INTRODUCTION:

Suicide can be defined as intentional self-inflicted death and is a serious cause of mortality worldwide¹. Suicide can be defined as intentional self-inflicted death. It is a serious cause of mortality worldwide. Suicide is considered as a psychiatric emergency and the awareness of the seriousness of suicide in our society should not be overlooked². The word suicide is derived from two Latin words Sui meaning self and “cedere” meaning to kill oneself. Hence suicide is an act of willfully ending one’s own life. Suicide is a type of deliberate self-harm (DSH) and is defined as a human act of self-intentioned and self – inflected cessation (death)³. Suicides are characterized as the victim’s personal choice and denies the chance of detailed investigation in many forensic caseworks⁴. The increased risk of ensuing suicide sustains without decline for at least two decades⁵. Suicide was considered both spiritual and legal offense against the king in Europe dating back to 673AD. Most religions consider suicide as a sin against God. Suicide is a controversial topic disputed in the fields of ethics, law and medicine. Manipulative suicides are the result of external pressure and persuasion that should be taken care of as a serious issue⁶. According to World Health Organization statistics, the annual world-wide incidence of completed suicide was 16 per 100000persons in 2000. This means that globally one person commits suicide every minute (WHO, 2012)1. As the largest continent in the World, Asia accounts for about 60% of World suicides, with China, India, and Japan accounting for about 40% of the World’s suicides⁷.

Tamil Nadu and Kerala had the highest suicide rates per 100,000 people among large population states in 2012. In India, the ratio of male to female suicides is around 2:1. The number of suicides in India is estimated to be in the millions. For example, a study published in The Lancet predicted 187,000 suicides in India in 2010, although official data from the Indian government claims 134,600 suicides. According to WHO data, India's age-standardized suicide rate for women is 16.4 per 100,000 (6th highest in the world), and for men it is 25.8 per 100,000. (Ranking 22nd)⁸.

Suicide attempts cause serious emotional, physical, and economic impacts. Suicidal ideations (SI), often called suicidal thoughts or ideas, is a broad term used to describe a range of contemplations, wishes and preoccupations with death and suicide⁹. The resulting trend of young avoidable deaths affects psychosocial and socio-economic factors worldwide requiring a renewed focus from a public mental health perspective.

There is a need for insights and better understanding that can shed light on the risk factors that contributing to suicidal behaviour¹⁰. Suicidal behavior is a complex phenomenon that is influenced by several interacting factors¹¹. The patients with depression and suicide among young with generator psychological stress resulting from the symptoms of diseases that affect his life¹². Depression can lead to suicide, which is the tragic fatality associated with the loss of about 850,000 lives every year¹³. In a study by Nielson.et, al. (1994) found that the genotype tryptophan hydroxylase(THP) was a factor influencing suicide attempts¹⁴. Freud's (1961) classic psychoanalytical theory of suicide described, suicidal clients as ambivalent, integrating concepts of love and hate in the decision to kill them¹⁵. Emile Durkheim’s (1951) stated that nature of a society predisposed it's individual members to suicide. He believed any condition that interfered with a stable socioeconomic status influences suicide¹⁶.

Every year one million people commit suicide, accounting for 1 to 2 percent of total global mortality¹⁷. Suicide affects all ages. It is the second leading cause of death for people 10 to 34 years of age, the fourth leading cause among people 35 to 54 years of age, and the eighth leading cause among people 55 to 64 years of age. About 800,000 people die by suicide worldwide every year, of these 135,000(17%) of them living in India, which accounts for 17.5% of the global population¹⁸. Suicide didn’t just occur in high in come countries, but is a global phenomenon in all regions of the world. Over 79% of global suicides occurred in low and middle income countries¹⁹.

General population suicide caring competence is important to prevent their relatives with suicidal tendencies from attempting suicide. Authors stated that clinicians and nurses are typically educated and trained to care for patients with suicidal tendencies, but general population of suicidal individuals do not receive the same level of suicide care education. General population may lack competence to care for the irrelatives with suicidal ideations and/or behaviours. In this perspective, Sun et al. proposed an assessment of suicide caring competence which may help clinicians to assess the caring competence of general population and provide proper suicide care education. In this perspective, general population could be involved systematically at the time of discharge of patients at suicide risk²⁰. The nurses should explore areas of seriousness of attempts and should create awareness about suicide risk and prevention strategies²¹.

MATERIALS AND METHODS:

A quantitative research study was conducted to identify the effectiveness of suicide prevention training package on the level of knowledge about suicide risk management among general population at Thrissur. Pre-experimental one group pretest posttest research design was selected for the study. There were 50 samples from selected panchayats (Nadathara, Adat, Ariboor, Avinissery, Cherpu, Aloor, Kachery) at Thrissur were selected for the present study using purposive sampling. Persons from both genders who are above 18 years of age were selected. Persons who suffer from sensory deficits such as visual and hearingloss, persons who have any psychiatricillness, and persons who had earlier attended any teaching programs on the suicide risk management were excluded from the present study. The data was collected by using structured socio-demographic profile and self-developed knowledge assessment questionnaire on suicide risk management. Informed consent was taken from the samples in written form and the objectives and purpose of study were explained and confidentiality was ensured.

Social and demographic variables of the samples were assessed using socio-demographic profile prepared by the researcher. The knowledge of the samples was assessed with help of researcher prepared structured knowledge assessment questionnaire on suicide risk management. Both the tools were validated by three experts.

Researcher has developed suicide prevention training package which consist of a teaching program (3 sessions of 30 minute duration) with various teaching techniques such as brain storming discussion and PPT including the contents about suicide, its causes, warning signs, myths and misconception and preventive measures. This intervention was validated by three experts.

Pilot study was conducted in 10 samples prior to actual study. On first day of research, pre-test was conducted to the subjects by the researcher using the socio-demographic profile and knowledge assessment questionnaire on suicide risk management. On the second day, suicide prevention training package was taught to the subjects by the researcher in 3 sessions (30 minutes each) through brain storming, discussion, and ppt. Third day, post test was conducted to the subjects by the researcher using the socio-demographic profile and knowledge assessment questionnaire on suicide risk management. Descriptive and inferential statistics were used for data analysis.

RESULTS:

The findings of the study suggested that the suicide prevention training package was effective in improving the level of knowledge about suicide risk management of subjects. Out of 50 samples 21 samples(42%) were belongs to the age group of 18 to 34 years, 14 samples(28%) belong to the age group of 35 to 49 years. 11 samples (32%) belongs to the age group of 50- 64 years and only 4 samples(8%) belong to >65 years. Most of the samples 21(32%) were females married(24%) and living in a nuclear family(46%). Majority of them were graduated (42%), about 17 samples(34%) completed secondary/higher secondary education, 10 samples(20%) completed primary education and 2 of them(4%) were illiterate. Most (44%) of them were unemployed, 13 samples(26%) were having a professional job and 11samples(22%) were having a non- professional job and about 4 of them(88%) were retired. Majority 44(88%) of them was above poverty level and living in rural area 30 samples(60%). 33(66%) of them were suffering from medical related diseases, 5(10%) were suffering from psychiatric illness and 9(18%) were suffering from other illnesses. About 2(4%) of them were having a family history of suicide.

Table 1 shows the level of knowledge of the 50 samples before and after intervention. Before intervention, most of the samples about 31 (62%) have moderate knowledge 17 (34%) have inadequate knowledge and only 2 (4%) have adequate knowledge on warning signs of suicide risk factors of suicide and suicide risk management. After intervention most of the samples about 40 (80%) have moderate knowledge, 6 (12%) of them has adequate knowledge and only 4 (8%) have inadequate knowledge.

The result also given no association between level of knowledge of suicide risk management of the subjects with selected socio demographic variables. Table 2 reflects that the overall level of knowledge of suicide risk management of the subjects has significantly improved after attending the suicide prevention training package (t=11.267, p<0.001)

Table 1: Distribution of pre-intervention and post-intervention level of knowledge of subjects on suicide risk management.

Sl. No	Socio-demographic variables		Adequate knowledge				Moderate knowledge				Inadequate knowledge
			Pre-test		Post-test		Pre-test		Post-test		Pre-test		Post-test
			f	%	f	%	f	%	f	%	f	%	f	%
1.	Age	18-34	1	4.54	3	15	13	59.10	15	75	8	36.36	2	10
		35-49	0	0	2	14.18	9	60	11	78.57	6	40	1	7.15
		50-64	0	0	1	8.33	7	70	10	83.34	3	30	1	8.33
		>65	1	33.33	0	0	2	66.67	4	100	0	0	0	0
2.	Gender	Male	0	0	3	15	15	76.95	15	75	4	21.05	2	10
2.	Gender	Female	1	3.22	0	0	17	54.84	25	83.34	13	41.94	5	16.66
3.	Marital status	Married	0	0	1	4.16	17	62.97	19	79.18	10	37.03	4	16.66
		Unmarried	1	5	0	0	12	60	17	77.3	7	35	5	22.7
		Widow/ widower	0	0	0	0	3	100	4	100	0	0	0	0
4.	Family type	Nuclear	1	2.17	2	4.34	50	65.22	37	80.43	15	32.61	7	15.23
4.	Family type	Joint	0	0	1	25	2	50	3	75	2	50	0	0
5.	Education	Illiterate	0	0	0	0	4	80	2	100	1	20	0	0
		Primary	0	0	1	9.09	8	80	8	72.73	2	20	2	18.18
		Secondary/ higher secondary	0	0	1	5.55	10	66.67	14	77.70	5	53.33	3	16.66
		Graduation	1	5	0	0	10	50	17	89.48	9	45	2	10.52
6.	Occupation	Unemployed/ homemaker	1	4.54	2	9.09	12	54.54	17	77.28	9	40.92	3	13.63
		Professional	0	0	1	7.69	12	70.59	9	69.24	5	29.4	3	23.07
		Non-professional	0	0	0	0	4	57.14	10	90.91	3	42.86	1	9.09
		Retired	0	0	0	0	4	100	4	100	0	0	0	0
7.	Socio-economic status	APL	1	2.27	3	16.66	27	61.37	37	82.23	16	36.36	5	11.11
7.	Socio-economic status	BPL	0	0	0	0	5	83.33	3	60	1	16.66	2	40
8.	Place	Urban	0	0	1	4	13	61.90	19	76	8	38.10	5	20
8.	Place	Rural	1	3.44	2	8	19	65.52	21	84	9	31.04	2	8
9.	History of any illness	Medical history	1	2.86	2	6.06	21	60	27	81.82	13	37.14	4	12.12
		Surgical history	0	0	0	0	5	71.43	3	75	2	28.57	1	25
		Psychiatric illness	0	0	0	0	0	0	4	100	0	0	o	0
		Other illnesses	0	0	1	11.11	6	75	6	66.67	2	25	2	22.22
10.	Family history of suicide	Yes	0	0	0	0	1	50	2	100	1	50	0	0
10.	Family history of suicide	No	1	2.08	3	6.25	31	64.59	38	79.17	16	33.33	7	14.58

Table 2: Effectiveness of suicide prevention training package on knowledge of suicide risk management

Components	LEVEL OF KNOWLEDGE												T value	P value
	Adequate Knowledge				Moderate Knowledge				Inadequate Knowledge
	Pretest		post test		pretest		posttest		pretest		Posttest
	f	%	f	%	f	%	f	%	f	%	f	%	11.267	0.001
Knowledge on warning signs of suicide	6	12%	7	14%	24	48%	33	66%	20	40%	10	20%
Knowledge on suicide risk factors	0	0	1	2%	2	4%	11	22%	48	96%	38	76%
Knowledge on suicide risk management	26	52%	40	80%	18	36%	9	18%	6	12%	1	2%
Overall	2	4%	6	12%	31	62%	40	80%	17	34%	4	8%
Mean	0.68		1.08		1.5		1.86		1.82		1
SD	4.71		7.48		10.41		12.88		12.61		7.34

The study helped the subjects to gain level of knowledge about suicide risk management. The intervention package developed by the researcher can be used for the further training program. The knowledge assessment questionnaire on suicide risk management also can be used further research purposes.

The present study findings were supported by the study conducted by Loganathan N(2014) on effectiveness of structured teaching programme on Knowledge regarding risk factors and prevention of suicidal behavior among adolescents in a selected College, Salem. The study result showed that during pre-test, most of the adolescents (75%) have inadequate knowledge, 25% adolescents have moderately adequate knowledge and none of them have adequate knowledge regarding risk factors and prevention of suicidal behavior and the structured teaching programme was effective in improving their knowledge²².

A study conducted by Knox KL, Litts DA, Talcott GW, FeigJ C, Caine ED(2003) on risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force shows that implementation of the programme was associated with a sustained decline in the rate of suicide and other adverse outcomes. A 33% relative risk reduction was observed for suicide after the intervention²³. Another study by Premkumar C, Jobin Mathew and Christulas Jyothi (2020) on a study to assess the prevalence of suicide risk behaviour and effectiveness of awareness program regarding Suicide Prevention among the higher secondary students of selected school, Dadra and Nagar Haveli showed that risk behaviour assessment and the suicide prevention awareness programme was an effective method of instruction for updating and enhancing the awareness among the higher secondary students²⁴.

CONCLUSION:

Thus, suicide is one of the epidemiological problems in the world²⁵. This study has shown that the suicide prevention training package is effective in improving the level of knowledge about suicide risk management among people living in selected panchayats at Thrissur. This suicide prevention training package could be utilized in clinical settings to improve the level of knowledge about suicide among health care providers and care givers of patients with both psychological and physical disorders.

CONFLICT OF INTEREST:

The authors have no conflict of interest regarding this research study.

ACKNOWLEDGMENTS:

The authors would like to thank all the family members supported during data collection.

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Received on 20.03.2023 Modified on 01.05.2023

Int. J. of Advances in Nur. Management. 2023; 11(3):155-159.

DOI: 10.52711/2454-2652.2023.00036