National Institute of Mental Health

Angoda, Sri Lanka

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Home Mental Health in the News Mental Health in the News The Island - September 17, 2015

The Island - September 17, 2015

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Psychological management of attempted suicide

By Dr. R. A. R. Perera
Consultant Psychologist

Attempted suicide is a major problem in Western and Eastern countries like Sri Lanka, though rates vary considerably, and there are marked differences in age and sex distributions of attempters. In Western countries, the attempted suicide rate is more than in developing countries (could be due to more patient information and reporting). Deliberate self-poisoning is one of the commonest reasons for acute medical admission of women to hospitals in the UK, and is second only to heart disease as the most common reason for admission of men.

Attempted suicide is primarily a behavior of the young adult, and is particularly common in under 35-year-olds, but seldom occurs in children under 12 years of age. Throughout adolescence, the incidence increases markedly among girls, reaching a peak in the 15-24 year old age group.

The incidence is highest among individuals of lower socio-economic status, and with people in urban areas, characterized by social deprivation and over crowding. Single and divorced individuals are more at risk than those in other marital categories. Many patients who attempt suicide have a background of disrupted family relationships, often because of early parental death or separation. Approximately 75% of adults who make attempts are facing problems in their relationship with their partner. A major quarrel or separation is the most common event preceding the act. Parents who attempt suicide often have difficulties with their children, and there is evidence for an association between attempted suicide and child abuse.

 

A marked association exists between unemployment and attempted suicide. Rates of attempted suicide in both men and women are 10-15 times higher among the unemployed than the employed; and the risk of attempted suicide increases substantially the longer a person is unemployed.

 

A greater than expected number of patients who attempt suicide have physical health problems, and there is an increased risk among people with epilepsy, especially men.

 

Teenagers who attempt suicide have similar difficulties to their adult counterparts, but in many cases, they too face problems in relationships with their parents. Although psychological difficulties are found in most patients who attempt suicide, only a third are found to have a definite psychological disorder and in many cases this is transient, being largely secondary to social difficulties. About 5-8% of patients suffer from serious psychological illnesses, which require treatment in a hospital. The most common disorder is depression, with anxiety and schizophrenia occurring in few cases. Personality disorders and problems related to the use of alcohol are also common, especially among men.

Approximately 90% of cases of attempted suicide involve deliberate self-poisoning. Most of the remainder are self-injuries. Heavy drinking immediately precedes an attempt, and alcohol may also be used as part of an overdose and add to its danger. The substance used in overdoses tends to reflect availability and those most often used are aspirin and paracetamol, such overdoses being particularly common in young people.

Self-injury is usually self-cutting, especially the wrist or forearm. Violent forms of self-injury (gun shot wounds, hanging and jumping in front of trains) are less common and suggest serious suicidal intent.

Attempted suicide may involve little premeditation — the act often being considered for less than an hour, and sometimes only for a few minutes. The motivation often appears to be complex. Indeed, it may be difficult to establish what a patient hoped would result from an overdose or self-injury. Psychologists often explain the behavior in -terms of communicating anger, eliciting guilt and trying to influence others, as well as, signaling distress. Attempted suicide usually evokes helpful responses from those close to the individual, leading to an improvement in social circumstances and psychological well being. However, attempts are often repeated, and are then sometimes fatal. The risk of repetition is highest during the first 6 months after an attempt. Many chronic repeaters suffer from severe personality disorders, abuse of alcohol or drugs, and have a history of violence and police convictions. The risk of suicide following an attempted suicide is considerable. Approximately 1% of patients end their lives by suicide during the year following an attempt, which represents a risk approximately 100 times that of the general population.

Primary prevention of attempted suicide appears to be difficult. Some patients, who are in a state of extreme crisis, may benefit from a brief period in hospital. About 30% of patients appear to be suitable for brief problem-solving counseling sessions on an outpatient basis. Counseling should be directed towards both the patient and the partner, or other family members, where appropriate. Cognitive therapy approaches may be helpful. Occasionally medications might be required, and when the risk of a further attempt seems high, should be supervised by a relative. When a person has attempted suicide, subsequent prevention depends on the occurrence of widespread social changes. Repetition could be reduced by special services that produce positive changes in psychological and social functioning.

 
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