Suicide and Attempted Suicide

Suicide Basics - Grim Numbers Game

• Suicide: Intentional, self-inflicted death. Latin: felo de se (felon of himself).
• Attempted Suicide (Parasuicide/DSH): Non-fatal act with intent to die. The Mental Healthcare Act (MHCA) of 2017, Section 115, decriminalized attempted suicide in India by presuming severe stress and removing punishment under BNS provisions.
• Suicidal Ideation: Thoughts, plans, or preoccupations about suicide.
• Global Burden (WHO): >700,000 deaths/year. A leading cause of death in 15-29 year-olds.
• Indian Scenario (NCRB): Suicide rate ~12.4 per lakh population (2022); ~1.71 lakh deaths.

⭐ Suicide is the leading cause of death in India for the 15-39 age group (Lancet).

Red Flags - Spotting the Signs

• Major Risk Factors:
  • Prior suicide attempt (strongest predictor)
  • Mental disorders: Depression, Bipolar, Schizophrenia, Substance Use Disorder
  • Hopelessness, impulsivity, chronic pain/illness
  • Family history of suicide; social isolation; recent major loss
  • Access to lethal means
• Acute Warning Signs (📌 IS PATH WARM):
  • Ideation (thoughts, threats, plans)
  • Substance abuse (new or increased)
  • Purposelessness (no reason for living)
  • Anxiety, agitation, insomnia
  • Trapped feeling
  • Hopelessness / Helplessness
  • Withdrawal (socially)
  • Anger (uncontrolled), rage
  • Recklessness, risky behaviors
  • Mood changes (dramatic)
• Behavioral Clues:
  • Putting affairs in order, giving away prized possessions
  • Sudden, unexplained improvement in mood after depression

⭐ A history of previous suicide attempt is the single most important risk factor for future suicide.

Crisis Clinic - Assess & Act

• Assessment Protocol:
  • Evaluate suicidal intent: specific plan, lethality, means access, past attempts. (📌 SAD PERSONS scale for risk factors).
  • Mental Status Exam (MSE), hopelessness, protective factors.
• Immediate Actions:
  • Ensure patient safety: remove potential lethal agents.
  • Hospitalize if high risk (voluntary/involuntary admission).
  • Crisis intervention: empathetic listening, problem-solving, support system engagement. Manage agitation.
• Medico-Legal Framework (India):

  ⭐ MHCA 2017, Sec 115: Decriminalizes suicide attempt; presumes severe stress. Mandates government care, treatment, and rehabilitation.

  • IPC Sec 309 (Attempt to commit suicide) significantly diluted by MHCA.

Methods & Marks - Tragic Trails

• Hanging: Comprehensive forensic examination essential beyond ligature marks. Oblique, non-continuous, above thyroid, parchment-like. Saliva dribbling. Immunohistochemical markers aid vitality assessment in doubtful cases.
• Strangulation: Manual, ligature, vehicular-assisted types. Distinguish from homicidal strangulation. Vehicular-assisted suicide rare but documented.
• Drowning: Fine froth at mouth/nostrils. Cadaveric spasm (clutching objects). Diatoms test.
• Poisoning (India):
  • Organophosphates (OPC): Garlic odor, miosis.
  • Aluminium Phosphide (Celphos): Garlic odor, severe shock.
• Firearms: Contact: Muzzle imprint, charring. Close range: Soot, tattooing.
• Cutting/Stabbing: Hesitation cuts (superficial, parallel). Defence wounds rare.
• Suicide Note: ~15-30% cases. Authenticity crucial under BSA provisions.
• Psychological Autopsy: Reconstructs mental state for BNS determinations.

⭐ Hesitation marks (tentative cuts) are characteristic of suicidal incised wounds, often on wrists or neck. Misinterpretation has severe BNS legal consequences.

High‑Yield Points - ⚡ Biggest Takeaways

• Attempted suicide completely decriminalized under Mental Healthcare Act, 2017 (BNS removed previous criminalization; presumes severe stress).
• Common Indian methods: hanging, poisoning (OPCs), self-immolation.
• Key risk factors: depression, substance abuse, previous attempts.
• Suicide notes found in ~25-30% of cases; crucial for intent.
• Hesitation marks (tentative cuts) strongly suggest suicidal sharp force injuries.
• Psychological autopsy reconstructs pre-death mental state and intention.
• Parasuicide (attempted suicide) is often a cry for help, not a definite death wish.