Suicide is the biggest killer of guys under 40 and with more and more people reporting to have suicidal thoughts at some point in their lives, we decided to write this list to show you that suicide is NOT an option…. Because no matter how lonely you feel. You are not alone.
We are here and you matter. Be there to say those words. Because help is available and millions of people all over the world have felt how your feeling and still recovered. Because without you, something will be missing and nobody else can replace it. Because when you hit rock bottom, the only way is up-it is always darkest before the dawn. Ditch the Label are here for you regardless of who you are. If you are dealing with any of the issues in this article or in 13 Reasons Why, speak to a Digital Mentor on our community who can help you; no judgement, no prejudice, just help.
In the UK , call the Samaritans on There is a global trend toward increased suicide in late life, again mainly in men. Also, life expectancy in the elderly is lower in India than elsewhere, contributing to the comparatively lower suicide rate. The ratio of completed suicide to attempted suicide in India is about in the elderly, which is double the ratio of in lower age groups.
Globally, attempted suicide is commoner in women and completed suicide is commoner in men. In contrast, women commonly use less lethal modes, and are more impulsive, less well planned, and more likely to be found and rescued. The male:female suicide ratio is 3. What are the data for India? Although some Indian studies have found a higher incidence of suicide in men than in women,[ 50 ] others have found the contrary. In children up to age 14 years, the ratio was 1. The common practice of arranged marriages in India result in social and family pressure for the woman to stay married even in an abusive relationship; this may increase the risk of suicide in women.
And what of suicide attempters in India? Although attempted suicide was as high as 1. Persons living alone are at particular risk. Young widowers were at highest risk. Lower rates of suicide among married compared to unmarried women may be explained by sociological theories based on marital status integration and social integration.
Marriage is not a strong protective factor for suicide attempts in developing countries. Divorcees and individuals who were separated accounted for about 3. Those who were unmarried were living with their extended families. The quality of marital relationship, emotional warmth, extended family support, and ability to handle stresses related to marriage and child rearing are more important than marital status, per se, but these qualifiers of marital status are difficult to study. Low intelligence results in a fold increased risk of suicide.
Possible explanations are that persons with low intelligence are less able to compete for jobs and therefore acquire lower income and social status. They may also be less efficient in coping with stress. Finally, neurodevelopmental vulnerabilities may increase their risk of a psychiatric disorder. Level of educational attainment is a surrogate marker of intelligence, though drawing conclusions on this premise is problematic when education is not universally available.
The NCRB data reveal that In one study of attempted suicide in India, People who are well integrated with their families and community have a good support system during crises, protecting them against suicide. Risk factors related to the family include parenting style, family history of mental illness and suicide, and physical and sexual abuse in childhood. India has witnessed a change in family structure during recent decades, with more people moving out of joint and extended families into nuclear family structures.
The effect of this change on suicide rate has not been systematically studied. Varying results in research may tap a secular trend. The majority of suicide attempters were from nuclear families,[ 46 , 47 ] possibly reflecting the role of social integration, though an earlier study shows that more suicide attempters come from joint families. The suicide rate is generally reported to be higher in urban areas because of a variety of stressors related to living and working in cities, including overcrowding and social isolation.
In India, during the year , though the suicide rate for the country was There is a fairly strong association between unemployment rates and suicide, but the nature of this association is complex. Unemployment may drive up the suicide risk through factors such as poverty, social deprivation, domestic difficulties, and hopelessness. Furthermore, persons with psychiatric disorders are at higher risk of suicide and are also more likely to be unemployed; this may be a double whammy.
Adding to the complexity is recent loss of employment vs long-term unemployment; the former is associated with greater risk.
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The NCRB data shows that housewives account for Those involved in farming and agriculture form the next largest group, comprising Students accounted for 5. Those employed in the public sector 2. The relationship of suicide to negative life events, stress, object loss, and negative interaction needs to be understood in the framework of a model of vulnerability, support, coping, and problem-solving. Indian society, being sociocentric, lays importance on interpersonal relationships. It is therefore unsurprising that marital conflict is the commonest cause of suicide among women, while interpersonal conflict is the commonest cause among men.
Other suicide triggers include physical illness, bankruptcy, illicit relationships, and drug intoxication. An interesting finding, rarely seen in the West, is the high rate of suicide associated with sexual abuse and illegitimate pregnancy. A similar trend is seen for attempted suicide with interpersonal conflict, financial stressors, and educational burden being the most common triggers. After all, everybody experiences stressful or negative life events.
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The difference between countries in methods employed for suicide may reflect differences in socioeconomic factors, availability of lethal means, and firearms legislation, rather than differences in the nature of the behavior, per se. Common methods used in developed countries include firearms, car exhaust asphyxiation, and poisoning whereas in developing countries, pesticide poisoning, hanging, and self-immolation lead the list. In India, during consumption of a poison This pattern is recapitulated in the NCRB report.
Studies show that consumption of pesticides, such as the readily available agricultural pesticides in rural areas, is the commonest means of suicide and attempted suicide in India[ 45 , 46 , 52 ] and in rural areas of low income countries. Suicide by hanging is the next most frequent method in India. With the practice of Sati and Jauhar, in ancient India, self-immolation was seen as an escape from hardship and humiliation.
More recently, self-immolation has been employed in India as a means of protest against government policy,[ 98 ] as by Buddhist monks in South Vietnam and Sri Lanka. Indian women may be over-represented in the population of self-immolators with domestic issues as a trigger. The intentionality and lethality of suicide are important dimensions which describe the motive behind the act.
Lethality is a function of the mode of suicide and has already been examined in an earlier section. The latter group utilized more drastic measures, such as hanging and was more likely to have a psychiatric disorder with comorbid alcoholism. In India, the top 10 causes or correlates of suicide in were family problems 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.
It is often reported that rates of psychiatric disorders are higher among suicide completers in developed countries relative to developing countries, though under-diagnosis in developing countries is a possible explanation. Studies in India show varying results with rates of psychiatric disorders ranging from 9. Rates of psychiatric diagnosis as high as Mood disorders, particularly depressive disorders, were the most common diagnosis followed by alcohol abuse. In a study of patients with major depressive disorder with suicidal ideation, incidence of suicidal attempt was Dysthymia underlying suicidal behavior is commoner in India than in the West.
In a study of patients with schizophrenia, the rate of attempted suicide was 4.
These patients did not differ in illness duration from patients with depression who had attempted suicide. Multiple suicide attempts of low intentionality and lethality are typically associated with maladaptive coping and impulsivity in personality disorders. Chronic physical illness, abnormal vaginal discharge, and tobacco use are risk factors for common mental disorders among women in India.
About one-fifth were found to have a physical illness in one study with dysmenorrhoea being the commonest ailment, followed by peptic ulcer disease; hypertension, bronchial asthma and arthritis comprised the remaining. In one study, depression and suicidal tendency were associated with early parental deprivation, recent bereavement, and family history of suicidal behavior.
Alcoholism is another risk factor with both high rates of suicide among alcoholics and high proportion of alcoholics among suicide attempters Agarwal et al. The risk of suicide is higher with early onset of alcohol use, dependence pattern of use, family history of alcohol dependence and depression, and comorbid antisocial personality disorder. Of significance is the emotional reaction of women in response to suspicion of their fidelity, reflecting the value Indian culture imposes on chastity.
In a year prospective study of patients admitted with suicidal ideation, Beck et al. In a more recent study of communication of suicidal intent among suicide attempters, Srivastava et al. Attempted suicide is of particular interest as it has been found to be one of the predictors of future suicide. Are persons who attempt suicide different from those who succeed? An Indian study which compared these two groups found more similarities than differences.
Both groups consisted of predominantly middle aged, unemployed, married males and housewives, with high school education and from rural background. The significant risk factors for fatal suicide includes presence of previous suicidal attempt, interpersonal conflicts and marital disharmony, alcoholism, presence of a mental illness, sudden economic bankruptcy, domestic violence, and unemployment. In an analysis of suicide attempters which distinguished between those who had intended to die but accidentally survived failed suicide group and those who had not intended to die deliberate self-harm group , Sarkar et al.
The attempts in this group were impulsive, of low intentionality and lethality, and most sought help after the attempt. The location of suicide offer clues to the individual's psychological state and to the intentionality of suicide. Few studies reported this detail. In one study, home was the most common place for committing suicide. Most males who consumed an insecticide or resorted to self-immolation did so at home.
Cancer was found to be related to 0. Psychiatric morbidity is known to be higher among patients with epilepsy relative to the general population, with rates of suicide being five times higher. Farmer suicides are a particular concern in the India, although this phenomenon has been reported in England and Wales as well. About two-thirds of these suicides were in 5 of the 28 states and 7 union territories: Maharashtra, Karnataka, Andhra Pradesh, Madhya Pradesh and Chattisgarh account for about a third of the country's population but two-thirds of farmer suicides.
Factors contributing to the high rate of suicide in this vulnerable population include economic adversity, exclusive dependence on rainfall for agriculture, and possibly monetary compensation to the family following suicide. Studies on the neurobiology of suicide have implicated dysfunction of serotonin, dopamine, acetylcholine, adrenaline, noradrenaline, opioid, GABA, and glutamate systems.
Abnormalities have been reported in the hypothalamic-pituitary-adrenal axis, lipid metabolism, polyamines, growth factors, and astrocytes and other glial cell. There is some literature that lipid-lowering agents may increase deaths due to suicide or violence, presumably via increased insulin secretion and low serotonin turnover. The role of the media is becoming increasingly relevant. The media and internet have been identified as playing a crucial role in the dispersion of information about novel suicide methods.
However, extensive media reporting of a few cases was blamed for the subsequent increase in popularity of these methods. In Vienna, media guidelines for the responsible reporting of suicides were introduced in , banning newspapers from reporting the method of suicides. A more recent study using interrupted time series analysis has confirmed these findings and the authors believed that the effects were due to changes in the quality and quantity of reporting. The media can also have a positive influence. In an interesting study, Ramdas et al.
The quality of media reports that appeared in a leading newspaper were assessed at 1 year, 2 years and 6 years after the workshop. Suicide is an important, largely preventable public health problem. In , the WHO launched the multisite intervention study on suicidal behaviors SUPRE-MISS which aimed to increase knowledge about suicidal behaviors and about the effectiveness of interventions for suicide attempters in culturally diverse places around the world.
Early detection and adequate treatment of a primary psychiatric disorder is of paramount importance. In psychiatrically ill subjects, lithium,[ — ] clozapine. Since the greatest predictor of completed suicide is the presence of a previous suicide attempt, interventions aimed at suicide attempters may be the most effective in reducing suicide rates. Vijayakumar et al.
Importantly however, the care received by the treatment-as-usual arm in this study was below desirable standards because it was limited to the acute management of the somatic sequelae of the suicide attempt and did not include psychiatric or psychological assessment or treatment. The early identification and treatment of vulnerable populations with risk factors for suicide across the life-span is another strategy.
The identification of such individuals requires a multidisciplinary approach with active participation from teachers and school authorities, health professionals and the legal system. Primary prevention strategies include promoting positive health and instilling adaptive coping stategies among children; improving awareness among parents, teachers and healthcare professionals regarding child-rearing practices and early intervention for maldaptive coping styles. At the community level, the establishment of social programs such as child and family support programs and programs aimed at achieving gender and socio-economic equality maybe prove useful.
The need for a strategy which will raise awareness and help make suicide prevention a national priority has long been recognized. The program would need to be tailored for populations at risk. Gatekeeper training focuses on skill development to enable community members such as teachers, coaches and others in the community to identify signs of depression and suicide-related behaviors among youth. It encourages individuals to maintain a high index of suspicion and to inquire directly about distress, persuade suicidal individuals to accept help, and serve as a link for local referrals.
Is Suicide "Contagious?"
Such approaches would also require a multidisciplinary team approach involving psychiatrists, general physicians, psychiatric nurses, psychiatric social workers, and non-governmental organizations NGOs. A delicate balance needs to be maintained between press freedom and responsibility of the press to minimize the harm to vulnerable individuals. The role of advocacy and legislature cannot be over-emphasized. Laws restricting availability of lethal agents such as firearms have been advocated by the WHO. NGOs can play an important role in advocacy as exemplified by the proactive stance taken by the NGO Sneha which found that the suicide rate was highest among students who had failed in one subject.
Subsequently, the government introduced a new scheme in wherein students who fail in one subject can rewrite their examination within a month and can pursue their further studies without losing an academic year. The task of suicide prevention is daunting. This group may continue to be vulnerable. Though restricting availability of lethal means appears to be a possible solution,[ ] an early study in India in West Bengal, where legislation was introduced to restrict sale of a pesticide, found no reduction in the overall suicide rate, but merely a change in the modes of suicide.
Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. Journal List Indian J Psychiatry v. Indian J Psychiatry. Rajiv Radhakrishnan and Chittaranjan Andrade 1. Author information Copyright and License information Disclaimer.
Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract Suicide is the third leading cause of death among young adults worldwide. Keywords: Suicide, India, epidemiology, prevention. Suicide in India The suicide rate in India is comparable to that of Australia and the USA; and the increasing rates during recent decades is consistent with the global trend. Table 1 Summary of selected studies on suicide and attempted suicide in India.
Open in a separate window. Demographics of suicide in India Traditionally, in western literature risk factors associated with suicide, including suicidal attempts - include young age years , female gender, low educational attainment, unemployment, living alone, and history of socioeconomic deprivation. Age Although suicide rates were commonly highest among older adult males, rates among young people have been increasing.
Adolescents and young adults Youth is a period of heightened risk of suicide[ 55 ] and suicide is a leading cause of death among young people in India. The average suicide rate for girls was per ,, and for boys, 58 per ,[ 29 ] Among young people, suicidal behavior was found to be associated with female gender, not attending school or college, independent decision making, premarital sex, physical abuse at home, lifetime experience of sexual abuse, and probable common mental disorders.
Elderly There is a global trend toward increased suicide in late life, again mainly in men.
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Gender Globally, attempted suicide is commoner in women and completed suicide is commoner in men. Education Low intelligence results in a fold increased risk of suicide. Urban vs. Occupation There is a fairly strong association between unemployment rates and suicide, but the nature of this association is complex. Precipitating event The relationship of suicide to negative life events, stress, object loss, and negative interaction needs to be understood in the framework of a model of vulnerability, support, coping, and problem-solving. Mode of suicide The difference between countries in methods employed for suicide may reflect differences in socioeconomic factors, availability of lethal means, and firearms legislation, rather than differences in the nature of the behavior, per se.
Psychiatric diagnosis 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. Personality disorders Multiple suicide attempts of low intentionality and lethality are typically associated with maladaptive coping and impulsivity in personality disorders.
Physical illness Chronic physical illness, abnormal vaginal discharge, and tobacco use are risk factors for common mental disorders among women in India. Attempters vs. Locations of suicide The location of suicide offer clues to the individual's psychological state and to the intentionality of suicide. Special populations Cancer Cancer was found to be related to 0. Epilepsy Psychiatric morbidity is known to be higher among patients with epilepsy relative to the general population, with rates of suicide being five times higher. Farmer suicides Farmer suicides are a particular concern in the India, although this phenomenon has been reported in England and Wales as well.
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13 Reasons Why Suicide is Not the Solution
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