Life Events, Social Support, Coping Strategies, and Quality of Life in Attempted Suicide: A Case-control Study

By Kumar, P. Suresh; George, Biju | Indian Journal of Psychiatry, January-March 2013 | Go to article overview

Life Events, Social Support, Coping Strategies, and Quality of Life in Attempted Suicide: A Case-control Study


Kumar, P. Suresh, George, Biju, Indian Journal of Psychiatry


Byline: P. Suresh Kumar, Biju. George

Background: Though deliberate self-harm encompasses a wide variety of medical and social disciplines some of the important psychosocial variable such as life events, social support, coping strategies, and quality of life have not yet been explored in depth in India. Aims: The aim was to analyze and compare the type and severity of life events, coping strategies, social support, and quality of life of suicide attempters versus matched normal controls, and to identify the risk factors leading to suicide. Materials and Methods: A total of 50 consecutive suicide attempters were compared with same number of age, sex, and martial status matched healthy controls using Presumptive Stressful Life Events Scale, Social Support Questionnaire, AECOM Coping Style Scale, and WHO QOL-Bref. Results: Attempters experienced significantly more life events especially untoward events whereas the control group experienced more desirable and impersonal life events. Social support, positive coping, and of QOL were significantly lower in attempters. Among all risk factors desirable life events, good education, and good social support were protective against suicide. Conclusion: Suicide attempters were differentiated from healthy controls based on more stressful life events, lower social support, less healthy coping, and poor QOL. Positive life events, good education, and good social support were protective factors against suicide. However, it is difficult to pinpoint a single factor responsible for suicidal behavior. It is the complex interplay of various interrelated factors and the resultant buffering effect, which is protecting the individual against deliberate self-harm.

Introduction

The World Health Organization [sup][1] defines suicide act as "the injury with varying degrees of lethal intent and that suicide may be defined as a suicidal act with fatal outcome." Deliberate self-harm is a major issue in the health care all over the world. Many factors including biological, socio-cultural, and personality traits can modify this complex behavior. Suicide is a significant problem in India also with a reported rate of 10.8 per 100,000 population. [sup][2] However it may be considerable under estimate due to underreporting and false reporting of many of the cases of suicides in India. [sup][3] Certain thought provoking studies on suicide have been reported from India. [sup][4] However, some of the important psychosocial variables such as life events or stressors, social support, coping strategies, and quality of life have not yet been assessed in relation to deliberate self-harm in India.

Life change could act as a stressor causing physiological arousal and enhanced susceptibility for illness. Suicide victims have experienced more changes in living conditions, work problems, and object losses than normal controls. [sup][5] A review of Indian studies on stressors in suicide shows maladjustment with significant family members and domestic strife as the most important causes, followed by physical factors and mental illness. [sup][6] However, most of the Indian studies have not used a proper scale to assess life events and many of them were descriptive and retrospective studies.

A body of research in recent years has focused on the role of social support in maintaining emotional well-being and moderating the effects of life events. There is evidence that social network among suicide attempters are weaker than in nonsuicidal individuals. [sup][7] Life events can alter the social support system in terms of size, frequency of interaction and stability, and such changes may be associated with suicidal behaviors.

Coping behavior, or the things people do to reduce the stress, has been a variable that has recently become the focus of research. [sup][8] Coping behavior is operationally defined as the responses to external life stress that serve to prevent, avoid, reduce or control stress and emotional distress. …

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