There is a steep rise in the number of suicides all over the world. Currently, it is becoming a matter of concern for mental-health professionals on account of its increasing incidence. Our study reports on 101 victims who committed suicide in 2003 in the Union Territory, Chandigarh. The study population was comprehensive as we had included consecutive suicides in Chandigarh in the year 2003. A community team comprising of a medical social worker (Master in Social Work) and a qualified counselor (Master in Psychology) visited the families and interviewed a key informant of the deceased, and thus the information available was reliable. Psychological autopsy approach was used in this study to elucidate the nature and causes of completed suicide. Similar approach has been employed in earlier Indian and international studies.[2
In the present study, a male preponderance was observed in the subjects who attempted or committed suicide (male; 57.4% vs female; 42.6%). The commonest age group committing suicide in our study was in the third decade (59.4%), followed by the fourth decade. Shukla et al.
] and other Indian workers[8
] have reported similar findings. Ponnudurai,[14
] after reviewing 12 studies on suicidology from different parts of India, has concluded that second and third decade of life seems to be the most susceptible period for Indian suicides. In our study, unmarried victims constituted 57.4% of the total sample. A large number of subjects in our study belonged to low socioeconomic category, and a high percentage of subjects were unemployed. Chandigarh being the capital of two states and being a union territory also, a large number of people from neighboring states migrate here in search of a job. In the present study, a large number of suicide victims (57.4%) were not permanent residents of Chandigarh and had migrated from other states. They were living on the outskirts of Chandigarh in slum colonies. A recent or repeated change of residence is often found to be more prevalent among people who kill themselves than among other people. These findings suggest the importance of social ties in relation to people's propensity to commit suicide. Similar findings were reported in a number of earlier studies.[15
] Our study endorses the previous research findings that unmarried persons, unemployed persons, and persons with poor socioeconomic status are at high risk of committing suicide.[15
] A job can provide many things. It may offer not only money but also social contacts, social position, support possibilities, and stable routines. The connection between unemployment and suicide is largely dependent on what exactly unemployment means for the individual. In the current scenario in India, employment opportunities are shrinking, and various government and non-government agencies must frame and implement adjustable policies of self-employment to address this emerging problem. The burden of suicide in the northern region of India can no longer be ignored. Recent reports of large numbers of farmers committing suicide in Punjab have raised many eyebrows. It has been observed that the farmers who committed suicide were under huge debts, and the income from agriculture was not adequate to repay the borrowed money. In the absence of any help, these farmers perhaps chose to end their lives. This phenomenon is imposing a challenge not only to mental-health professionals but also to political, religious, and social reformers. Suicide can be the tragic end point of interplay of a wide array of factors, including biological, genetic, social, cultural, psychological, and behavioral factors.[3
] It is imperative that multiple approaches be adopted for intervention with the goal of suicide prevention. Government of India enacted the National Rural Employment Guarantee Act on August 25, 2005. Starting April 1, 2008, this act now in 330 districts, is being extended to cover the remaining districts across India. The Government of India guarantees employment upto 100 days to every rural household that demands work. In future, proper implementation of such schemes can prove to be beneficial in tackling the growing menace of unemployment.
Hanging was the commonest method used by the subjects in this study. Similar findings were reported by many authors from Indian studies.[8
] Some hospital-based Indian studies had revealed that insecticide poisoning was the commonly employed method in committing suicide.[19
] The present study was conducted in a city where majority of the population is non-agriculturist. Chandigarh being the capital of two states (Punjab and Haryana), law-enforcing agencies implement strict rules and regulations with regard to sale of insecticides in this region. In this study, the time of committing suicide among majority of suicide victims was during office hours (8 A.M.-5 P.M.). The suicide victims might have been alone in their homes during this time to complete the act. In hanging, chances of successful suicide are high; as compared to other methods, no investment and preparation are required for hanging.
Interpersonal stress appears to be the common cause of suicide in this study. Similar observations have been made by several other researchers.[4
] Psychiatric illness was found in 33.6% (n
= 34) of the subjects in this study. This figure was higher than the reported rate (23%) in a previous Indian study.[9
] We found that 11.9% (n
= 12) of the victims had depressive episode, 23.7% had alcohol/substance abuse, and 16.8% of the subjects had epilepsy. As many as 57.4% of the subjects had shown behavioral change before the suicidal act. In our study, less than half (48.5%) of the subjects who were suffering from mental illness and alcohol/substance abuse sought treatment prior to the act, and only 11.8% sought treatment from mental-health professionals. In many international studies, psychiatric illness has been thought to be the most important cause of suicide. In these studies, the proportion of suicide victims with psychiatric illness ranged from 73% to 100%.[2
] In Chandigarh, there are many public health dispensaries which cater to the general health needs of the local residents. However, general physicians working in these dispensaries have very little exposure to psychiatry during their undergraduate training. In Chandigarh, there is a need of a suicide prevention program to decrease the incidence of suicide in this region. Physicians’ and general practitioners’ education for assessment of suicide risk may be organized through professional medical associations, for example, the Indian Medical Association (IMA), Association of Physician of India (API) etc.
Our study suggests that specific focus in suicide prevention strategies should be on the migrant population. Family education programs for early identification of mental illness and risk of suicide are urgently required in India. There is a need to bridge the treatment gap in psychiatric care services. Another need is to improve the quantum of psychiatry training in the medical undergraduate curriculum. This should include suicide, its understanding and prevention.