The word suicide breaks down into the Latin words sui and caedere, which together translate to “kill oneself. Approximately one million people die from suicide every year and 10‑20 times more attempt suicide. [1] 

T There were 2,30, 314 suicide deaths in India in 2016. There is drastic increase in Indian contribution to global suicide deaths from 25.3% in 1990 to 36.6% in 2016 among women, and from 18.7% to 24.3% among men. [2] Suicide was the leading cause of death in India in 2016 for those aged 15–39 years; 71.2% of the suicide deaths among women and 57.7% among men were in this age group. [3] Southern India has a high rate of suicide and the average suicide rate for young women is as high as 148 per 100,000 and 78 per 100,000 in men. The quality of the information about suicide in India is quite limited Suicidal ideation is defined as thinking about, considering, or planning suicide. [4]

A suicide attempt is defined as a nonfatal, self-directed, potentially injurious behavior with an intent to die as a result of the behavior. Suicide is defined as a death caused by self-directed injurious behavior with an intent to die as a result of the behavior. The suicidal behavior may be impulsive, ambivalent, planned, or recurrent. [5]

There is increased suicidal risk among youth, and youth are now the group at highest risk in one‑third of the developed and developing countries. The emerging phenomenon of “cyber‑suicide” in the internet era is a further cause for concern which further increases the incidence of suicide in youth. [6]

There is considerable debate on whether those who attempt suicide are different from suicide completers. An Indian study which compared these two groups found more similarities. Both groups had predominantly middle aged, unemployed, married, with high school education and from rural background. [7] The study concluded that attempters with high intent/lethality and completers were overlapping populations. [8]

The etiological understanding of suicide is complex and comprises social, biological, psychological factors. Various psychological theories were proposed in causation of suicide. Freud's theory of internalized aggression, the relation of suicide impulses to depression, the operation of narcissistic components in the complex motivation of suicide are related to the concept of the victim-introject as central to the pathology of suicide. [9] Aaron Beck Suicide is associated with depression. The critical link between depression and suicidal intent is hopelessness. Hopelessness, defined operationally in terms of negative expectations, appears to be the critical factor in the suicide. The suicidal person views suicide as the only possible solution to his/her desperate and hopeless, unsolvable problem. [10]

This is a cross-sectional descriptive study done on psychosocial factors and family dynamics of young adults who attempt suicide by methods other than burns. The study is done in Gandhi Medical College and Hospital located in Secunderabad, it is a multispeciality tertiary care teaching hospital, it provides services to patients from twin cities of Hyderabad and Secunderabad and other districts of Telangana.

Inclusion criteria:

1. The subjects with suicidal attempt
2. Age: Including 18 upto 35 years
3. Gender males &females
4. Unmarried
5. Accompanied by parent or sibling
6. Those who are in a condition and willing to participate in the study by giving written informed consent

Exclusion criteria:

The subject who attempts suicide by burns Study is done on consecutive 150 referrals of young suicide attempters admitted in other departments. Referrals were received from medical and surgical departments. The suicide attempters were interviewed after their medical condition was stable and were fit for interview. The patients were interviewed separately and information corroborated from reliable informant. Those patients with self-harm without intention to kill themselves were not included in the study. After taking informed consent each case was interviewed for information related to their sociodemographic features, detailed account of present attempt and past attempt if any, history of past illnesses, personal history, family type, history of illnesses, suicide/ suicide attempt in family a detail history of the patient is followed by assessment of psychiatric disorders using MINI -7.0.2 followed  by  assessment  of  psychosocial  factors  using  PSLE, to  look  for presumptive stressful events in last 1 Year, this was followed by assessment of family dynamics using Smilkstein's family system APGAR. The patients received standard treatment which however was outside the study protocol.

Statistical Analysis

This is an Observational study and ethical permission was obtained from ethical committee. Results are analyzed statistically by software SPSS 29.

International Classification of Diseases-10 was used for diagnosis, study is done mainly in rural area most of the attempters were between 16- 20 years 90% and 90%attempters were unmarried more females (1.1:1), rural, literate, lower socioeconomic status (67.5%), mostly single (90%), living in nuclear (95%), and Hindu (87.5%), educational level of high school and higher secondary were 82%. Psychosocial stressors before suicide attempt was seen in 100%. Acute stress disorder/adjustment disorder was the most common diagnosis. Emotionally unstable and anankastic personality traits were seen in 12%. Pesticide ingestion (45%) was the most common suicide method. 60% attempted suicide within <30 min of suicidal contemplation. Among psychosocial factors parenting issues 47.5%, and academic issues 17.5%, romantic relationship 15% , most patients had no previous attempts of suicide, no past history of psychiatric Illness 97.5% . Adolescent and youth suicide attempts occur due to psychosocial stressors rather than due to the past or on-going mental health disorders with above personality traits suggest poor coping skills and resilience taken to deal with stressful situations by younger people

Table 1 Domicile

The chi-square statistic is 2.2708. The p-value is .131834. The result is not significant In this study 52% of population was from urban and 48% were from rural background

Table 2: Age range and gender

The chi-square statistic is 6.0491. The p-value is .04858. The result is significant

This study shows significant number 80% of suicide attempters between age group 18- 25 years

Table 3 Gender distribution

No significant difference between male (53.3%) and female (46.7%) distribution is observed

Table 4; Education and gender

The chi-square statistic is 10.2105. The p-value is .037027. The result is significant Majority were studied upto secondary school (34%) males were educated more than females

Table 5: Various Life events in last one year

Various life events in last 1 year

Family conflict was seen in majority of SA 47.33%; personal health of aelf and family member was seen in 36.67%; sleep disturbance was seen in 35.33%; other family and social problems and unemployment of self or other family member is seen in 34.67%

In our study 100% of suicide attempt patients had precipitating stressful events. As seen in other studies [10] family conflict commonly scolding by parents and siblings was most common precipitating event seen in 71 (47.33%,) other family and social life events were seen in 52(34.67%) conflicts due to excessive use of alcohol by family member was seen in 34 (22.67%) unemployment was a problem in 52(34.67%) other work related life events were seen in 36(24%) among financial related events loan in 36(24%) other financial problems were seen in 29(19.33%) personal, and family member related health events were seen 55(36.67%) and sleep disturbance was seen in 53 (35.33%). Education related life events including exam failure were seen in 27(18%). Love failure, broken engagement in33(22%) other life events like death of family member, court cases, minor violation of law was seen in14(9.33%).

Another important negative life event in our study is excessive use of alcohol by family member usually father or sibling seen in 22.67% effecting equally to both male and female suicide attempters. Some studied have shown much higher incidence of 84.5%.[11]

Pondicherry (which has a high rate of alcohol consumption) also has the highest suicide rate in (58%) in India. [12] In USSR after strict restrictions on alcohol sale suicide rate has came down by 34% in 1984-1988. [13] Hence alcohol use must be addressed societal and individual level. Strict policies and programs should be initiated for reducing the availability and consumption of alcohol at the individual level with good treatment and follow-up strategies for the treatment of alcoholics and their families.

In this study 24% of suicidal attempters had loans and 19.33% had financial difficulties. Those with loans reported experiencing financial difficulties in repayment of loan as a factor associated independently with suicide attempt. These findings points towards exploration of link between factors related between the lack of education and unemployment and the financial problems. this may lead to negative feeling of burdensomeness a low sense of competence. In a study one standard deviation increase in perceived competence reduced the odds of being at risk for suicidal behavior by 51%. Suicidality was significantly associated with work intensity in men and with work-related emotional demands in women. [14]

Interestingly in this study sleep disturbance was seen in 35.33% of suicide attempters this is not much studied in Indian studies. However, western studies have reported higher incidence of sleep disturbance in individual with suicidal behavior. [15] Physical illness as negative life event was seen in 18 (12%) and illness of family member was seen in 12 (8%).

Education related life events more commonly involved failure in exams, followed by beginning or ending of school were seen in 27(18%) of which two thirds were females. NCRB data 2015 reveals 2% of suicide in India are due to exam failure. [16]

These suicidal attempts result from poor relationships with parents, excessive expectations, the feeling of being budened, poor understanding of their peer relationships which result in an impulsive decision to make a suicidal attempt, students find it difficult to cope with failure in exam and could not find support from family members and schools. Failure in the examination was an important antecedent in student population; hence, the suicide prevention programs should include skills development for children and families to handle the multitude of issues related to academic pressure, Schools especially in areas of increase risk of suicide must provide regular counseling services to students and parents, and enhance positive coping among students.

There was slight increase in males and urban suicide attempters when compared to female and rural suicide attempters. When compared to males, females were less educated and suicide attempt was more common among less educated and was statistically significant (The chi-square statistic is 10.2105. Majority of suicide attempters were from nuclear families (67%). When compared to male and female more male suicide attempters used organophosphorous poisoning and more females used drug overdose the difference is statistically significant (The chi-square statistic is 10.8013. Among suicide attempters 34% had psychiatric illness of which major depressive episode was most common when compared to other psychiatric illness and the difference is statistically significant. About 66% of suicide attempters had no psychiatric illness. All the suicide attempters had life events negative life events majority had interpersonal problems (47.33%). More dysfunctional families were seen among suicide attempters with psychiatric illness when compared to those without psychiatric illness the difference is statistically significant.

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