The word suicide is derived from Latin, meaning “self-murder”. The World Health Organization defines suicide act as “the injury with varying degrees of lethal intent and that suicide may be defined as a suicidal act with fatal outcome [1].” According to World Health Oorganisation, based on current trends, by the year 2020, approximately 1.53 million people will die from suicide, and 10-20 times more people will attempt suicide worldwide [2,3].

      Attempted suicide/deliberate self-harm may be defined as “An act with non-fatal outcome, in which an individual deliberately initiates a non-habitual behaviour.

      Non-fatal suicidal behaviours can have very different motivations, varying from an intention to die to a cry for help. These behaviours may be well prepared or carried out impulsively, and may have different physical consequences [4].

      Depressive disorders are more commonly associated with suicide attempts. Social isolation enhances suicidal tendencies among depressed patients. The largest group of male alcoholdependent patients is composed of those with an associated antisocial personality disorder [5].

      There are various life events that contribute and drive patients towards taking this step of attempting suicide. It is also important to obtain information as to the patient’s family history of suicide [6].

      Keeping these factors under consideration, the present study aims to document the various factors, life stress events and psychiatric co morbidity in patients with first attempt suicide.

Study Sample

      The sample size comprised of 115 patients with first attempt suicide who were referred, also the patients who were attending the psychiatry outpatient department and admitted in the ward for treatment consultation after being medically stabilized following first suicide attempt, which was consensus among the patient, their caregivers and the treating clinician. Consecutive sampling method was used to select subjects after attempting suicide for the first time and who were satisfying the inclusion and exclusion criteria were recruited into the study. Wherever possible, relatives, friends and other sources of information such as spouse or relatives were also interviewed for eliciting further information.

Tools

      A semi structured proforma to record details of the patient, such as age, sex, marital status, education, occupation, income, place of residence, religion, family history of suicide, mode of suicide, time of attempt, psychiatric diagnosis and medical treatment.

      A clinical sheet was used to collect data regarding the family history of suicide, mode of attempt etc.

      All patients were explained about the purpose of the study and a written informed consent was obtained.

      The patients were evaluated by a trained psychiatrist and the clinical picture was assessed. The patients were assessed for severity of depression according to the scoring of Hamilton depression rating scale.

      Becks Suicide Intent Scale was administered for assessment of the severity of the intent with which the suicide was attempted.

      The severity of stress was assessed by Holmes and Rahe life stress inventory that pushed him / her to attempt suicide.

      Also a Mini-International Neuropsychiatric Interview scale was administered to find if there was any psychiatric condition that lead to the attempt.

Statistical analysis

      The data was analyzed by using ‘descriptive’ and ‘inferential’ statistics, using the statistical software SPSS version 20. Mean and standard deviation were computed for all continuous variables. The correlation between socio demographic variables and severity of depression, severity of suicide intent and severity of stress in patients who attempted suicide for the first time was assessed using Chi square test.

      The sample of 115 patients show that the mean age of the current study participants is 29 years (Mean ± SD: 28.66 ± 6.915). Majority of our study samples are males (58%), while females contribute 43% (Table 1).

      Clinical profile of the patients shows the most common mode of attempting suicide was drug overdose and most of the patients had adjustment issues due to various domestic household issues and financial stressors (Table 2).

      The severity of depression using HAMD scale found that almost half of the participants in the study exhibit symptoms of depression with mild severity (Table 3).

      The severity of suicide intent using beck suicide intent scale found that about 67% of the participants had low intent to die, while 30% had medium intent to die and only few (3%) had high intent.

      Various stressful life events as assessed by Holmes and Rahe life stress inventory and our study participants exhibited mild levels of stress (Table 4).

      In our study Chi square test was used to compare the statistical association between socio demographic variables with severity of depression (Table 5).

      Chi square test was used to compare the statistical association between socio demographic variables with severity of suicide intent (Table 6).

      In our study chi square test was used to compare the statistical association between socio demographic variables with severity of stress showed no significant association with any of the socio demographic variables.

      The mean age of participants who attempted suicide for the first time was 29 years, findings were in concordance with the study by Lakshmi Vijaykumar et al 2010, in which majority of the suicides attempts (37.8%) in India are by those below the age of 30 years. An international study reported suicides attempts were common in the third decade of life (i.e., in persons 20 to 29 years of age) and similar results were reported in an Indian study Das et al 2008 study [7]. One of the most consistent findings in suicide research is that women make more suicide attempts than men, but men are more likely to die in their attempts than women. However most of our participants came from urban background (52%) vast of them belonged to lower class to lower middle class group which is in concordance with Shanghai archives of psychiatry, 2014.

      In our study we found that there are various methods for attempting suicide, among which drug overdose (46%) is the most common method followed by organo phosphorous poisoning (16%) and rat poison consumption (10%).

      In our study most of the patients were diagnosed with adjustment disorder (82%) followed by substance abuse, mainly alcohol (12%) which is in concordance with the earlier studies Shanghai archives of psychiatry, 2014 Das et al 2008 study [7].

      Both of which have shown higher percentage of affective disorders or adjustment disorders (58%) followed by substance abuse (25%).

      Changing in living conditions (15%), and changing to a different line of work (16%), and taking loan (11%) or mortgage (11%) were among the other stressful events which is in concordance with Das et al 2008 study and with Shanghai Archives of Psychiatry, 2014 showing highest attempts following troubles in interpersonal relationship with spouse and family, financial conditions. Where marital satisfaction is low, there is Lack of intimacy and marital strife these are linked.

      The present study found that there is mild levels of depression, low to medium severity of suicide intent and low levels of stress in patients who attempted suicide for the first time. Adjustment disorder with mild depressive symptoms remains the most common diagnosis; its early identification and proper treatment can lead to reduction in suicide attempts/intentional self-harm and perhaps completed suicides. Hence, promoting healthy coping mechanism and reduction in stress is required to reduce self-harm [8]. As is evident from the study, modifying the interpersonal relationship problems in the family might help in preventing many of suicide attempts/intentional self-harm and therefore important to address their various life events that might be stressful for them forcing them to take this step [9]. In a country like India, where formal mental health resources are limited and are attached to a stigma, it is important to provide adequate information also among people hailing from lower economic status [10].