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A physical and psychiatric evaluation of young females with suicidal attempts with special reference to thyroid profile and PCOS.

BACKGROUND

The word suicide is derived from Latin word sui and caedere means to kill one self. It is purposely ending one's own life. A suicide attempt is defined as "self-destructive behaviour with inferred or explicit intent to die." [3] Suicidal behaviour is a highly complex human behaviour and is known to mankind since antiquity. Suicidal behaviour ranges from suicidal thought to completed suicide. [2]

Today, suicide attempt has become a major social problem, not only for developed countries but also for developing countries. Nearly four lakh people every year commit suicide around the world. Suicide is the tenth leading cause of death for all ages in the most of the countries. [4]

The risk factors for suicidal attempt include disorders like depression, schizophrenia, OCD, personality disorder, phobic disorder, post-traumatic stress disorder, dementia, substance abuse alcohol, cocaine, etc. In addition to mental disorder, stress is also a major risk factor of suicide. [5]

This voluntary attempt at the tragedy of self-inflicted death has always attracted the attention of the medical as well as the legal fraternity. Although it is quite obvious that one has to 'attempt' suicide in order to 'commit' it, it could be held that the event of attempting suicide need not always have death as its objective.

Attempted suicide is the problem of major concern in today's society, which sometimes or the other affects the lives of a significant proportion of the population. The factors implicated in the attempt to suicide includes age, sex, race, religion, culture, marital status, habitat, climate and social systems.

Suicidal behaviour required an integrated and in-depth exploration in light of prevailing biophysical sociocultural frame. This study aimed to analyse risk factors, mode of attempt of suicide, and spectrum association with PCOS, Thyroid Profile Dysfunction in young females considering attempted suicide as a major health problem in this subgroup of population.

MATERIALS AND METHODS

All female (15-49 years) subjects with the selection criteria were evaluated with the help of a semi-structured proforma consisting of sociodemographic and clinical variables, age, education level, living standers, socioeconomic level, smoking, and illegal substance use. Information about previous suicide attempts, family history of suicide, psychiatric disorders, pre-morbid personality traits, internal family problems, precipitating factors, and suicide methods were obtained by parental and patients' interviews. A detailed general, physical, systemic examination and relevant investigations like abdominal sonography, thyroid function test was done. Mental disorder diagnosis made as per ICD-10 criteria. Severity of co-existing psychiatric disorders and stress were evaluated with corresponding scales.

OBSERVATIONS AND RESULTS

In our study, mean age for attempt of suicide was 25.5+7.6, but majority of the victims (41%) were in their third decade of life followed by those in fourth decade (30%).

The above table reveals that more number of attempts of suicide was found in the age group of 20-29 years (41.0%) followed by 30-39 years (30%), 15-19 years (25%) and 40-49 years (4%).

P value is 0.3731, Chi-square statistic= 0.7933. Majority of females (75%) belonged to urban area of which most of them (83%) were unmarried. However, domicile was not a significant (p 0.37) indicator for attempt of suicide.

The above table reveals that majority of the patients were from low income group (70%), rest 20% and 10% belong to upper and lower groups respectively.

P value is 0.0036, Chi-square: 11.250.

The above table reveals that 47% patients who attempted suicide had no formal education, 48% were high school literates and the proportion went down to 5% among graduates and postgraduates implying significant differences (p < 0.01) in the education level and suicidal attempt.

P value is 0.4001, Chi-square: 8.350. The above table reveals that there are 96% cases of poisoning out of which 27% were unmarried and 69% were married females the rest 4% by hanging with 2% each. Among the cases of poisoning most common was rat poison which is 48%, and second most common is organophosphate 19%, others are Kaner 6%, Celphos 3%, and least common are Datura, Alprazolam, Ergotamine, each constituting 1%.

P value is 0.0812, Chi-square statistic = 3.041. The above table reveals that poisoning is the primary mode of attempt in most of the patients (96%). However, this does not have a significant bearing (p >0.05) on the age group of patients who had attempted suicide.

The above table reveals that Depression is present in majority of patients--81% with hypothyroidism, 100% in hyperthyroidism and 57% with PCOS. Among the latter, obesity and stress was present in 36% and 29% patients respectively.

The above table reveals that intimate partner (40%) is the most commonly associated problem in social life, followed by financial issues (25%) and recent crisis, problem at work, physical health 20%, 10%, 5% respectively.

DISCUSSION

The present study was carried out in patients admitted in Department of Medicine, S.S. Medical College and associated S. G. M. H, Rewa (M. P.) from March 2015 to May 2016. 100 patients of attempted suicide admitted to the emergency department during the study period were studied. A total 738 female patients of age 15-49 years presented with complaints of attempted suicide by various modes of attempts like poisoning, hanging and drowning. This study showed female predominance with females constituting 54.5% of the total cases. This is in contrast to study by Jain et al (2011) which showed male dominance (56%). [6] In our study, mean age for attempt of suicide was found out to be 25.5+7.6 years, a finding similar to study by Jain et al (2011) where mean age at suicide attempt was 31.5 years. In Narang et al [7] study from Ludhiana, majority (71%) of suicides in India were by persons below the age of 44 years. Urban dwellers constituted 75% of the study sample including unmarried females 24%, married females 51%. Parkar et al (2009) found that marital problems contributed significantly in suicide and suicide attempts in the urban slum of Mumbai, India. [9] Subjects from lower middle class attempted suicide more often (70%), followed by subjects from upper socioeconomic status (20%). Preti and Miotto (1999) also confirm the link between the economic status of people and suicide. [10] 85% of the victims lived in nuclear families against 15% who lived in extended nuclear families in contrast to study by Jain et al (2011) which showed 41% attempters belonging to nuclear family. [6]

In our study, 95% females were either illiterate or educated up to secondary school in contrast to the finding in the study by Jain et al (2011) where 63% were educated up to matriculation or beyond.

Married females (71%) have outnumbered the unmarried ones (29%). Majority (71%) of suicides in India are by persons below the age of 44 years which imposes a huge social, emotional and economic burden in a study from Ludhiana by Narang et al. [7]

In our study, Housewives (46%) topped the list followed by manual labourers (29%) and students (25%). Panda B.B. et al (2015) found attempted suicide in the proportion as Housewives 20%, followed by Manual labour 23%, and students 21%. [10]

Poisoning (34.8%), Hanging (31.7%) and Self-immolation (8.5%) were the common methods used to commit suicide.

Similar observation was noted by Farzaneh et al (2010), which observes self-poisoning as the most common nature of suicide associated with students in Tehran, Iran. [12]

During hospitalisation, in cases of attempt of suicide, on further evaluation shows 14% PCOS, 16% Hypothyroidism and 1% Hyperthyroidism.

According to Etsenbruch's & Benson's study [12] (2006), PCOS was leading to frustration in 67%, anxiety in 16%, stress in 10%, obesity in 50% cases, but depression according to Bhattacharya study (2010) [13] is 5%, in contrast to our study which led to frustration in 7%, anxiety in 7%, stress in 29%, depression in 57% cases.

It is found that in case of Hypothyroidism according to Bartalena (1990) [14] study, depression was present in 32% patients unlike our study. According to Cassidy (2002), [15] depression was found in 11.5% cases unlike in our study where depression was present in 81% cases with hypothyroidism.

CONCLUSION

Present study revealed importance of hormonal changes in PCOS, hypothyroidism and stress which causes psychophysical changes in young and reproductively active females. These hormonal changes along with modern lifestyle, less literacy in females, poor handling of pesticides, urbanisation are implicated in the suicidal attempt in young females. We, therefore, suggest the evaluation for PCOS and thyroid hormones in the young females in an attempt to intervene timely and perhaps prevent what could be an unforeseen disastrous implication like attempt to suicide.

REFERENCES

[1] Suicide prevention. WHO sites: Mental health. World Health Organization 2006.

[2] Shneidman ES. Basic words & approaches. In: Definition of suicide. John Wiley & sons, Canada 1985:3-23.

[3] O'Carroll PW, Berman AL, Maris RW, et al. Beyond the tower of babel: a nomenclature for suicidology. Suicide Life Threat Behav 1996;26(3):237-52.

[4] Retterslot N. Introduction and definitions. In: Suicide-a European perspective. 4th edn. Cambridge: Cambridge University Press 1993:9-20.

[5] Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol 2010;24(4 Suppl):81-90.

[6] Jain V, Singh H, Gupta SC, et al. A study of hopelessness, suicidal intent and depression in cases of attempted suicide. Indian J Psychiatry 1999;41(2):122-30.

[7] Narang RL, Mishra BP, Nitesh M. Attempted suicide in Ludhiana. Indian J Psychiatry 2000;42(1):83-7.

[8] Parkar SR, Nagarsekar B, Weiss MG. Explaining suicide in an urban slum of Mumbai, India: a sociocultural autopsy. Crisis 2009;30(4):192-201.

[9] Preti A, Miotto P. Social and economic influence on suicide: a study of the situation in Italy. Archives of Suicide Research 1999;5(2):141-56.

[10] Panda BB, Hansda MK, Mishra K, et al. Study of poisoning cases in an Indian tertiary care teaching hospital. JIAFM 2015;37(2):165-8.

[11] Farzaneh E, Mehrpour O, Alfred S, et al. Self-poisoning suicide attempts among students in Tehran, Iran. Psychiatric Danubina 2010;22 (1):34-8.

[12] Benson S, Hahn S, Tan S, et al. Prevalence and implications of anxiety in polycystic ovary syndrome: results of an internet-based survey in Germany. Hum Reprod 2009;24(6):1446-51.

[13] Bartalena L, Pellegrini L, Meschi M, et al. Evaluation of thyroid function in patients with rapid-cycling and non-rapid-cycling bipolar disorder. Psychiatry Res 1990;34(1):13-7.

[14] Cassidy F, Ahearn EP, Carroll BJ. Thyroid function in mixed and pure manic episodes. Bipolar Disord 2002;4(6):393-7.

Hariom Gupta (1), Shailendra Kumar Manjhvar (2), Nimisha Mishra (3), Ajit Kumar Jain (4), Manoj Indurkar (5)

(1) Associate Professor, Department of Medicine, Sanjay Gandhi Memorial Hospital & Shyam Shah Medical College, Rewa.

(2) Associate Professor, Department of Medicine, Sanjay Gandhi Memorial Hospital & Shyam Shah Medical College, Rewa.

(3) Associate Professor, Department of Psychiatry, Sanjay Gandhi Memorial Hospital & Shyam Shah Medical College, Rewa.

(4) Postgraduate Student, Department of Medicine, Sanjay Gandhi Memorial Hospital & Shyam Shah Medical College, Rewa.

(5) Professor and HOD, Department of Medicine, Sanjay Gandhi Memorial Hospital & Shyam Shah Medical College, Rewa.

Financial or Other, Competing Interest: None.

Submission 08-01-2017, Peer Review 01-02-2017, Acceptance 07-02-2017, Published 16-02-2017.

Corresponding Author:

Dr. Hariom Gupta, Doctors Colony, S. S. Medical College, Rewa-486001.

E-mail: guptadr.hariom@yahoo.co.in

DOI: 10.14260/jemds/2017/239
Table 1. Age Group of Presentation of Attempt of Suicide

Age     Present Study

15-19        25%
20-29        41%
30-39        30%
40-49        4%

Table 2. Nature of Domicile in Women with
Correlation, According to Marital Status

Living in   Urban      Rural        Total
            n=75       n=25       (p>0.05)

Unmarried   24   83%   5    17%      29
Married     51   72%   20   28%      71
Total       75         25           100

Table 3. Shows Correlation of Socioeconomic
Status and Attempt of Suicide

Socioeconomic Class        n    Incidence

Upper (I)                  5        5%
Upper Middle (II)         15       15%
Middle/Lower-middle(IH)   60       60%
Lower/Upper lower (IV)    10       10%
Lower (V)                 10       10%
Total                     100     100%

Table 4. Shows Correlation of Literacy and Attempt of Suicide

Education           Unmarried   Married      Present Study
                                              (p<0.05)

Illiterate           10   35%   37   52%         47
PRI. To SEC.         15   51%   15   45.5%       48
GRA. To Post GRA.    04   14%   01   1.5%         5
Total                29         71              100

Table 5. Shows Correlation of Marital Status
and Poison Selection

Mode              Unmarried    Married        Total
                                            (p>0.05)

Rat poison         13   45%    35    51%       48
OPP                07   24%    12   16.5%      19
Unknown            03   10%    14    18%       17
Kaner seed         01   3.5%   05    07%       06
Hanging            02   07%    02    03%       04
Celphos            01   3.5%   02    03%       03
Datura Fruit       00    00    01   1.5%       01
Alprazolam tab.    01   3.5%   00    00        01
Ergotamine tab     01   3.5%   00    00        01
Total              29          71             100

Table 6. Shows Correlation with Mode of Attempt
of Suicide and Age Group

Mode         15-24       25-49      Total
              Age         Age      (p>0.05)
             Group       Group

Poisoning   41   43%    55   57%      96
Hanging     04   100%   00   00       04
Total       45          55           100

Table 7. Shows effects of Thyroid Dysfunction and PCOS
leading to Attempt of Suicide

Hormonal Profile        Effects          Present study
Dysfunction

Hypothyroidism (16)   Frustration   3         19%
                      Depression    13        81%
                        Obesity     5         30%
Hyperthyroidism (1)   Depression    1        100%
PCOS (14)             Frustration   1         07%
                        Anxiety     1         07%
                      Depression    8         57%
                        Stress      4         29%
                        Obesity     5         36%

Table 8. Precipitating Factors Commonly
Associated with Attempt of Suicide

Sl. No.     Precipitating     Present Study
               Factor

1         Intimate partner         40%
2         Financial problem        25%
3           Recent crisis          20%
4          Problem at work         10%
           Physical health         5%

Figure 1

correlation with PCOS, Hypothyroidism and
Stress causes cofactor for attempt of suicide

factor affecting      Percentage of cases

                      Effects

HYPOTHYROIDISM (16)

FRUSTRATION           19
DEPRESSION            81
Obesity               30

HYPERTHYROIDISM

DEPRESSION            100

PCOS (14)

FRUSTRATION           7
ANXIETY               7
DEPRESSION            57
STRESS                29
OBESITY               36

Note: Table made from bar graph.
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Article Details
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Title Annotation:Original Research Article; polycystic ovary syndrome
Author:Gupta, Hariom; Manjhvar, Shailendra Kumar; Mishra, Nimisha; Jain, Ajit Kumar; Indurkar, Manoj
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Date:Feb 16, 2017
Words:2298
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