Year : 2017  |  Volume : 59  |  Issue : 2  |  Page : 256--257

Suicide from a global perspective

Prakash B Behere1, Animesh Sharma2,  
1 Vice Chancellor, Professor of Psychiatry, D. Y. Patil University, Kolhapur, Maharashtra, India
2 Department of Psychiatry, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Correspondence Address:
Prakash B Behere
Vice Chancellor, Professor of Psychiatry, D. Y. Patil University, Kolhapur, Maharashtra

How to cite this article:
Behere PB, Sharma A. Suicide from a global perspective.Indian J Psychiatry 2017;59:256-257

How to cite this URL:
Behere PB, Sharma A. Suicide from a global perspective. Indian J Psychiatry [serial online] 2017 [cited 2020 Jul 4 ];59:256-257
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Full Text


Editors: Amresh Shrivastava, Megan Kimbrell, David Lester

New York, Nova publications


Through these comprehensive volumes of “Suicide from a global perspective,” the authors have encompassed a vast array of topics from the history to the neurobiology of suicide and finally to the various treatment modalities available for suicidal clients. Suicide is a public health problem since time immemorial and ranks among the top ten causes for deaths, according to the World Health Organization. Important areas such as global epidemiology, impact on the family members, care at the primary level and in the hospital setup have been discussed. Role of electroconvulsive therapy (ECT) and various public health initiatives have been adequately covered. The authors have meticulously provided references wherever necessary. Each chapter provides an in-depth discussion for easy understanding of the subject.

The first volume on “Public Health Approaches” deals with chapter on history which elaborately explains as to how the ancient Egyptians perceived suicide as delinking of the soul from the body to the Romans who thought of suicide as an escape from suffering and illness. References from literatures such as Ramayana and Mahabharata also give reports of suicide being practiced in those days. The chapter on global epidemiology provides us with the estimate of mortality by suicide on a global scale of a staggering 873,000 in 2002, and briefly explains as to how we can curb the growing number of suicides by introducing a barrier between the vulnerable population and the lethal means of committing suicide. The authors have properly explained the various epidemiological parameters such as disability adjusted life years, years of life lost, years lived with disability, among others, with the help of graphical representations using tools such as pie charts and bar diagrams. The chapter on public health initiatives is especially helpful in explaining how suicide prevention is a responsibility of all the people who are with the client. It explains regarding the self-help groups and how they benefit the high-risk clients. They have also provided a tabular format of the suicide prevention form, the different levels of strategic preventive interventions along with information regarding the psychological autopsy. The authors bring to notice the concept of suicide as a silent pandemic and need for a multidisciplinary approach as it is high time to recognize that psychiatrists alone cannot handle this burden. There is a dire need for the nonpsychiatric professionals such as community nurses, social workers, and general physicians to take the mantle alongside the psychiatrist in helping those in need of immediate help. The importance of suicide prevention helplines cannot be overlooked. The authors have also commented on the stigma associated with suicide and given various methods that can be utilized to reduce the stigma associated with suicide.

The next volume on “vulnerable populations and controversies” deals with suicide among the different groups. The authors have delineated the groups based on gender, age, ethnicity, cultural backgrounds and religion, sexual orientation, those suffering from intellectual disabilities and from mental illness. They have provided the accurate statistics relating to the incidence of suicide among the various age groups. They have described, in depth, regarding the various risk factors associated with suicide among the various age groups based on their personal/individual characteristics, family characteristics/psychopathology, and negative life stressors/environmental factors. There is a separate chapter on suicide and old age in which the authors have presented a tabular format of cross-national suicide rates in the elderly population with different age groups, between both genders in different years. Along with this, the different etiological factors associated with suicide in old age are also provided in detail. The issue of sexual orientation and suicide is also properly addressed with the authors explaining the existing gaps in our system wherein the sexual orientation of the individual is not recorded due to reasons of shame faced by the family members. Suicide risk with the various chronic illnesses has been given wherein the risk associated with HIV/AIDS is given in much detail since it has evolved into a pandemic and how it disrupts the stability of the individual and those close to him/her both mentally and emotionally. Furthermore, given importance is the role of work stress on the individual in the current cutthroat economically driven culture we live in. The authors have also shed light on the topic of suicide risk among the prison population and the different strategies that can be applied to reduce the risk. The chapter on antidepressants and suicide risk is very useful as the authors have given references of various studies that have been conducted and the results they found. The data show that antidepressants are useful for suicide prevention and there are a lot more factors at play than just prescribing antidepressants and suicide risk. A detailed graphical description of the suicide rates and suicide acceptance has been shown for different countries. The role of media and the internet in suicide has also been discussed.

The next volume on “Psychiatric Approaches” is regarding phenomenology, neurobiology of suicide, and the various psychiatric disorders associated with suicide. Differences between “attempted suicide” and suicidal gestures are provided. Brief discussion on suicide risk among individuals who suffer from various psychiatric disorders such as schizophrenia, bipolar disorder, personality disorders, among others, is also given. The importance of the role of family and society in helping these individuals, apart from pharmacotherapy is also expressed. The concept of “presuicidal syndrome” and “suicide carrier” have been discussed. A brief about deliberate self-harm and nonfatal suicidal behavior along with their implications is also written so that the reader does not get confused with the terminologies. The unit on neurobiology of suicide is written in detail whereby the authors have explained regarding the centers and hormones in the brain, biological markers as well as the advances in genetic studies. A brief regarding evaluation and management strategies of patients suffering from minor and major mental illness, substance abuse is also written so that the reader gets a clearer perspective of their interconnected nature to suicide risk.

The final volume on “Risk Assessment and Management” focuses on prediction and risk assessment, psychiatric and clinical management for suicidal patients, and pharmacological and psychotherapy available for these individuals. The authors here explain that screening for suicide in the community is the need of the hour. They have explained the differences between risk factors and warning signs pertaining to suicide. Various suicide assessment scales have been provided for the reader. A separate chapter on risk factors on suicide is written which gives an in-depth knowledge regarding the effects of the various organic and mental disorders, substance abuse disorders, social, occupational, and familial factors on risk of suicide. Further on, the chapter on clinical rationale and utility of guidelines provides a table which tells us the characteristics one must evaluate while assessing patients with suicidal behavior. In the same chapter, there is a separate table explaining how to choose among different treatment modalities.

Finally, to end the chapter, the authors have told regarding the importance of documentation of the assessment of suicidal patients. The next few chapters deal with the situation faced in the emergency department, general hospital, and in primary care setting. The various hurdles experienced and solutions are explained. The need for admitting the patient in intensive care setup is also explained. The role of ECT in suicide prevention and as a treatment approach has been discussed. The various pharmacotherapeutic modalities available for patients with suicide risk are provided in detail. Roles of antidepressants, antipsychotics, lithium, and other mood-stabilizing agents have been expressed. Treatment approach using cognitive behavioral therapy and psychosocial rehabilitation is explained in detail.

Finally, there is a chapter on crisis intervention approach which explains to the reader the application of this approach as well as the debates encompassing this topic.

This book will be useful for researchers and postgraduate trainees.