Shakya, J Trauma Stress Disor Treat 2014, 3:3 http://dx.doi.org/10.4172/2324-8947.1000129
Journal of Traumatic Stress Disorders & Treatment
Research Article
Common Stressors among Suicide Attempters as Revealed in a Psychiatric Service of Eastern Nepal Dhana Ratna Shakya1*
Abstract Background: Stressor is one of the three major risk factors of suicide, along with altered mental state and access to suicidemeans. There is scant data from Nepal about the stressors being common among suicide attempters. Objective: To identify common stressors among suicide attempters visiting a psychiatric service in Eastern Nepal Methodology: It is a hospital based descriptive study looking into stressors as revealed by patients and care-takers in psychiatric assessment. All patients consulting the investigating psychiatristteam within study period (12 months, 2011) were enrolled after informed consent. During detailed work-up; suicidal state was ascertained, relevant information were recorded in the proforma and an intensive qualitative exploration was made in all subjects into the stressors present during the time of suicide-attempt. Results: Fifty seven percent of subjects (66/115) were female, 70% (80/115) married and 88% (101/115) from rural and semiurban settings. Average age was 29.68 years. Nearly one fifth was illiterate or barely literate. Poisoning was the most common mode of suicide attempt. About 75% (86/115) had at least one ICD10 mental disorder. ‘Stress related disorder’ was present in 13% (15/115). In a great majority (112/115), at least one stressor was reported. The most commonly revealed stressor was interpersonal conflict, dispute or quarrel (72/115), followed by the stressor related to subject’s health issues, e.g. illness, treatment cost. Some cases reported easy access to suicide means as a risk factor. Conclusion: Interpersonal dispute, health problems and easy access to suicide means were reported as common stressor/factors among suicide attempters.
a SciTechnol journal a complex interplay of various psychological, social and biological factors behind suicide and its attempt [3-5]. Depression, other psychiatric disorders, and alcohol and other substance ab/use result in an altered mental state and raise the suicidal risk. Most of the existing studies highly associate suicide phenomena with these disorders [6], mainly depression [3,4,6]. Stressors; in the form of environmental, social, cultural, circumstantial, financial, professional, physical, legal and many other adversities; of short or long duration have been linked with suicide and its attempt [1-4,716]. We need to identify modifiable stressors; to foster the coping and resilience among the host and to adopt strategies to minimize the access to suicide means to prevent them at the greatest possible extent [12]. There is, however a dearth of information about the common stressors associated with suicide attempt in Nepalese setting. This study was conducted to sort out the common stressors as revealed among suicide attempters during psychiatric assessment.
Methods It is a hospital based descriptive study looking into the stressors reported by the patients and or their care taker while consulting a psychiatric service in Eastern Nepal for the management of suicide attempt or deliberate self harm (DSH). All DSH attempt cases consulting this study-team of B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal, within the study period (12 months; from October 2010 to September 2011) were enrolled after informed consent. BPKIHS is a tertiary care hospital, a referral centre for all parts of eastern Nepal and a health science Institute with a wide range of academic programs. Department of Psychiatry of this Institute has MD Post-graduate program. With usual detailed psychiatric assessment, suicidal state was ascertained. Relevant informations were recorded in a particular proforma. An intensive exploration was made in all subjects into the presence of and then sorted out the stressors. Both the stressors, perceived and reported by the DSH attempter plus presumptive as revealed by the
Keywords Deliberate self harm; Nepal; Stressor; Suicide attempt
Introduction Suicide or suicide-attempt is an outcome of a complex interaction of three main risk factors: 1) underlying stressor, 2) disturbed mental state or psychiatric disorder and 3) the circumstances making the access to suicide means easier. These factors predispose, precipitate or perpetuate the suicide phenomenon [1,2]. Even though one or other particular precipitating event or factor usually stands out in a particular incidence (as commonly seen in media), studies reveal *Corresponding author: Dhana Ratna Shakya, Department of Psychiatry, BPKIHS, Nepal, Tel: 025-525555-3225, E-mail:
[email protected] Received: July 17, 2013 Accepted: June 24, 2014 Published: June 30, 2014
International Publisher of Science, Technology and Medicine
No., % 45 40 35 30 25 20 15 10 5 0
Age groups (in years) 44, 38.3%
25, 21.7%
21, 18.3% 15, 13.0% 10, 8.7%
50
Figure 1: Age distribution of suicide attempters visiting a psychiatry service.
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Citation: Shakya DR (2014) Common Stressors among Suicide Attempters as Revealed in a Psychiatric Service of Eastern Nepal. J Trauma Stress Disor Treat 3:3.
doi:http://dx.doi.org/10.4172/2324-8947.1000129 informant care-taker of the person, were analyzed. The information was kept confidential.
showed- the 1st in 25 (21.7%), 2nd in 45 (39.1%), 3rd in 33 (28.7%), 4th in 3 (2.6%) and 5th and above in 9 (7.8%) subjects.
Data were entered into a computer and analyzed using ‘Statistical Package for Social Studies’ (SPSS 10) – software.
• Thirteen subjects (11.3%) were from cities; 34 (29.6%) semiurban and 68 (59.1%) from villages.
Results
• Eighty six subjects (74.8%) had psychiatric disorder. The most common psychiatric diagnosis was mood disorder (38%), mainly depression (37%) (Table 2).
• Out of total of 115 cases enrolled in this study, 66 (57.39%) were female, with M : F ratio of 0.74 : 1. • Average age of the subjects was 29.68 years, with age range of 15- 81. Age groups (20- 29) and (
