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J Indian Acad Forensic Med, 32(1)

ISSN 0971-0973

Original research paper


Suicide in Youth: Shifting Paradigm
*Rastogi Pooja, M.D. **Kochar SR, M.D.

Abstract
In todays scenario high occupational mobility, high ambition and desire for high standard of living is leading to high incidence of suicidal deaths. Nowadays suicidal gesture, attempted suicide & well successful suicide
cases are seen in the society often on. A prospective cum retrospective study is carried out in the Department of Forensic Medicine and Toxicology, Mahatma Gandhi Medical College & Hospital, Jaipur w.e.f. 2004- 2008. In this
period out of total 627 autopsies performed, 223 were found as suicidal deaths. In these 223 cases , 88 cases ended
their life by poisoning, rest of them in the decreasing order are as follows Train Run-over (55), Hanging (43),
Drowning (20), Alcohol (9), Burn (4), Celphos Poisoning (3), Insecticides Poisoning (1).
This clearly indicates that availability of highly lethal suicidal method and rate of suicide are interrelated.
During the study we have found three new innovative methods of committing suicide. All three victims were pursuing their professional qualification and will be discussed in this study.
Key Words: Suicide, Poisoning, Burn, Hanging, Intentional Self-Harm
The word suicide was first used by Sir Thomas Browne in his Religio Medici in 1642 and
subsequently by Walter Charleton in 1651. Prior to
the introduction of word Suicide self destruction,
self killing and self murder were in practice.
Suicide has been defined by Beck et al as, a
willful self inflicted life threatening act which results
in death.
Schneidman (1976) defined it as, the human act of
self inflicted, self intentional cessation of life. It is
an act committed out of constricted thinking, tunneled logic and acute anguish. [1]
The world health organization defines suicidal act as the injury with varying degrees of lethal
intent and suicide may be defined as a suicidal act
with fatal outcome.
Durkheim (1858-1917) defined suicide as
death resulting directly or indirectly from a positive
or negative act of the victim himself, which he knows
will produce this result. This excludes those who
survive the attempt. [2]
Suicide may be defined as, an intentional
act causing harm to a person amounting to death and
committed by person himself in the absence of contribution from any external agency particularly in the
commencement of act. Recently the term suicide has
been replaced by Intentional Self-Harm(ISH) in the
scientific literature due to derogatory nature of the
word Suicide.
Nowadays suicidal gesture, attempted suicide, well successful suicide cases are every now and
then we seen or hear in the society. Increasing numbers of deaths from suicide is a measure public health
problem in India today.

Introduction:
Suicide is not new in human history rather it
is as old as humanity itself and its sources reaches far
back into the beginning of the culture. It is a specifically human problem. Any animal can die by disease
and can be destroyed intentionally or accidentally by
an outside agency but as far as we know only man
can will his death and kill himself. At some stage of
evolution man must have discover that he can kill
himself. It is the most personal action, which an individual can take. The study on suicide illustrates that
human action, however personal is also interaction
with other people and that the individual can not understood in isolation from his social matrix.
Suicide is widely prevalent and no nation
and culture has escaped from it, though the toll varies
from place to place. The prevalence of suicide in todays world is quite alarming. In year 2000 about
800000 suicide deaths occurred worldwide.
The World Health Organization estimates
that more people die each year from suicide than in
all the worlds arm conflicts.

Corresponding Author:
Dr.Pooja Rastogi
*Assistant Professor, Department of Forensic Medicine & Toxicology, School of Medical Sciences &
Research, Sharda University, Greater Noida, U.P.
Email: pooja1372@hotmail.com
**Professor, Department of Forensic Medicine &
Toxicology, SMSMC Hospital, Jaipur

45

ISSN 0971-0973

J Indian Acad Forensic Med, 32(1)


ceeding of 498 A. He ends his life by self cannulation
, a cocktail of Ketamine (3 vial) and Vecuronium(2
vial), on assessable left wrist.

Aims and Objectives:


1.
2.
3.

To find out the pattern of suicide


To find out the stressful life event
To study the Psycho social cultural and precipitating factors for suicide in relation to
age and gender with a view to formulate
some preventive strategies

Material and Method:


The study is confined to the undoubtful cases of suicide. In the study various epidemiological
characteristics of cases and medico legal aspects were
collected from the perusals of police papers, postmortem reports and thorough questioning of the parents,
relatives, friends, neighbours and police officers.
The nature of death was first evaluated by exclusion
method then the dead body was examined externally
and internally on autopsy table in different natures of
death. Finally data pertaining to external and internal
findings were collected, compiled and discussed.

Case 2:

Observations:

A young unmarried 22 years old, Second


year Engineering Student designed a scene on the
basis of his technical skills to end his life due to unhappy love affair. He has sealed the ventilators and
windows of his rented room after putting a live coal
Angeethi and bolted the door from inside. The dead
body on postmortem examination depicted the typical
features of CO poisoning.

In the study Suicidal cases from 2004-2008


were examined retrospectively and was carried out
in the Department of Forensic Medicine and Toxicology, Mahatma Gandhi Medical College and Hospital,
Sitapura, Jaipur.
Since year January 2004 to December 2008 total 627
medico legal autopsies were conducted, out of them
223 cases were found to be of Intentional Self Harm
(ISH).(Table-1)
Among them the most vulnerable age group
was 21-30 years (Graph 1). Male outnumbers the
females (male 79, female 14- Graph 2).
Suicidal deaths are more prominent in married persons (Table 2)
Poisoning was the most common method used for
ending the life irrespective of the education level,
socio-economic status and rural-urban life etc.(Table
3)
Jumping against the moving train was the
second most common method used for ISH (55),
Hanging remain the third manner of choice for ISH
(43 ) followed by Burn (4 ) being the least preferred
method.(Table 3).
The study also reveal that Domestic unhappiness and shattered Family relation is the most
common precipitating factor for committing suicide
(23.77%), followed by Unhappy Love affairs
(18.83%). However despair over torture is the lease
common precipitating factor (1.35%) (Table 4)
In our study out of these 223 cases, we have found
three new innovative method , especially used by
educated professionals, that are as follows

Case 1:

Case 3:

A young Doctor of 32 years, married anesthetic by profession has applied his professional
knowledge to put an end on the frustration and fear
aroused due to marital disharmony and fear of pro-

A young male patient of 19 year, student of


engineering college, brought to the hospital with the
history of diffuse swelling around the dorsum of left
hand with pain. After taking the patient in confi-

46

J Indian Acad Forensic Med, 32(1)


dence, he revealed highly significant history indicating his suicidal intention by injecting snake venom
on assessable left dorsum of hand that he bought
through a local snake charmer.

ISSN 0971-0973
In our case study three different type of the
case reports are identified and highlighted, that gives
a warning alarm that youth are misusing their knowledge.
It is pertinent to mention here that cases of
suicidal death due to firearm, sharp edged weapons
are not found in our study.
Jumping from height and use of motor vehicles has
not been found in our study and these two types of
cases if not impossible but difficult to prove to be
suicidal in nature.

Discussion:
The causes and circumstances for suicide are
numerous and do not admit an easy classification and
categorization. The common means adopted for suicide in India are poisoning, hanging, drowning,
jumping from height, jumping against moving train,
fire arm and fire etc.
The incidence and rate of suicidal deaths is
lowest in Bihar (1.10/lakh) while maximum cases are
found in Sikkim(48.20/Lakh), However in Union
Territories of India Pondicherry reported maximum
number (46.90/Lakh)-(Source- National Crime
Record Bureau).
In our study the young age group (21-20 Yrs) is the
most common victim of ISH and consistent with P.
Midha et al (2001). [3]
The motives behind suicide in our study are
marital disharmony and shattered family relations,
Unhappy Love affairs and depression. This is in
agreement with Kuo W H, Gallo J J and Eaten W.W.
et al (2004), [4] where they have mentioned depression as the motive for committing suicide. Our findings are also in agreement with Gupta S.C. & Singh
H. (1981). [5] who has found marital or relationship
dispute as one of the motives for suicide. Marital
disharmony is the most common precipitating factor
both in India and abroad (P. Midha et al -2001, Philips M. R. et al. 2002, [6] Vijay Kumar L. et al -2003.
[7]
The WHO has also reported the poverty as a
major factor for suicide followed by stress, mental
illness, unemployment and substance abuse. (Jancloes M.1998, [8]
Among the methods of suicides that are commonly
encounter in the routine medico-legal practice could
be categorize into physical and chemical methods.
The methods of suicide employed generally
reflect the different avenue available in the community. Knowing the pattern of suicide in an area not only
help in early management of such cases but also suggests taking earlier preventive measures. It is necessary for the death investigators to be aware of the
common scenario, risk factors, methods and the victims as well as pitfalls that may be encountered. In
our study most common method is unknown poisoning (39%), jumping against moving train (25%),
hanging (19%), Drowning (9%), Alcohol (4%), Burn
(1.8%).Higher numbers of death due to jumping
against a running train are due to the highly busy rail
track connecting Jaipur, to West and South part of the
India. At the time of peak impulse the availability of
passing by train is almost always there.

Conclusion:
The methods of suicide employed generally reflect the different avenue available in the community.
In this study most commonly used methods are:
Unknown poisoning (39%)
Jumping against moving train (25%)
Hanging (19%)
Drowning (9%)
Alcohol (4%)
Burn (1.8%)
Higher numbers of death due to jumping against
a running train are due to the highly busy rail track
connecting Jaipur to West and South part of the nation. At the time of peak impulse the availability of
passing by train is almost always there. In our case
study three different type of the case reports are identified and highlighted, that gives a warning alarm that
youth are misusing their knowledge.
The above-stated facts indicate that the unnatural
death is an alarming indicator for the democratic ruling government morally. Therefore the government
with its full resources in the association with the Non
Government organization must develop a continuous
intervention services for suicide attempts and population at risk in order to prevent further risk of suicide
and safeguard valuable lives at risk without loosing
any time.

Recommendations:
Responsibility for prevention of violence in
our society does not rest only on the law enforcing
personnel but also public health and other human
service agencies should assist in preventing primary
violence to reduce other major causes of morbidity
and mortality
It is necessary for the death investigators to
be aware of the common scenario, risk factors, methods and the victims as well as pitfalls that may be
encountered
Therefore, the government with its full resources in the association with the Non Government
organization must develop a continuous intervention
services for suicide attempts and population at risk in
order to prevent further risk of suicide and safeguard
valuable lives at risk without loosing any time.

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ISSN 0971-0973

J Indian Acad Forensic Med, 32(1)


6.

References:
1.

Durkheim E. A study in sociology trans by J.A. Spolding &


G. Simpson with introduction by Simpson Glancole, 1917,
free press.
Schneidman E. Definition of suicide; Jason Aronson 1977.
P. Midha et al. A comprehensive study of deliberate self
harm, a dissertation submitted to university of Rajasthan for
MD psychiatry 2001.
Kuo W.H., Gallo J.J., Eaten W.W. et al. Hopelessness,
depression, substance disorder and
suicidality; -A 13 year community based study. Journal of

2.
3.

4.
5.

7.

8.

9.

Table 3
Choice of method of ISH

Table A
Incidence and rate of suicidal deaths in India
(2004-2008))
S.No.

Year

Total No. of
Suicides

1
2
3
4
5

2004
2005
2006
2007
2008

113,697.00
113,914.00
118,112.00
122,637.00
125,017.00

social psychiatry
39(6):497-501.

&

Estimated MidYear Population


(Lakhs)
10,856.00
11,028.00
11,197.75
11,365.50
11,531.30

psychiatric

Method
Unknown Poisioning
Jumping against running train
Hanging
Drowning
Alchohol poisioning
Burn
Celphos Poisioning
Insecticide Poisioning
Total

Suicide Rate
(per 100,000)
10.5
10.3
10.5
10.8
10.8

epidemiology

Gupta S.C. and Singh H. Psychiatric illness in suicide attempters; Indian Journal of Psychiatry1981; 23 (1):69-74.
Phillips M.R., Yang G., Zhang Y et al. Risk Factors for
suicide in China: A National Case Control Psychological Autopsy Study, Lancet 2002; 360: 1728-1736.
Vijay Kumar L. Psycho Social Risk Factors for Suicide in
India and Suicide prevention- Meeting the challenges together, Orient Longman-2003; 49-162.
Jancloes M. The Poorest First: W.H.O. activities to help the
people in greatest needs 1998; 19(2: 182-187).

2004;

Table 1
Cases of intentional self harm (ISH)
Year
2004
2005
2006
2007
2008
Total

Total Postmortem
117
88
121
145
156
627

Total Suicidal
Deaths
32
31
44
55
61
223

Male
105
46
38
189

Age wise distribution in


ISH

Percentage
27.35
35.23
36.36
37.93
39.10

No.

Female
22
9
3
34

Total
127
55
41
223

8
0
7
0
6
0
5
0
4
0
3
0
2
0
1
0
0

Precipitating Factors

Male
Female

Below
10

1120

2130

31-

41-

Age40group 50

5160

Above
60

Graph 2

Gender wise distribution in


ISH

Table 4
Precipitating factors for ISH
Domestic Unhappiness and
shattered family relations
Unhappy Love affairs
Dowry related
Monetary Loss in Lottery/Shares
Failure in examination
Poverty and unemployment
Insanity
Unknown/undetermined
Dispute over properties
Multiple attempts
Despair over torture

Percentage
39.46
24.66
19.28
8.97
4.04
1.79
1.35
0.45

Graph 1

Table 2
Distribution of marital status of people committing intentional self harm (ISH)
Marital Status
Married
Unmarried
Unknown
Total

Cases
88
55
43
20
9
4
3
1
223

Numbers

Percentage

53
42
26

23.77
18.83
11.66

21
19

9.42
8.52

18
16
13
6
6
3

8.07
7.17
5.83
2.69
2.69
1.35

Males Females
70

No.

60
50
40
30

cases

20
10
0

200
4

200
5

Total

48

200
6Yea

200
7

200
8

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