This is a retrospective study which assesses the various
socio-demographic correlates, the methods adopted to
commit suicide and the psychiatric disorders in patients
attempting suicide. The most common psychiatric diagnosis
was found to be Adjustment disorder followed by
Depressive disorder. Organo-phosphorous compounds were
the most frequent agent used among suicide attempt
patients

Baby, Sanjush

KF, Yesudas

P, Manju

English

CogPrints Cognitive Sciences Eprint Archive

Psychiatric diagnosis in attempted suicide

Cognitive Sciences ePrint Archive

Baby et al  
Calicut Medical Journal 2006;4(3):e2 
 
Psychiatric diagnosis in attempted suicide | Page 1 (Page number not for indexing purposes) 
Report 
Psychiatric diagnosis in attempted suicide 
Sanjush Baby , Manju..P.Haridas & K .F.Yesudas 
1
Department of Psychiatry, Academy of medical Sciences, Pariyaram, Kannur, Kerala, India 680302 
E mail: sanjush@gmail.com
 
 
ABSTRACT 
This is a retrospective study which assesses the various 
socio-demographic correlates, the methods adopted to 
commit suicide and the psychiatric disorders in patients 
attempting suicide.  The most common psychiatric diagnosis 
was found to be Adjustment disorder followed by 
Depressive disorder.  Organo-phosphorous compounds were 
the most frequent agent used among suicide attempt 
patients.   
 
Key words- attempted suicide, adjustment disorder, organo-
phosphorous compounds, depressive disorder, and socio-
demography 
INTRODUCTION 
Suicide is a major cause of mortality and use of health 
resources.  It is also a tragic and serious preventable public 
health problem all over the world.  (1, 20) 
 
Suicide rates among young people appear to be rising in 
both developed and developing countries more quickly than 
all other age groups.  In recent times adolescent suicides 
have been on the increase.(1,2,3,12, 16).Exams, peer 
pressure and emotional issues are said to be the triggers 
(16).  If the young generation of today have already run out 
of hope, the challenge lies in the hands of the adult society 
to make them realize that life is worth living (1,3). 
 
Suicide is the human act of self inflicting, self intentioned 
cessation, committed out of constricted thinking, tunneled 
logic and acute anguish. 
 
Attempted suicide is defined as a potentially self injurious 
action with a non-fatal outcome for which there is evidence, 
either explicit or implicit that the individual intended to kill 
himself or herself.  The action may or may not result in 
injuries.(4) Para suicide is a term introduced to describe 
patients who injure themselves by self-mutilation but who 
usually do not wish to die (21). 
 
Suicide because of its low base rate is virtually impossible 
to predict on a case by case basis (13).  Prevalence studies 
show between 4 – 12% of the general population have made 
at least one attempt and the repetition ratio (persons who 
attempt suicide again) is 50 %.( 5, 14) 
 
According to National Crime Records Bureau, in India 
every 5 minutes a person commits suicide, 7 attempts to kill 
themselves forming about 100,000 suicide death per year in 
India.  South India formed by four states (Kerala, Tamil 
Nadu, Andhra Pradesh, and Union Territory of Pondicherry) 
records around 50,000 suicide deaths per year. The 
discrepancies in suicide rates between Southern India and 
other parts of India could be attributed to different reporting 
and classification systems (22). Regarding the incidence of 
suicide in Kerala, the report of the Government of India 
shows that the suicide rate is highest in the State of Kerala, 
ninth year in a row, when compared to other states in India 
(6, 14). 
 
Financial difficulties, psychosocial problems, failure in 
exams, defamation are the major stressors that lead to 
suicide in males.  Females found harassment, family 
problems, diseases, unemployment etc. as the major 
stressors that they were forced to kick the bucket.(6) 
Consumerism, spending beyond resources pushing people in 
to debt is claimed to be major factor. Low frustration 
tolerance, problems in education system, parenting attitudes, 
weakening protective values of social institutions like 
family, increased use of alcohol all contributes to the 
stressor ultimately leading to suicide.  
 
8096
8981
9306
9778
9304
9572
9810
9438
7600
8000
8400
8800
9200
9600
10000
1996 1997 1998 1999 2000 2001 2002 2003
 
Fig 1 Number of suicide deaths in Kerala 
 
Baby et al  
Calicut Medical Journal 2006;4(3):e2 
 
Psychiatric diagnosis in attempted suicide | Page 2 (Page number not for indexing purposes) 
 
 
YEAR 
 
KANNUR DISTRICT 
 
KERALA STATE 
 
 
 
MALE 
 
FEMALE 
 
TOTAL 
 
MALE  
 
FEMALE 
 
TOTAL 
 
2001 
 
 
542 
 
228 
 
 
770 
 
6787 
 
2785 
 
9572 
 
2002 
 
 
558 
 
197 
 
783 
 
7165 
 
2645 
 
9810 
 
2003 
 
528 
 
195 
 
721 
 
6935 
 
2503 
 
9438 
Table   1 Figures for suicide death during the last three years 
 
Biological studies suggest that low serotoninergic activity is 
associated with suicidal behaviour.   Data from work with 
monoz gotic and dizygotic twins indicate that the clustering 
of suicide in a family may represent a genetic predisposition 
to the psychiatric disorders that are associated with suicide 
(5). 
 
MATERIALS AND METHODS 
This was a retrospective study conducted at Academy of 
Medical Sciences, Pariyaram, Kannur, Kerala, India, which 
is a 1000 bedded medical college hospital catering to the 
health requirements of the people of Kannur District.  The 
district has a number of private hospitals in addition to the 
Medical College which provide health care facilities to 
patients. 
 
All attempted suicide patients admitted in the Medical 
wards during the period 1/January/03 to 01/June/04 were 
included in the study.  The patients who died after reaching 
the hospital and those died during the recovery phase from 
physical ill health   following attempted suicide were 
excluded from the study.   
 
After admission, patients were treated in the wards or in the 
ICU.   These patients were referred to the consultant 
psychiatrists for evaluation after the physical condition was 
stabilized. The Hospital encourages psychiatric evaluation 
of all attempted suicide cases before discharge. 
 
A detailed clinical interview of each patient was conducted 
after the toxic effect of the substances ingested has 
subsided. The psychiatric   assessment was done by 
consultant psychiatrists and a psychiatric diagnosis 
according to the ICD-10 was reached. The information 
regarding pre-morbid personality and illness  was cross 
checked with a close relative or a reliable informant. 
  
Data was collected for the study purpose from clinical notes 
made by the consultant, IP charts and psychiatric case 
records.   
 
The present study included 206 cases of attempted suicide 
patients who were admitted in the medical wards or ICU. 
 
RESULTS 
 
a) Socio-demographic variables of the study sample- 
During the one and a half year study period 206 patients 
were admitted in the medical wards for treatment of 
attempted suicide which throws light on the fact that out of 
every 1000 in-patient admissions 5 of them were for 
attempted suicide.  
 
The age of the subjects ranged from 14 to 82 years.  68% of 
the patients were in the age group of 15 to 44years.  Hindus 
constituted almost 3/4th of the total study sample.   
 
Christians slightly less than 1/5th  and Muslims numbered 
only 15.  Regarding the marital status, majority of the 
subjects (n=137, 67%) were married.    
 
0
10
20
30
40
50
60
<14 15-24 25-34 35-44 45-54 >55
Females
Males
Total
 
Fig 2  Age distribution 
 
b) Characteristics of the suicidal behavior- 
Majority of the patients (58%) consumed organo-
phosphorous compounds in an attempt to put an end to their 
lives.  This was followed by drug over dosage (20%) and 
rodenticide (8%).  The remaining patients either consumed 
other chemical agents or used physical methods like 
hanging.  
 
AGENTS USED
58%
20%
6%
8%
4%
1%
1%
2%
Organophosphorous
Drug Overdosage
Corrosive Acid
Rodenticide
Hanging
Kerosene
Petrol
Others
 
 
 
Fig  3 Agents used 
 
In most cases stressors could not be identified,     
Baby et al  
Calicut Medical Journal 2006;4(3):e2 
 
Psychiatric diagnosis in attempted suicide | Page 3 (Page number not for indexing purposes) 
of the identified sressors most common was  
problems in the family or primary support 
 group coded as Z63 in ICD 10.(18,7) ( See table) 
Table   2 Identified stressors for attempted suicide 
 
c) Psychiatric diagnosis in people committing suicide- 
Of the the 206 patients admitted during the study period 
65% (n=134) were referred for psychiatric assessment.  Of 
these 134 cases referred for psychiatric consultation 73% 
(n=98) had identifiable stressors that prompted them to 
make this decision to commit suicide.   
 
Majority of the subjects had a psychiatric diagnosis except 
for a few, numbering 12.  Among the patients who had a 
psychiatric diagnosis Adjustment disorder comprised the 
major bulk (40%, n=54).  Depression (28%, n= 38) formed 
the next most common diagnosis followed by Alcohol 
Dependant syndrome (≈1%, n-13). 
 
 
Table   3 Completed suicide 
Psychiatric diagnosis in attempted 
suicide patients
0
10
20
30
40
50
60
A
dj
us
tm
en
t d
is
or
de
r
D
ep
re
ss
io
n
A
D
S
G
rie
f 
re
ac
tio
n
S
ch
iz
op
h
re
ni
a
M
R
A
nt
is
oc
ia
l p
er
so
na
lit
y
Z
(n
o 
di
ag
no
si
s)
Ep
ile
pt
ic
M
ul
tip
le
 D
ru
g 
A
bu
se
B
P
A
D
 
Fig 4 Psychiatric diagnosis 
 
DISCUSSION 
As the study was retrospective in nature it had it’s own 
inherent limitations and weaknesses.  The clinical diagnosis 
was cross sectional and not by consensus.  The study sample 
was fairly large. The Psychiatric referral rate was only 65% 
and was comparable to a study done at St.Johns Medical 
College, Bangalore (7).  The reasons for not referring could 
be due to the stigma associated with psychiatric referral 
which could not be assessed since this was a retrospective 
study. 
 
In this study 45.6% (n=94) patients belonged to the age 
group 15 to 34 years, which was comparable to other studies 
done in Kerala (8). 
 
In the present study males constituted 65% (n=134) of the 
total sample and females 35% (n=72).  Comparing these 
figures with the number of completed suicide cases that 
underwent medico legal autopsy at the Forensic Department 
at Academy of Medical Science, Kannur, Kerala, India, it 
was found that males constituted 66% (n=245) and females 
34% (n=135) of the completed suicide group during the 
same time period(9). 
 
Organo-phosphorus and Organo-carbamate poisoning was 
the most frequent method used by patients to attempt suicide 
and it was supported by other studies from India (7,8).  This 
is explained by the easy availability of insecticides and 
pesticides in most households.  Over dosage with 
prescription drugs such as barbiturates and anti-depressants 
were next most common employed methods. 
 
Adjustment Disorder 40% (n=54) constituted the most 
common psychiatric diagnosis followed by Depressive 
Categories  Problems related to suicide Number 
Z55 Education 3 
Z58 Employment / Unemployment 2 
Z59 Housing / Economic 
circumstances  
19 
Z63 Primary support group / 
Family 
47 
Z65 Other psychosocial factors 14 
Z85 Diseases of circulation 1 
  
MALE 
 
FEMALE 
 
TOTAL 
 
COMPLETED 
SUICIDE 
 
245  
(66%) 
 
125  
(34%) 
 
370 
 
 
ATTEMPTED 
SUICIDE 
 
134  
(65%) 
 
72   (35%) 
 
206 
Baby et al  
Calicut Medical Journal 2006;4(3):e2 
 
Psychiatric diagnosis in attempted suicide | Page 4 (Page number not for indexing purposes) 
disorder which is comparable to other studies(7).  The next 
major psychiatric diagnosis contributing to attempted 
suicide cases was substance abuse especially Alcohol 
Dependant Syndrome (n=13, 10%).  The fourth most 
common group of patients had no psychiatric diagnosis 
(n=12, 9%).  The diagnosis of Schizophrenia, Personality 
disorder, Mental Retardation were comparable to other 
studies (7,8,9,10,11). 
 
IMPLICATIONS FOR PREVENTION 
 
Suicide is a complex, long-term outcome that requires 
complex theoretical models for appropriate study and 
complex interventions for effective prevention.  The highest 
likelihood of success in saving lives in the long run lies in 
well designed, comprehensive programs focused on 
prevention, identification and appropriate treatment of 
Mental and Addictive Disorders particularly in Primary 
care.(15,16,20)  This could be facilitated by Continuing 
education for health care professional to identify and treat 
Mental illness and by making Psychiatric consultation 
mandatory for all patients admitted following attempted 
suicide.(7)  At the policy and public health level, increased 
restrictions on access to most commonly used lethal 
methods of suicide especially insecticides (organo-
phosphorus and organo-carbamate compounds) and 
prescription medications and improving control of  
facilitatory factors such as alcohol, influencing the media in 
their portrayal of suicide and reporting of method  may 
contribute to a reduction in suicide rates.(17,19) 
 
REFERENCES 
1) WHO. The World Health Report 1999 
2)  Venkoba Rao.A, Kuruvilla.K, Psychiatry;  
B.I.Churchill Livingstone, New Delhi, 1998, 160-
167 
3)  WHO The World Health Report 1995- Bridging 
the gaps.  World Health Organisation, Geneva; 17, 
1995. 
4)  Moscicki, The Psychiatric Clinics of North 
America;  Suicide, W.B.Saunders Company 504-
513 
5)  Dunner (1997), Current Psychiatric Therapy, 
W.B. Saunders company, 1997, Pg-548 
6)  Government of Kerala 2004 suicides, Kerala 
Crime Records Bureau, Government of Kerala, 
Trivandrum. 
7)  Galgali.R.B, Sanjeev Rao, Ashok.M.V, Appaya.P 
and Srinivasan.K, (1998)  Psychiatric Diagnosis of 
Self Poisoning Cases a General Hospital Study.  
Indian Journal of Psychiatry 40(3)  254-259 
8) Kandamuthan.M (1998)  Preliminary findings on 
the Psychosocial factors for attempt of suicide in 
Kerala.  NIMHANS Journal 261-270 
9) Gupta.S.C, Harjeet Singh (1981) Psychiatric 
illness in Suicide Attempters. Indian J.Psychiatry  
23(1)  69-74. 
10) Narang.R.L., Mishra.B.P and Nithesh Mohan 
(2000) Attempted Suicide in Ludhiana, Indian J. 
Psychiatry 2000, 42(1)  83-87 
11) Venkoba Rao.A.(1971) Suicide Attempters in 
Madurai) Journal of Indian Medical Association 
57, 278 
12) WHO Suicide and the Young, WHO Chron 1979; 
29; 193-8 
13) John Geddes (1999), Suicide and Homicide by 
people with Mental illness, BMJ Vol-15. No-6 
Nov 1999 Pg407 
14) Abhaya Indrayan, M.J.Wysocki, Rajeev Kumar, 
Anil Chawla, Nihal Singh (2002), Estimates of 
the Years of Life lost due to the top nine causes 
of death in rural areas of major states in India in 
1995, Nat Med J. of India Vol-15, No-1 Jan/Feb 
2002 
15) Maris.R.W, Suicide, Lancet 2003;306;pg319-26 
16) Michael Eddleston, Rezvi Sheriff.M.H, Keith 
Hawton,  Deliberate Self Harm in Srilanka: an 
overlooked tragedy in the developing world. 
British Medical Journal 1998; No:7151, Pg133-
135 
17) World Health Organisation Ad Hoc cCommittee on 
Health Research relating to future intervention 
options, investing in health research and 
development, Geneva: WHO 1996 (document 
TDR/Gen/96.1) 
18) ICD-10 Classification of mental & behavioral 
disorders, Diagnostic criteria for Research, 
WHO, Geneva 
19) Andrew T A Cheng, Tony H H chen, Chwen- Chen 
Chen &M Rachel Jenkins (2000) Psychosocial 
and psychiatric risk factors for suicide;Case 
control psychological autopsy study British 
Medical Journal(2000) 177,360-365 
20) Andrew A. Nierenberg, Stephen M. Gray, 
&Lousisa D Grandin Mood disorders and suicide 
Journal of clinical Psychiatry 2001;62 (suppl 25) 
21) Benjamin James Sadock & Virginia Alcott Sadock, 
Synopsis of Psychiatry, Ninth edition Pg 919 
22) Wun Jung Kim, Tanvir Singh, The Lancet 2004, 
363, 1090-1091. 
 
 
 ACKNOWLEGEMENTS 
1) Dr. Shajee  P.P & Dr. Padmini for their guidance 
and valuable support 
2) Dr. Balachandran, Medical Superintendant for 
permitting us to access the medical records library 
3) Department of  Community Medicine for helping 
us with the conduct of the study. 
Baby et al  
Calicut Medical Journal 2006;4(3):e2 
 
Psychiatric diagnosis in attempted suicide | Page 5 (Page number not for indexing purposes) 
4) Department of  Forensic Medicine for the statistics 
on completed suicide cases 
5) To all our colleagues especially Dr. Praveen, 
Dr.Praveena, Dr. Pravija, Dr. Nirish, Dr. David, 
Dr.Rajesh Vijayan for helping us and their 
wholehearted support and encouragement. 
6) Jayadevan for the painstaking statistical work 
7) The medical records library staff for helping us 
gather the informations 


Sanjeev Rao, Ashok.M.V, Appaya.P and Srinivasan.K,

The Psychiatric Clinics of North America; Suicide, W.B.Saunders Company 504-513 5) Dunner

The World Health Report 1999 2) Venkoba Rao.A, Kuruvilla.K, Psychiatry; B.I.Churchill Livingstone,

Psychiatric diagnosis in attempted suicide

Abstract

Similar works

Full text

Available Versions

CogPrints Cognitive Sciences Eprint Archive

Cognitive Sciences ePrint Archive