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Suicide - Current Maze & Future Movement by Dr. Lakshmi Vijayakumar M.B.B.S., D.P.M., Ph.D., FRCPsych. (Hon.) Founder, SNEHA Member, W.H.O. International.

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Presentation on theme: "Suicide - Current Maze & Future Movement by Dr. Lakshmi Vijayakumar M.B.B.S., D.P.M., Ph.D., FRCPsych. (Hon.) Founder, SNEHA Member, W.H.O. International."— Presentation transcript:

1 Suicide - Current Maze & Future Movement by Dr. Lakshmi Vijayakumar M.B.B.S., D.P.M., Ph.D., FRCPsych. (Hon.) Founder, SNEHA Member, W.H.O. International Network for Suicide Research Hon. Associate Professor, University of Melbourne Member, International Academy of suicide research M.B.B.S., D.P.M., Ph.D., FRCPsych. (Hon.) Founder, SNEHA Member, W.H.O. International Network for Suicide Research Hon. Associate Professor, University of Melbourne Member, International Academy of suicide research

2 Global Suicide rates, 2008

3 Distribution of WHO regions by change in total suicide rate since 2000 (Mishara, 2010, based upon WHO 2009 latest year available)

4 Magnitude Suicide 1 million Suicidal Attempts10 – 20 million Affected by Suicide50 – 120 million Suicide 1 million Suicidal Attempts10 – 20 million Affected by Suicide50 – 120 million 19981.8% Global burden 20102.4% 19981.8% Global burden 20102.4%

5 500,000 suicides a year 61% of world suicides

6 A global perspective on the magnitude of suicide mortality 5 – 1415 – 2425 – 3435 – 4445 – 5455 – 6465 – 7475 + Male1.421.129.337.042.540.940.752.1 Female0.44.86.27.89.710.612.315.9 5 – 1415 – 2425 – 3435 – 4445 – 5455 – 6465 – 7475 + Male1.421.129.337.042.540.940.752.1 Female0.44.86.27.89.710.612.315.9

7 Male Gender Specific Rates Medium12.517.561.2NA5.915.4 HDI High20.4NA36.119.58.619.3 HDI Medium12.517.561.2NA5.915.4 HDI High20.4NA36.119.58.619.3 HDI Gender HDI Level AsiaTransition EconomicsEurope &South &Total NorthCentral Central Asia Europe AmericaAmericas & Aus. & NZthe caribbean Suicide rate Female Medium13.03.811.7NA1.811.7 HDI High9.8NA8.75.82.55.9 HDI Medium13.03.811.7NA1.811.7 HDI High9.8NA8.75.82.55.9 HDI

8 Self-injurious behavior Suicidal self-injurious behavior Non-suicidal self- injurious behavior Suicide attempt Other suicidal behaviors* Suicide (death) Undetermined self- injurious behavior CDC Uniform Definitions for Self-Injurious Behavior * Other behaviors with some intent to die that are not suicide or suicide attempt such as interrupted attempts or aborted attempts A. Crosby (2009)

9 Ecological Model Individual Peer/Family Society Community

10 Mood disorders 35.8% Schizophrenia 10.6% Substance-related disorders 22.4% No diagnosis 3.2% Adjustment disorders 3.6% Anxiety/somatoform disorders 6.1% Other psychotic disorders 0.3% Organic mental disorders 1.0% Personality disorders 11.6% Other DSM axis I diagnosis 5.1% (8205 cases, 12292 diagnoses) Suicide and Mental Disorders: general population studies (N=15,629)

11 Life time risk of suicide Life time risk of suicide following onset of mental disorders have been estimated to be high. In an often cited review Miles (1977) estimated that 15 percent of persons affected with depression would die from suicide, 15 per cent with alcoholism and 10 per cent with schizophrenia.

12 A complete national sample of all persons born in Denmark between 1 January 1955 and 31 December 2006 (3.51 million people) Danish Psychiatric Case register (since 1969) Danish National Patient Register (since 1979) Danish Cause of Death Register (1970-2006) M Nordentoft in press Danish Psychiatric Case register (since 1969) Danish National Patient Register (since 1979) Danish Cause of Death Register (1970-2006) M Nordentoft in press

13 Cumulative absolute risk of suicide MenWomen Disorder Cumulative incidence (95% confidence interval) Schizophrenia 6.47(5.78-7.25)4.87(4.00-5.93) Schizophrenia like disorders 5.72(5.06-6.46)3.97(3.23-4.88) Bipolar affective disorder 7.63(5.91-9.85)4.74(3.46-6.50) Other affective disorders 6.54(5.61-7.63)3.70(3.00-4.56) Substance abuse, psychiatric 4.68(4.22-5.19)3.42(2.86-4.09) Substance abuse, somatic 2.44(2.13-2.81)1.63(1.33-2.00) Anorectic disorder 6.42(2.62-15.73)1.97(0.87-4.44) Any mental illness 3.63(3.36-3.91) 1.89(1.68-2.12) No mental illness 0.68 (0.60-0.78)0.20(0.14-0.28)

14 Co-morbid substance abuse – Cumulative absolute risk of suicide MenWomen Disorder Cumulative incidence (95% confidence interval) Schizophrenia5.82(4.86-6.97)6.78(4.78-9.61) Schizophrenia like disorders6.17(5.15-7.40)5.68(4.36-7.40) Bipolar affective disorder9.89(6.33-15.48)5.09(2.76-9.38) Other affective disorders6.71(5.22-8.62)6.95(4.65-10.37) Anorectic disorder6.59(1.74-24.96)4.40(2.28-8.46)

15 Mental disorders & suicide IndiaChinaTaiwan Depression35%40%89% Schizophrenia8%7%7.9% Comorbidity30%6%55% Prior psychiatric treatment10%7%25% Alcoholism 34% 7% 44% IndiaChinaTaiwan Depression35%40%89% Schizophrenia8%7%7.9% Comorbidity30%6%55% Prior psychiatric treatment10%7%25% Alcoholism 34% 7% 44%

16 Previous Suicide Attempt (26 – 42%) Family history of Suicide and Mental Disorders(12 – 18%) Previous Suicide Attempt (26 – 42%) Family history of Suicide and Mental Disorders(12 – 18%)

17 Personality Characteristics 1.Impulsivity / Aggressive 2.External Locus of Control 3.Hopelessness 4.Reduced Specific Memory 1.Impulsivity / Aggressive 2.External Locus of Control 3.Hopelessness 4.Reduced Specific Memory

18 Genes and Suicidality Genes 43%Environment 57% TPH 2, 5HT 2 AReceptor gene 5HTTLPRPolymorphismSS, SL & LL SS & SL – Left frontal, prefrontal & middle temporal gyri

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20 Source: Morrell S et al, Soc. Sci. Med. 1993; Vol 36, 6, 749-756

21 Results: trends in suicide rates in East Asia Chang et al Soc Sci Med 2009

22 Gunnell et al BJPsych 1999 Association between unemployment and suicide rates (non poisons and gases) in 25-34 year old males (1921-1995)

23 SEV & Suicide Rate Socio-economic Annual suicide rate variables Total Male Female Human Development + 0.21 (n = 26) + 0.27 (n = 24) - 0.12 (n = 24) index, 1995 Human Development + 0.19 (n = 33) + 0.24 (n = 31) - 0.01 (n = 31) Index, 2001 Education Index+ 0.26 (n = 33) + 0.31** (n = 31) - 0.06 2001 Urban population+ 0.03 (n = 33) + 0.18 (n = 31) - 0.04 (n = 31) as a percent of total population 2001 Telephone density+ 0.36* (n = 33) + 0.44* (n = 31) + 0.32** (n = 31) 2001 Gender development+ 0.26 (n = 27) + 0.26 (n = 25) + 0.004 (n = 25) index 2001 Socio-economic Annual suicide rate variables Total Male Female Human Development + 0.21 (n = 26) + 0.27 (n = 24) - 0.12 (n = 24) index, 1995 Human Development + 0.19 (n = 33) + 0.24 (n = 31) - 0.01 (n = 31) Index, 2001 Education Index+ 0.26 (n = 33) + 0.31** (n = 31) - 0.06 2001 Urban population+ 0.03 (n = 33) + 0.18 (n = 31) - 0.04 (n = 31) as a percent of total population 2001 Telephone density+ 0.36* (n = 33) + 0.44* (n = 31) + 0.32** (n = 31) 2001 Gender development+ 0.26 (n = 27) + 0.26 (n = 25) + 0.004 (n = 25) index 2001

24 SEV & Suicide Rate (Contd...) Socio-economic Annual suicide rate variables Total Male Female Gini Ratio - 0.33** (n = 29) - 0.31** (n = 27) - 0.23 (n = 27) (inequality) Cigarette consumption + 0.41* (n = 27) + 0.46* (n = 25) + 0.40* (n = 25) per head Alcohol (total)+ 0. 13 (n = 30) + 0.20 (n = 29) - 0.02(n = 29) consumption per head Alcohol consumption+ 0.19 (n = 30) + 0.23 (n = 29) + 0.24 (n = 29) (spirits) per head Unemployment rate+ 0.08 (n = 19) + 0.14 (n = 17) - 0.15 (n = 17) 2001 Crime rate- 0.03 (n = 15) - 0.007 (n = 15) - 0.14 (n = 15) (in major cities) Pesticide consumption- 0.06 (n = 24) - 0.10 (n = 22) - 0.25 (n = 22) (per hectare of land) Socio-economic Annual suicide rate variables Total Male Female Gini Ratio - 0.33** (n = 29) - 0.31** (n = 27) - 0.23 (n = 27) (inequality) Cigarette consumption + 0.41* (n = 27) + 0.46* (n = 25) + 0.40* (n = 25) per head Alcohol (total)+ 0. 13 (n = 30) + 0.20 (n = 29) - 0.02(n = 29) consumption per head Alcohol consumption+ 0.19 (n = 30) + 0.23 (n = 29) + 0.24 (n = 29) (spirits) per head Unemployment rate+ 0.08 (n = 19) + 0.14 (n = 17) - 0.15 (n = 17) 2001 Crime rate- 0.03 (n = 15) - 0.007 (n = 15) - 0.14 (n = 15) (in major cities) Pesticide consumption- 0.06 (n = 24) - 0.10 (n = 22) - 0.25 (n = 22) (per hectare of land)

25 Domestic violence & suicidal ideation Brazil48% Egypt61% Phillippines28% Brazil48% Egypt61% Phillippines28% India64% Indonesia11% India64% Indonesia11%

26 Proportion of suicides (%) in Hong Kong

27 Religion & Countries 0 0 5 5 10 15 20 25 30 35 40 45 Hindu 1995 Hindu 1995 Buddhist 1986 Buddhist 1986 Muslim 1985,87 Muslim 1985,87 Atheist 1995,96 Atheist 1995,96 Christian 1994 Christian 1994 total male female Suicide rates according to religion (per 100,000)

28 TBI and Suicide [ 1979 – 1993 ] NoSuicideSMR Concussion1261147503.0 Cranial fracture7560462.7 Cerebral contusion and ICM11766994.1 NoSuicideSMR Concussion1261147503.0 Cranial fracture7560462.7 Cerebral contusion and ICM11766994.1 Females Age 21 – 59 years (Teasdale & Engberg JNN S& Psy, 2001) Females Age 21 – 59 years (Teasdale & Engberg JNN S& Psy, 2001)

29 Refugees15.2 million Asylum seekers827,000 (0.83 m) IDP26 million Repatriated 604,000

30 Location 80% in developing countries 50% in urban areas 33% in refugee camps

31 Socio demographic factors Age25 – 40 GenderFemales Marital statusSingle SESHigher, Educated CountriesFar and S.E. Asia Eastern Europe Latin America

32 Method Blunt forceJumping Water tortureDrowning Sharp forceStabbing / cutting One million refugees and A.S. at risk of suicide

33 Cyber suicides [ Japan ] First in October2000 Published2003 First in October2000 Published2003

34 Cyber bullying Online bullying - 1/3 of children Every 30 mts a child attempts suicide due to bullying Online bullying - 1/3 of children Every 30 mts a child attempts suicide due to bullying

35 Suicide Prevention Strategies Environmental Reduced access to Methods Enlightened Media Reporting Cluster Prevention Individuals at Risk Identifying and Easy access Education of GPs Crisis Line Environmental Reduced access to Methods Enlightened Media Reporting Cluster Prevention Individuals at Risk Identifying and Easy access Education of GPs Crisis Line Psychopharmacology Lithium Clozapin Psychotherapy D.B.T. Psychopharmacology Lithium Clozapin Psychotherapy D.B.T.

36 BiopsychosocialEnvironmentalSociocultural UniversalScreening for access to Positive portrayal alcoholism Pesticideof women in media alcohol SelectiveImprove recognitionPreventPre / Post exam & referral of M.D.Domesticcounseling by crisis workersViolenceAssertiveness Intergenerational Conflict resolution IndicatedA.D. in P.H.C.Safe havenCommunity support Managementfor suicidal of poisoning

37 Alcohol consumption 1 litre of alcohol consumption in suicide rate Sweden13% Hungary5% USA & Canada4% France & Protugal3% Switzerland0% 1 litre of alcohol consumption in suicide rate Sweden13% Hungary5% USA & Canada4% France & Protugal3% Switzerland0% Perestroika 1984 – 84 Men 32% Women 19%

38 Edge study Post CardsW 1, 2, 3, 4, 6, 8, 10, 12 TAUINT 394378 Repetition21.2%22.8% TAUINT 394378 Repetition21.2%22.8%

39 Carter, G. L. et al. Br J Psychiatry 2007;191:548-553 Cumulative readmissions to hospital for treatment of self-poisoning (24 months; unadjusted for multiple admissions).

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42 Pesticides 300,000 deaths in South Asia & Asia Pacific toxicity medical management access bio pesticides toxicity medical management access bio pesticides

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44 Suicide & Attempted suicide Study villages A & B in North Western Province YearStudy Village AStudy Village B Total attempts Deaths Total attempts Deaths 20002010 20011030 20023010 20036021 20043110 20050000

45 YearControl Village A1Control Village B1 Total attempts Deaths Total attempts Deaths 20000011 20011122 20021000 20032041 20044210 20054021 Suicide & Attempted suicide Control villages A1 & B1 in North Western Province

46 Suicide in NPM Villages VillageYearBefore NPMAfter NPM Punnukula20013- Pullaigudem200331 Kodipunjalavagu200241 Devijathanda200341 Suicides in CP Villages 1998 - 2003 2003 - 2006 Keshavapuram42 Pandurangapuram5 3 Rangapuram32 Bikkuthanda3 1 Suicides in CP Villages 1998 - 2003 2003 - 2006 Keshavapuram42 Pandurangapuram5 3 Rangapuram32 Bikkuthanda3 1

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48 15% in pesticide suicide45,000 1 litre in alcohol30,000 15% in pesticide suicide45,000 1 litre in alcohol30,000 75,000 lives can be saved every year Lives saved

49 Thank You


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