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JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
How to cite this article:
KHAJURIA B, SHARMA R, BHARTI O C, KUMAR D. PROFILE OF SUICIDAL
AUTOPSIES IN A MILITANCY-AFFECTED STATE OF INDIA. Journal of Clinical and
Diagnostic Research [serial online] 2007 December [cited: 2007 Dec 3]; 6:505-510.
Available from
http://www.jcdr.net/back_issues.asp?issn=0973-
709x&year=2007&month=December&volume=1&issue=6&page=505-510&id=131
Khajuria et al.: Suicidal trends
Journal of Clinical and Diagnostic Research. 2007Dec; 1(6):505-510
505
ORIGINAL ARTICLE / RESEARCH
Profile of Suicidal Autopsies in a Militancy-Affected State of
India
KHAJURIA B*, SHARMA R**, BHARTI O C***, KUMAR D****
ABSTRACT
Background: Suicidal behavior is a major public health problem. Aims: To
know the socio-demographic factors affecting suicidal attempts and the modes
of suicidal death. Design: The retrospective observational study. Setting:
Forensic Medicine and Toxicology Department of a tertiary care hospital.
Subjects and Methods: All autopsies performed between January 2001 to
December 2005 were analysed for total number of autopsies performed,
allegedly suicide autopsies, mode of suicidal deaths, variation in suicidal
deaths in relation to age, sex, place of residence and religion.
Statistical Analysis Used: Chi-square test was used to analyse the variability of
suicidal deaths with age, sex, place of residence and religion. P-value <0.05
was considered statistically significant. Results: Out of total 3485 autopsies
16.24% (566) were allegedly suicidal autopsies. 335 (59.18%) and 231 (40.82%)
victims were males and females respectively (p=0.080). 223 (39.39%) and 343
(60.61%) victims were from urban and rural area respectively (p=0.030).
Majority of the victims [373 (65.90%)] were between 20-40years of the age. 463
(81.80%), 64 (11.30%), 37 (3.54%) and 2(0.35%) victims were from Hindus,
Muslims, Sikhs and Christian religion (p< 0.0001). Poisoning was found to be the
most common mode of suicide [243 (42.93%)], followed by burns [168
(29.69%)], hanging [52 (9.18%)], railway trauma cases [23 (4.06%)] and gunshot
[23 (4.06%)]. Conclusion: It is important to have awareness about trends, risk
factors and methods used for committing suicide in order to make remedial
measures against this preventable cause of death.
Key words: Suicidal trends, risk factors, autopsies.
Introduction
Suicide is termination of one's life intentionally
as a result of violence directed against self.
Suicide is an indicator of the mental health and
social wellbeing of society and a major cause of
injury-related death in the population. Self
inflicted violence accounts for around half of the
1.6 million violent deaths that occur every year
worldwide and about 63% of global deaths from
self harm in the Asia Pacific region.[1] Most of
these deaths occur in rural areas, where easy
access to highly toxic pesticides turns many
impulsive acts of self poisoning into suicide [1].
In India over the span of ten years (1988-1998)
death due to suicide increased by 62.9%
involving all age groups [2]. Recording suicidal
deaths in developing countries represent only the
tip of the iceberg due to unreliable population
counts, non reporting of deaths, variable
standards in certifying deaths due to social
Khajuria et al.: Suicidal trends
Journal of Clinical and Diagnostic Research. 2007Dec; 1(6):505-510
506
stigma and various others religious, political and
legislative reasons [3]. However, it is important
to have awareness about trends, risk factors and
methods used for committing suicide in order to
make remedial measures against this preventable
cause of death. For the last two decades due to
increased militancy in our state, there is
increased stress and depression in the
population, which could be an important cause
for suicidal attempts among the population. As
no study has been conducted in this region
regarding the suicidal trends; hence, the present
study was conducted to determine the profile of
suicidal autopsies in the tertiary care institute of
the state.
Materials and Methods
The present retrospective study was conducted
in the Forensic Medicine and Toxicology
Department of a tertiary care hospital to know
the socio-demographic factors affecting suicidal
attempts and the modes of suicidal death over a
period of five years (from January 2001 to
December 2005). The institution caters not only
to the city population, but also satellite
population from nearby villages, kashmiri
migrant camps and medico-legal cases referred
from adjoining rural and semi urban areas. All
the reported deaths and autopsies performed in
the mortuary of the institution over the past five
years were analysed for the suicidal deaths.
International Statistical Classification of
Diseases and Related Health Problems ICD-10
classification was used to categorize the
methods of suicidal death. By using the WHO
international proforma of death certification, and
highlighting the terminology used within the
ICD-10, it tells the doctor to identify the
*Department of Forensic Medicine and Toxicology, Govt
Medical College, Jammu, India
**Postgraduate Department of Pharmacology and
Therapeutics, Govt Medical College, Jammu, India
***Pathology, Govt Medical College, Jammu, India
****Preventive and Social Medicine, Govt Medical College,
Jammu, India
Corresponding author: Bhupesh Khajuria, MD, Head of the
Department. Department of Forensic Medicine and
Toxicology, Govt Medical College, 216-A Last Morh,
Gandhi Nagar, Jammu 180004, India.
E-mails: rashmichams@yahoo.com, drrashmi@india.com
underlying cause of death, defined as "all those
diseases, morbid conditions, or injuries which
either resulted in or contributed to death and the
circumstances of the accident or violence which
produced any such injuries" [4]. The year wise
data thus collected was analysed for total
number of autopsies performed, allegedly
suicide autopsies, mode of suicidal deaths,
variation in suicidal deaths in relation to age,
sex, place of residence and religion.
Statistics
All the parameters were expressed in number
and percentage. Chi-square test was used to
analyse the variability of suicidal deaths with
age, sex, place of residence and religion. P-value
<0.05 was considered statistically significant.
Results
Total 3485 autopsies were conducted over the
period of five years with 16.24% (566) allegedly
suicidal autopsies. Maximum number [194
(26.86%)] of allegedly suicidal autopsies were
performed during the year 2002, followed by
116 (18.23%) in year 2005 and 106 (15.51%) in
year 2001 ([Table/Fig 1]). Out of the total
allegedly suicidal autopsies 335 (59.18%)
victims were male and 231 (40.82%) were
female. Male predominance in suicidal deaths
was observed through out the period of five
years ([Table/Fig 1]). However, no statistically
significant difference was found between two
sexes (p= 0.080).
Out of the total allegedly suicidal autopsies 223
(39.39%) and 343 (60.61%) victims were from
urban and rural area respectively (p= 0.30).
However, during the year 2005 more allegedly
suicidal autopsies were performed on the victims
from urban [62 (53.45%)] than rural areas [54
(46.55%)] ([Table/Fig 1]). Majority of the
victims [373 (65.90%)] were between 20-
40years of the age. 80 (14.13%) and 113
(19.96%) allegedly suicidal autopsies were
performed on victims in the age group of ≤ 19
years and > 40 years respectively. Predominance
of suicidal deaths (60.30-74.52%) in the age
group of 20-40 years was observed during all the
five years (p <0.0001) ([Table/Fig 2]).
Khajuria et al.: Suicidal trends
Journal of Clinical and Diagnostic Research. 2007Dec; 1(6):505-510
507
[Table/Fig 1] Allegedly Suicidal Autopsies from year 2001 to 2005 with sex and residential
area distribution
Year Total
autopsies
Total ASA
n (%)
ASA in males
n (%)
ASA in
females
n (%)
ASA in urban
population n
(%)
ASA in
Rural
population
n (%)
2001 683 106 (15.51%) 59 (55.66%) 47 (44.34%) 40 (37.73%) 66 (62.26%)
2002 722 194 (26.86%) 111 (57.21%) 83 (42.79%) 75 (38.65%) 119
(61.34%)
2003 786 84 (10.68%) 48 (57.14%) 36 (42.86%) 26 (30.95%) 58 (69.05%)
2004 658 66 (10.03%) 39 (59.09%) 27 (40.91%) 20 (30.30%) 46 (69.70%)
2005 636 116 (18.23%) 78 (67.24%) 38 (32.76%) 62 (53.45%) 54 (46.55%)
Total 3485 566(16.24% of
total
autopsies)
335 (59.18%) 231 (40.82%) 223 (39.39%) 343
(60.61%)
ASA = Allegedly suicidal autopsies, n= number.
[Table/Fig 2] Age and religion wise distribution of allegedly suicidal autopsies between
year 2001 and 2005
Year
(total
ASA)
≤19 years
n (%)`
20–40
years
n (%)
>40 years
n (%)
Hindus
n (%)
Muslims Sikh
n (%)
Christian
n (%)
2001
(106)
14
(13.20%)
79
(74.52%)
13 (12.26%) 87 (82.07%) 12
(11.32%)
7 (6.60%) –
2002
(194)
30
(15.46%)
117
(60.30%)
47 (24.22%) 116 (59.79%) 2.2
(11.34%)
5 (2.57%) 1 (0.51%)
2003
(84)
14
(16.66%)
55
(65.47%)
15 (17.85%) 69 (82.14%) 10
(11.90%)
5 (5.95%) –
2004
(66)
14
(21.21%)
40
(60.60%)
12 (18.18%) 52 (78.78%) 7 (10.60%) 7 (10.60%) –
2005
(116)
8 (6.89%) 82
(70.68%)
26 (22.41%) 89 (76.72%) 13
(11.20%)
13
(11.20%)
1 (0.86%)
Total
(566)
80
(14.13%)
373
(65.90%)
113
(19.96%)
463 (81.80%) 64
(11.30%)
37 (3.54%) 2 (0.35%)
ASA=Allegedly suicidal autopsies, n= number.
Out of the total allegedly suicidal autopsies 463
(81.80%), 64 (11.30%), 37 (3.54%) and 2
(0.35%) were performed on Hindus, Muslims,
Sikhs and Christian respectively (p< 0.0001)
([Table/Fig 2]). Predominance of suicidal deaths
in Hindu (59.79%-82.14%) religion was
observed throughout the period of five years,
followed by Muslims (10.60% -11.90%), Sikhs
(2.57%-11.20%) and Christian (0.51%-0.86%)
([Table/Fig 2]). No statistically significant
difference was found between males and
females; however, statistically more victims
belong to rural area, Hindu religion and age
group between 20-40 years ([Table/Fig 3]).
Khajuria et al.: Suicidal trends
Journal of Clinical and Diagnostic Research. 2007Dec; 1(6):505-510
508
[Table/Fig 3] Factors influencing suicidal
deaths between year 2001 and 2005
Factors
influencing
suicidal
inclination
Allegedly suicidal
autopsies number (%)
p-Value
Rural and
urban area
Urban = 223 (39.39%)
Rural = 343 (60.61%)
0.030*
Religion Hindu= 463 (81.80%)
Sikh= 37 (3.54%)
Muslim =64 (11.30%)
Christian = 2 (0.35%)
<0.0001*
Age ≤19 years = 80 (14.13%)
20–40 years = 373 (65.90%)
>40 years = 113 (19.96%)
<0.0001*
Sex Male = 335 (59.18%)
Female = 231 (40.81%)
0.080
*Statistically significant difference, P-value
calculated using chi square test.
Poisoning was found to be the most common
mode of suicide [243 (42.93%)], followed by
burns [168 (29.69%)], hanging [52 (9.18%)],
railway trauma cases [23 (4.06%)] and gunshot
[23 (4.06%)]. Miscellaneous modes for suicide
were used in 4.31% to 23.71% of allegedly
suicidal autopsies during the year 2001-2005
([Table/Fig 4]).
Discussion
More than 4,00,000 people commit suicide all
around the world every year [5]. It is amongst
the top ten causes of death for all ages in most
countries of the world. Nearly one lakh Indians
are dying of suicide every year, which is about
20% of the world suicide population [5]. In
general, males are more than four times likely to
commit suicide than females [5]. In our study
59.18% of the victims of suicidal death were
male and 40.82% were female indicating narrow
gap between male and female suicide rate in
India. Majority of the victims (65.90%) were
between 20-40years of the age and 60.61% from
rural back ground in the present study. Similar,
trends were also reported earlier from India and
other countries, but with male predominance.
[Table/Fig 4] Reported modes employed to commit suicide in allegedly suicidal autopsies
conducted between year 2001 and 2005
Year (total
ASA)
Poisoning
n (%)
Gunshot
n (%)
Burns
n (%)
Hanging
n (%)
Railway
trauma cases
n (%)
Miscellaneo
us
n (%)
2001 (106) 46 (43.39%) 3 (2.83%) 26 (24.52%) 14 (13.20%) 10 (9.43%) 7 (6.80%)
2002 (194) 70 (36.08%) 3 (1.54%) 60 (30.42%) 12 (9.52%) 3 (1.90%) 46 (23.71%)
2003 (84) 42 (50%) 2 (2.38%) 23 (27.38%) 8 (9.52%) 2 (2.38%) 7 (8.33%)
2004 (66) 27 (40.90%) 0 23 (34.84%) 8 (12.12%) 3 (7.57%) 5 (4.31%)
2005 (116) 58 (50%) 0 36 (31.03%) 10 (8.60%) 5 (4.31%) 7 (7.57%)
Total (566) 243 (42.93%) 23 (4.06%) 168 (29.69%) 52 (9.18%) 23 (4.06%) 72 (12.72%)
ASA=Allegedly suicidal autopsies, n= number.
A 25-year autopsy study (1972-1997) of acute
poisoning deaths from a tertiary care hospital in
northern India revealed that majority (68%) of
subjects were between the ages of 14 and 30
years and there was a male preponderance (69%)
[6]. In an other study from Maharashtra during
Khajuria et al.: Suicidal trends
Journal of Clinical and Diagnostic Research. 2007Dec; 1(6):505-510
509
the five years period, 1997-2001 acute poisoning
is the leading most cause of unnatural deaths and
third common cause of emergency
hospitalizations in this rural part of India [7].
Majority of the victims were male 67% and
about 83% of them were from rural residence.
Insecticides were responsible for 35% of clinical
and 55.4% of fatal cases [7].
Another study from North India (1997-98)
showed male to female ratio of 3:1 among
poisoning cases admitted (76.47% of the victims
committed suicide) with 45.59% victims
between 21-30 years of the age and 51.47%
from urban population [8]. Similarly a study
from south India reported 72% of the poisoning
cases admitted between January 2001 to May
2003 as intentional with 70% males and 30%
females cases showing predominance in the age
group of 21-30 years (36%) [9]. A study from
north India reported 91.4% cases of poisoning as
suicidal with majority of the patients young
(mean age 27years), males (twice than females)
and from rural areas [10]. Similarly, studies
from New- Zealand reported highest suicide rate
between 25-34 years of age with higher suicide
death rate in males than females [11]. In US
also, suicide is the eighth leading cause of death
for men and four times more male are likely to
die from suicide than females [12].
However, a few studies reported increased
trends in female suicidal attempts [2],[13],[14].
A study from India (1991-1997) reported nearly
equal suicide rates for young women and men as
shown in our study [13]. Similarly, a study from
north India in adolescent population reported
suicidal deaths with Female: Male ratio of
1.24:1 [2]. This gender disparity may be because
of occurrence of psychological disorders like
depression anxiety more often in girls than boys
in early adolescence with onset of puberty.
Moreover, social factors like subordinate role of
females in developing society can generate
feeling of helplessness and frustration which
contribute to psychiatric illness. Similarly,
suicide is the fifth leading cause of death in
China, with predominance of suicidal deaths in
females (15-34 years) than males [14]. Out of
the total allegedly suicidal autopsies 81.80%,
11.30%, 3.54% and 0.35% were performed on
Hindus, Muslims, Sikhs and Christian
respectively. The predominance of victims from
Hindu religion in the present study may be
because of the fact that the institution caters
adjoining kashmiri migrant camps, rural and
suburban areas, which are richly populated with
followers of Hindu religion.
The selection of methods for committing suicide
involves availability and sociocultural
acceptability of the methods along with
accessibility to necessary aids or equipment and
possibility of translation of decision impulse
without any delay [15–17]. Poisoning was found
to be the most common mode of suicide
(2.93%), followed by burns, hanging, railway
trauma cases and gunshot in the present study.
Similarly, Joseph et al. also reported poisoning
and hanging as the commonest method of
suicide in rural India [18]. However, in a study
from Delhi (India) commonest method used for
committing suicide was hanging followed by
poisoning [2]. In US fire arm was reported to be
the most common mode (60%) committing
suicide [19].
Suicidal behaviour is a major public health
problem. There is no one explanatory theory of
suicidal behaviour and various combinations of
sociological and biological/medical
interventions are required to reduce associated
mortality and morbidity [20],[21]. In the present
study trend of suicidal attempts was more seen
in the middle age group, Hindu religion and
rural background. However, the major lacunae
of the present analysis was that the autopsy
reports failed to provide the information about
basic etiological factors behind the act of suicide
like history of any psychiatric disorder and any
socioeconomic factor like failure in
examination, family problem, illness, love affair,
dowry dispute, poverty and unemployment.
Suicide attempters are ten times more than the
suicide completers [5]. The first step in
preventing suicide is to identify and understand
the risk factors like, previous suicide attempt,
history of mental disorders, history of alcohol
and substance abuse, family history of suicide,
family history of child maltreatment, feelings of
hopelessness, impulsive or aggressive
tendencies, barriers to accessing mental health
treatment and loss (relational, social, work, or
financial) [20]. Hence, periodically such
epidemiological studies are required to find out
the hidden socio-demographic factors behind
suicidal behaviour; so that appropriate measures
will be taken against this major public health
problem.
Khajuria et al.: Suicidal trends
Journal of Clinical and Diagnostic Research. 2007Dec; 1(6):505-510
510
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