Annals of Tropical Medicine and Public Health
Home About us Ahead Of Print Instructions Submission Subscribe Advertise Contact e-Alerts Editorial Board Login 
Users Online:2065
  Print this page  Email this page Small font sizeDefault font sizeIncrease font size
 


 
Table of Contents   
ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 1  |  Page : 154-159
Psychosocial risk factors and clinical profile associated with attempted suicide in young adult and adolescent patients in conflict zone-Kashmir


Govt Psychiatric Disease Hospital, Govt Medical College, Srinagar, Jammu and Kashmir, India

Click here for correspondence address and email

Date of Web Publication5-May-2017
 

   Abstract 

Background: Several efforts have been made in the past to study psychosocial risk factors and clinical profile associated with attempted suicide, but only few have addressed the issues of youth in a conflict area Kashmir. Aims: To study psychosocial risk factors and clinical profile associated with attempted suicide in young adult and adolescent patients in conflict zone-Kashmir. Material and Method: It was a hospital-based study in which 200 young adults and adolescent patients who were admitted following unsuccessful suicide attempts to the emergency and referred to Department of Psychiatry, Govt. Medical College, Srinagar, Jammu and Kashmir, India. Selected patients were subjected to Mini International Neuropsychiatric interview (MINI) and International Personality Disorder Examination (IPDE) for evaluation of symptoms and diagnosis. Subjects of age less than 15 years and more than 34 years have been excluded. Results: Majority of the suicide attempters 65% were < 24 years of age with adolescent over represented in the sample (Mean = 21.24 ± 4.66), females were 58%, low socioeconomic status (86%), oral agents (most common method) was used by 84%, 64% had expressed suicidal or death wishes before act and 72% made an impulsive attempt. Eighty-two percent of the suicide attempters were suffering from some psychiatric illness at that time. Out of which 40% had mood disorder with predominance of major depressive disorder, 15% had personality disorders, and 9% had posttraumatic stress disorder. Conclusion: Knowledge of clinical phenomenology may assist in identification and early intervention of youth who are at high risk. Overall, findings indicate a strong and immediate relationship between suicide attempt and psychiatry morbidity.

Keywords: Attempted suicide, clinical phenomenology, psychosocial risk factors, young adult and adolescent patients

How to cite this article:
Jan MM, Rather YH, Majeed N, Wani ZA, Dar MA, Margoob MA, Hussain A, Bhat TA. Psychosocial risk factors and clinical profile associated with attempted suicide in young adult and adolescent patients in conflict zone-Kashmir. Ann Trop Med Public Health 2017;10:154-9

How to cite this URL:
Jan MM, Rather YH, Majeed N, Wani ZA, Dar MA, Margoob MA, Hussain A, Bhat TA. Psychosocial risk factors and clinical profile associated with attempted suicide in young adult and adolescent patients in conflict zone-Kashmir. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Sep 21];10:154-9. Available from: http://www.atmph.org/text.asp?2017/10/1/154/205561

   Introduction Top


Suicide is a serious public health problem.[1] The World Health Organization, recognizing the growing problem of suicide worldwide, urged member nations to address the phenomenon. During the past decade, there have also seen dramatic and disturbing increases in report of suicide among youth.[2]

In all countries, suicide is now one of the three leading causes of death among people aged 15-34 years. Until recently, the suicide rate was higher for the elderly, but now suicide predominates in younger people, both in absolute and relative terms, in a third of all countries.[2],[3],[4]

In the last two decades, official figures of the suicide rate in India have increased from 7.9 to 10.3 per100,000.[5] The actual number of suicides is understandably more than the reported official figures as nonreporting, underreporting, and misclassification are prevalent due to various sociocultural stigmas, religious sanctions, legal issues, and insufficient registration systems.

The real magnitude of suicide as a public health problem is not clear in the conflict zone Kashmir Valley. War damage the very fabric of society.[6] Kashmir has been no exception and the ongoing conflict has had its toll on Kashmiri population. Nearly everybody has been affected by the violence. High levels of confrontation with violence have been reported in studies from Kashmir. People are frequently confronted with physical and psychological mistreatment. Torture, detention, threats, killings, and disappearances are common. The most frequent traumatic events encountered are firing and explosions (81%) and exposure to combat zones (74%).[7] Exposure to violence has potential implications for mental health. Poverty, low education, social exclusion, gender disadvantage, conflict, and disasters are the major social determinants of mental disorders. Examination of the literature reveals a paucity of data on the impact of violence on mental health of population in Kashmir. In areas affected by chronic strife a larger chunk of population would be expected to experience mental health problems and such figures ought to apply to the people of Kashmir. There are high levels of psychological distress prevalent in the population.[8]

There has been a qualitative and quantitative difference in the psychiatric morbidity as a direct result of the violence. A phenomenal increase in the number of people attending the psychiatric hospital is a direct reflection of that. There is a significant increase in the number of people being diagnosed with acute stress reaction, depressive disorders, anxiety disorders, and posttraumatic stress disorder (PTSD).[9],[10]

The prevalence of PTSD is reported to be 15.9%.[11] A predominantly Muslim society where death due to suicide has always been very low finds suicide as the second most common cause of unnatural deaths.[12] One-third of the respondents contemplate suicide as per a survey done in four districts of the region. Most of the people who complete suicides are young males in the age group 25-34.[12]

There have been an increase in the number of people who attempt suicide. The law makes attempted suicide a punishable offence and help is often not sought, which leads to underreporting. Kashmir, which is a predominantly Muslim society and Muslim suicide rates in whole India were lowest at 0.5/100,000 two decades back.[5],[12] But in the last two decades the scenario has changed, the prevalence of mental illness has increased dramatically in Kashmir.[13] We have also noticed an increase in cases of suicidal behavior in young adult and adolescent patients reporting to our hospital although not reported.

In the above context, it was intended to study the risk factors associated with suicide attempts in young adult and adolescent patients reporting to our hospital, and of its first kind from this state which has seen decade long sociopolitical disturbance. The specific objectives of this study were to evaluate sociodemographic variables, clinical diagnosis, and the methods used during suicide attempts.


   Methodology Top


The study has been conducted in Department of Psychiatry, which belongs to a 1000 bedded tertiary care hospital associated to Govt. Medical College, Srinagar, Jammu and Kashmir, India. 200 consecutive young adults and adolescent patients following an unsuccessful suicide attempt were recruited for the study. They had reported to the Emergency Department and were referred to Psychiatry Department for further treatment. A suicide attempt is defined as a nonfatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. It may or may not result in injury.[14]

General description, demographic data, and circumstances of the attempt were recorded using the semi-structured interview schedule. Mini International Neuropsychiatric interview (MINI) was applied for evaluation of symptoms and diagnosis. MINI is a DSM-IV based diagnostic interview with high reliability and validity.[15]

International personality disorder examination (IPDE) was applied to evaluate the personality disorders. IPDE is a semi structured clinical interview in accordance with both ICD-10 and DSM-IV criterion. That provides a means of arriving at the diagnosis of major categories of personality disorders.[16]

An informed consent was taken from the participants and those who did not consent were excluded.

Patients less than 15 years and more than 34 years of age are excluded.

The study was approved by the department and institutional ethical committee and to maintain confidentiality of the study, the names of the participants were not recorded.

The original study protocol was approved by the ethical committee of medical college Srinagar and accepted by Kashmir University. Authors declare that the study confirms the regulations of the Declaration of Helsinki.

The data was tabulated and analyzed and the averages were calculated and subjected to descriptive as well as inferential statistics (chi-square) by using SPSS 20.0.


   Results Top


Out of 200 patients, 58% were females and 42% were males. Sixty-five percent of all suicide attempters were in the age group of 15-24 years while 35% in the age group of 25-34 years (Mean = 21.24 ± 4.66). Forty-six percent patients were single. Twenty-four percent of suicide attempters were from rural areas and 76% were from urban settings. Most of the suicide attempters were Muslims. Eighty-six percent subjects were from poor socioeconomic status [Table 1].
Table 1: Shows sociodemographic variable study characteristics, subjected to chi-square test and significant values (P < 0.05)

Click here to view


Eighty-two percent patients in our study were having some psychiatric illness at the time of suicide attempt. In this study there was predominance of mood disorders, which was present in 40% of our sample, with depressive disorder being most prominent. We found that 15% of cases were suffering from personality disorders. Eighteen percent of our cases were not having any psychiatric illness before the suicide attempt [Table 2].
Table 2: Psychiatric status of patients before the suicidal attempt and the observations

Click here to view


Self-poisoning was the most common method adopted for attempting suicide, 84% of the subjects used this method. Insecticides and pesticides were taken by 21% patients. Only 16% of patients resorted to physical methods like by burning (self-immolation) and jumping into river (drowning) [Table 3].
Table 3: Methods adopted during suicidal attempt and the observations subjected to chi-square test and significant values (P < 0.05) marked by*

Click here to view



   Discussion Top


Analysis of the material showed that females outnumbered the males in the present study, which is in agreement with the findings of Chandrasekaran et al.;[17],[18] according to them suicide attempts are more common among females than males. Most of the suicide attempters were in the age group of 15-24 years. This is in accordance to WHO (2001) report according to that there have been dramatic and disturbing increases in suicide among youth (WHO report showed that age from 15 to 30 is at increased risk of suicide).[19] Same results were also obtained in studies by Vijaykumar and Conwell.[20],[21]

The majority of suicide attempters were from adolescence age group, as this age group mark the period of the life cycle when impulsive behavior and risk taking behavior are most common, and substance abuse and many mental illnesses emerge first. Other social and environmental factors such as increased academic pressure and competition for jobs are more in this age group.

It has been observed that most of the patients were single. Many studies in India have reported a higher percentage of unmarried patients in attempted suicide, Rao (1965)[22] (66%); Sethi et al. (1978)[23] (65.3%), Gupta and Singh (1981)[24] (62%), and Ponnudurai (1986)[25] (57%).

Most of the patients in our study were either illiterate or had a low education level when compared to findings reported by Lal and Sethi (1975)[26] and Gupta and Singh (1981),[24] the difference may be because most of the patients of our study belong to low socioeconomic group and were suffering of psychiatric illnesses which may have affected their school performance.

Housewives predominated in the attempted suicide group followed by semi-skilled laborers, unskilled laborers, and students. This is in agreement with the general perception that housewives have to face more household stresses than working class females which make them depressed and leading to suicidal attempts. While students accounted for the majority of suicide attempters in the study done by Rao and Chinnian (1972),[27] surprisingly in our study there were only 8% students.

Fifty-four percent patients were from nuclear families, which are considered to be a nonprotective factor for attempted suicide in contrast to being in a joint family. In the study of Bansal[28] 53% were from joint family, whereas the study of Ramdurg et al.[29] showed that 41% belonged to nuclear family.

Most of the suicide attempters were from urban settings which is similar to other studies.[28],[29] The reason for urban preponderance may be because the present hospital, being located in the city, gets emergency patients predominantly from the city, and some surrounding villages.

Most of the suicide attempters were Muslims; this may be due to a large Muslim population in the study area. This is in contrast to earlier beliefs that suicide is very rare in Muslims.[12]

Most of the subjects were from poor socioeconomic status. This finding is in agreement with the findings of the study of Nagendra et al. who found that most (83%) of the suicidal attempts were from the low socioeconomic groups.[30] Most of the studies in different countries have reported that lower social class is an important risk factor for suicide and attempted suicide.[31],[32] In our study, self-poisoning was the most common method adopted for attempting suicide, which is also supported by the findings of other Indian and foreign studies.[33],[34] This may be due to the easy availability of insecticides and pesticides in most of the homes. Self-poisoning with sleeping pills which either have been prescribed by doctors or purchased from market without prescription, both trends highlight the fact that benzodiazepines can be easily purchased from a pharmacy in our society. Eight percent of the patients had a previous history of suicidal attempts. Bagadia et al. (1979) found 7% patients and Sethi et al. (1978) observed that 14.6% patients had previous suicide attempts.[23],[35]

Identifying them is important because it has been reported that the adolescents often with past histories of suicide attempts are more vulnerable to suicide behavior.[36]

Psychiatric Morbidity

Eighty-two percent patients in our study were having some psychiatric illness at the time of suicide attempt. This figure is much higher than the western reports may be because of the stressful environment in this part of the world (Kashmir Valley) due to longstanding sociopolitical disturbance and low intensity conflict like situation since last two decades. Although it is consistent with the other hospital studies done in other parts of our country.[34],[37],[39]

In our study there was predominance of mood disorders, with depressive disorder being most prominent. This is in agreement with the findings of Indian as well as western studies.[34],[40],[41],[42],[43],[44] According to Sainsbury(1953),[45] approximately two-thirds of suicides are linked to depressive illness. Weismann (1974)[46] reported depression to be most common diagnostic entity in suicide attempters (35%). In 2009, Qusaret al.[47] found most common psychiatric diagnosis was major depressive disorder in attempted suicide.

In our study schizophrenia accounted only 4% cases. Rao[27] in 1972 in his study reported 2.4% cases which is close to our study. Only 2% of our cases had adjustment disorders with depressive reaction. Four patients (2%) were suffering from obsessive compulsive disorder. Two percent cases were having substance dependency.

Using standardized tool that is IPDE we found that 15% of cases were suffering from personality disorders. Chandrashekaran et al. (2003) used the same tools and reported the prevalence of personality disorder only in 7% of patients; this could be due to the fact that they have included only first attempters which might exclude borderline patients.[47]

Nine percent of our cases had PTSD. Various studies have found that PTSD is associated with increased risk of a subsequent suicide attempt.[48] In our study prevalence PTSD is high compared to other studies done other parts of country, this can be explained by the fact that there is a higher rate of PTSD in this part of the world as reported by a series of studies of Margoob et al.[10],[11],[13]

Substance abuse was less frequently reported in this study than elsewhere. The likely reason could be stigma and fear of getting identified and so denial, as patients want to conceal addiction from family.[49]

Eighteen percent of our cases were not having any psychiatric illness before the suicide attempt. However, these cases were suffering from depressive mood at the time of suicide attempt, but they could not be fitted into any psychiatric disorder. This figure is quite less than the reports in the earlier studies of Badri Narayan (1977),[34] Sethi et al. (1978),[23] Gupta and Singh (1981),[24] who did not find any psychiatric disorder in 34%, 45%, and 38% their cases, respectively, this difference is because of the growing concern of mental illnesses in Kashmir since two decades due to conflict.[10],[11],[13]

There were limitations that should be taken into consideration in interpreting the results from this study. First, its a hospital-based study, sample size is small, the findings cannot be generalized to whole community. Second, in our study statistics used that is chi-square test as a univariate test, is not a strong method to show correlation of psychosocial risk factors and clinical profile with suicide attempters.


   Conclusion Top


Ongoing conflict has had its toll on Kashmiri population. Nearly everybody has been affected by the violence. Exposure to violence has potential implications for mental health. There have been increases in the number of people who attempt suicide. So we should take steps to decrease suicide rate in society, especially in younger age groups who are at risk. As we have seen that most of the suicide attempters were having psychiatric comorbidity at the time of attempt to suicide, so measures should be taken to provide timely psychiatric services to these patients in the form of psychotherapy, pharmacotherapy, and adequate social support. Traditional ways of living in joint families are a protective factor as it provides more social support. In addition, public education and awareness should be generated in youth regarding mental illness to decrease stigma and encourage timely intervention. Government agencies should also strictly implement laws to restrict the easy availability of highly toxic pesticides and sedative drugs in the market.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest

 
   References Top

1.
World Health Organization. World Health Report-2002. Health System; improving performance.  Back to cited text no. 1
    
2.
Houston K, Howton K, Shepperd R. Suicide in young aged 15-24: a psychological autopsy study. J Affect Disorder 2001;63:159-70.  Back to cited text no. 2
    
3.
Knipe DW, Metcalfe C, Fernando R, Pearson M, Konradsen F, Eddleston M, et al. Suicide in Sri Lanka 1975-2012: age, period and cohort analysis of police and hospital data. BMC Public Health 2014;14:839.  Back to cited text no. 3
[PUBMED]    
4.
Beghi M, Rosenbaum JF, Cerri C, Cornaggia CM. Risk factors for fatal and nonfatal repetition of suicide attempts: a literature review. Neuropsychiatric Dis Treat 2013;9:1725-36.  Back to cited text no. 4
[PUBMED]    
5.
Murthy RS. Suicide prevention policies and priorities, community mental health perspective. Indian J Soc Psychiatry 1993;9:47-52.  Back to cited text no. 5
    
6.
Palmer I. Psychosocial costs of war in Rwanda. Adv Psychiat Treat 2002;8:17-25.  Back to cited text no. 6
    
7.
Jong KD, Ford N, Kam SVD, Lokuge K, Fromm S, Galen RV, et al. Conflict in the Indian Kashmir Valley I-exposure to violence. Conflict and Health 2008;2:10.  Back to cited text no. 7
    
8.
Jong KD, Kam SVD, Ford N, Lokuge K, Fromm S, Galen RV, et al. Conflict in the Indian Kashmir Valley II-psychosocial impact. Conflict and Health 2008;2:11.  Back to cited text no. 8
    
9.
Khan AW, Beg AA. A study of psychiatric morbidity in Kashmir under stressful conditions in the valley. MD Thesis. 1993. (Unpublished).  Back to cited text no. 9
    
10.
Margoob MA, Firdosi MM, Banal R, Khan AY, Malik YA, Sheikh AA, et al. Community prevalence of trauma in South Asia-experience from Kashmir. JK-Practitioner 2006;13:S14-7.  Back to cited text no. 10
    
11.
Margoob MA, Sheikh AA. Community prevalence of adult PTSD in South Asia-experience from Kashmir. JK-Practitioner 2006;13:S18-25.  Back to cited text no. 11
    
12.
Hussain A. Muslim suicide-Kashmir experience. Eur Psychiatry 2008;23:S84.  Back to cited text no. 12
    
13.
Margoob MA, Firdosi MM. Community prevalence of trauma in south Asia-experience from Kashmir. JK-Practitioner 2006;13:S14-17.  Back to cited text no. 13
    
14.
Kaplan and Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. 10th ed. 719-20.  Back to cited text no. 14
    
15.
Sheehan D, Shytle D, Milo K, Lecrubier Y, Herguetta T. American Psychiatric Association: DSM-IV, Diagnostic and Statistical Manual of Mental disorders, Washington 2000. 4th ed; 1994.  Back to cited text no. 15
    
16.
Loranger AW. Personality disorder examination (PDE) manual.Yonkers, NY: DV Communications. 1988.  Back to cited text no. 16
    
17.
Chandrasekaran R, Gnanaseelan J, Sahai AR, Swaminathan RP, Perme B. Psychiatry and personality disorders in survivors following their first suicide attempt. Indian J Psychiatry 2003;45:45-8.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
Blackmore ER, Munce S, Weller I, Zagorski B, Stephen AS, Donna ES, et al. Psychosocial and clinical correlates of suicidal acts: results from a national population survey. Br J Psychiatry 2008;192:279-84.  Back to cited text no. 18
    
19.
World Health Organization. World Health Report-2000. Mental health and Behavior; improving performance   Back to cited text no. 19
    
20.
Vijayakumar L, Rajkumar S. Are risk factors for suicide universal? A case-controlled study in India. Acta Psychiatr Scand 1999;99:407-11.  Back to cited text no. 20
[PUBMED]    
21.
Conwel Y, Duberstein PR, Cox C, Herrmann JH, Forbes NT, Caine ED. Relationship of age and axis I diagnosis in victims of completed suicide: a psychological autopsy study. Am J Psychiatry 1996;153:1001-8.  Back to cited text no. 21
    
22.
Venkoba RA. Attempted suicide. Indian J Psychiatry 1965;7:253-64.  Back to cited text no. 22
    
23.
Sethi BB, Gupta SC, Singh H. Psycho-social and personality character in cases of attempted suicide. J Psychiat 1978;20-5.  Back to cited text no. 23
    
24.
Gupta SC, Single H. Psychiatric illness in suicide attempters. Ind J Psychiat 1981;23:69-74.  Back to cited text no. 24
    
25.
Ponnudurai R, Akar JJ, Saraswathy M. Attempted suicide in Madras. Indian J Psychitry 1986;28:59-62.  Back to cited text no. 25
    
26.
Lal N, Sethi BB. Demographic and socio-economic variables in attempted suicide by poisoning. Ind J Psychiat 1975;17:100.  Back to cited text no. 26
    
27.
Venkoba RA. Suicide attempts in Madurai. J Ind Med Ass 1971;57:278.  Back to cited text no. 27
    
28.
Bansal P, Gupta A, Kumar R. The psychopathology and the socio-demographic determinants of attempted suicide patients. J Clin Diagnostic Res 2011;5:917-20.  Back to cited text no. 28
    
29.
Ramdurg S, Goyal S, Goyal P, Sagar R, Sharan P. Socio-demographic profile, clinical factors, and mode of attempt in suicide attempters. Ind Psychiatry J 2011;20:11-6.  Back to cited text no. 29
[PUBMED]  [Full text]  
30.
Nagendra Gouda MR, Rao SM. Factors related to attempted suicide in Davanagere. Indian J Community Med 2008;33:15-8.  Back to cited text no. 30
[PUBMED]  [Full text]  
31.
Narang RL, Mishra BP, Nitesh M. Attempted suicide in Ludhiana. Indian J Psychiatry 2000;42:83-7.  Back to cited text no. 31
[PUBMED]  [Full text]  
32.
Arun M, Yoganarasimha K, Palimar V, Kar N, Mohanty M. Para suicide: an approach to the profile of victims. J Indian Assoc Forensic Med 2004;26:58.  Back to cited text no. 32
    
33.
Ponnudurai R, Akar JJ, Saraswathy M. Attempted suicide in Madras. Indian J Psychiatry 1986;28:59-62.  Back to cited text no. 33
[PUBMED]  [Full text]  
34.
Badrinaryana A. Suicidal attempt in Gulbarga. Indian J Psychiatry 1977;19:69-70.  Back to cited text no. 34
    
35.
Bagadia V, Abhyankar R, Shroff P, Mehta P, Doshi J, Chawla R. Suicidal behavior: a clinical study. Indian J Psychiatry 1979;21:370-5.  Back to cited text no. 35
  [Full text]  
36.
Gould MS, Shaffer D, Greenberg T. The epidemiology of youth suicide. In King RA, Apter A, editors. Suicide in children and adolescents. Cambridge, England: Cambridge University Press; 2003:1-40.   Back to cited text no. 36
    
37.
Helen ZR, Jennifer LT, Sasha RB, William RB, Garrett MF. Adolescent suicidal ideation as predictive of psychopathology, suicidal behavior, and compromised functioning at age 30. Am J Psychiatry 2006;163:1226-32.  Back to cited text no. 37
    
38.
Seager CP, Flood PA. Suicide in Bristol. Brit J Psychiatry 1965;111:919.  Back to cited text no. 38
    
39.
Arun M, Yoganarasimha K, Kar N, Palimar V, Mohanty MK. A comparative analysis of suicide and parasuicide. Med Sci Law 2007;47:335-40.  Back to cited text no. 39
[PUBMED]    
40.
Satyavathi K. Attempted suicide in psychiatric patients. Indian J Psychiatry 1971;13:37.  Back to cited text no. 40
    
41.
Jain V, Singh H, Gupta SC, Kumar S. A study on hopelessness, suicidal intentions and depression in cases of suicide attempts. Indian J Psychiatry 1999;41:122-30.  Back to cited text no. 41
[PUBMED]  [Full text]  
42.
Gregory JR. Grief and loss among Eskimos who attempted suicide in western Alaska. Am J Psychiatry 1994;151:1815-16.  Back to cited text no. 42
    
43.
Stenager EN, Jensen K. Attempted suicide and contact with the primary health authorities. Acta Psychiatr Scand (Denmark) 1994;90:109-13.  Back to cited text no. 43
[PUBMED]    
44.
Beautrais AL, Joyu PR, Muldev RT. Psychiatric illness in a New Zealand sample of young people making serious attempts. New Zealand Med J 1998;111:44-8.  Back to cited text no. 44
    
45.
Sainsbury P. Suicide in London: an ecological study. London: Chapman; 1955:46.   Back to cited text no. 45
[PUBMED]    
46.
Weissmann NM. The epidemiology of suicide attempts 1960 to 1971. Arch Gen Psychiat 1974;30:737.  Back to cited text no. 46
    
47.
Qusar S, Morshed NM, Azad AK, Kader KA, Shams SF, Ahmed MF, et al. Psychiatric morbidity among suicide attempters who needed ICU intervention. Bangabandhu Sheikh Mujib Med Univ J 2009;2:76-77.  Back to cited text no. 47
    
48.
Wilcox HC, Storr CL, Breslau N. Posttraumatic stress disorder and suicide attempts in a community sample of urban American young adults. Arch Gen Psychiatry 2009;66:305-11.  Back to cited text no. 48
[PUBMED]    
49.
Bagadia VN, Ghadiali HN, Shah LP. Unemployment and attempted suicide. Indian J Psychiatry 1976;18:131-9.  Back to cited text no. 49
  [Full text]  

Top
Correspondence Address:
Dr. Mohd Muzzafar Jan
Govt. Psychiatric Disease Hospital, Srinagar, Jammu & Kashmir
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.205561

Rights and Permissions



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *


    Abstract
   Introduction
   Methodology
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed1578    
    Printed48    
    Emailed0    
    PDF Downloaded19    
    Comments [Add]    

Recommend this journal