SUICIDE

Suicide is the act of killing yourself, most often as a result of depression or other mental
illness. Suicide is when people direct violence at themselves with the intent to end their lives,
and they die because of their actions. It’s best to avoid the use of terms like “committing
suicide” or a “successful suicide” when referring to a death by suicide as these terms often
carry negative connotations.

A suicide attempt is when people harm themselves with the intent to end their lives, but they
do not die because of their actions

Suicide is an irrational desire to die. We use the term "irrational" here because no matter how
bad a person's life is, suicide is a permanent solution to what is nearly always a temporary
problem. Suicide is a symptom and sign of serious depression. Depression is a treatable
disorder, but often the treatment takes time, energy and effort on the part of the person whose
feeling depressed. Sometimes, as a person who is depressed feels the energizing effects of an
antidepressant medication, they will still feel depressed, but have more energy. It is during
this time in treatment that many people turn to suicide and suicidal acts.

Suicide's effects are tragic and felt long after the individual has taken their own life. It is
usually the second or third leading cause of death amongst teenagers, and remains one of the
top ten leading causes of death well into middle-age. A person who dies by suicide leaves
behind them a tangled confusion of family members and friends who try to make sense of a
senseless and purposeless act.

DEFINITION :

The definition of suicide has been a subject of controversy amongst researchers and scholars alike.
The converging point or least ambiguous in their definitions of suicide is that the outcome of the act is
death.

The suicide word is derived from Latin word “sui = oneself , cidium = a killing”

Suicide refers to an act whereby the person kills him or herself of his or her own free will, mostly to
escape a situation at home, in school, or within the social environment that he/she considers to be
unbearable . (Moore, 2000).

An incomplete suicide attempt (parasuicide) refers to the intentional act of self-injury of which the
outcome is not fatal. Such an act or acts vary from minor suicidal gestures to serious suicidal acts

(Rutter, 1995).

Suicidal tendency arises from complicated motives, and the intention is not necessarily death. As an
individual process, suicidal behavior can be conceptualized as ranging from suicidal ideas and threats
to suicide attempts and completed suicide (Brent et al.,1988a;Paykel,1974).

Stengel(1973) defined suicide as the fatal, act of self-injury undertaken with more or less conscious
self-destructive intent, however ague or ambiguous”.

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Self-harm is defined as a compulsion or impulse to inflict physical wounds on one’s body
motivated by a need to cope with unbearable psychological distress or regain a sense of
emotional balance. This act is usually carried out without suicidal, sexual or decorative intent.

(Sutton 2007, 22-23.)

FACTS ABOUT SUICIDE

Eight out of ten people who kill themselves have given definite clues and warnings
about their suicidal intentions. Very subtle clues may be ignored or disregarded by
others.

Most suicidal people are very ambivalent about their feelings regarding living or
dying. Most are “gambling with death” and see it as a cry for someone to save them.

People who want to kill themselves are only suicidal for a limited time. If they are
saved from feelings of self-destruction, they can go on to lead normal lives.

Most suicides occur within about 3 months after the beginning of “improvement,”
when the individual has the energy to carry out suicidal intentions.

Suicide is not inherited. It is an individual matter and can be prevented. However,

suicide by a close family member increases an individual’s risk factor for suicide.

A large percentage of people who commit suicide have been diagnosed with a mental
disorder. However, many others are merely unable at that point in time to see an
alternative solution to what they consider an unbearable problem.

All suicidal behavior must be approached with the gravity of the potential act in mind.
Attention should be given to the possibility that the individual is issuing a cry for
help.

Gunshot wounds are the leading cause of death among suicide victims.

Between 50% and 80% of all people who ultimately kill themselves have a history of
a previous attempt.

TYPES OF SUICIDE :

Durkheim's theory of 'suicide' is related in various ways to his study of the division of labor. It is
also linked with the theory of 'social constraint'. Durkheim has established the view that there are
no societies in which suicide does not occur.

Rejecting most of the accepted theories of suicide, Durkheim on the basis of his monographic
studies claims suicide as primarily a social phenomena in terms of the breakdown of the vital
bond of life. Durkheim in his classical study of 'Le Suicide' which was published in 1897,
demonstrates that neither psycho-pathic factor nor heredity nor climate nor poverty, nor
unhappy love nor other personal factors motivate along form sufficient explanation of suicide.
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According to Durkheim, suicide is not an individual act nor a personal action. It is caused by
some power which is over and above the individual or super individual. He viewed "all classes of
deaths resulting directly or indirectly from the positive or negative acts of the victim itself who
knows the result they produce" Having defined the phenomenon Durkheim dismisses the
psychological explanation. Many doctors and psychologists develop the theory that majority of
people who take their own life are in a pathological state, but Durkheim emphasizes that the
force, which determines the suicide, is not psychological but social. He concludes that suicide is
the result of social disorganization or lack of social integration or social solidarity.

Emile Durkheim classified different types of suicides on the basis of different types of
relationship between the actor and his society.

(1) Egoistic suicide

According to Durkheim, when a man becomes socially isolated or feels that he has no place in
the society he destroys himself. This is the suicide of self-centered person who lacks altruistic
feelings and is usually cut off from main stream of the society.

(2) Altruistic suicide

This type of suicide occurs when individuals and the group are too close and intimate. This kind
of suicide results from the over integration of the individual into social proof, for example - Sati
customs, Dannies warriors.

(3) Anomic suicide

This type of suicide is due to certain breakdown of social equilibrium, such as, suicide after
bankruptcy or after winning a lottery. In other words, anomic suicide takes place in a situation
which has cropped up suddenly.

(4) Fatalistic suicide

This type of suicide is due to overregulation in society. Under the overregulation of a society,
when a servant or slave commits suicide, when a barren woman commits suicide, it is the
example of fatalistic suicide

Although Durkheim's theory of suicide has contributed much about the understanding of the
phenomenon because of his stress on social rather than on biological or personal factors, the
main drawback of the theory is that he has laid too much stress only on one factor, namely social
factor and has forgotten or undermined other factors, thereby making his theory defective and
only one sided.

HISTORICAL PERSPECTIVES OF SUICIDE

The story of suicide is probably as old as that of man himself. Through the ages, suicide has
variously been glorified, romanticized, bemoaned, and even condemned. Be it the tragic
Greek heroes Aegeus, Lycurgus, Cato, Socrates, Zeno, Domesthenes or Seneca; or the
Roman figures Brutus, Cassius, Mark Anthony or the Egyptian princess, Cleopatra; or

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Samson, Saul, Abimelech and Achitophel of the Old Testament; or the suicide bombers in the
present world, the universality of suicide transcends religion and culture.

An understanding of suicide in the Indian context calls for an appreciation of the literary,
religious, and cultural ethos of the subcontinent because tradition has rarely permeated the
lives of people for as long as it has in India. Ancient Indian texts contain stories of valor in
which suicide as a means to avoid shame and disgrace was glorified.
Suicide has been mentioned in the great epics of Ramayana and Mahabharata. When Lord Sri
Ram died, there was an epidemic of suicide in his kingdom, Ayodhya. The sage Dadhichi
sacrificed his life so that the Gods may use his bones in the war against the demons. The
Bhagavad Gita condemns suicide for selfish reasons and posits that such a death cannot have
“shraddha’, the all-important last rites. Brahmanical view had held that those who attempt
suicide should fast for a stipulated period. Upanishads, the Holy Scriptures, condemn suicide
and state that ‘he who takes his own life will enter the sunless areas covered by
impenetrable darkness after death’.

However, the Vedas permit suicide for religious reasons and consider that the best sacrifice
was that of one's own life. Suicide by starvation, also known as ‘sallekhana’, was linked to
the attainment of ‘moksha’ (liberation from the cycle of life and death), and is still practiced
to this day. Sati, where a woman immolated herself on the pyre of her husband rather than
live the life of a widow and Jahuar (Johar), in which Rajput women killed themselves to
avoid humiliation at the hands of the invading Muslim armies, were practiced until as
recently as the early half of the 20th century; stray cases continue to be reported

EPIDEMIOLOGY OF SUICIDE

India's suicide rate per 100,000 people compared to other countries, according to the World
Health Organization, Geneva. Peeter Värnik claims China, Russia, United States, Japan,
and South Korea are the biggest contributors to the absolute number of suicides in the world.
Värnik claims India's adjusted annual suicide rate is 10.5 per 100,000, while the suicide rate
for the world as a whole is 11.6 per 100,000.

In 2016 the number of suicides had increased to 230,314. Suicide was the most common
cause of death in both the age groups of 15–29 years and 15–39 years.
About 800,000 people die by 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.

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According to WHO data, the age standardized suicide rate in India is 16.4 per 100,000 for
women (6th highest in the world) and 25.8 for men.
STATISTICS OF SUICIDE IN INDIA

Sr.no. Causes No of people

1. Bankruptcy or indebtedness 2,308

2. Marriage Related Issues (total) 6,773

3. (including) Non Settlement of Marriage 1,096

4. (including) Dowry Related Issues 2,261

5. (including) Extra Marital affairs 476

6. (including) Divorce 333

7. (including) Others 2,607

8. Failure in Examination 2,403

9. Impotency/Infertility 332

10. Other Family problems 28,602

11. Illness (total) 23,746

12. (including) AIDS/STD 233

13. (including) Cancer 582

14. (including) Paralysis 408

15. (including) Insanity/Mental illness 7,104

16. (including) Other prolonged illness 15,419

17. Death of dear person 981

18. Drug abuse/addiction 3,647

19. Fall in social reputation 490

 RISK FACTORS RELATED TO SUICIDE :

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 Marital Status: The suicide rate for single persons is twice that of married
persons. Divorced, separated, or widowed persons have rates four to five times greater
than those of the married (Jacobs et al., 2006).

 Gender : Women attempt suicide more, but men succeed more often. Successful
suicides number about 70 percent for men and 30 percent for women. This has to do
with the lethality of the means. Women tend to overdose; men use more lethal means
such as firearms. In the United States, from 1970 to 2005, annual suicide rates per
100,000 rose from 16.8 to 17.7 in men, but decreased from 6.6 to 4.5 in women
(National Center for Health Statistics, 2007). These differences between men and
women may also reflect a tendency for women to seek and accept help from friends or
professionals, whereas men often view help-seeking as a sign of weakness.

 Age : Suicide risk and age are positively correlated. This is particularly true with
men. Although rates among women remain fairly constant throughout life, rates
among men show a higher age correlation. The rates rise sharply during adolescence,
peak between 40 and 50, and levels off until age 65, when it rises again for the
remaining years (National Center for Health Statistics, 2007). The suicide rate among
young people ages 15 to 19 peaked in 1990 at 11.1 per 100,000 and declined to 7.7
per 100,000 in 2005 (National Center for Health Statistics, 2007). Several factors put
adolescents at risk for suicide, including impulsive and high-risk behaviors, untreated
mood disorders (e.g., major depression and bipolar disorder), access to lethal means
(e.g., firearms), and substance abuse. The use of firearms, which accounts for about
49 percent of cases, is the most common method of completed suicide in children and
adolescents (CDC, 2004). The suicide rate for the elderly peaked in 1990 at 20.5 per
100,000 and declined to 14.7 per 100,000 in 2005 (National Center for Health
Statistics, 2007). While the elderly make up less than 13 percent of the population,
they account for 16 percent of all suicides (NIMH, 2007). White males over the age of
80 are at the greatest risk of all age/gender/race groups . Eighty-five percent of elderly
suicides are men, which is 5.5 times greater than for women, and firearms are the
most common means of completing suicide (American Association of Suicidology,
2006). The overall rate of suicide for women declines after age 65.
 Religion: Historically, suicide rates among Roman Catholic populations have been
lower than rates among Protestants and Jews (Sadock & Sadock, 2007). In a recent
study published in the American Journal of Psychiatry, depressed men and women
who consider themselves affiliated with a religion are less likely to attempt suicide
than their nonreligious counterparts (Dervic et al., 2004). The study showed no
statistical significance for affiliation with any particular religious group, but only for
the affiliation itself.

 Socioeconomic Status : Individuals in the very highest and lowest social classes
have higher suicide rates than those in the middle classes (Sadock & Sadock, 2007).

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 With regard to occupation, suicide rates are higher among physicians, artists, dentists,
law enforcement officers, lawyers, and insurance agents.
 Ethnicity : With regard to ethnicity, statistics show that whites are at highest risk
for suicide, followed by Native Americans, African Americans, Hispanic Americans,
and Asian Americans (National Centre for Health Statistics, 2007).

 Other Risk Factors : Individuals with mood disorders (major depression and
bipolar disorder) are far more likely to commit suicide than those in any other
psychiatric or medical risk group. Sadock and Sadock (2007) report, “Almost 95
percent of all people who commit or attempt suicide have a diagnosed mental
disorder. Depressive disorders account for 80 per cent of this figure.” Suicide risk
may increase early during treatment with antidepressants, as the return of energy
brings about an increased ability to act out self destructive wishes. Other psychiatric
disorders that may account for suicidal behavior include psychoactive substance abuse
disorders, schizophrenia, personality disorders, and anxiety disorders (Jacobs et al.,
2006). Severe insomnia is associated with increased suicide risk, even in the absence
of depression. Use of alcohol, and particularly a combination of alcohol and
barbiturates, increases the risk of suicide. Psychosis, especially with command
hallucinations, poses a higher than normal risk. Affliction with a chronic painful or
disabling illness also increases the risk of suicide.

PSYCHIATRIC DISORDERS THAT LEAD TO SUICIDE :

Depression
Untreated depression is the number one cause for suicide. You are not depressed when you feel
sad for a day or two; you are depressed when you experience a prolonged period of sadness that
interferes with your ability to function. Depression occurs because of an imbalance of chemicals
in the brain. It is an illness. And it is highly treatable. Unfortunately, many people do not receive
treatment for depression, and thus are at risk for suicide.

If you or have some of these symptoms below, please seek help immediately:

 Feeling sad for two or more weeks

 Feeling lethargic -- feeling like you have no energy
 Unable to concentrate
 Sleeping too much or too little
 Eating too much or too little
 Feeling worthless
 Feeling hopeless
 Feeling helpless
 Feeling negative or pessimistic
 Losing interest in activities that you previously enjoyed
 Crying frequently
 Withdrawing from others

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  Neglecting personal appearance
 Feeling angry
 Feeling guilty
 Unable to think clearly
 Unable to make decisions

Basically, if "the blues" do not go away after two weeks, you probably have depression. And you
need to get treatment. So please make an appointment with a medical doctor and a therapist so
you may be properly evaluated. Many people do not think of going to a medical doctor when
they are depressed, but it is an important step because there could be a physical problem beside
the chemical imbalance that is causing the depression. And please get into therapy. If the
therapist believes that you need medication he or she can refer you to someone.

Anxiety
What are the links between anxiety and suicide? They’re deep and surprising, according to a few
new studies. While suicide has long been linked to more “severe” mental disorders, such as
depression and schizophrenia, anxiety and suicide are being linked now more than ever. Of
course, not everyone with anxiety will commit or attempt suicide, but understanding that these
links are deep and strong will go a long way towards helping us understand just how serious a
problem an anxiety disorder can be.

One recent study from Sweden showed that people who have nervous or anxious feelings on a
regular basis are more likely than average to attempt suicide sometime in the next decade. This
study is a little vague, but others have linked anxiety and suicide even more deeply.

It used to be thought that anxiety disorders had to go along with other things – such as
depression or other mental illnesses – in order to raise a person’s risk for committing suicide.

Now, though, psychologists are admitting that an anxiety disorder alone is enough to cause
suicidal thoughts and attempts in a huge number of patients.

In a study published in the Archives of General Psychiatry in 2005, it was found that 52.4% of people
who imagine committing suicide have at least one anxiety disorder and that about 64.1% of
those who attempt suicide had at least one anxiety disorder. Also, the presence of just one
anxiety disorder in a patient is enough to increase the lifetime risk of suicide in an individual.

PREVENTION
Clearly the links between anxiety and suicide are strong enough to be of major concern to
clinicians and therapists – as well as anxiety sufferers. If you or someone you know is at risk for
anxiety and suicide, there are things that you can do to help reduce the risks of anxiety leading to
suicide:

 Understand that anxiety is a serious problem, even if it is not as severe as a phobia or

panic attack disorder. Even if you’re just struggling with everyday feelings of generalized
anxiety and nervousness, your risk for committing or attempting suicide could go up.

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 Seek help immediately whenever you feel that you’re being overtaken by anxiety in your
life.
 Seek help whenever you have suicidal thoughts or intentions. If you find your mind
drifting to thoughts of suicide, particularly if you already feel anxious, seek help
immediately. Cognitive behavioral therapy and medication can straighten out the
problem before it becomes out of control.
 Understand your own anxiety. Learn to understand how your mind and your anxiety
work, so that you can combat them on a daily basis. Learn relaxation techniques to keep
your general anxiety levels lowered, and seek further help in the form of therapy if
relaxation techniques aren’t enough.

On the social level, it’s time that we take anxiety and suicide seriously. If you know someone
who struggles with constant or overwhelming anxiety, talk to that person about what you might
be able to do to help. You might be surprised at how much just having someone take them
seriously can help a person with an anxiety disorder, as these disorders are often overlooked or
brushed off by observers!

Stress
Stress isn't inherently bad. It causes you to respond to events, to "rise to the challenge", and to
better yourself. But too much stress can be catastrophic and too much stress can cause or
exacerbate suicidal feelings. But, keep in mind that what stresses you may not stress someone
else, and vice versa. And it does not matter how someone else responds to stress; what matters is
how you respond. If you feel stressed, you are stressed.

One of the most effective ways to deal with people that causes you stress is don't deal with them
(unless you really have to). Stay away from them. If you need to make some adjustments in your
life for this, then do so.

Remember this: You, and only you, are in control of your life. You decide who you want to be
with and who you don't want to be with. You decide where you want to go and where you don't
want to go.

Mental Illness
The term mental illness refers to a group of illnesses, disorders or diseases that affect a person’s
thought processes, perception of reality, emotions, or judgment, and could lead to disturbed
behavior. People living with mental illness may experience the following symptoms:

 auditory and visual hallucinations

 delusions
 disordered thinking
 impaired memory
 diminished concentration
 disruptions in sleeping patterns or appetite

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  irritability
 lack of motivation
 flashbacks
 mood swings
 distress

THEORIES OF SUICIDE :

 The biological perspective

It emphasizes the role of bodily processes by suggesting that bodily disturbances can be caused
by a genetic defect, an injury or infection, or a temporary physiological malfunction caused by a
current condition.

Another point of view would be that maladaptive behavior is jointly caused by the body, the
psychological functioning, and the social environment. Genetic factors, which influence the
biological perspective, include the nervous system being affected not only by genes but
environment as well. One major factor in genetic abnormalities is irregularities in the structure or
number of chromosomes, which are present in all body cells.

Abnormalities in the brain are often caused by chromosomal abnormalities. An implication of

the biological perspective is that many types of abnormal behavior is largely due to factors that
are beyond people’s control such as the type of brain and body someone is born with and the
environment in which they live.

Most teenage suicide is driven by impulsive or aggressive behavior, stress, or anxiety, which have
been shown to be related to abnormalities in serotonergic mechanisms.

 The psychodynamic perspective

It emphasizes the role of anxiety and inner conflict, meaning that thoughts and emotions are
important causes of behavior and environment and personal experiences play roles in how the
brain functions. Observable behavior is a function of intra-psychic processes. Many
psychodynamic theorists agree that personality is shaped by a combination of inner and outer
events emphasizing on the inner ones. Sigmund Freud, the originator of the psychodynamic
perspective, believed that in order to understand behavior it is necessary to analyze the thoughts
preceding and associated with it, and that to understand these thoughts, a person’s deepest
emotions and feelings must be explored.

 The behavioral perspective

It examines how environment influences behavior in that it focuses on behavior as a response

to stimuli in the environment. Psychologists who use the behavioral perspective focus on
learning and view behavior as a product of stimulus-response relationships rather than delving
into the past to try to get people to figure out why they are the way they are.

Classical conditioning and operant conditioning are two of the most important pillars in the
behavioral perspective. Classical conditioning is the response that occurs automatically to one

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stimulus and then is transferred to a new stimulus by pairing the two stimuli. Operant
conditioning uses reinforcements in order to achieve a response. Positive reinforcements and
rewards increase the chance of the behavior happening again whereas negative reinforcement or
punishments provide a negative consequence for the behavior thus decreasing the probability of
repetition.

 The cognitive perspective

It looks to defective thinking and problem solving as causes of abnormal behavior as it focuses
on the way people acquire and interpret information and use it in problem solving. It puts great
emphasis on mental processes that we are aware of or can easily be made aware of, as opposed
to hidden motivations, feelings and conflicts.

Cognitive perspective pays attention to people’s thoughts and problem solving strategies rather
than their personal histories. People are continually collecting; storing, modifying, interpreting
and understanding both internally generated information and environmental stimuli. People
develop schemata, which contain information about different parts of a person’s life and assist in
information processing and strategy development.

 The humanistic-existential perspective

It emphasizes out uniqueness as individuals and freedom to make our own decisions in that in
every person there is an active striving toward self-actualization, or a desire to be all that you can
be. Humanists are more optimistic than existentialists when it comes to human condition and
they see undesirable environmental influences as disruptions of self-actualization where
existentialists emphasize the responsibilities of the individual to deal realistically with
environmental givens.

 The community-cultural perspective

It is concerned with the roles of social relationships and the impact of socioeconomic
conditions and maladaptive behavior suggesting that maladaptive behavior, rather than being a
personal health problem or character defect, is a result of an inability to effectively cope with
stress. Instead of viewing the behavior as a disease or a problem existing within the individual it
is seen partly as a failure of the individuals social system which would include a person’s spouse,
parents, siblings, relatives, friends, teachers, employers, religious advisors, community
organizations, government agencies and others. Social causation is a theory that argues that the
poor schools, crime, inadequate housing and prejudice often found in deteriorating low-income
neighborhoods may increase the stress experiences by already venerable people, whereas the
social selection theory suggests that lower socioeconomic groups show greater incidence of
maladaptive behavior because people who do not function well tend to experience downward
social mobility.

NEUROLOGICAL BASIS OF SUICIDE

Decades of research have documented abnormalities in the hypothalamic pituitary adrenal
(HPA) axis as well as the serotonergic, dopaminergic, and noradrenergic systems with regard

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to the neurobiology of suicide. These systems are integral to stress response, and their altered
functioning may be influenced by genetic, epigenetic, and/or adverse life events .

 Serotonergic system
As regards the serotonergic system, depressed patients with suicidal behavior were found to
have significantly lower CSF levels of the serotonin metabolite 5-hydroxyindoleacetic acid
(5-HIAA) than depressed patients without suicidal behavior or controls . Low CSF 5-HIAA
levels were also shown to predict future suicide attempts and completions . Interestingly,
lower levels of the same metabolite were shown to correspond with the lethality of the
suicide attempt . Similarly, low serotonergic function was observed in suicide attempters with
major depressive disorder (MDD), as indicated by a blunted prolactin response to challenge
dosing with a serotonin reuptake inhibitor, fenfluramine . Among the many serotonin (5-HT)
receptor subtypes, extensive postmortem studies implicate 5-HT2A receptors . Early studies
found increased 5-HT2A binding in suicide victims compared to controls , and subsequent
studies similarly showed patterns of increased protein expression of 5-HT2A in the prefrontal
cortex (PFC) and hippocampus in suicide victims . It thus appears that post-synaptic
serotonin receptor upregulation reflected in increased gene expression may be a
compensatory response to reduced serotonin neuronal activity .

 Noradrenergic system
Fewer noradrenergic neurons were found in the loci cerulei of suicide victims with MDD ,
and increased β-adrenergic receptor binding was found in the PFC of suicide victims . In
addition, lower urinary and plasma levels of 3-methoxy-4-hydroxyphenylglycol (MHGP), a
major metabolite of norepinephrine, were found in patients displaying suicidal behaviors
compared with controls . Another study found that the lethality of suicide attempts in BD
patients negatively correlated with MHGP levels .

 Dopaminergic system
Few post-mortem studies examining the dopaminergic system have shown conclusive trends;
however, one study demonstrated higher cortical levels of homovanillic acid (HVA)
(dopamine’s primary metabolite) in suicide and homicide victims compared to those who
died of physical disease, but not accident victims . High CSF levels of HVA have also been
shown to correlate with human aggression .

 HPA system
With respect to the HPA axis, considerable evidence suggests that early-life adverse events
can produce enduring changes in the regulation of stress-response systems in humans . In
addition, the HPA axis has bidirectional relationships with the neurotransmitter systems
discussed above . As a result, many investigators have examined components of the HPA axis
in suicide victims. For example, one postmortem study identified a significant decrease in the
number of corticotropin releasing factor (CRF) receptor binding sites in suicide completers
compared to controls . Similarly, increased CRF immunoreactivity was found in the frontal
cortex of suicide victims . A recent study also demonstrated that BD patients with a past
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history of attempted suicide had bedtime salivary cortisol levels 7.4% higher than unaffected
healthy controls . BD alone was not associated with a cortisol increase, suggesting a role for
stress dysregulation in mediating the high suicide risk in BD.

 Other hormonal systems: cholesterol and testosterone

The link between lipids and suicidal behavior was investigated after large randomized clinical
trials and other meta-analyses revealed an increase in violence-related activities— including
suicide in patients taking cholesterol-lowering medications. Specifically, clinical studies

Suicide Warning Signs

Talking about suicide Any talk about suicide, dying, or self-harm, such as "I
wish I hadn't been born," "If I see you again...," and "I'd
be better off dead."

Seeking out lethal Seeking access to guns, pills, knives, or other objects that
means could be used in a suicide attempt.

Preoccupation with Unusual focus on death, dying, or violence. Writing

death poems or stories about death.

No hope for the future Feelings of helplessness, hopelessness, and being trapped
("There's no way out"). Belief that things will never get
better or change.

Self-loathing, self-hatred Feelings of worthlessness, guilt, shame, and self-hatred.

Feeling like a burden ("Everyone would be better off
without me").

Getting affairs in order Making out a will. Giving away prized possessions.
Making arrangements for family members.

Saying goodbye Unusual or unexpected visits or calls to family and

friends. Saying goodbye to people as if they won't be
seen again.

Withdrawing from Withdrawing from friends and family. Increasing social

others isolation. Desire to be left alone.

Self-destructive Increased alcohol or drug use, reckless driving, unsafe

behavior sex. Taking unnecessary risks as if they have a "death
wish."

Sudden sense of calm A sudden sense of calm and happiness after being
extremely depressed can mean that the person has made
a decision to 13
commit suicide.
 suggested a relationship between reduced total cholesterol levels and suicidal behavior . One
recent study found lower serum cholesterol and triglyceride levels in men with BD who
attempted suicide compared with BD men who had not . Additional support for this potential
biological marker comes from a study noting that the biological relatives of Smith-Lemli-
Opitz syndrome carriers—an autosomal recessive condition characterized by abnormally low
cholesterol levels resulting from mutations in the genes involved in cholesterol
biosynthesis—had an increased number of suicide attempts and completions compared to
controls . Low cholesterol levels have been associated with decreased serotonergic activity
and lower cholesterol in the brain, which may lead to reduced synaptic plasticity and brain
dysfunction . As a result, Smith-Lemli-Opitz patients and carriers may be important sub-
groups for further study with regard to suicide neurobiology.

A recent exploratory study in male and female BD patients experiencing a depressive or

mixed episode who had at least one past suicide attempt found that testosterone levels were
positively correlated with both the number of previous manic episodes and with suicide
attempts . Notably, cholesterol serves as a precursor to testosterone and other hormones such
as cortisol and estrogen. While the relationship between serum testosterone levels and
suicidal behavior is not consistent , testosterone and other androgens are believed to be
involved in the pathophysiology of mood disorders and suicidal behavior .

LEVELS OF SUICIDE RISK

Level of Suicide Risk

Low — Some suicidal thoughts. No suicide plan. Says he or she won't commit suicide.

Moderate — Suicidal thoughts. Vague plan that isn't very lethal. Says he or she won't commit
suicide.

High — Suicidal thoughts. Specific plan that is highly lethal. Says he or she won't commit suicide.

Severe — Suicidal thoughts. Specific plan that is highly lethal. Says he or she will commit suicide.

SUICIDE IN THE ELDERLY

Compared to other age groups, those 65 years and older have the highest risk of committing
suicide. For example, the suicide rate for the elderly is 50 percent higher than the rate for
teenagers or the U.S. national rate. In the United States 18 elderly persons commit suicide
each day, 1 every 80 minutes. The majority of elderly suicides are committed using a firearm.
Some older individuals have a higher suicide risk than others: most at risk are males, whites,
the recently widowed, and those aged 75 years or more.

The two psychiatric conditions most associated with suicide in the elderly are depression and
alcoholism. Psychological autopsy studies show that approximately 70 percent of elderly

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suicide victims suffered from depression in the weeks and months before their suicide.
Approximately 20 percent of elderly suicides meet the criteria for a substance abuse disorder,
usually alcohol abuse or dependence.

Studies show that loss and stress are major etiologic factors in the depression and alcohol
abuse found among elderly suicide victims. These include physical losses resulting from poor
health, painful illness, sensory deficits, and cognitive decline;

social losses like death of a spouse and loss of the work role; and income losses associated
with retirement and medical expenses. Such losses may lead to reduced social networks and
social isolation, and can produce feelings of despair, loneliness, demoralization, dependency
on others, helplessness and hopelessness, as well as suicidal ideation.

SUICIDE AMONG PSYCHIATRIC INPATIENTS

The great majority of psychiatric patients who commit suicide do so as outpatients. Many of
these outpatients suicides occur within the first few weeks or months after discharge from a
psychiatric institution, which highlights the fact that the post discharge period is a period of
increased suicide risk for psychiatric patients.

However, up to 15 percent of psychiatric patients who commit suicide do so as inpatients.

Many of these suicides do not actually occur on the ward itself but in stairwells, other
hospital buildings, on the grounds, near railway lines, or in rivers. Other inpatients commit
suicide at home when out on a pass, on weekend leave, or when absent without leave.

The commonest diagnosis among inpatient suicides in the acute psychiatric ward is
depression and the suicide risk is highest in the first few days of the admission. Times of staff
rotation, particularly of psychiatric residents, are periods associated with inpatient suicides.
Clusters of inpatient suicides tend to be associated with periods of ideological change on a
ward, staff disorganization, or staff demoralization.

However, suicides also occur among long-term psychiatric inpatients. In hospitals the
diagnosis most often associated with suicide is schizophrenia. Surprisingly, inpatients with
schizophrenia may commit suicide after having been in the hospital for more than a year.
Often, they have previously exhibited suicidal behavior and have been admitted involuntarily
. Suicide in such schizophrenia patients may be precipitated by attempts at rehabilitation or
discharge.

METHODS OF SUICIDE
 Pesticide poisoning(30%)
 Hanging
 Firearms
 Drug overdose
 Fatal injuries
 Exsanguinations

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  Suffocation
 Drowning
 SUICIDAL IDEATION

MANAGEMNT OF SUICIDAL CLIENT

The key factor for treatment include the patient’s suicide plan, access to lethal means, social
support and judgment. Admission is strictly voluntary but patient may also refuse treatment.
The grounds for involuntary commitments are:

1. Imminent danger to self or others and

2. An inability to care for one’s self. Management in wards gives time to interview suitable
informants and for psychotropic medications to be administered and for their beneficial
effects or side effects to be closely monitored.

Psychotherapy : Individual, group, family or marital. When patient hold a conversation and
is able to describe his problem, feelings then supportive psychotherapy or brief problem –
oriented psychotherapeutic approach are indicated. Individual sessions of cognitive behavior
therapy, interpersonal or dynamic psychotherapy would also be beneficial.

Suicide caution

 Patient of immediate risk should be placed on ‘suicide caution’

 Searching the belongings for dangerous objects

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  Ward environment- unnecessary tubes, wires or sharps etc
 Shower units should be wall mounted
 If forks or knives are used during meal, there should be accounted at the end
 Windows should be protected with grills and ward doors lockable
 Bed should be close to the nursing station
 Observe for frequent interval and record
 Attention to neuro vegetative symptoms such as sleep and appetite disturbance
 If lying motionless in the bed , do not assume sleeping
 Subjective report of poor sleep should be checked with objective observation
 Do not allow to leave the ward
 Watch on appearance and affect
 Spend time to describe difficulties of patient and listen in empathetic manner
 MEDICATIONS
Antidepressant selective serotonin reuptake inhibitor act more rapidly tricyclic
antidepressant should be avoided due to lethal potentials in overdose. Safer agents

Fluoxetine (Prozac) – 20 -40 mg/day

Sertraline (Zoloft) - 50-200mg/day
Paroxetine (Paxil) - 20-40mg/day
Fluvoxamine (luvox) -150 – 250mg/day
Venlafaxine (effexor) - 75-300mg/day
Nefazodone (serzone) -400-600mg/day In anxiety and insomnia
Lorazepam (ativan) - 0.5-4mg/day
Oxazepam (serax) - 15-45mg/day
Temazepam (restoril)- 15-20mg/day HS
Zolpidem (Ambien) 5-10mg HS

ECT is considered in patient who do not respond to medications.

NURSING MANAGEMENT

The psychiatric evaluation is the core element of the suicide risk assessment. This section provides an
overview of the key aspects of the psychiatric evaluation as they relate to the assessment of patients
with suicidal behaviors.

 ASSESSMENT
1. Identify specific psychiatric signs and symptoms

It is important to identify specific psychiatric signs and symptoms that are correlated with an
increased risk of suicide or other suicidal behaviors. Symptoms that have been associated with
suicide attempts or with suicide include aggression, violence toward others, impulsiveness,
hopelessness, and agitation. Psychic anxiety, which has been defined as subjective feelings of
anxiety, fearfulness, or apprehension whether or not focused on specific concerns, has also been
associated with an increased risk of suicide, as have anhedonia, global insomnia, and panic
attacks. In addition, identifying other psychiatric signs and symptoms (e.g., psychosis, depression)
will aid in determining whether the patient has a psychiatric syndrome that should also be a focus
of treatment.

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2. Assess past suicidal behavior, including intent of self-injurious acts
A history of past suicide attempts is one of the most significant risk factors for suicide, and
this risk may be increased by more serious, more frequent, or more recent attempts.
Therefore, it is important for the psychiatrist to inquire about past suicide attempts and self-
destructive behaviors, including specific questioning about aborted suicide attempts.
Examples of the latter would include putting a gun to one’s head but not firing it, driving to a
bridge but not jumping, or creating a noose but not using it. For each attempt or aborted
attempt, the psychiatrist should try to obtain details about the precipitants, timing, intent, and
consequences as well as the attempt’s medical severity. The patient’s consumption of alcohol
and drugs before the attempt should also be ascertained, since intoxication can facilitate
impulsive suicide attempts but can also be a component of a more serious suicide plan. In
understanding the issues that culminated in the suicide attempt, interpersonal aspects of the
attempt should also be delineated. Examples might include the dynamic or interpersonal
issues leading up to the attempt, significant persons present at the time of the attempt, persons
to whom the attempt was communicated, and how the attempt was averted.
3. Review past treatment history and treatment relationships: A review of the patient’s
treatment history is another crucial element of the suicide risk assessment. A thorough
treatment history can serve as a systematic method for gaining information on comorbid
diagnoses, prior hospitalizations, suicidal ideation, or previous suicide attempts. Obtaining a
history of medical treatment can help in identifying medically serious suicide attempts as well
as in identifying past or current medical diagnoses that may be associated with augmented
suicide risk. Many patients who are being assessed for suicidality will already be in treatment,
either with other psychiatrists or mental health professionals or with primary care physicians
or medical specialists. Contacts with such caregivers can provide a great deal of relevant
information and help in determining a setting and/or plan for treatment. With patients who are
currently in treatment, it is also important to gauge the strength and stability of the therapeutic
relationships, because a positive therapeutic alliance has been suggested to be protective
against suicidal behaviors. On the other hand, a patient with a suicide attempt or suicidal
ideation who does not have a reliable therapeutic alliance may represent an increased risk for
suicide, which would need to be addressed accordingly
4. Identify family history of suicide, mental illness, and dysfunction Identifying family history is
particularly important during the psychiatric evaluation. The psychiatrist should specifically
inquire about the presence of suicide and suicide attempts as well as a family history of any
psychiatric hospitalizations or mental illness, including substance use disorders. When
suicides have occurred in first-degree relatives, it is often helpful to learn more about the
circumstances, including the patient’s involvement and the patient’s and relative’s ages at the
time of the suicide. The patient’s childhood and current family milieu are also relevant, since
many aspects of family dysfunction may be linked to self-destructive behaviors. Such factors
include a history of family conflict or separation, parental legal trouble, family substance use,
domestic violence, and physical and/or sexual abuse. 5. Identify current psychosocial
situation
5. Identify current psychosocial situation and nature of crisis : An assessment of the
patient’s current psychosocial situation is important to detect acute psychosocial crises or
chronic psychosocial stressors that may augment suicide risk (e.g., financial or legal
difficulties; interpersonal conflicts or losses; stressors in gay, lesbian, or bisexual youths;
housing problems; job loss; educational failure). Other significant precipitants may include
perceived losses or recent or impending humiliation. An understanding of the patient’s

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 psychosocial situation is also essential in helping the patient to mobilize external supports,
which can have a protective influence on suicide risk.
6. Appreciate psychological strengths and vulnerabilities of the individual patient : In
estimating suicide risk and formulating a treatment plan, the clinician needs to appreciate the
strengths and vulnerabilities of the individual patient. Particular strengths and vulnerabilities
may include such factors as coping skills, personality traits, thinking style, and developmental
and psychological needs. For example, in addition to serving as state-dependent symptoms,
hopelessness, aggression, and impulsivity may also constitute traits, greater degrees of which
may be associated with an increased risk for suicidal behaviors. Increased suicide risk has
also been seen in individuals who exhibit thought constriction or polarized (either-or)
thinking as well in individuals with closed-mindedness (i.e., a narrowed scope and intensity
of interests).
Begin with questions that address the patient’s feelings about living
• Have you ever felt that life was not worth living?
• Did you ever wish you could go to sleep and just not wake up?
Follow up with specific questions that ask about thoughts of death, self-harm, or suicide
• Is death something you’ve thought about recently?
• Have things ever reached the point that you’ve thought of harming yourself?
For individuals who have thoughts of self-harm or suicide
• When did you first notice such thoughts?
• What led up to the thoughts (e.g., interpersonal and psychosocial precipitants, including real
or imagined losses; specific symptoms such as mood changes, anhedonia, hopelessness,
anxiety, agitation, psychosis)?
• How often have those thoughts occurred (including frequency, obsessional quality,
controllability)?
• How close have you come to acting on those thoughts?
• How likely do you think it is that you will act on them in the future?
• Have you ever started to harm (or kill) yourself but stopped before doing something (e.g.,
holding knife or gun to your body but stopping before acting, going to edge of bridge but not
jumping)?
• What do you envision happening if you actually killed yourself (e.g., escape, reunion with
significant other, rebirth, reactions of others)?
• Have you made a specific plan to harm or kill yourself? (If so, what does the plan include?)
• Do you have guns or other weapons available to you?
• Have you made any particular preparations (e.g., purchasing specific items, writing a note
or a will, making financial arrangements, taking steps to avoid discovery, rehearsing the
plan)?
• Have you spoken to anyone about your plans?
• How does the future look to you?
• What things would lead you to feel more (or less) hopeful about the future (e.g., treatment,
reconciliation of relationship, resolution of stressors)?
• What things would make it more (or less) likely that you would try to kill yourself?
• What things in your life would lead you to want to escape from life or be dead?
• What things in your life make you want to go on living?
• If you began to have thoughts of harming or killing yourself again, what would you do?
 DIAGNOSIS/OUTCOME IDENTIFICATION

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 Nursing diagnoses for the suicidal client may include the following:
1. Risk for suicide related to feelings of hopelessness and desperation.
2. Hopelessness related to absence of support systems and perception of
worthlessness.
Outcome Criteria Outcome criteria include short- and long-term goals. Timelines are
individually determined. The following criteria may be used for measurement of
outcomes in the care of the suicidal client.
Examples of outcomes for a suicidal person include the following:
• The client will be safe from harming self or others.
• The client will engage in a therapeutic relationship.
• The client will establish a no-suicide contract.
• The client will create a list of positive attributes.
• The client will generate, test, and evaluate realistic plans to address underlying
issues.
 PLANNING/IMPLEMENTATION: Nursing diagnoses are presented, along with
outcome criteria, appropriate nursing interventions, and rationales for each.
Intervention with the Suicidal Client Following Discharge (or Outpatient Suicidal
Client) In some instances, it may be determined that suicidal intent is low and that
hospitalization is not required. Instead, the client with suicidal ideation may be treated
in an outpatient setting. Guidelines for treatment of the suicidal client on an outpatient
basis include the following:
Intervention
 Using an Authoritative Role Intervention for suicide or suicidal ideation
becomes the first priority of nursing care. The nurse assumes an authoritative
role to help clients stay safe. In this crisis situation, clients see few or no
alternatives to resolve their problems. The nurse lets clients know their safety
is the primary concern and takes precedence over other needs or wishes. For
example, a client may want to be alone in her room to think privately. This is
not allowed while she is at increased risk for suicide.
 Providing a Safe Environment Inpatient hospital units have policies for
general environmental safety. Some policies are more liberal than others, but
all usually deny clients access to materials on cleaning carts, their own
medications, sharp scissors, and penknives. For suicidal clients, staff members
remove any item they can use to commit suicide, such as sharp objects,
shoelaces, belts, lighters, matches, pencils, pens, and even clothing with
drawstrings. Again, institutional policies for suicide precautions vary, but
usually staff members observe clients every 10 minutes if lethality is low. For
clients with high potential lethality, one-to-one supervision by a staff person is
initiated. This means that clients are in direct sight of and no more than 2 to 3
feet away from a staff member for all activities, including going to the
bathroom. Clients are under constant staff observation with no exceptions.
This may be frustrating or upsetting to clients, so staff members usually need
to explain the purpose of such supervision more than once. No-suicide or no-
self-harm contracts have been used with suicidal clients. In such contracts,

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 clients agree to keep themselves safe and to notify staff at the first impulse to
harm themselves (at home, clients agree to notify their caregivers; the contract
must identify backup people in case caregivers are unavailable). These
contracts, however, are not a guarantee of safety, and their use has been
sharply criticized (McMyler & Pryjmachuk, 2008). At no time should a nurse
assume that a client is safe based on a single statement by the client. Rather a
complete assessment and a thorough discussion with the client are more
reliable.
 Creating a Support System List Suicidal clients often lack social support
systems such as relatives and friends or religious, occupational, and
community support groups. This lack may result from social withdrawal,
behavior associated with a psychiatric or medical disorder, or movement of the
person to a new area because of school, work, or change in family structure or
financial status. The nurse assesses support systems and the type of help each
person or group can give a client. Mental health clinics, hotlines, psychiatric
emergency evaluation services, student health services, church groups, and
self help groups are part of the community support system. The nurse makes a
list of specific names and agencies that clients can call for support; he or she
obtains client consent to avoid breach of confidentiality. Many suicidal people
do not have to be admitted to a hospital and can be treated successfully in the
community with the help of these support people and agencies.
 Family Response Suicide is the ultimate rejection of family and friends.
Implicit in the act of suicide is the message to others that their help was
incompetent, irrelevant, or unwelcome. Some person—even to the point of
planning how that person will be the one to discover the body. Most suicides
are efforts to escape untenable situations. Even if a person believes love for
family members prompted his or her suicide—as in the case of someone who
commits suicide to avoid lengthy legal battles or to save the family the
financial and emotional cost of a lingering death—relatives still grieve and
may feel guilt, shame, and anger.

Nurse’s Response : When dealing with a client who has suicidal ideation or attempts, the
nurse’s attitude must indicate unconditional positive regard not for the act but for the person
and his or her desperation. The ideas or attempts are serious signals of a desperate emotional
state. The nurse must convey the belief that the person can be helped and can grow and
change. Trying to make clients feel guilty for thinking of or attempting suicide is not helpful;
they already feel incompetent, hopeless, and helpless. The nurse does not blame clients or act
judgmentally when asking about the details of a planned suicide. Rather, the nurse uses a
nonjudgmental tone of voice and monitors his or her body language and facial expressions to
make sure not to convey disgust or blame. Nurses believe that one person can make a
difference in another’s life. They must convey this belief when caring for suicidal people.
Nevertheless, nurses also must realize that no matter how competent and caring interventions
are, a few clients will still commit suicide. A client’s suicide can be devastating to the staff
members who treated him or her, especially if they have gotten to know the person and his or

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her family well over time. Even with therapy, staff members may end up leaving the health
care facility or the profession as a result.

 EVALUATION : Evaluation of the suicidal client is an on going process

accomplished through continuous reassessment of the client, as well as determination
of goal achievement. Once the immediate crisis has been resolved, extended
psychotherapy may be indicated. The long-term goals of individual or group
psychotherapy for the suicidal client would be for him or her to:
1. Develop and maintain a more positive self-concept.
2. Learn more effective ways to express feelings to others.
3. Achieve successful interpersonal relationships.
4. Feel accepted by others and achieve a sense of belonging. A suicidal person feels
worthless and hopeless. These goals serve to instill a sense of self-worth, while
offering a measure of hope and a meaning for living.

LEGAL AND ETHICAL CONSIDERATIONS

Assisted suicide is a topic of national legal and ethical debate, with much attention focusing
on the court decisions related to the actions of Dr. Jack Kevorkian, a physician who has
participated in numerous assisted suicides. Oregon was the first state to adopt assisted suicide
into law and has set up safeguards to prevent indiscriminate assisted suicide. Many people
believe it should be legal in any state for health care professionals or family to assist those
who are terminally ill and want to die. Others view suicide as against the laws of humanity
and religion and believe that health care professionals should be prosecuted if they assist
those trying to die. Groups, such as the Hemlock Society, and people, such as Dr. Kevorkian,
are lobbying for changes in laws that would allow health care professionals and family
members to assist with suicide attempts for the terminally ill.

Controversy and emotion continue to surround the issue. Often, nurses must care for
terminally or chronically ill people with a poor quality of life, such as those with the
intractable pain of terminal cancer or severe disability or those kept alive by life-support
systems. It is not the nurse’s role to decide how long these clients must suffer. It is the nurse’s
role to provide supportive care for clients and family as they work through the difficult
emotional decisions about if and when these clients should be allowed to die; people who
have been declared legally dead can be disconnected from life support. Each state has defined
legal death and the ways to determine it.

Law commission of India (42nd report, 1971) advocated to repeal section 309. IPC
Amendment Bill was introduced in the Rajya Sabha in 1972 and passed in 1978.
Unfortunately, before it could be passed by the Lok Sabha, it was dissolved and
consequently, the Bill lapsed. In 1994 (P. Rathinam Vs Union of India), Supreme Court
repealed Section 309 but only after a gap of 2 years, Supreme court reversed its own decision
and the law was reinstated.

Legal implications of Specific Suicide Problems In India

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 Sati : Sati Regulation Act was passed as early as in 1827 in India. There are a
number of provisions under which the persons supporting the execution of sati can be
held. In case of the woman being forced to commit the act, it shall be treated as plain
murder, but where the woman has conducted sati on her own volition, those who
have assisted her can be held for culpable homicide and/or abetment to suicide.
Presence of any intoxicant or anything that inhibits free will of the woman would
attract section 305 IPC, the punishment of which is exactly the same as for murder.
Similarly, when the act is not accomplished, provisions of attempt to murder, attempt
to culpable homicide not amounting to murder or abetment to suicide would be
attracted. Commission of Sati (Prevention) Act, 1987.
The Act clearly states that burning or burying alive of widows is revolting to the
feelings of human nature and is not enjoined in the religion. The Act recognizes the
following as offences:
• Attempt to sati: Whoever attempts to commit sati or does any act towards such
commission shall be punished with imprisonment upto six months, or fine or both
• Abetment of sati: Whoever abets the commission or attempt to the commission of
sati, shall be punished with death or imprisonment for life
• Glorification of sati: Whoever does any act for the glorification of sati shall be
punishable with imprisonment for not less than one year, which may extend upto
seven years
• Burden of proof: Section 16 of the Act reverses the burden of proof on to the
accused. Under the Act, it is the accused who has to prove that he has not committed
the offence
• Bar from inheriting property: The Act bars that person convicted for commission
of sati from inheriting the property of the person in respect of whom sati was
committed Suicide committed as a means of homicide
The final report submitted by the commission stated that, “Section 309 of the Indian
Penal Code provides double punishment for a person who has already got fed up with
his own life and desires to end it. Section 309 is also a stumbling block in prevention
of suicides and improving the access of medical care to those who have attempted
suicide”.
The commission hence concluded that, “Section 309 needs to be effaced from the
statute book because the provision is inhuman, irrespective of whether it is
constitutional or unconstitutional”.
For the young population :
— Special counselling sessions can be arranged at the time of examinations and
declaration of results (C.B.S.E. [Central Board for Secondary Education] has recently
taken an initiative in this regard)
— Continued support groups, sound career advice and better educational policies by
the govt. so that there is equitable distribution of seats in academic institutions (not
favouring particular sections for political gains only)
For the farmers

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 — Better agricultural policies to be drafted keeping ground realities in purview —
Provision of short term loans at low interests to tide over difficult times Better
provision and education about insurance cover of the crops Where should the law
intervene?
• Mandatory psychiatric consultation of all patients admitted following attempted
suicide
• Increased restrictions on access to the most commonly used lethal methods of
suicides (insecticides, prescription medications) and improving control of facilitatory
factors such as alcohol
• Media could be influenced about how to portray suicide and the method used in a
humane way so that further attempts are discouraged. Help of the media and NGOs
could also be taken to propagate the fact that around 90% of those who die by suicide
have a mental disorder and that timely intervention by experts can bring down this
number significantly
• Last but not the least, there is an urgent need for the development of a national plan
for suicide prevention in all the countries of south Asia. The highest likelihood of
success in saving lives in the long run lies in well designed, comprehensive programs
focused on prevention, identification and appropriate treatment of Mental and
Addictive Disorders particularly in Primary care
Conclusion :
Suicide is not the way out of any problem. It’s a time to have a healthy life style. We
should make our private psychiatrist and visit them normally. We should make our life
easy and believe on the factor of “HOPE”. Movies are being made to motivate people
what it feels after doing suicide what goes on the family whose child do suicide. Different
societies are being made for it. To stop this activity we need to do a lot more even in our
country Pakistan.

Not only this, we should do whatever we like life is short care for others and get care for
others. Remove the word “problem”. Remove the word “SUICIDE”. Live a happy life
with a happy family. Don’t care for those who hurt you. Because they will hurt you more.
Work hard so that you don’t face any difficulties financially. Choose your best profession,
so, you should get success in it and live a healthy life.

No worries no tension so no depression no SUICIDE.

REFERENCES

1. Kaplan HI, Sadock BJ. Synopsis of Psychiatry , Behavioral Sciences/ Clinical

Psychiatry .9th ed. Hong Kong :William and Wilkinson Publishers;2009.
2. Moyer, KE. 1968. Kinds of aggression and their physiological basis. Communications
in Behavioral Biology 2A:65-87
3. Townsend M C Psychiatric mental health nursing- concepts of care. 8 th edn.
Philadelphia: F.A Dais company; 2009.

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4. Videbeck Shiela . Psychiatric mental health nursing , 5th ed. Wilkins Kluwer,
lippinkot Williams and Wilkins 2011
5. www.wikipedia.com
6. www.slideshare.com
7. www.scribd.com

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