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ORIGINAL ARTICLE Table of Contents  
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A cross-sectional study of attitude toward suicide among medical and nonmedical groups from South India


1 Junior Resident, Department of Psychiatry, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
2 Associate Professor, Department of Psychiatry, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

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Date of Submission12-Jul-2021
Date of Acceptance04-May-2022
Date of Web Publication14-Jul-2022
 

  Abstract 


Context: Suicide and attempted suicide are some of the alarming issues in recent times. It was the second leading cause of death among 15–29 years old in 2015. The suicide death toll is rising alarmingly in India, which needs prevention strategies and a suicide prevention policy nationally. Attitude toward suicide varies depending on social, cultural, and individual perceptions and beliefs. The studying of attitudes of the people in society towards suicide helps in devising better suicide prevention strategies and planning early intervention measures.
Aims: This study explores attitude toward suicide between the medical and nonmedical groups and their relationship with other sociodemographic variables.
Settings and Design: A cross-sectional comparative study was done at a tertiary care hospital in South India.
Materials and Methods: One hundred participants belong to nonmedical and 100 belong to medical groups were assessed using Eskin's Attitude towards Suicide Scale.
Statistical Analysis Used: Descriptive statistical tests and independent t-tests were applied to find the significant difference in the means between the two groups using SPSS version 23.
Results: Nonmedical group scored high in “hiding the suicidal behavior” and low in “communicating psychological problems” and vice versa in the medical group. Females scored higher on “acceptability of suicide” and “punishment after death” among the medical group.
Conclusion: Imparting psychoeducation and promoting awareness about suicide can help change individuals' attitudes toward suicide at the microlevel and society's macrolevel.

Keywords: Adults, attitude, gender, marriage, medical, nonmedical, suicide


How to cite this URL:
Godi SM, Neredumilli PK. A cross-sectional study of attitude toward suicide among medical and nonmedical groups from South India. Arch Ment Health [Epub ahead of print] [cited 2022 Aug 11]. Available from: https://www.amhonline.org/preprintarticle.asp?id=351034





  Introduction Top


An attitude is defined as “a relatively enduring organization of beliefs, feelings, and behavioral tendencies toward socially significant objects, groups, events, or symbols.” The tripartite model is one of the most cited models of attitude, and it suggests that attitude has three elements – affect, behavior, and cognition.[1] Attitude influences behavior by the interaction of feelings and cognitive beliefs held by an individual toward a particular object.

Suicide and attempted suicide are some of the alarming issues in recent times. Every year, nearly 8,00,000 people take their own lives, and many more people attempt suicide (WHO). It was the second leading cause of death among 15–29 years old in 2015. Furthermore, the suicide death toll is rising alarmingly in India, which needs prevention strategies and a suicide prevention policy nationally.[2]

Boldt reported that suicide acquires its meaning from sociocultural values and attitudes, which vary from one cultural context to the other culture. The increase in suicide rates in youth is due to more accepting or stigmatizing attitudes toward suicide by youth in modern society.[3],[4]

Unfortunately, suicide and related behaviors are heavily stigmatized.[5] The interplay of social and cultural factors, individual perceptions, and beliefs shape the attitude toward suicide. The attitude toward suicide varied from historical times to the modern era across various cultures. In Indian mythology and scriptures, there is ambiguity in the attitude held by society toward suicide, where it is extolled in some contexts and upbraided in others. Thus, individuals' attitudes toward suicide can influence suicidal behaviors and may reflect suicidal behavior in the future. The attitudes held by people can be positive or negative, and attitudes are often influenced and conditioned by social, cultural, and religious backgrounds. There was always confusion regarding the people's attitudes toward suicide and a debate over the right of a person to take their own life.[6] According to Durkheim, social factors play a role in shaping attitudes toward suicide and suicidal behaviors. The social theory of suicide by Emile Durkheim also explains how social integration and regulation determine and drive suicidal behavior.[7] In the 20th century, the emphasis of attitude toward suicide had changed from social causation to mental health, and the study of its psychological and biological basis has begun. Even after decades of research, controversies, and discussions over suicide in the modern era, there is still a debate over whether it is “right or wrong,” “moral or immoral,” “crime or not,” and “illness or weakness.”[8]

Therefore, studying people's attitudes toward suicide helps devise better suicide prevention strategies and plan an early intervention. The primary study objective is to compare the attitude toward suicide in the medical and nonmedical groups. The secondary objectives are to compare the attitude toward a suicide based on age, gender, and marital status.


  Materials and Methods Top


Study design

It is a cross-sectional comparative study carried out as an online survey at a tertiary care hospital in South India after permission from the hospital's academic and research committee. The study included a total of 200 subjects who gave informed consent for participation in the study. The participants are also ensured about their confidentiality and anonymous study participation. Of the total sample, 100 belong to the medical and 100 belong to the nonmedical group who were the family members or friends of participants in the medical group.

Study tools

The attitude toward suicide scale is a 24-item scale developed by Mehmet Eskin. The respondents were asked to respond on a five-point scale ranging from 1 = completely disagree to 5 = completely agree. The scale has good validity and inter-rater reliability. Most of the studies investigating the scale have derived six factors from factor analysis. The six factors are acceptability of suicide, punishment after death, suicide as a sign of mental illness, communicating psychological problems, hiding behavior, and open reporting and discussion about suicide. The scale was used after obtaining permission from the author.[9]

Descriptive statistical tests and independent t-tests are applied to find the significant difference in the means between the two groups using IBM SPSS Statistics for Windows, version 23 (IBM Corp., Armonk, N.Y., USA).[10]


  Results Top


The sociodemographic data of the study sample found that about 110 (55%) of the sample are in the age group of <30 years, and the remaining 90 (45%) are in the age group of more than 30 years. The mean age is 23.2 years of individuals with an age range between 18 and 29 years, and the mean age of participants of the age group between 30 and 45 years is 38.5 years. The majority of the sample are unmarried 135 (67.5%), followed by married 65 (32.5%). About 51% (102) are male and 49% (98) are female.

[Table 1] shows the mean value differences between medical and nonmedical groups on different factors of attitude toward suicide. A significant difference is found between two groups on factors such as “communicating psychological problems” and “hiding suicidal behavior” in the present study. It is found that the medical group scored high in the domain of “communicating the psychological problems” and low in “hiding suicidal behavior” compared to the nonmedical group. Among the medical group, females scored significantly higher on “acceptability of suicide,” i.e., 1.80 (standard deviation [SD].753) and “punishment after death,” i.e., 2.27 (S.D.881) compared to males.
Table 1: Comparison of six factors of attitude toward suicide between medical and nonmedical groups

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[Table 2] shows the comparison of attitudes toward suicide with age. In the present study, a significant difference is found between the two groups on factors such as acceptance of suicide, communicating psychological problems, and hiding suicidal behavior. The individuals with <25 years had a high score in “acceptability of suicide” and “hiding suicidal behavior” and low on “communicating psychological problems” than those over 25 years.
Table 2: Comparison of six factors of attitude toward suicide based on the age group

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[Table 3] shows that the domains of acceptability of suicide and punishment after death found significant differences between male and female gender. Although both the genders scored low on “acceptability of suicide,” the female gender was associated with a significantly higher score on “acceptability of suicide” than males (P = 0.05). The females also scored significantly higher on the “punishment after death” domain compared to males.
Table 3: Comparison of six factors of attitude toward suicide based on gender

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[Table 4] shows the mean value differences based on the marital status between unmarried and married groups on different factors of attitude toward suicide. In the present study, a significant difference is found between the two groups on factors such as “acceptability of suicide,” “communicating psychological problems,” and “hiding suicidal behavior.” It is found that unmarried scored high in acceptability of suicide and hiding suicidal behavior, whereas married scored high in communicating psychological problems significantly.
Table 4: Comparison of six factors of attitude toward suicide based on marital status

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  Discussion Top


It is found that the nonmedical group scored high in hiding the suicidal behavior. At the same time, the medical group individuals scored high in communicating their psychological problems, i.e., these individuals share their psychological issues with their family or friends. This attitude may be due to awareness about mental illnesses and suicide in the medical group. This implies better medical knowledge and psychoeducation can change the attitudes toward suicide and better communication and early seeking of help with mental health professionals.[8],[11]

When explored the differences in attitudes toward suicide with the age group, <30 year age group scored high in “acceptability of suicide” and “hiding suicidal behavior” and low in “communicating psychological problems.” This may be due to poor coping abilities in the setting of high social demands, i.e., stress arises from career choices to achieve financial and social stability and to be dependent on parents. According to Zao (2007), who classified five common attitudes toward suicide, viewing suicide as personal freedom is one of the common attitudes.[12] People who hold this view believe that the significance of life consists of freedom of choice, and they have the right to take their own lives. This attitude might be expected in adolescents who generally seek more freedom and have no restrictions in life. The impulsiveness and risk-taking behaviors may be one reason for the high acceptability of suicide in this age group. The acceptability further decreases the willingness to ask for help in times of crisis and view suicide as a solution to problems.

This study also found that young adults in the age group of 18–29 years scored high in hiding suicidal behavior. This attitude may be due to the stigma associated with the disclosure of suicide in Indian society and the negative impact held by the survivors of suicide. The study by Batterham et al. also found stigmatizing attitudes toward suicide in young adults compared to older adults.[13] In recent times, technological advances hindering family interactions and ambitiousness toward a career increase stress levels in the competitive world in this age group. This is also reflected in increased suicidal rates in this age group, with suicide being the second leading cause of death.[2] This finding might be because of the discrimination associated with suicidal individuals, earlier stringent laws, and punishments for attempted or abetment to suicide (IPC 309). This study finding is consistent with the study by Li and Phillips, Joe et al., and Eskin et al., which reported that students have a more permissive and accepting attitude toward suicide.[14],[15],[16],[17]

A study by Segal et al. regarding attitudes toward suicide found that older adults scored significantly higher than younger adults, indicating that for older adults, suicide was more acceptable than younger adults and might be strongly associated with a lack of religious conviction. This finding contradicts our study's results, which found that young adolescents accept suicide more than older adults.[18]

Females scored high in acceptability of suicide and punishment after death. This implies females agreed that suicide is a right behavior as a solution to suffering from an incurable illness and also agreed that those who are tired of their living because of the ups and downs in life could seek suicide as a solution which may be due to poor coping mechanisms in the face of stress. However, females believe that individuals who commit suicide are sinful and punished after death because of the high spirituality seen in women in the Indian context. This can also explain why suicide attempts rather than completed suicides are more common in females than males. The fear associated with punishment after death might be stopping females from completing suicide. This study's findings are not consistent with Pereira and Cardoso in 2019 which found that male adults considered suicide a sinful act, and a study by Zou et al. in 2016 where males held stigmatizing attitudes.[19],[20],[21]

This study also examined the association between marital status and attitude toward suicide and found that unmarried scored high in acceptability of suicide and hiding suicidal behavior, whereas married scored high in communicating psychological problems. This can be understood with the assumption that marriage assumes responsibility for the individual. The children give a reason for living in married people and family gives responsibility and meaning to life. Cutright et al. also found that the low suicide rates among married women compared to unmarried women were explained strongly by marital status integration and societal integration theory.[22] According to Zao, among the common attitudes toward suicide, suicide is viewed as an immoral behavior that cowardly people abandon their responsibility and leave tremendous pain to others with a negative impact on family members. As marriage comes with responsibilities, extended relationships, and emotional ties, the acceptability of suicide might be less in married people than in unmarried. This also explains why suicide rates are high in unmarried, and it acts as a risk factor for suicide in the general population because of poor social support. Even Durkheim explained the immunity of married persons to suicide due to the influence of the family environment and matrimonial selection. He further explained an inverse relationship between domestic integration and suicide; thus, marriage is a protective factor by domestic integration.[6],[12],[22]

According to Kim et al., attitudes toward suicide were associated with suicidal thoughts, although not necessarily lead to any suicidal behavior.[23],[24] The efforts to study and utilize the results of the studies on attitude toward suicide will help create awareness programs and suicide prevention measures. In this context, training the gatekeepers of suicide by assessing their attitudes would further help address this preventable pandemic.[25] Conducting surveys and opinion polls in the general public about suicide, using the results to understand and spread awareness through campaigns, and imparting the knowledge in various policies will be the first step for suicide prevention. The new Mental Health Care Act 2017 may be promising which decriminalized suicide and had provisions for the treatment of individuals with suicidal behavior assuming they are under severe mental stress. Let us hope these drive India to come up with policies and strategies focused on suicide at various levels of society.


  Conclusion Top


An attitude of “hiding of suicidal behavior” is expressed by nonmedical group whereas the medical group had an attitude of “communication of psychological problems with friends and family.” Persons with age <30 years and unmarried individuals had an attitude of “acceptability of suicide,” “hiding of the suicidal behavior,” and “not communicating psychological problems.” This implies that providing psychoeducation and promoting awareness about suicide can help change individuals' attitudes toward suicide at the microlevel and society's attitude at the macrolevel.

Limitations

The study sample size is small. This study did not confound other factors such as age group, gender, and marital status. Family history of suicide and history of medical illnesses are not considered in this study.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

The authors declare that there is no conflict of interest.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
World Health Organization. Preventing suicide: A Global Imperative. Geneva, Switzerland: World Health Organization; 2014. Available from: http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf. [Last accessed on 2017 Sep 16].  Back to cited text no. 2
    
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[PUBMED]  [Full text]  

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Correspondence Address:
Sangha Mitra Godi,
Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/amh.amh_99_21




 
 
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