A Comparative study of impulsivity, lethality and intent among patients attempting suicide by self-immolation and poisoning

Namita Nazeer; Harish M Tharayil; Varsha Vidyadharan

doi:10.30834/KJP.32.1.2019.165

Authors

Namita Nazeer Assistant Surgeon, PHC Chirakkara, Kollam
Harish M Tharayil Professor, Department of Psychiatry, Government Medical College, Kozhikode
Varsha Vidyadharan Assistant Professor, Dept. of Psychiatry, Govt. Medical College, Calicut.

DOI:

https://doi.org/10.30834/KJP.32.1.2019.165

Keywords:

self-immolation, poisoning, impulsivity, lethality, intent

Abstract

Background: Suicide is one of the top ten leading causes of death in the world as well as India. Poisoning is one of the most common modes of attempting suicide. Self-immolation is a devastating form of suicide attempt. Impulsivity has been demonstrated as an important risk factor for suicide. Lethality and intent were found to be interrelated in previous studies. But a comparative study of impulsivity, lethality and intent between self-immolation and poisoning was not found in a literature search.

Objectives:

To compare socio-demographic characteristics, impulsivity, intent and lethality in those who attempt suicide by self-immolation and poisoning.
To find the intercorrelations between intent, impulsivity and lethality.

Methods: A cross-sectional comparative study was done among persons attempting suicide by self-immolation (n=40) and poisoning (n=50). Barratt's impulsivity scale, Smith's LSARS (lethality of suicide attempt rating scale) and Beck's suicide intent scale were used to assess impulsivity, lethality and intent, respectively. Percentages, mean, median and range were used to describe the data. Chi-square test, t-test and Pearson correlation were used for statistical analysis.

Results and discussion: There were significant associations between occupation, family income and socioeconomic status and mode of suicide attempt. Lethality was higher in self-immolation. Lethality and intent were significantly intercorrelated in both groups. Impulsivity and lethality were negatively correlated in the self-immolation group.

Conclusion: Self-immolation is a highly lethal method of attempting suicide. Highly lethal suicide attempts have high intent. Greater the impulsivity, less lethal the attempt is likely to be.

References

World Health Organization. Preventing suicide: a global imperative. World Health Organization. 2014. Available from: http://www.who.int/iris/handle/10665/131056Last accessed on November 2015.

Cowen P, Harrison P, Burns T. Shorter Oxford textbook of psychiatry. 6th ed. Oxford: Oxford University Press.2012;421â€“440.

National Crime Records Bureau. Accidental Deaths and Suicides in India. 2015;192.

Menon V, Kattimani S, Sarkar S, Muthuramalingam A. Gender differences among suicide attempters attending a Crisis Intervention Clinic in South India. Ind Psychiatry J. 2015 Jan-Jun;24(1):64-9.

Rezaie L, Khazaie H, Soleimani A, Schwebel DC. Is self-immolation a distinct method for suicide? A comparison of Iranian patients attempting suicide by self-immolation and by poisoning. Burns. 2011 Feb;37(1):159-63.

Nasser EH and Ovelholser JC. Assessing varying degrees of lethality in depressed adolescent suicide attempters. Acta Psychiatr Scand. 1999;99:423-31.

Hamdi E, Amin Y, Mattar T. Clinical correlates of intent in attempted suicide. Acta Psychiatr Scand. 1991;83:406-11.

Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. Am J Psychiatry. 2001;158:1783-93.

Mann JJ, Arango, VA, Avenevoli S, Brent, DA, Champagne FA, Clayton, P, et al. Candidate endophenotypes for genetic studies of suicidal behaviour. Biol Psychiatry. 2009;65(7), 556â€“63.

Sapyta J, Goldston D, Erkanli A, Daniel S, Heilbron N, Mayfield A, et al. Evaluating the predictive validity of suicidal intent and medical lethality in youth. Journal of Consulting and Clinical Psychology. 2012;80:222â€“231.

Zhang Jxu H. Degree of suicide intent and the lethality of means employed: a study of Chinese attempters. Arch Suicide Res. 2007;11(4):343-50.

Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC, 2001. Psychiatric aspects of impulsivity. Am J Psychiatry 158, 1783â€“93.

Beck AT, Beck R and Kovacs M. 1975. Classification of suicidal behaviours I. Quantifying Intent and Medical lethality. Am J Psychiatry 132(3): 285-87

Smith K, Conroy RW and Ehler BD. Lethality of suicide attempt rating scale. Suicide Life Threat Behav. 1984;14(4): 215-42

Nasser EH and Overholser JC. Assessing varying degrees of lethality in depressed adolescent suicide attempters. Acta Psychiatr Scand. 1999; 99(6): 423-431

Kalist DE, Molinari NA, Siahaan F. Income, employment and suicidal behaviour. J Ment Health Policy Econ.2007;10(4):177-87.

Smith NDL, Kawachi I. State-level social capital and suicide mortality in the 50 US states. Soc Sci Med. 2014;120:269-77.

Saurina C, Bragulat B, Saez M, Lopez-Casasnovas G. A conditional model for estimating the increase in suicides associated with the 2008-2010 economic recession in England. J Epidemiol Comm Health. 2013;67:779-87.

Castana O, Kourakos P, Moutafidis M, Stampolidis N, Triantafyllou V, Filippa E. et al. Outcomes of patients who commit suicide by burning. Ann Burns Fire Disasters.2013;26(1):36â€“39.

Nock MK, Kessler RC: Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the national comorbidity survey. J Abnorm Psychol 2006, 115(3):616â€“23.

Goldston DB, Daniel SS, Erkanli A, Heilbron N, Doyle O, Weller B, et al. Suicide attempts in a longitudinal sample of adolescents followed through adulthood: Evidence of escalation. J Consult Clin Psychol. 2015;83(2):253-64.

Lim M, Lee S, Park JI. Differences between Impulsive and Non-Impulsive Suicide Attempts among Individuals Treated in Emergency Rooms of South Korea. Psychiatry Investig. 2016 Jul; 13(4):389-96.

Sonneborn CK, Vanstraelen PM. A retrospective study of self-inflicted burns. Gen Hosp Psychiatry1992;14(6):404-7

Venkoba Rao A, Mahendran N, Gopalakrishnan C, Reddy TK, Prabhakar ER, Swaminathan R, et al. One hundred female burns cases: A study in suicidology. Indian J Psychiatry.1989; 31(1): 43â€“50.

Kannapiran T, Haroon AE, Vivekanandan S, Arnagiri S. Personality profiles of self-immolators. Indian J Psychiatry.1997;39(1): 37â€“40.