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 Table of Contents  
RAPID COMMUNICATION
Year : 2016  |  Volume : 3  |  Issue : 1  |  Page : 38-39

Magnitude of suicide attempt in Pondicherry: An under estimate


1 Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
2 Department of Preventive and Social Medicine, JIPMER, Puducherry, India
3 Department of Psychiatry, JIPMER, Puducherry, India

Date of Web Publication24-Jun-2016

Correspondence Address:
Dr. P Punitha Kumary
Department of Community Medicine, PSG Institute of Medical Science and Research, Coimbatore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2350-0298.184675

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How to cite this article:
Kumary P P, Premarajan K C, Sahu SK, Kattimani S. Magnitude of suicide attempt in Pondicherry: An under estimate. Int J Adv Med Health Res 2016;3:38-9

How to cite this URL:
Kumary P P, Premarajan K C, Sahu SK, Kattimani S. Magnitude of suicide attempt in Pondicherry: An under estimate. Int J Adv Med Health Res [serial online] 2016 [cited 2021 Apr 11];3:38-9. Available from: https://www.ijamhrjournal.org/text.asp?2016/3/1/38/184675

Suicide is a major public health problem and a leading cause of death worldwide. Every year, approximately one million people commit suicide.[1] Seventy-five percent of global suicide occurred in low- and middle-income countries in 2012. Suicide accounted for 1.4% of all deaths worldwide, making it the 15th leading cause of death and second among the leading causes of death for both genders in the age group of 15–29 years in 2012.[2] This represents a massive loss to societies of young persons in their productive years of life.[1]

Globally, there is an increasing trend of suicide rate from 10 per lakh population in 1950 to 18 per lakh in 1999.[3] In India too there is an increasing trend from 10.4 per lakh in 2003 to 10.9 per lakh in 2009. Puducherry recorded the highest suicide rate of 47.2 per lakh population in 2009; which is four times the national rate. The suicide rate in Tamil Nadu was 21.5 per lakh which is twice the national level.[4],[5] The World Health Report 2001 estimated that suicidal attempts are twenty times higher than the completed suicides.[1] Worldwide, the estimated numbers of yearly suicidal attempts are 9–36 million.[6] One suicide attempt occurs in every 3 s.[1] In India, the prevalence and incidence of suicide attempts were found to be 0.8% and 5.36%.[7],[8] Of all those who engage in nonfatal suicidal behaviors, one-third repeat the behavior within a year, and nearly 10% eventually commit suicide.[9],[10] For every one suicide, there are 7–10 suicide attempts.[11] Hence, attempted suicide is one of the predictors of suicide deaths.[12]

Attempted suicide is a major public health problem requiring mental health interventions, but it continues to be treated as a criminal offence under the section IPC 306 (suicide) and 309 (suicide attempt).[13] Criminalization of suicidal acts causes the problem of suicide to go underground, making it difficult for suicidal persons to receive necessary assistance.[14] Hence, the magnitude of suicide attempts is an underestimate because of the associated social stigma. In India, many deaths, particularly in rural areas, are not registered at all partly because of an inefficient registration system [15] and partly because of the fear of social and legal consequences associated with suicide.

For the year 2009–2010, the rate of suicide was 50.7 and attempted suicide was 17.95 per lakh population as per CRB Puducherry. However, data on suicide attempt from hospitals (MRD of JIPMER and GH) Puducherry alone showed the rate to be 119.26 per lakh population.[11] Previous studies have found that suicide attempt rate was 5-10 times the suicide rate.[8] Even though the rate of completed suicide was 50.7 according to data from Crime Record Bureau (CRB) of Puducherry, attempted suicide rate was found to be only 17.95 per lakh population.[16]

This revealed that there was gross under-reporting of attempted suicide cases to CRB Puducherry. Not only in Puducherry, but also in the neighboring district of Tamil Nadu (Villupuram) there is gross under-reporting of attempted suicide, as per CRB Villupuram. Possible reason could be due to the social stigma associated with the suicidal attempts and fear of legal implications; people prefer the private health facility than the government. Reported cases of attempted suicide to CRB and hospitals are only the tip of iceberg with huge submerged portion of suicide attempt in the community, which needs to be indentified for better policy prescription.


  Way Forward Top


From a societal perspective, decriminalization is a more sensitive and humane way of dealing with the problem compared to prosecution. Decriminalization will reduce the trauma and potential prosecution in the aftermath of a suicidal attempt. In addition, it will also help in improving the reporting and generation of better epidemiological data on suicidality. The criminalization of suicidal acts causes the problem of suicide to go underground, making it difficult for suicidal persons to receive necessary assistance.[14] Improved and accurate statistics can help in better planning and resource allocation for efforts toward suicide prevention.[13]

Currently, World Health Organization identified 59 countries across the world that have decriminalized suicide.[2] Attempted suicide has been decriminalized in the whole of Europe, North America, much of South America and few parts of Asia. The Indian judiciary and polity both have recognized the need to repeal the section and several attempts have been made starting from 1970. Supreme Court had recommended to Parliament to consider decriminalizing attempt to suicide, saying the provision had become anachronistic. Eventually, it was included in a few sections of the recently drafted Mental Health Care Bill 2013 which has recently been introduced to Rajya Sabha and is still pending approval before it can take effect as a law.[13]

With a shift in official position from “legal” to a “medical” model of attempted suicide, which is an important challenge from a policy perspective will be to provide access to mental health care for all those with attempted suicide. (e.g., JIPMER suicide attempt clinic-run by Psychiatry Department).[16] There is a need to further increase the emphasis on the public health approach to suicide prevention, for example, increased awareness generation, restrictions on access to commonly used lethal methods of suicides (insecticides, prescription medications) and control over facilitating factors such as alcohol. There is also need to develop an effective framework integrating the mental health with social welfare, education, and other related sectors.[13]

Financial support and sponsorship

ICMR grant.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. World Health Report. Mental Health – New Understanding – New Hope. Geneva: WHO; 2001.  Back to cited text no. 1
    
2.
World Health Organization (WHO). Suicide Prevention; 2012. Available from: http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/index.html. [Last accessed on 2014 Sep 18].  Back to cited text no. 2
    
3.
WHO. Suicide Prevention: Emerging from Darkness. Facts and Figures. Mental Health and Substance Abuse; 2006. Available from: http://www.searo.who.int/en/Section1174/Section1199/Section1567/Section1824_8081.htm. [Last accessed on 2016 Feb 18].  Back to cited text no. 3
    
4.
Crime in India 2009. National Crime Record Bureaue. Ministry of home affaires. New Delhi: Govt of India; 2009.  Back to cited text no. 4
    
5.
Annual Report, Crime Record Bureau Pondicherry; 2008.  Back to cited text no. 5
    
6.
Bertolote JM, Fleischmann A, Butchart A, Besbelli N. Suicide, suicide attempts and pesticides: A major hidden public health problem. Bull World Health Organ 2006;84:260.  Back to cited text no. 6
[PUBMED]    
7.
Maselko J, Patel V. Why women attempt suicide: The role of mental illness and social disadvantage in a community cohort study in India. J Epidemiol Community Health 2008;62:817-22.  Back to cited text no. 7
    
8.
Das PP, Grover S, Avasthi A, Chakrabarti S, Malhotra S, Kumar S. Intentional self-harm seen in psychiatric referrals in a tertiary care hospital. Indian J Psychiatry 2008;50:187-91.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Pirkis J, Beautrais A, Durkee T. Suicide attempts in New Zealand and Australia. In: Wasserman D, Wasserman C, editors. Oxford Textbook of Suicidology and Suicide Prevention: A Global Perspective. Oxford: Oxford University Press; 2009. p. 127-31.  Back to cited text no. 9
    
10.
Silverman M. Suicide attempts in North America. In: Wasserman D, Wasserman C, editors. Oxford Textbook of Suicidology and Suicide Prevention: A Global Perspective. Oxford: Oxford University Press; 2009. p. 117-21.  Back to cited text no. 10
    
11.
Chowdhury AN, Banerjee S, Brahma A, Das S, Sarker P, Biswas MK, et al. A prospective study of suicidal behaviour in Sundarban Delta, West Bengal, India. Natl Med J India 2010;23:201-5.  Back to cited text no. 11
    
12.
Chandrasekaran R, Gnanaseelan J, Sahai A, Swaminathan RP, Perme B. Psychiatric and personality disorders in survivors following their first suicide attempt. Indian J Psychiatry 2003;45:45-8.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.
Ranjan R, Kumar S, Pattanayak RD, Dhawan A, Sagar R. (De-) criminalization of attempted suicide in India: A review. Ind Psychiatry J 2014;23:4-9.  Back to cited text no. 13
[PUBMED]  Medknow Journal  
14.
Wendo C. Suicide Cases on the Rise-Survey. The New Vision; 31 August, 2007. Available from: http://www.newvision.co.ug/PA/8/12/584299. [Last accessed on 2014 Sep 18].  Back to cited text no. 14
    
15.
Bose A, Konradsen F, John J, Suganthy P, Muliyil J, Abraham S. Mortality rate and years of life lost from unintentional injury and suicide in South India. Trop Med Int Health 2006;11:1553-6.  Back to cited text no. 15
    
16.
Purushothaman P, Premarajan KC, Sahu SK, Kattimani S. Risk factors and reporting status for attempted suicide: A hospital-based study. Int J Med Public Health 2015;5:45-9.  Back to cited text no. 16
  Medknow Journal  




 

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