Manoranjitham, S D (2009) Community based studies to Investigate Risk Factors and to develop a Nursing Intervention to Reduce Suicide. Doctoral thesis, The Tamilnadu Dr. M.G.R. Medical University, Chennai.
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Abstract
The community based studies were carried out in Kaniyambadi block of Vellore district, Tamil Nadu, Southern India. The Department of community health, Christian Medical College, Vellore has been operating, a community health programme in this block for the past five decades. The qualitative study employed focus group discussion to elicit local perspectives about suicide in a diverse group of individuals. The psychological autopsy study is the first community based study from India to use verbal autopsies for all deaths as part of an ongoing community surveillance programme. It also employed the standard psychological autopsy procedure and used a standard structured interview schedule for diagnosis. The intervention study was a structured educational intervention for school students to enhance their knowledge and attitude regarding suicide. SIGNIFICANT FINDINGS OF THE STUDY: Perceptions regarding suicide: • Many participants particularly emphasized marital discord (14/45), family problems and interpersonal conflict, while only a minority mentioned mental disorders as the main cause for suicide. • Participants commonly reported that social and financial difficulties had an adverse impact on individuals coping, significantly straining relationships and forcing them to commit suicide. • Participants considered suicide as an option during the time of duress. • Participants said that poisoning (16/45) and hanging (7/45) were the common methods of committing suicide, employed by all age groups. • Most participants (20/45) reported that the social impact of suicide was more in the rural community. They also highlighted the psychological impact of suicide on families. • Participants knew little about the support services available for suicide prevention. However, they gave suggestions regarding suicide prevention. RISK FACTORS FOR SUICIDE: • Widowhood or separated (p = 0.02) was identified as the risk factor for suicide, which increased the risk by three times. • Lack of close friends during past six months (p = 0.001), ongoing stressors (p = 0.001) and chronic pain (p = 0.006) were the significant psychosocial risk factors for suicide. • Being single (p = 0.02) was a significant demographic risk factor associated with suicide after adjusting for the effects of potential confounders. • Other factors like living alone (Fisher’s exact test p < 0.001) and break in steady relationship (Fisher’s exact test p < 0.001) were also significantly associated with suicide but were not present in the control group. • 37% (95% CI 27.54 – 46.46) of suicide and 16% (95% CI 8.81 – 23.19) of controls had at least one Axis I psychiatric diagnosis. • Majority among those who had psychiatric illness had adjustment disorder (15% in cases and 5% in controls; p = 0.02) and men with alcohol dependence (16% in cases 7% in controls; p = - 0.04). • Family history of suicide, previous suicide attempt, and family history of psychiatric illness, major depressive disorder, Dysthymia and paranoid schizophrenia were not significantly associated with suicide. EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING SUICIDE FOR SCHOOL CHILDREN. • There was significant difference found in the intervention group between the pretest and post test mean score on overall knowledge, attitude regarding suicide and their ability to identify the severity using case vignettes after the structured teaching programme ( p = 0.001). • The control group did not have significant difference between the pretest and post test mean scores on over all knowledge, attitude regarding suicide and their ability to identify the severity using vase vignettes without the structured teaching programme. • Intervention and control groups significantly differed on the various aspects of knowledge regarding suicide such a risk factors (p = 0.002) warning signs (p = 0.001) beliefs or myths about suicide (p = 0.01) and interventions to prevent suicide (p = 0.02) after the structured teaching programme. Three hypotheses were formed on the basis of the objectives and were tested. The findings are as follows: H1 - Depression was not common among subjects who committed suicide. H2 - Alcohol abuse was more likely to be common among men who commit suicide than among male controls. H3 - The students who received the structured educational intervention about suicide had greater knowledge about the issues. The findings of the studies confirmed only the third hypothesis stated. IMPLICATIONS OF THE STUDY: NURSING PRACTICE: Nurses spend a lot of time with patients on a one – to – one basis. Nurses working in health services like accident and emergency, child and adolescent mental health and community, offer care to people who engage in suicidal behaviour. So they need to be well trained in suicide risk and suicide prevention strategies. Nurses who are the prime care givers to the suicidal should focus on the interventions regarding safety and alleviation of immediate crisis. The nurses working at the community play a vital role as teachers, facilitators, counselors and guides. They should plan and educate the public regarding suicide prevention. They should take more efforts to strengthen the interventions aimed at people with a high risk for suicide and those who present with early warning signs. A trusting relationship can be developed which may encourage individuals to reveal concerns, they are reluctant to share even with their family. So, it is an important part of the nurses to educate the family to pick up changes in behaviour or cues that can precipitate a suicide attempt. Mass education should be planned and conducted at periodic intervals to increase the public awareness regarding suicide. School health services are an essential component of community health. The nurses working in the community need to educate the school students regarding suicide facts and coping skills. The school teachers can be equipped with adequate knowledge about adolescent suicide by providing appropriate training. Nursing as a discipline has a duty and is challenged to provide what is needed and necessary in helping prevent suicide among this population. NURSING EDUCATION: The educational back ground of the nurses should equip them with the knowledge necessary to recognize warning signs of suicide and its management. At present the syllabi of basic nursing courses have a very minimal emphasis on suicide prevention. The nursing curriculum should include more content on suicide. The nurses working in the hospital and in the community should be given in service education to update their knowledge and abilities in identifying people who are at risk for suicide. The nurse educators should train the students in the area of counseling people in distress. NURSING ADMINISTRATION: The nurse administrators should take an active role in developing teaching modules on suicide that are cost effective, which can be used to educate these school children and public. The nurse administrators also should take an active role in developing policies regarding suicide prevention. Periodical workshops and conferences can be organized for the nurses to update their knowledge regarding suicide prevention. NURSING RESEARCH: The present studies can be done in an urban setting and the risk factors can be compared between the rural and urban population. The psychological autopsy can be carried out between living controls, suicide attempters and suicide victims to understand the issues regarding suicide in depth. RECOMMENDATIONS: The present study findings revealed that psychosocial stress and adverse life events play a major role as risk factors for suicide. The structured teaching programme was effective and there was a significant increase in the knowledge and attitude regarding suicide. Following strategies are recommended for reducing suicide. 1. Conduct regular school health programme on suicide prevention. 2. Prepare appropriate teaching modules on suicide to use with different population. 3. Conduct training programme for school teachers to identify students with poor coping skills and counsel them. 4. Conduct regular mass education to increase public awareness. 5. Educate the nursing personal in the area of counseling. So, that they will be equipped in dealing with people in distress. 6. Interventions to foster supportive family relationships 7. Reducing the availability of means of suicide 8. Control the access to lethal means of committing suicide. 9. Establish counseling centers in rural areas. 10. Educate the public about mental illness and its treatment. 11. Support the broad population based socio economic interventions to improve the overall life standards and social justice. CONCLUSION: The qualitative study revealed that many people in the local community perceived suicide as an option to get over interpersonal, family and financial stress among normal individuals as well as among those with mental illness. The psychological autopsy study documented severe mental disorder only in a minority of subjects who killed themselves. The psychological autopsy study also reported that psychosocial stress and social isolation are risk factors for suicide in the region. The intervention study demonstrated the effectiveness of a structured educational programme about suicide in improving knowledge and attitude among students who received the education. Suicide remains as a distinct global public health problem and the reduction of rates continues to be major concern of many countries. Knowledge of risk and protective factors can be a guide for support and prevention of suicide.
| Item Type: | Thesis (Doctoral) |
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| Uncontrolled Keywords: | Community based studies, investigation, risk factors, nursing intervention, reduce suicide. |
| Subjects: | NURSING > Psychiatric Nursing |
| Depositing User: | Subramani R |
| Date Deposited: | 19 Aug 2017 10:18 |
| Last Modified: | 27 Oct 2022 03:13 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2709 |
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