Diapositiva 1

SUICIDEA SORROWFUL END OF LIFESABRAR1

HEADINGSIntroductionHistorical perspectiveReligious & Global scenarioEtiology Risk factorsProtective factorsCommon methodsStagesWarning signsTreatmentPreventionRecommendationsABRAR2

REFERENCES

Kaplan & Sadocks Synopsis of Psychiatry (10th edition)

New Oxford Textbook of Psychiatry ; Michael Gelder, Nancy Andreasen (2nd edition)

Community Mental Health in India; B. Chavan, Nithin Gupta

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REFERENCES

Essentials of Psychiatry; Jerald Kay, Allan Tasman

A hand book on Suicide Prevention Strategies, KRISIS

World Health Organization. World Health Report 2001. Mental health: New understanding, new hope. Geneva

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REFERENCES

S.Manoranjitham;Towards a National Strategy to Reduce Suicide in India; The National Medical Journal of India vol. 18, no. 3, 2005

Aaron R, Joseph A, Abraham S, Muliyil J, George K, Prasad ; Suicides in young people in rural southern India Lancet; 2004;363:111718

http://archive.dhakatribune.com/crime/2014/sep/10/28-people-commit-suicide-veryday#sthash.hmX72mEE.dpuf

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INTRODUCTION Suicide defined as an act with a fatal outcome that is deliberately initiated and performed by the person in the knowledge or expectation of its fatal outcome.

Its a complex phenomenon Insurmountable disparity between expectations and outcomes, real or imagined tremendous pressure on mind, blinding its logic, forcing it a conclusion of escape

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Derived from Latin word

sui = oneself , cidium = a killing

Primary emergency for mental health professional

Major public health problemINTRODUCTION ABRAR7

HISTORICAL PERSPECTIVEThe story of suicide is probably as old as that of man himself

Suicide has variously been glorified, romanticized, emoaned, and even condemned

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HISTORICAL PERSPECTIVE

Inancient Athens, a person who committed suicide without the approval of the state was denied the honours of a normal burial

Inancient Greece & Rome suicide was deemed to be an acceptable method to deal with military defeat

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ISLAM: Suicide is PROHIBITED

CHRISTIANITY: Suicide is considered asin

In 19th-century in Europe the act of Suicide shifted from being viewed as caused bysin to being caused byinsanity.

RELIGIOUS PERSPECTIVEABRAR10

RELIGIOUS PERSPECTIVE Hinduism:When Lord Sri Ram died, there was an epidemic of suicide in his kingdom, Ayodhya

The Bhagavad Gita - condemns SuicideUpanishads, the Holy Scriptures - condemn suicide he who takes his own life will enter the sunless areas covered by impenetrable darkness after deathABRAR11

Vedas - permit suicide for religious reasons consider that the best sacrifice was that of one's own life - sallekhana

Sati, where a woman immolated herself on the pyre of her husband rather than live the life of a widow

RELIGIOUS PERSPECTIVEABRAR12

Sociological Factors Durkheims Theory: Emile Durkheim ( French Sociologist )suicideEgoisticAltruisticAnomicETIOLOGYFatalisticABRAR13

ETIOLOGYEgoistic - This type of suicide occurs when the degree of social integration is low

Altruistic - degree of social integration too high

Anomic Integration into society is disturbed

Fatalistic Luck & Slavery!!! EXCESSIVE REGULATIONS

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Psychological Factors

Freuds theory: Mourning and Melancholia

Menningers theory: suicide as inverted homicideGenetic factors

Molecular biology polymorphism in TPH gene (tryptophan hydroxylase enzyme)

ETIOLOGYABRAR15

Biological FactorsSerotonergic system: low concentration of 5-HIAA (metabolite of serotonin)

Nonadrenergic system: stress-diathesis model

HPA axis: Dexamethasone suppression test- non-suppressors

( suicide is more common in groups with low cholesterol levels)ETIOLOGYABRAR16

Gender differences- Men 4 times > WomenExceptions India and China , ratio is 1.3:1 (Kaplan & Sadocks Synopsis of Psychiatry (10th edition)Age- Increase with age men peak age- after 45 yearswomen 55years (Ibid)

Race- Two out of every three suicides are White males (Ibid)

RISK FACTORSABRAR17

Religion- Degree of orthodoxy and integration (Community Mental Health in India; B. Chavan, Nithin Gupt)Marital status- Lessens the risk (Ibid)Occupation- Higher social status greater the risk (Ibid) unemployed > employedPhysician suicides - physicians particularly females are at greater risk (Ibid)

RISK FACTORSABRAR18

Mental illness- 90- 95% have a diagnosed mental disorder

Psychiatric patients- Depressive Disorder- 80% Alcohol Related Disorders 4-60% Schizophrenic Disorder- 3-10% Personality Disorder- 5-44% Organic Mental Disorder- 2-7% (Dr. Suhasini K. 2014)

RISK FACTORSABRAR19

BIOLOGICAL, PSYCHOSOCIAL AND DEMOGRAPHIC FACTORSDepression SchizophreniaAddiction disorderFamily history& past history of suicidalityDysregulated serotonergic systemEarly parental lossIsolationUnemploymentAcute life eventsOlder ageMale sexVulnerable periodsABRAR20

GLOBAL SCENERIOMore than 8,00,000 people die by suicide per year

Estimated annual mortality is 145 deaths per 1,00,000 people (Mental health: New understanding, new hope by WHO, 2001)Around one person every 40 seconds (Ibid)

75% of suicides occur in low- and middle-income countries (Dhaka Tribune)

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GLOBAL SCENERIOSuicide worldwide was estimated to represent 1.8% of the total global burden of disease in 1998

By 2020 - projected to be 2.4% (Mental health: New understanding, new hope by WHO, 2001)

Tenth leading cause of death worldwide (Google.com)

It is the second leading cause of death in 15-29 year-olds globally (Ibid)

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GLOBAL SCENERIO

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GLOBAL SCENERIOSuicide belt (25 per 100,000) Scandinavia, Switzerland, Germany, Austria, eastern European countries (Belarus, Estonia, Lithuania, and the Russian Federation) and Japan (New Oxford Textbook of Psychiatry, 2001)Prime suicide site of the world Golden Gate Bridge in San Francisco (Dr. Suhasni K, 2014)

Japan- reported to have highest number of cases (New Oxford Textbook of Psychiatry, 2001)ABRAR24

GLOBAL SCENERIO75% of suicide occur in low and middle-income countries. (Dhaka Tribune 10 SEP 2014)

In wealthier countries, three times as many men die by suicide than women. Men aged 50 years and over are particularly vulnerable. (Dhaka Tribune 10 SEP 2014)ABRAR25

SUICIDE IN BANGLADESH10,000 people commit suicide every year (Statistics of the Police Headquarters.)

73,389 people committed suicide in seven years from 2002 to 2009. 31,857 hanged themselves & 41,532 had swallowed poison. (The Daily Star 28.04.2012)

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SUICIDE IN BANGLADESH258 people--180 women and 78 men--killed themselves in eight months from January 2011 to August 2011. (Bangladesh Manabadhikar Bastabayan Sangstha)

40 girls committed suicide from 2006 to 2010 because of stalking. (Jatiya Mahila Ainjibi Samity)

4,747 women and girls killed themselves from 2001 to 2010 due to family violence. (Ibid)

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SUICIDE IN BANGLADESHHidan Mehjabin, a seventh grade student of Viqarunnisa Noon School, killed herself on October 9, 2011 having failed to endure the agony caused by the separation of her parents. (The Daily Star 28.04.2012)

Sultana Akhter, 24, a resident of Kandapara village in Dharmapasha upazila of Sunamganj district, committed suicide following torture by her husband over dowry on October 13, 2011 (The Daily Star 28.04.2012)

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SUICIDE IN BANGLADESHDr. Mohammad Jahangirul Alam, a physician at Bangabandhu Sheikh Mujib Medical University (BSMMU), says the most common underlying disorder is- Depression and 30-70 percent of suicide victims suffer from major depression or bipolar (manicdepressive) disorder.ABRAR29

SUICIDE IN BANGLADESHAccording to the latest WHO data published in may 2014 Suicide Deaths in Bangladesh reached 10,167 or 1.40% of total deaths. The age adjusted Death Rate is 7.63 per 100,000 of population Rank of Bangladesh in suicide is #97 in the world. ABRAR30

COMMON METHODS OF SUICIDEPesticide poisoning(30%)

Hanging

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Exsanguinations

Suffocation

Drowning

COMMON METHODS OF SUICIDE

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Firearms

Drug overdose

Fatal injuries

COMMON METHODS OF SUICIDE

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WARNING SIGNS

Trouble coping with recent losses, death, divorce, moving, break-ups, etc.

Feelings of hopelessness and despair

Making final arrangements: writing a will or eulogy, or taking care of details (i.e. closing a bank account).

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SIGNS / INVITATIONS TO TALKStressful events especially with feelings of loss IncludingAny Major Change E.G. School / Work Etc.BereavementUnemploymentMoney WorriesMove / Any Loss Of Social SupportEnd Of RelationshipABRAR35

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Physical signs include...

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Feelings include...

THOUGHTSI wont be needing these things anymoreI cant do anything right I cant think straight anymoreI cant take it anymore I wish I was deadEveryone will be better off without me All my problems will end soon No one can help me now Now I know what they were going throughABRAR39

Thoughts are sometimes expressed verbally. Listen out for....

STAGES OF SUICIDE Ideation

Threatening

AttemptingIntervention

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Strong connections to family and community supportSkills in problem solving, conflict resolution, and non-violent handling of disputesPersonal, social, cultural and religious beliefs that discourage suicide and support self-preservationRestricted access to means of suicideSeeking help and easy access to quality care for mental and physical illnesses

PROTECTIVE FACTORSABRAR41

Evidence from Australia, Canada, Japan, New Zealand, the United States and a number of European countries revealed that limiting access to these means of committing suicide can prevent such deaths. Currently, only 28 countries are known to have national suicide prevention strategies. Another key to reducing deaths by suicide is a commitment by national governments to establish and implement a coordinated plan of action. PROTECTIVE FACTORSABRAR42

PEOPLE WHO TALKS ABOUT SUICIDE DO NOT MEAN TO DO IT

PEOPLE WHO TALK ABOUT SUICIDE MAY BE REACHING OUT FOR HELP OR SUPPORT

We Just Need To Help Them.BECAUSE -

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ANY ORGANIZATION?YES!!!!!LETS INTRODUCEABRAR45

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SUICIDE PREVENTION DAY-10TH SEPTEMBER

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