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Suicide
Incidence
In India :
Commiting suicide : 1.2 lakh/year
Ateempting suicide : 4 lakhs/year

Approximately 1.5 million people die from suicide worldwide.
19-20 times more people will attempt suicide worldwide.

Highest suicide rates in Europe

Risk Factors
Gender :
Men commit suicide four times more than women.
Women are four times more likely to attempt suicide than men.
Age :
Suicide rate increases with age.
Amongmen, suicide peaks after 45 years.
Among women suicide increases after 55 years of age.
Marital Status :
marriage protects against suicide. Single, never married, have an increased suicide risk.
Occupation :
Higher the personal social status, the greater the risk of suicide.
Mental Illness
95% of all persons who commit suicide have a mental disorder.BPAD accounts for 80 percent. schizophrenia 10%. delirium/dementia-5%.    25% are alcohol dependent

Etiology
Psychological theories
Suicide represents aggression turned inwards against an introjected ambivalently cathected love object. Also describes suicide as an inverted homicide.
Biological factors.   Diminished central serotonin plays a role in suicide behaviour, low concentration of 5- HIAA( hydroxyl indoleacetic acid) in CSF was associated with suicidal behaviour.
Genetic Factors
Family history of suicide increases risk of suicide.
Monozygotic twins have higher concordance rate for suicide.

Management
Complete psychiatric history
A complete mental status examination
Inquiry about depressive symptoms.
Suicide thoughts
Suicide intent, plans and attempts

Simple scale to assess the risk of suicide
SAD PERSONS SCALE.
S- Sex is male
A- Age older than 45 or younger than 19
D- Depression
P- Previous attempt.
E- Ethanol abuse
S- Social support lacking
O- Organise plans
N-no spouse
S- Sickness

Score; 0-2 low risk
            3-4 moderate risk
            5-6 high risk
            7-10 very high risk.

Decision to hospitalize patient depends on diagnosis.
Depression severity and duration
Patient and the family's coping abilities
Availability of social support
Presence of risk factors for suicide
Goals to reduce suicide
Promote awareness
Develop and implement strategies to reduce stigma associated with being a consumer of substance abuse and suicide prevention services.
      
Develop and implement suicide prevention programmes.
Develop and promote effective clinical and professional practices
Promote and support research on suicide and suicide prevention
Improve and expand surveillance systems.


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Indian union health ministry estimates state that 1.2 lakh people commit suicide every year in India. Also, over 4 lakh people attempt suicide.On World Suicide Prevention Day 2008, WHO claimed that Japan, China and India might account for about 40% of the world suicides. Most people who commit suicide in India (37.8%) are below 30 years of age. The percentage of suicides committed by those below 44 years is 71% [Figure 1]. Experts opine that 60% of suicides may not have occurred if proper intervention was undertaken. Ministry officials state that majority of those commiting suicide suffer from depression or other emotional disorders. Over 7.5% of Indians are facing some sort of emotional disorder. Out of these, more than 1.75% (16 million) need institutional intervention. Out of every three cases of suicide reported every 15 minutes in India, one is committed by a youth in the age group of 1529 years. Kerala, the country's first fully literate state, has the highest number of suicides. Some 32 people commit suicide in Kerala every day. In the United States, the overall rate is approximately 20 suicidal deaths per 100,000 persons, which is almost twice as much as the 10.5 reported in India [Table 1].

Figure 1
Figure 1
Suicide victims by sex and age-group during 2006
Table 1
Table 1
Incidence and rate of suicidal deaths in India (19892006)
According to the WHO, every year, almost 1 million people die from suicide, a "global" mortality rate of 16 per 100,000, or one death every 40 seconds. Suicide is among the three leading causes of death among those aged 1544 years in some countries and the second leading cause of death in the 1024 years age group; these figures do not include suicide attempts which are up to 20 times more frequent than completed suicide.

Although traditionally, suicide rates have been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries. Mental disorders (particularly depression and alcohol use disorders) are a major risk factor for suicide in Europe and North America; however, in Asian countries, impulsiveness plays an important role. Suicide is complex with psychological, social, biological, cultural and environmental factors involved.

Although global rates are shown in Figure 2, there are marked differences between individual countries with Belarus and Lithuania topping the list, while India ranks 43rd, thus having a much lower suicide rate than many developed countries [Figure 3]. Within the country, suicide rates vary between 8.1 and 58.3/100,000 population for different parts of India.

Figure 2
Figure 2
Changes in the age distribution of cases of suicide between 1950 and 2000