Attitude Deference among Suicide Attempters and Non Attempters: An Indian Perspective-Juniper Publishers
Global Journal of Intellectual & Developmental Disabilities (GJIDD)
Aim: The aim of this paper is to conduct an
analysis of attitude differences in the outcome of a broad range of
suicidal behavior occurring within the general publics.
Methodology: This study was a cross sectional descriptive survey carried out among general population residing in an urban community.
Data analysis: Descriptive (frequency and
percentage) and inferential statistics (chi square test) were used to
analyze and interpret the data.
Result: There are few significant attitude
difference found between the suicide attempters and non-attempters of
the general public's. Majority of the respondent believe that People who
make suicidal threats seldom complete suicide, one should rather not
talk about, it and suicide can happen without warning.
Conclusion: These attitude differences need to
be taken in to consideration when developing appropriate programs to
prevent suicide. Raising wakefulness about suicide avoidance among
general population is vital in developing countries like India. Since
the causes of suicides are multiple, there is no single solution that
can prevent all suicides. The prevention program need to be tailored for
different age, sex, cause and setting.
Keywords: Non attempters; Suicide; Attempters; AttitudesIntroduction
Suicide has become a major health care problem today.
It is frequently said, "People carrying out suicides leave their
skeletons behind" The loss of a young person or an attempt leaves
infinite scars for the survivors and their family members, in a society
where suicides are highly stigmatized. For those who attempt, the
psychosocial problems are huge and live with them for rest of their life
[1].
Suicide and suicide attempts are a major source of death and morbidity
in global. For every accomplished suicide, there are somewhere between
10 and 40 attempted suicides [2,3].
Other sources estimate that there are 10-25 nonfatal
suicide attempts for every suicide completion, and these numbers rise to
100-200 for adolescents [4]. In addition, high rates of suicide have been well documented in India [5-8]. However, recent reports from Vellore in southern India have revealed that suicide rates in India are grossly underreported.
In Karnataka, the number of people ending their life
in a voluntary/deliberate act has varied from 12 to 13,000 per year
during the years 2005 to 2007, with 12,304 suicides in 2007 (rate of
21.6/100,000 population) Suicides in Bangalore [1].
The general population ratio of suicide attempts to
completed suicide varies with such factors as age, sex, ethnicity, co
morbid conditions, and the accuracy of case recognition, particularly
for suicide attempts of varied brutality and potential lethality [9]
. These authors reflected that, given these caution, rates of attempted
suicide in the general population are estimated to be 0.14-0.28% per
year, compared with an average suicide rate of 0. 014% per year, for a
ratio of at least 10 : 1 and as high as 30:1[10] .
Farberow [11] and Farberow & Shneidman [12]
conducted study with veterans and found that, while no significant
differences between the attempters and the threateners were observed in
demographic details or case histories, marked differences were found in
the mood of the attempters and threateners. The attempters showed a much
more favorable psychiatric picture, with considerably less anxiety,
depression, and hostility/aggression. It seems that, the attempt had
provided a release from most of the pressures that had preceded their
suicide attempt.
Attitudes are the key concept in the
socio-psychological model of explaining and predicting human behaviour
and social construction of the world around us [13]. They are defined as lasting cognitive, emotional and active predispositions towards a certain object [14].
The aim of this present study was to conduct a
analysis of attitude differences in the outcome of a broad range of
suicidal behavior occurring within the general public's. The objectives
were identifying socio demographic characters and assessing the attitude
difference between attempters and non attempters of suicidal action.
Materials and Methods
This study was a cross sectional descriptive survey
carried out among general population residing in an urban community. In
this study the respondents were randomly selected from the government's
household registry. The sample under study was randomly selected from
1897 of 436 households in a geographically defined area of Bangalore
City. The total population of this selected community is 1897, of whom
47.7% (n=905) were belonged to 18-65 years age group. Majority (n=241,
57.38%) were Muslims followed by 39.76% (n=167) of Hindus and 2.86%
(n=12) of Christians and contradicting with 2011 census that shown
majority population (80.5%) belongs to Hindus. However this area was
selected considering logistic and feasibility present study was
conducted. House to house survey was done among 50% of the randomly
selected houses. The inclusion criteria for the present study was
a. Above 18 years of age or older
b. Individuals who had lived in the target community for at least three months in the six months prior to the survey
c. Who were willing to participate in the study
Persons those are suffering with severe psychiatric
illnesses and cognitive disorders were excluded. A total of 216
individuals were invited to participate in the study. However, after
exclusion of individuals who refused to participate including eight of
the approached suicide attempters (n=21) and those who could not be
reached after several home visits (n=23), the final sample consisted of
172 individuals.
Data collection instruments
The questionnaire has two sections
a. Personal data included information about the
gender, age, marital status, family monthly income, education and
religion of participants.
b. The Attitudes towards Suicide questionnaire (ATTS)
was used to measure participants attitudes towards suicide and suicidal
behavior [15].
The original version of tool consisted of 61 items.
The present study adopted first three items to measure exposure to
suicidal problems (ideation and attempts) and suicide by self and
significant others in the family and outside the family [16]. For example:
a. Have you attempted suicide?
b. Is there anyone in your closest surroundings that
has had or has suicidal thoughts, has expressed suicidal plans or has
threatened to take their life?
i. In the family (father/mother, child, husband/wife, girlfriend/boyfriend.)
ii. Others (other relatives, friends, work- and schoolmates, others).
c. Has anyone you personally know committed suicide?
The ATTS includes 37 statements (to measure
attitudes) about suicidal behavior with a five-point Likert answering
scale. The attitude items present a view on suicide, for example,
"People have a right to commit suicide” and the respondents were asked
to give a response on a five point scale ranging from 1=Strongly
disagree to 5=Strongly agree. The higher scores therefore represent
grater agreement with the items. The reliability coefficients vary from
0.38 to 0.86 for the scale [15].
Data on internal consistency of the instrument are presented in the
results part and other psychometric properties of the original ATTS
questionnaire have been well documented. The ATTS is also appropriate
for a wide range of populations; it is not limited for use among certain
age groups, people with specific cultural backgrounds, or those working
in certain professional disciplines.
Data collection procedure
The researchers themselves reached the selected
houses. The family members were asked about pedigree charting and head
of the family was invited to participate (women in case of absence of
men) after explaining purpose of the study by the researchers and taking
the written consent from the participants. English version of the
questionnaire was used for this present study Data was collected through
face to face interview format at the participant's home. Despite of the
random sampling procedure, individuals without education and primary
education and women were substantially overrepresented in our sample
could be due to data was collected during working hours.
Ethical considerations
The study protocol was reviewed and approved by the
Ethics Committee of the Dr. BR Ambedkar Medical College, Bangalore. The
aims and purpose of the study were thoroughly explained to all
participants and written informed consent was taken. Participation was
voluntary, their information was kept confidential and those in need
were referred for psychiatric consultation.
Statistical analysis
The data were analyzed using appropriate statistical
procedures and the results were presented in narratives and tables.
Descriptive (frequency and percentage) and inferential statistics (chi
square test) were used to interpret the data. Wherever numbers were less
in a category, those categories were clubbed while doing chi-square
analysis. Prevalence of self reported suicidal expression was classified
as an affirmative response to any of the questions, i.e. all response
alternatives except "never” were aggregated. The results were considered
significant at p<0.05.
Result
The Table 1 revealed
that majority of the study subjects those who attempted for suicide
n=11(37.9%) and not attempted for suicide n=50(35.0%) were from the age
group of 26-35 years, also there is no significant association between
their attitudes towards suicide (X2= 0.843, P=0.765). Majority of the
subjects those who attempted for the suicide n=23(79.3%), not
attempted=119(83.2%) were from married category, there is no significant
association between married, unmarried and other category (X2=0.338a,
P=0.845). Majority of the study subjects were females that is attempted
for the suicide n=17(58.6%), not attempted for the suicide were,
n=99(69.2%) and there is no significant association between attitudes of
the male and female study subjects (X2=1.236, P=0.266). Majority of the
study subjects those who attempted n=16(55.2%) and not attempted for
the suicide n=76(53.1%) were from Muslim category, also there is no
significant association between the attitudes of the study subjects
based on the religion (X2=0.671, P=0.577). Majority of the study
subjects those who attempted n=15(51.7%) and not attempted for the
suicide, n=56(39.2%) were from Muslim category, also there is no
significant association between the attitudes of the study subjects
based on the religion (X2=0.671, P=0.577). Majority of the respondents
who attended, n=15(51.7%) and not attended for the suicide, n=56(39.2%)
were studied primary education, there is no significant association
between them based on the education (X2 = 1.976, P-Value=0.577).
Based on the Table 2,
majority, n=26(89.6%) of the attempted and 109(76.3%) of the non
attempted for suicide expressed and agreed that it is always possible to
help a person having suicidal thoughts, there is no significant
association between them was found through Chi Square test. Only
24(82.2%) of the attempted and 112(77.5%) of the non attempted
respondents expressed and agreed that suicide can never be justified.
Only 8(27.6%) of the respondents those who attempted for the suicide and
48(33.6%) of the non attempted for suicide agreed and strongly said
that people who commit suicide are usually mentally ill there is no
significant association between them also. Only 24(82.7%) of the
attempted and 111(77.7%) of the non attempted study respondents agreed
and strongly said that it is human duty to try to stop someone from
committing suicide. Again only 10(34.5%) of the study respondents those
who attempted for the suicide and 46(39.2%) of the non attempted
expressed, agreed and strongly said that they would consider the
possibility of taking their life if they suffer from a sever incurable
disease . seven (24.1%) of the attempted and 49(34.3%) of the non
attempted agreed and strongly said that people who make suicidal threats
seldom complete suicide and there is significant association between
them also(X2=9.544,P=0.049*). Similarly another 11(37.9%) of the
attempted and 49(34.3%)of the non attempted study respondents agreed and
strongly said that Suicide is a subject that one should rather not talk
about, it showed significant association between them also (X2=10.327,
P=0.035*). The study respondents, those who attempted for the suicide,
n=15(51.7%) and 94(65.8%) of the non attempted expressed, agreed and
strongly said that suicide happen without warning and there is
significant association between them were present (X2 = 13.274,
P=0.010*).
Discussion
Suicidal thoughts and feelings interfere in the day
to-day functioning of an individual and lead to decreased productivity
over a period of time. It is possible to recognize those who are
vulnerable to suicides. Some of the common warning symptoms include-loss
of interest in day to day activities, disturbances in sleep, feeling
isolated/dejected/depressed, excessive sadness and crying, communicating
about suicidal thoughts, excessive smoking and drinking, feeling non
communicative, sudden or gradual change in behavior, etc. These symptoms
though gradual in onset, become repetitive, progressive and severe with
passage of time.
The present study found that, most of the study
subjects were from the age group of 26-35 years, also there is no
significant association between their attitudes towards suicide.
Majority were married , there is no significant association between
married, unmarried and other category towards the suicidal attitudes
Majority of the study subjects were females,there is no significant
association between attitudes of the male and female study subjects. But
contrarily to this other study found significant differences between
males and females [17]. This kind of gender specific attitude was also reported in the adult population in other countries [15,18].
Many of the study subjects were from Muslim category; also there is no
significant association between the attitudes of the study subjects
based on the religion. Majority of the respondents who attended and not
attended for the suicide, were studied primary education, there is no
significant association between them based on the education.
Maximum of the study subjects expressed and agreed
that it is always possible to help a person having suicidal thoughts.
They also expressed and agreed that suicide can never be justified
andsaid that people who commit suicide are usually mentally ill there is
no significant association between them also. Similar result found by
other researchers also as follows, mental disorders occupy a premier
position in the matrix of causation of suicide. Majority of studies note
that around 90% of those who die by suicide have a mental disorder [19].
Countless experts have found that affective disorders
are the most important diagnosis related to suicide. In Chennai, 25% of
completed suicides were found to be due to mood disorders. However, the
suicide rate increased to 35% when suicide cases with adjustment
disorder with depressed mood were also counted. The crucial and causal
role of depression in suicide has limited validity in India. Even those
who were depressed, for a short duration and had only mild to moderate
symptomatology. The majority of cases committed suicide during their
very first episode of depression and more than 60% of the depressive
suicides had only mild to moderate depression [20].
Many of the attempted and non attempted study
respondents agreed and strongly said that it is human duty to try to
stop someone from committing suicide. Also they expressed, agreed and
strongly said that they would consider the possibility of taking their
life if they suffer from a sever incurable disease and people who make
suicidal threats seldom complete suicide. At the same time our
respondents were said that suicide is a subject that one should rather
not talk about, it might happen without .Similar concept were found and
discussed in their study as many beliefs andexplain negative attitude.
Chief among these is that suicide is a personal matter that should be
left for the individual to decide. Another belief is that suicide cannot
be prevented because its major determinants are social and
environmental factors such as unemployment over which an individual has
relatively little control. However, for the irresistible majority who
slot in suicidal behavior, there is most likely an appropriate
substitutedeclaration of the precipitating harms. Suicide is often an
enduring solution to a provisional problem [21].
Strength and Weakness
The strength of the present study is the
methodological assessment of attitude towards suicide attempts of the
general public's. There are limitations to the generalization of the
present study results because, the small sample sizes. Second, the study
did not examine the effect of the lethality of the present suicide
attempt, and during the assessment did not use a psychometric instrument
to measurefuture suicide risk. Nevertheless, participants were
conveniently selected.Thirdly it is the first study done in the southern
state of India; hence the discussion with supportive article was
difficult.
Conclusion
The health care professionals especially the nurses
have more opportunity to come across with patient having suicidal
ideation or attempted suicide so suicide risk prediction and prevention
of most proportion of suicide is their responsibility. Raising
wakefulness about suicide avoidance among general population is vital in
developing countries like India. Since the causes of suicides are
multiple, there is no single solution that can prevent all suicides. The
prevention program need to be tailored for different age, sex, cause
and setting.Considering that public attitudes are strongly connected to
people's social presentations which help to create social reality [22],
the non- judgmental attitude should be implemented into life skills of
human being through media by preventive guidelines, stating that there
are better solutions to solving problems than suicide. The health care
administrators can conduct in-service education programs for various
levels of nursing professionals working with suicidal patients. Nurse
administrator should see that courses and workshops for nurses are
conducted to update their knowledge there by improve the quality of care
that provided to the suicidal patients.
Acknowledgement
Researchers heart fully thank the participants for their valuable contribution.
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