriously.

“People who attempt suicide are just trying to get the attention but truth is, it does not matter if that is the motivation! If they do not get attention, the results could be fatal! It has been clearly established that individuals who have attempted suicide have an increased risk for subsequent suicidal behavior. This is a recognized risk factor. Most suicidal people will not tell anyone or seek help but many people thinking about suicide will tell someone of their plans and some will certainly seek professional help for suicidal thinking.

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Fig 2 Age and Gender wise profiles of those who died by suicide in India (Year: 2006)

(SNEHA SUICIDE PREVENTION CENTRE)

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(National Bureau of Crime Records 2009).

Fig 3 Occupational profiles of those who died by suicide in India (Year: 2006)

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When accounting the age and gender profile of suicide attempters the males attempt suicide twice when compared to female (fig2) (Sneha Suicide Prevention Centre). People who are self employed and House wives were at higher rate in attempting suicide (fig 3) (National Bureau Of Crime Records 2009).

Table 2 shows the statistics of suicide attempters at Poison Control Training and Research centre RGGGH from (2007 to 2010)

The cause and risk factors related to suicidal attempt is always not very clear which in turn makes the strategies and the preventive measures more complicated. So there is an urgent need for the Psychiatric Nurses to identify the risk factors associated with suicide attempt.

S.NO YEAR TOTAL

1 2 3 4

2007 2008 2009 2010 till Nov

1564 1792 1827 1983

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22 1.1 NEED FOR THE STUDY

The suicidal behavior is ascertained by various numbers of personal, social and other factors. Esquirol quoted that all the person committing suicides are insane, and Durkheim suggested that suicide was the outcome of social problems, individual vulnerability and social stressors. Suicide is believed to be multifactorial and multidimensional. In our country suicide is perceived as one of the social problem and along with this mental illness is also given same abstractable status with maladjustment, marital conflicts …etc.

According to the W.H.O data, the reason for suicide is not known for about 43% of suicides while illness and family problems contribute to about 44% of suicides.

The risk of completed suicide is more among the suicide attempters. The world wide study conducted on suicide lethality proved that suicide attempters has 10 times more chance for progressing to the state of completed suicide during the course of the years (W.H.O survey).Suicide attempts are more than the completed suicide this is due to the ignorance of the suicide attempters about its consequences (Log raj et al 2OO6)

Suicide attempts are up to 20 times more frequent than completed suicide. Nearly 20- 30% of registrations in hospital emergency departments are due to attempted suicide. In India more than one lakh lives are lost every year due to suicide. The southern states like Kerala, TamilNadu, Karnataka and Andhra Pradesh have a suicidal rate of 15% that is greater than the northern states where it is than 3%.the majority of the suicidal rates (37.8%) in India are by those below the age of 30 years. Suicidal rates are increased among middle age men and women than others (SNEHA SUICIDE PREVENTION CENTRE)

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23 The majority of suicides (37.8%) in India are by those below the age of 30 years. The fact that 71% of suicides in India are by persons below the age of 44 years imposes a huge social, emotional and economic burden on our society. The near-equal suicide rates of young men and womenand the consistently narrow male: female ratio of 1.4: 1 denotes that more Indian women die by suicide than their Western counterparts. Poisoning (36.6%), hanging (32.1%) and self- immolation (7.9%) were the common methods used to commit suicide.

Two large epidemiological verbal autopsy studies in rural Tamil Nadu revealed that the annual suicide rate is six to nine times the official rate. If these figures are extrapolated, it suggests that there are at least half a million suicides in India every year. It is estimated that one in 60 persons in our country are affected by suicide. It includes both, those who have attempted suicide and those who have been affected by the suicide of a close family or friend. Thus, suicide is a major public and mental health problem, which demands urgent action (National Bureau of Crime Records 2009).

Stressful life events before the six months of attempting suicide contributes more to the suicidal ideation among the suicide attempters (Pompili M et al., (2007)). Low socio economic group are more prone for attempting suicide because of lower educational attainment, Unemployment and alcohol use Disorders. Hence, there is need for careful assessment of risk factors for early detection and prevention of suicidal lethality (Giupponi G et al., (2009) )

In this study the researcher takes this opportunity in identifying the various risk factors contributing to suicide as the time is ripe for psychiatric nurses to adopt proactive and leadership roles in suicide prevention

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24 1.2 STATEMENT OF THE PROBLEM:

Identify the risk factors associated with attempted suicide among suicide attempters at Government General Hospital at Chennai

1.4 OBJECTIVES:

1. To describe the socio demographic characteristics of suicide attempters

2. To identify the risk factors associated with attempted suicide among suicide attempters

3. To assess the mental health of the suicide attempters 4. To correlate the risk factors of attempted suicide and

mental health of suicide attempters

5. To associate the risk factors of attempted suicide and mental health of suicide attempters with selected demographic variables

1.5 DEFINITION OF TERMS:

SUICIDE ATTEMPTERS:

It refers to a person who has made deliberate act of self harm consciously aimed at self destruction irrespective of his / her intention to die with non-fatal outcome

RISK FACTORS:

It refers to all the predisposing factors and the stressful life events, perceived by an individual as the potential cause for attempting suicide.

MENTAL HEALTH STATUS:

It refers to the mental well being of the suicide attempters for coping and adaptation

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25 1.5 ASSUMPTION:

1. Stressful life events potentiates the risk of attempting suicide

2. Suicide attempters possess decreased level of tolerance

1.6 HYPOTHESIS:

There is a significant relationship between the risk factors of attempted suicide with the selected demographic variable

There is a significant relationship between the risk factors of attempted suicide with the mental health status of the suicide attempters

1.7 DELIMITATION OF THE STUDY:

1. The data collection period is limited to one month only

2. Suicide attempters above the age of 20 years only 3. The samples from the department of Toxicology and

Medical Wards of GGH only

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26

CHAPTER II

REVIEW OF LITERATURE

The primary purpose of reviewing relevant literature is to gain broad background of knowledge and understanding of the information that is related to the research problem of interest. This enhances the researcher view about the researchable problem and gives direction to the study

The literature found relevant and useful, has been presented in this chapter under the following headings;

♣ Studies related to suicide

♣ Studies related to suicidal ideation

♣ Studies related to factors contributing to suicide

STUDIES RELATED TO SUICIDE

Evans S 2009 conducted a case control study to identify the relationship between the deliberate self harm and attempted suicide.

77 cases were selected as the case group. The cases were selected from the geographically contagious population. The results showed that cases were very impulsive and at high risk for suicide attempt than the control group.

Allement z 2009 performed a retrospective study at South Delhi with the primary objective to determine the factors contributing to suicide risk. 769 suicide attempters were selected by convenient sampling technique, from the psychiatric department. The samples were assessed using suicide lethality and intent scales. They concluded that unemployment, bank mort age, marital conflicts and impulsive behavior as the major factors for suicide risk. The results also proved that unemployment and financial crisis were the risk

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27 factors for the male suicide attempters and marital conflicts and family problem were the risk factors for the female suicide attempters

Chavan BS 2008 conducted a psychological autopsy of 101 suicidal cases from northwest region of India .They assessed the socio demographic characteristics, psychosocial factors and physical co morbidity associated with completed suicide. Psychosocial stressors were found in 61.3% of suicide victims, co morbidity was found in 39 cases. The study revealed the need of specific preventive strategies to reduce suicide death in India

Sharma R 2008 conducted a study to assess the prevalence of suicide among the Delhi people. A total of 550 samples were selected by random sampling method form the out patients of private hospital.

The findings revealed higher prevalence (14.5%) of suicidal behavior

Siddhartha T 2006 assessed the suicidal behavior among the college students in Orissa.1232 samples between the age group of 19 - 23 were selected. A self structured questionnaire on deliberate self harm was used. The results showed that 31.4% of them had the life time prevalence of suicidal ideation, 12.8% had attempted suicide in their life time. The results proved higher prevalence of suicidal ideation, and deliberate self harm among college students

Karen dineen 2006 conducted a study on cognitive factors related to suicidal ideation and resolution. The cognitive factors of attribution style, hopelessness and self esteem were assessed among subjects aged 21 – 35 years (50 with and 50 without suicidal ideation).

The results revealed that suicidal ideation; attribution style became significantly more positively contributed to suicidal risk

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28 STUDIES RELATED TO SUICIDAL IDEATION

Scott M et al 2009 assessed the risk of suicide among the college students of Columbia University. They used 641 students for high suicide risk (recent ideation or lifetime attempt and depression, or anxiety, or substance use) and the students were assessed with diagnostic interview schedule. The results showed that about 96% of the students are at high risk .The major risk factors identified were lifetime stressors, recent depression, and substance use problems.

Mabey D 2009 conducted a study among female sex workers in Goa (India).The objective of this study is to determine the prevalence of suicidal behavior and its association with sex work , health factor.326 sex workers were selected by respondent driven sampling, an interviewer-administered questionnaire regarding self-harming behaviors. Nineteen percent of sex workers in the sample reported attempted suicide in the past 3 months. They concluded that Suicidal behaviors among sex workers were common and associated with gender disadvantage and poor mental health

Matthew K 2007 conducted a Cross-national study on prevalence and risk factors for suicidal ideation, plans and attempts.

A total of 84,850 adults from 17 countries were interviewed regarding suicidal behaviours and socio-demographic and risk factors. The results showed that cross-national lifetime prevalence of suicidal ideation, plans, and attempts is 9.2%, 60% of transitions from ideation to plan and attempt occur within the first year after ideation onset. The risk factors includedbeing female, younger, less educated, and unmarried and impulse control disorders in low- and middle- income countries

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29 STUDIES RELATED TO FACTORS CONTRIBUTING TO SUICIDE

Karl N 2010 conducted a study on risk factors associated with suicide attempts in Orissa. totally 149 suicide attempters were evaluated for psychosocial, situational and clinical risk factors using the risk rescue rating scale, suicide prevention centre scale , lethality of suicide rating scale and presumptive stressful life event scale . the findings suggest that the suicide potential was high in almost half of the cases , more than 80% of all attempters had psychiatric disorder and only 31.5% had treatment . The results show that the Factors like middle age, family history of psychiatric disorder physical illness , failure in examination , family conflicts , increases the risk of suicide attempt.

(News Line 2010) reported that in a developing country like Pakistan, where many of the 170 million people earn less than two dollars a day, a little surge in the price of flour and edible oil can be devastating. The suicide rate has been increased from 10.2% (2006) to 11.4% (2009). So there is greater relationship between unemployment and poverty.

Satheesh V 2009 conducted a study to assess the psycho socio demographic and clinical profile of suicide attempters. 1000 suicide attempters were evaluated with the history , physical assessment , mental status examination and psychological assessment .The results show that the male subjects were associated with low socio economic class , unskilled work , past psychiatric illness and female subjects were below 35 years , upper socio economic class , highly educated , had marital conflicts, failure in examination and less severe disorders.

The study revealed that male suicide attempters have more of biological disorder, while female suicide attempters have more of stress related disorder

Leventhal T 2009 conducted a study to determine whether living in poor neighborhood is associated with suicidal thoughts.

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30 Totally 2776 participants were selected and using Canadian census suicidal behavior and risk factors were self reported. The results showed suicidal thoughts were about twice as high in poor than in the non poor neighbors. The study concluded that there is greater risk of suicide thought and attempt among the people in poor neighborhood

Sourander A 2009 conducted a study to assess the childhood predictors of completed and severe suicide attempts. 5302 people who born in1981 were examined at the age of 8 years to gather information about psychopathologic conditions, school performances, family demographics from parents, teachers and children. Out of 8-24 years of age, 54 males have completed suicide whereas only 27 female have completed suicide. The results showed that there are less predictive factors available with completed suicide among females

J Joseph et al , 2009 conducted a verbal autopsy among the elderly members of the kaniyanbadi village, Vellore district. The setting for the study was a comprehensive community health program in a development block in rural South India. The main outcome measure was death by suicide diagnosed by a detailed verbal autopsy and census, birth and death data to identify the population base.The average annual suicide rate was 189 per 100,000 for people over 55 years of age. The ratio of male to female suicides was 1: 0.66. The age- specific suicide rate for men and women increased with age. Hanging (52%) and poisoning with organo-phosphorus compounds (39%) were the commonest methods employed for committing suicide.

Significantly more women chose drowning or burning than men who preferred poisoning or hanging (χ2 19.75; df 1; p < 0.001)

Aravind Pillai 2009 conducted a study among young people to estimate the prevalence and risk factors for suicidal behavior. 3662 youth (16–24 years) from rural and urban communities in Goa, India were selected. Suicidal behaviour during the recent 3 months and

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31 associated factors were assessed using a structured interview.

Premarital sex, independent decision making, physical abuse and alcohol use were the major independent risk factor for suicidal behavior. They concluded that violence and psychological distress were the dependent risk factors for suicidal attempts. Prevention programs for youth suicide in India need to address both the structural determinants of gender disadvantage, and the individual experiences of violence and poor mental health.

George Davey Smith 2009 performed an Ecological study of social fragmentation, poverty, and suicide. The aim of the study was to investigate the association between suicide and deprivation and social fragmentation. The results proved a strong association between suicide and area based measures of deprivation and social fragmentation.

Jessica R 2008, analyzed the risk factors of suicide, 693 out patients were selected for this prospective study. Subsequent deaths for the sample were identified through the National Death Index.

Forty-nine (1%) suicides were determined from death certificates obtained from state vital statistics offices. Univariate analysis revealed that severity of depression, hopelessness, and suicide ideation were significant risk factors for eventual suicide. A multivariate survival analysis indicated that several modifiable variables were significant and unique risk factors for suicide, including suicide ideation, marital conflicts, and unemployment status.

D Feskanich 2008 conducted a cohort study with 14 years of follow up. Stress at home and at work were assessed by questionnaire and scored on a four point scale: minimal, light, moderate, or severe.

Female nurses (n=94 110) between 36 to 61 years of age were selected from eleven parts of USA. 73 Suicide were reported and the risk of suicide was over eightfold among women reporting high stress or

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32 diazepam use compared with those reporting low stress and no diazepam use.

Klein J et al 2008 performed a study with the primary objective of determining the factors contributing to suicide. Semi- structured interview schedule was planned and patients between the age group of 18 -70 were selected from the primary care setting. The researchers concluded that factors contributing to suicide were complex and majority of the factors were stress, hopelessness, family conflicts, recent major life change event.

Fordwood Sr 2007 conducted a study to identify additional risk factors of suicide among depressed individuals. 451 suicide attempters were examined among the depressed between 18-31 years of age. The results showed along with depression the environmental stress increased the suicidal attempt

Jacob et al 2006 from the department of community health nursing conducted a study on the rates and factors associated with suicide in Kaniyambadi Block, Tamil Nadu. The aim of this study was to prospectively determine the suicide rate in Kaniyambadi Block, Tamil Nadu, and South India. The setting for the study was a comprehensive community health programme in a development block in rural South India. The average suicide rate was 92.1 per 100,000.

The ratio of male to female suicides was 1:0.66. The age-specific suicide rate for men increased with age. They concluded that the suicide rate documented is very high and is a major public health concern.

Innamorati M 2006 the primary aims of this study was to investigate risk factors for suicide attempts. 263 suicide attempters admitted in the Division of Psychiatry of the Department of Neurosciences of the University of Parma were compared with non- attempter clinical control subjects. Multifactorial analysis

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33 questionnaire was used for both the experimental and the control group. The results were analyzed between the suicide attempters and non-attempters, they concluded that suicide attempters life events in the last 6months, life events during age 0-15years and their interaction was the major factor triggering for attempting suicide.

Dr.Selwyn Stanley 2006 conducted a study to assess family interaction patterns and the dysfunction in suicide attempters in India. 50 suicide attempters from a private psychiatric hospital were assessed of their family interaction as well as the extent of dysfunctions on several domains. The result revealed that female respondents had better family interactions than men and unmarried respondents.

Beautrias Al 2006 conducted a study to identify the risk factors of suicide and attempted suicide. The evidence about the risk factors of suicidal behavior in young people was gathered by review of articles, papers which were published since 1980s. The evidence suggested that increase in stressful life events, childhood and family adversity, psychopathology will increase suicidal behavior.

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34

2.2 CONCEPTUAL FRAME WORK

Conceptual framework or a model helps the researcher in identifying the flow or direction of researchable question tentatively.

This deals with convergence of various phenomenon to a common topic. A conceptual framework helps in representing the researcher views, interests, and ideas in a positively approachable and acceptable way as it is a proven concept.

Betty Neumann’s system model provides holistic approach for all the interrelated problems of the client. This system model views each person in a multi dimensional concept. The conceptual model selected by the researcher for the present study modified form of Betty Neumann’s system model (1989). The main focus of this model is on stress and consequences of stress on physiological and psychological health of an individual.

Basic Core Structure

The basic core structure in this study comprises of physical, psychological, social components of health of the suicide attempters.

Lines of resistance

Lines of resistance are the lines surrounding the basic core structure of the suicide attempters. When an individual is affected by an interpersonal, intrapersonal, and extra personal stressors they guard themselves by adopting appropriate coping mechanisms to support during stressful situation. In this study the suicide attempters fails to adapt coping mechanisms to restore basic core structure.

Normal line of defense

The solid line outside the line of defense is the normal line of defense. This line indicates the state of equilibrium developed by the

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35 individual over time. In this study suicide attempters attains a state of disequilibrium and results in failure to adaptation

Flexible line of defense

These are the dotted broken lines outside the normal line of defense. These lines help in protecting the normal line of defense.

Strengthens the line of defense can be achieved by a. Crisis intervention

b. Relaxation techniques

c. Anger and aggression management skill d. Suicidal tendency management tips e. Counseling sessions

f. Group therapy

g. Behavior modification programs

h. Soft skills and personality building programs i. Family support

j. Divertional activities

Stressors

Neumann classified the stressors under three divisions; they are interpersonal, intrapersonal and extra personal stressors. The intensity and frequency of stressors determines the devastation of normal line of defense and further leads to demolition of the basic core structure

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36

Figure 4: Modified Betty Neumann’s System Model

Coping mechanisms

Preventive strategies

Crisis intervention

Relaxation techniques

Anger and aggression management skill

Suicidal tendency management tips

Counseling sessions

Group therapy

Behavior modification programs

Soft skills and personality building programs

Family support

Divertional activities

Suicide attempters

Stressors

Interpersonal stressors

Broken relationship

Marital conflict

Family problems

Poor understanding

Pre/extra-marital relationship Intrapersonal stressors

Guilt

Failure

Foiling

Anger

Illness

Lack of support

Unemployment

Extra personal stressors

Financial crisis

Problems in working place

Societal isolation

Demotion

Transfer

Failure in coping

Distortion of lines of resistance

Adaptive coping mechanisms

Strengthening

of line of

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37

CHAPTER – III METHODOLOGY

This chapter deals with the description of research design, variables, sample, sampling technique, inclusion & exclusion criteria, tool description, content validity, pilot study report, data collection procedure and plan for data analysis

3.1 RESEARCH DESIGNS

In this study the researcher selected Retrospective Descriptive study design. Risk factors associated with attempted suicide are analyzed after the suicidal attempt

3.2. VARIABLES

Independent variable – Risk factors of suicide Dependent variable – Attempted suicide

Attributable variable – Age, education, monthly income, occupation, marital status, history of suicidal exposure and attempts, stressful life events

3.3 RESEARCH SETTING

Poison Control Training and Research Centre and medical wards at Government General Hospital Chennai. Toxicology is the poison control centre with research laboratory. More than 1800 cases of attempted suicide are treated each year in this department. It is one of the famous and the biggest poison control centres in India

3.4 STUDY POPULATION

Suicide attempters admitted in the toxicology and medical wards at GGH

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38 3.5 SAMPLE CHARACTERISTICS AND SELECTION

3.5.1. Sample Size

100 patients of suicide attempters with non –fatal outcome admitted at Toxicology and medical ward

3.5.2. Sampling Criteria Sampling Criteria

Inclusion criteria:

1. Clients with the history of attempted suicide 2. Clients above the age of 20 years

3. Clients whose general health condition is stable 4. Clients who are willing to participate in this study 5. Clients who can understand Tamil & English Exclusion criteria:

1. Clients with the history of burns 2. Clients with hearing impairment

3. Client with diagnosis of psychiatric disorders 3.5.3. Sampling Technique

The samples admitted in the poison control and research centre for each day were less than 10; the samples fulfilling the sampling criteria were minimal. So all suicide attempters admitted in the poison control and research centre and Medical wards at RGGGH who fulfilled the sampling criteria were conveniently selected and interviewed by the researcher for this study

3.6 TOOLS USED FOR DATA COLLECTION

The tools selected for this research study are:

♣ Socio-Demographic Information Schedule

♣ Pre- Designed Proforma for Assessing Personal History, History of Past Illness, Family History of Suicide, No. Of.

Suicide Attempts ,Pre/Extra-Marital Relationship, Religiosity

♣ The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)

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39

♣ Modified recent life events checklist( Miller And Rahe 1995)

3.7. DESCRIPTION OF THE TOOLS AND SCORING TECHNIQUE 1) Socio-demographic Information Schedule

Socio demographic information schedule was developed by the researcher itself for the present study. It has 8 questions, data regarding age, sex, occupation, education, marital status, domicile, religion are included in this schedule

2) Pre Designed Proforma

This predesigned Proforma was developed by the researcher itself to get the additional information regarding the personal habits, long term illness, number of suicidal attempt, family history of suicidal attempts, social support, type of marriage, pre/ extra relationship, pre –dominant mood, failure(love exam others), religiosity. These questions are included to compare the stressful life events with these data to demarcate the risk factors appropriately

3)a. Modified recent life events scale

In 1967, psychiatrists Thomas Holmes and Richard Rahe examined the medical records of over 5,000 medical patients to determine whether stressful life events might cause illnesses. Patients were asked to tally a list of 43 life events based on a relative score. A positive 0.1 correlation was found between their life events and their illnesses. Thus, the Social Readjustment Rating Scale (SRRS) or the Holmes and Rahe Stress Scale were born. Each event, called a Life Change Unit (LCU), had a different "weight" for stress. The more events the patient added up, the higher the score. The higher the score, and the larger the weight of each event, the more likely the patient was to become ill. Miller and rahe in the year 1995 modified the SRRS and grouped the question under five dimensions which was called as the miller and rahe recent life change event questionnaire.

This questionnaire provokes information about the life change event

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40 contributed to suicide attempt .Totally it consists of 55 questions divide under five dimensions / factors

1. HEALTH 2. WORK

3. PERSONAL AND SOCIAL 4. HOME AND FAMILY 5. FINANCIAL

Each life change event is provided life change unit (scores)

Low – if score is below 100

Mild - if score is between 101-150

Moderate - if score is between 151-200

High - if score is above 200

ABOVE 200: This score indicates a major life crisis and is highly predictive (80%) of serious physical illness within the next 2 years.

FROM 151 TO 200 POINT: Moderate life crisis. 50% chance of illness such as: headache, diabetes, fatigue, hypertension, chest and back pain, ulcers, infectious disease etc

FROM 100 TO 151POINTS: Mild life crisis. 33% chance of illness such as: headache, diabetes, fatigue, hypertension, chest and back pain, ulcers, infectious disease etc.

If the score is below 100 - no significant crisis

3) b. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) This scale helps in assessing the mental well being of the individual.

Totally it consists of 14 questions , in a 5 point scale from 1-5. This scale explores the mental well being of the clients

None of the time - 1

Rarely - 2

Some of the time - 3

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41

Often- 4

All of the time – 5 Interpretation

a. More than 50 = mentally healthy

b. 50 – 30 = moderately mentally healthy c. Below 30 = mentally unhealthy

4) Interview with suicide attempters

Ten suicide attempters were interviewed separately to determine the various factors contributing to suicide attempt

3.8 CONTENT VALIDITY

After construction of questionnaire for “Identify the risk factors associated with attempted suicide among suicide attempters at Government General Hospital, Chennai” It was tested for its validity and reliability. Content validity was obtained from various experts from the field of Nursing, Medicine, and psychology. They suggested certain modifications in tool. As per the suggestions given by them corrections were made in the socio demographic schedule and also in the predesigned Proforma.

After pilot study reliability of the tool was assessed by using Cron bach Alpha method. Risk factors questionnaire reliability was assessed using Cron bach Alpha method and its correlation coefficient value is 0.82. Mental health questionnaire reliability was assessed using Cron bach Alpha method its Alpha coefficient value is 0.80. These correlation coefficients are very high and it is good tool for assessing risk and mental health.

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42 3.9 PILOT STUDY REPORT

A pilot study was conducted to check the feasibility, reliability and validity of the tool. After the pilot study the researcher found that the questionnaire took approximately 30 – 40 minutes to administer and was easy to collect the needed information

3.10. DATA COLLECTION

To conduct the study permission was obtained from the Head of the department Toxicology and medical wards at Government General Hospital Chennai. The data collection period was from 16/12/2010 to 15/01/2011. Suicide attempters fulfilling the selection criteria were selected and was interviewed between 9am to 5pm. Informed consent was obtained from all the samples. About 3 -5 patients were interviewed each day for about 30 -40 minutes

3.11. PLAN FOR ANALYSIS OF DATA

♣ Percentage, mean and standard deviation to identify the risk factors

♣ Chi-square to associate the identified risk factors with selected demographic variables

♣ Karl person correlation method to correlate mental health of suicide attempters and risk factors of attempted suicide

3.12. PROTECTION OF HUMAN SUBJECTS

The proposal was approved by the experts prior to the pilot study and permission for conducting the main study was obtained from the Head of the Department, Department of Mental Health Nursing, College of Nursing, Madras Medical College, Chennai-03 and Head of The Department of Toxicology at RGGGH Chennai. The study proposal was presented before the members of the ethical committee. Acceptance was given by the panel of members to precede the study. An informed consent was obtained from the study participants, assurance was given to them that confidentiality and privacy would be maintained.

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43

S

SC CH HE EM MA AT TI IC C R RE EP PR RE ES SE EN NT TA AT TI IO ON N O OF F T TH HE E S ST TU UD DY Y

Research Approach (Quantitative Approach)

Research Design

(Retrospective study Design)

Target Population (Suicide attempters)

Accessible Population

(Suicide attempters admitted at RGGGH Chennai)

Sample

(suicide attempters admitted in PCTRC and medical wards)

Sample Size (100 suicide attempters)

Sampling Technique (Convenience Sampling)

Tool

(Recent life change event questionnaire)

Analysis and Interpretation

(Descriptive and Inferential Statistics) Findings of the Study

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44

CHAPTER IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with the detailed description of the data gathered from the suicide attempters admitted at Poison Control Training and Research Centre RajivGandhi Government General Hospital. The data were analyzed based on the objectives formulated by the researcher. The analyzed data are tabulated under tables and figures under the sections given below

SECTION I:

A. This deals with description about the socio- demographic characteristics of the suicide attempters

B. This deals with the description of data from the pre- designed Proforma

SECTION II: This deals with the risk factors associated with attempted suicide among suicide attempters

SECTION III: This deals with the analysis of mental well being of the suicide attempters

SECTION IV: This deals with correlation of the risk factors of attempted suicide with mental health status of suicide attempters SECTION V: This deals with the association of the risk factors and mental health of suicide attempters with selected demographic variables

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45 Section I: A:

Table 3: The demographic information of suicide attempters

Among the samples higher proportion of them were from the age group of 31-40 yrs, majority of the samples 65% were males, only 9% of them were graduates, nearly half of them were unemployed. Among the employed 23.1% were self employed and only 5.8% were from Government sectors. When considering the place of residence more than half of the samples 56% were from rural area

Socio-demographic characteristics

No. of persons % 20 -30 yrs 31 31.0%

31 -40 yrs 56 56.0%

Age

41 -50 yrs 13 13.0%

Male 65 65.0%

Sex

Female 35 35.0%

Primary 12 12.0%

High school 47 47.0%

Higher

secondary 13 13.0%

Graduate 9 9.0%

Education

Non formal

education 19 19.0%

Employed 52 52.0%

Occupation

Unemployed 48 48.0%

Private 20 38.5%

Government 3 5.8%

Self business 12 23.1%

Nature of working place

Agriculture 17 32.7%

< Rs.3000 11 11.0%

Rs.3000 -4000 18 18.0%

Rs.4000 -5000 30 30.0%

Income

>Rs.5000 41 41.0%

Rural 56 56.0%

Urban 25 25.0%

Domicile

Sub urban 19 19.0%

Hindu 66 66.0%

Christian 24 24.0%

Religion

Muslim 10 10.0%

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46 SECTION I: B

Table 4: The personal information of suicide attempters from the pre- designed Proforma

Personal information of suicide attempters from pre- designed Proforma

No. of persons % Marital

status Single 22 22.0%

Married 78 78.0%

Type of

marriage Arranged

marriage 53 67.9%

Love

marriage 15 19.2%

Love cum

arranged 10 12.8%

Age at

marriage < 20 yrs 34 43.6%

20 -25 yrs 37 47.4%

> 25 yrs 7 9.0%

Family type Nuclear

family 56 56.0%

Joint family Extended family

32

12 32.0%

12.0%

Family history of suicidal attempt

Present Absent

Do not know

35 56 9

35.0%

56.0%

9.0%

No. Of suicide attempt

1st attempt 2nd

attempt

>2nd attempt

52 42 6

52.0%

42%

6%

Among the samples higher proportion 78% of them were married , among them 67.9% of them married by arranged marriage, only 9% of them were married after 25 years of age and more than half of them 56% were living in nuclear family. About 35% of the samples had the familial history of suicidal attempt. Nearly half of them 52% attempted suicide for the first time

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47 FIG 5: PERSONAL HABITS OF THE SUICIDE ATTEMPTERS

Among the suicide attempters 39% of them had the habit of smoking and alcohol consumption

(48)

48 SECTION II

Table 5: LEVEL OF CRISIS (LIFE CHANGE EVENTS)

H

Higher proportion of the samples 67% of them had experienced high level of crisis in their life before the suicidal attempt

score No. of persons %

Low 0 0.0%

Mild 15 15.0%

Moderate 18 18.0%

High 67 67.0%

Total 100 100%

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49 FIG 6: ANALYSIS OF RISK FACTORS ASSOCIATED WITH ATTEMPTED SUICIDE AMONG SUICIDE ATTEMPTERS

Among suicide attempters higher proportion 72% of them considered stressors from home and family as the major factor for suicidal attempt

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50 SECTION III

FIG 7: MENTAL WELL BEING OF THE SUICIDE ATTEMPTERS

More than half of the suicide attempters 56% were not mentally healthy

(51)

51 SECTION IV

Table 6: CORRELATION BETWEEN LEVEL OF RISK FACTOR AND MENTAL HEALTH STATUS

MENTAL HEALTH STATUS

Mentally healthy

Moderately mentally healthy

Mentally unhealthy

n % n % n % n

Pearson chi square test

Mild

2 13.3% 8 53.3% 5 33.3% 15

Moderate

2 11.1% 6 33.3% 10 55.6% 18

High 0 00.0% 26 38.8% 41 61.2% 67

Level of risk factor Total 4 40 56 100

χ2=10.81 P=0.02*

DF=4 significant

* significant at P<0.05 ** highly significant at P<0.01 *** Very high significant at P<0.001

As the crisis level increases the mental well being of the samples decreases. So, level of risk factors and mental health were significantly associated.

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52 SECTION V

TABLE 7: ASSOCIATION BETWEEN TYPE OF FAMILY AND MENTAL HEALTH

WEMWBS Mentally healthy

Moderately mentally healthy

Mentally unhealthy Family Type

n % n % n %

n

Pearson chi square test

1 Nuclear family

1 1.8% 25 44.6% 30 53.6% 56

2 Joint family

2 6.3% 14 43.8% 16 50.0% 32

3 Extended family

1 8.3% 1 8.3% 10 83.3% 12

χ2=5.54 P=0.04 DF=4, significant

* significant at P≤0.05 ** highly significant at P≤0.01 *** very high significant at P≤0.001

More than half of the samples 53.6% living in nuclear family was mentally unhealthy thus; samples from the nuclear family were at high risk in attempting suicide.

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53 FIG 8: ASSOCIATION BETWEEN LEVEL OF RISK FACTORS AND AGE OF

SUICIDE ATTEMPTERS

Younger age group were at high risk for suicidal attempt

(54)

54 FIG:9 ASSOCIATION BETWEEN LEVEL OF RISK FACTORS AND OCCUPATION STATUS OF SUICIDE

ATTEMPTED

Unemployed samples were at high risk for stressful events and suicidal attempt

(55)

55 FIG 10 ASSOCIATION BETWEEN OCCUPATION STATUS AND MENTAL HELATH STATUS

Majority of the unemployed samples 68.8% were mentally unhealthy than the employed samples

(56)

56 FIG 11 ASSOCIATION BETWEEN MARITAL STATUS AND LEVEL OF RISK FACTORS

Unmarried samples were at high risk for suicide were compared with married samples

(57)

57 FIG 12 ASSOCIATION BETWEEN WORKING HOURS AND LEVEL OF RISK FACTORS

Samples worked for longer hours were at high risk for suicidal attempt

(58)

58 FIG 13 ASSOCIATION BETWEEN PROBLEMS AND LEVEL OF MENTAL HEALTH STATUS

Samples with family and financial problems were mentally unhealthy when compared with the samples with out those problems

(59)

59 FIG 14 ASSOCIATION BETWEEN MARITAL STATUS AND LEVEL OF MENTAL HEALTH

Marital status was significantly associated with their level of mental well being. Unmarried samples were mentally unhealthy when compared with the samples married samples

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60 FIG 15 ASSOCIATION BETWEEN WORKING HOURS AND LEVEL OF MENTAL HEALTH

Samples worked for long hours of duration were at higher risk for suicidal attempt

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61

CHAPTER V DISCUSSION

This chapter deals with detailed description of the study findings gathered from the statistical analysis. Suicide is becoming one of the leading causes of death in all countries. The unfortunate thing is its causes and risk factors still not unfolded. The data gathered from the suicide attempters reveal various factors contributing for the attempt, the data are statistically analysed and findings are discussed under the objectives formulated by the researcher.

The first objective of this study is to describe about the socio- demographic variables of the suicide attempters

Higher proportion of the samples participated in this study were between the age group of 31-40 yrs, about 65% of the study samples were males, when comparing their marital status into account majority of the samples 78% were married, only 9% of them were married after 25 years of age and more than half of them 56% were living in nuclear family and only 9% of the samples were graduates and 47% of the samples had high school education in this about 52%

that is nearly half of the samples only were employed, about 41% of the samples monthly income was more than 5000 rupees. Majority of the study samples 66% were Hindu and 56% of the samples were from rural area

When taking the details of pre-designed Proforma higher proportion for the samples 39% of them had both the habits of alcoholism and smoking. Higher proportion of the samples 52% had no significant history of suicide in their family

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62 The second objective of this study is to identify the risk factors associated with attempted suicide among suicide attempters The risk factors were analysed using Miller and Rahe recent life change unit scale. When studying each domain in separate heading the samples were at least risk for suicidal attempt due to health, minimal of them considered troubles of work as the precipitating factor for the suicidal attempt, but majority of the samples 72%

considered problems related to home and family as the major factor for their attempt, and the second major dimension of risk was social and personal problems

The study conducted by Klein J et al 2008, with the primary objective of determining the factors contributing to suicide by Semi- structured interview schedule for the patients between the age group of 18 -70 selected from the primary care setting, supports the present study by concluding that factors contributing to suicide were complex and majority of the factors were stress , hopelessness, family conflicts, recent major life change event.

The study conducted by Aravind Pillai (2009) in Goa among young people to estimate the prevalence and risk factors for suicidal behavior also supports this study. They concluded that Premarital sex, independent decision making, physical abuse and alcohol use as the major independent risk factor for suicidal behavior and violence and psychological distress as the dependent risk factors for suicidal attempts. This study supports both the second and the third objective of this study. Firstly, the marital status, alcohol use were identified as the risk factor in both the studies. Secondly, psychological distress was also identified as the risk factor for suicidal attempt

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