International Journal of Current Research and Review (IJCRR)

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IJCRR - vol 05 issue 21, November

Pages: 65-69

Date of Publication: 21-Nov-2013


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PSYCHIATRIC MORBIDITY IN PATIENTS OF ATTEMPTED SUICIDE ADMITTED IN A RURAL AREA HOSPITAL OF NORTHERN ANDHRA PRADESH

Author: Srikrishna Nukala, Ravinder Edam, M. Dattatrey

Category: Healthcare

Abstract:World Health Organization estimates about one million people die of suicide each year. Approximately one suicide occurs every minute, and a suicidal attempt every 3 seconds. In India the rate of suicide is 12 per lakh and more than 100,000 people die of suicide every year. Aims and Objectives: To study the demographic profiles and other related details of attempted suicides in rural area. To investigate for the presence of any physical or psychiatric morbidity in the subjects. To assess increase in psychosocial stress, in any specific area, preceding the event Material and methods: Fifty patients who have survived the attempt and as defined by Dorpat and Boswell (1963) and Morgan (1975) were taken up for study after taking informed consent. All the subjects were subjected to detailed psychiatric interview and are assessed on different scales. Results: In the present study, the most common Psychiatric disorders are depressive disorder 42% followed by Alcohol abuse 14% and Anxiety disorders 8%, No psychotic disorders were noted . 68% of the subject?s common mode of Attempt was organo-phosphorous, and 60% of the attempts were impulsive in nature Conclusion: In a country like ours, where literacy is low and poverty is high, the biggest challenge will be to dispel the stigma and superstitions associated with mental illness and explode the myths shrouding „suicide?.

Keywords: Attempted suicide, Psychiatric morbidity, Suicidal ideation, Stress

DOI URL: http://dx.doi.org/10.31782/IJCRR.2013.111313

Full Text:

INTRODUCTION

Global mortality due to suicide has increased by about 60% in the last five decades. According to World Health Organization estimates about one million people die of suicide each year. Approximately one suicide occurs every minute, and a suicidal attempt every 3 seconds [1]. In India the rate of suicide is 12 per lakh and more than 100,000 people die of suicide every year. Though 70 to 90% of suicide cases have a treatable underlying psychiatric illness, only less than 10% seek mental health care, because ‘attempted suicide’ continues to be a punishable offence in our country [2].

AIMS AND OBJECTIVES

  1. To study the demographic profiles and other related details of attempted suicides in a rural setting.
  2. To investigate for the presence of any physical or psychiatric morbidity that led the subjects to the extreme step.
  3. To assess increase in psychosocial stress, in any specific area, preceding the event that could be contributive to the attempt.

METHODOLOGY

Hospital based study, 50 patients between 15years and 65 years are included. Variables related to Socio-demographic features, family dynamics, suicide characteristics, Psychiatric morbidity were studied. All the subjects who attempted suicide as defined by Dorpat and Boswell (1963) [3] and Morgan (1975) [4] were taken up for study, Dorpat and Boswell’s definition of attempted suicide includes all willful, self-inflicted, life threatening acts which have not led to death. Morgan’s definition which is restricted to self poisoning includes all the deliberate, nonfatal acts done in the knowledge that it was potentially harmful and the amount taken was excessive in the case of drug over dosage.

Tools

  • Structured Pro forma for collecting demographic data and details of suicide attempts.
  • Socio-economic scale by O.P Aggarwal.
  • Alcohol use disorders identification test (AUDIT).
  • Becks depression inventory (BDI).
  • Hamilton Anxiety rating scale (HARS).
  • Brief Psychiatric Rating Scale (BPRS).
  • Family Interaction Scale - NIMHANS Scale  I-Bhatti (1982).
  • Family and Social Integration Schedule - Venkoba Rao (1989).
  • Presumptive Stressful Life Event Scale Gurmeet singh, Dalbir Kaur and Harsharan Kaur (1981).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               DISCUSSION

    Socio- Demographic Features

    Peak occurrence of suicides was observed in the age group of 15 to 25yrs, the youngest and the oldest being 15yrs and 70yrs respectively. Nagendra Gouda, Sambaji (2008) showed similar results [5]. Female predominance of 64% in the sample is in conformity with the earlier studies reported on attempted suicides. WHO studies hold unmarried, divorced, widowed and single people at a high risk than married people. But in the present study 74% of the subjects were married. This may be due to the nature of the institution of marriage in India, which is more of a social obligation, performed by elders, irrespective of the individual’s preparedness for it. Marital partners in India are virtually strangers to each other, and so are the families. Hence, several adjustment problems can arise after marriage. The study of Nagendra Gouda, Sambaji M Rao (2008) [5] also reported similar results. As most of the studies in India are from Hindu residential areas it is very difficult to make any observation from the religious perspective. Majority of the sample in this study had only school education, while in the study of Nagendra Gouda, Sambji (2008) [5] majority had college level and above education. Different domiciliary backgrounds of the samples could be a reason for this observation. Underdeveloped rural

    background with low educational and employment opportunities could be a reason for the poor socio economic status

    Features of suicide Attempt

    60% of the suicides were impulsive in nature in the present study and it is in accordance to the study done by Kretman (1975) [6]. The commonest method was ingestion of organo-phosphorous compounds, followed by self poisoning with over dosage of drugs and other substances. The area of study being agrarian, the subjects have an easy access to these compounds both at home and at local markets. This could be the reason for the high choice of this method. Diurnal variation is observed in this study. In general, planned and highly motivated attempts occur in solitude and nights and it in accordance to the study done by B.S. Chavan, Gurvinder pal singh (2008) [7]. In the present study suicidal ideation was observed in 40% of the subjects. Suicidal ideation is a high risk factor and dependable indicator. Paykel reported 8.9 % [8] in his study In the present study 8% of the subjects had past history of suicide attempt, it in similar line with the study done by B.S. Chavan, Gurvinder pal singh(2008) [7] who had 8.9% Suicidal behaviour in the past is a very high risk factor in the predictability of future attempts.

    Current psychopathology

    On Beck Depression Inventory (BDI) 42% of the sample were found to be suffering from depressive disorder. The result in the present study is comparable with those of Barraclough et al (1974) [9], A Roy et al. [10]. Hamilton Anxiety Rating Scale (HARS) was used to assess anxiety. In contrast to the present study, T.Pettri, Taraja k. Melartin (2003)[11] reported 63 %. Indians, more so the villagers take life in their stride with a philosophical fortitude and hence have a high threshold to anxiety. This might have reflected as low anxiety levels in the present study Brief Psychiatric Rating Scale (BPRS) was used to evaluate psychotic disorders. In the present sample none had psychosis. However few subjects scored high on depression related questions of BPRS.  Brain A. Palmer (2005) [12] in a Meta analysis reported a life time prevalence of 4.9% in schizophrenia. Assessment of subjects was done using Alcohol Use Disorders Identification Test (AUDIT). In this study 14% were found to be having alcohol use disorder. B.S.Chavan, Gurvinder Pal singh (2008) [7] noted 23.7 %  H. Gethinin noted 12% [13].

    Other observations

    On Gurmeeth singh’s Presumptive Scale of Life Events, the subjects in the present study scored a total of 189 life events during the past one year and 115 life events during the life time. The corresponding mean scores are 3.78 and 2.3 while the standard deviations are 2.38 and 2.18 respectively. These results show that subjects had increased psychosocial stress preceding the attempt. Failures in the examination, frustration in love affairs were the common causes in the 15-25 year age group. In married females persecution in the family topped the list. Financial problems were the cause of stress in the male subject. Only 14% of the samples were aware of the ensuing legal complications beforehand. This can be explained on the basis of low education level in the rural area.

    CONCLUSION

    By and large ingestion of pesticides, indigenous substances and drugs in excess is the commonest method of attempt in the rural areas, perhaps due to their easy availability. A free access to these substances poses a great threat to the villagers. Conducting awareness programmes regarding the use and safety of these substances may help prevent suicides to a greater extent in the rural areas.  In our country, where people can freely purchase drugs of any quality and quantity without an authorized prescription, it is high time the Government impose strict rules making the prescription of a Medical practitioner mandatory for dispensation of drugs. Total prevention of suicides is never possible. In a country like ours, where literacy is low and poverty is high, the biggest challenge will be to dispel the stigma and superstitions associated with mental illness and explode the myths shrouding ‘suicide’. This is possible with a multi dimensional and well concerted approach under a National Community Health Program.                

    Limitations

    As the study was conducted in a rural area and the sample size being small the study results cannot be generalized to the overall population though personality disorders carry a substantial risk for suicide, personality was not assessed for the current sample.

    ACKNOWLEDGEMENTS

    I sincerely thank all the participants for their contribution to the study. I extend my thanks to Dr. Lakshmi Naresh, M.D, Dr. Rajesh, M.D for their valuable suggestions.

    Ethical Issues

    Institutional ethical clearance was obtained for the study. Confidentiality of participant’s personnel information was maintained throughout the study.

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  5. Factors related to attempted suicide in Davanagere, MR Nagendra Gouda, Sambabi Rao, Indian journal of community Medicine vol. 33, No 1, January 2008.
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