Suicide as an issue has attracted the attention of society since time immemorial. The word suicide was first used by Sir Thomas Browne in 1642 in his Religio Medici. The word originated from SUI (of oneself) and CAEDES (murder). So it was considered as murder of oneself. Since then, the world has evoked constant and continuous debate and has been defined in various ways for medical, social, psychological, administrative, legal, spiritual and religious purposes.

Suicide evokes mixed reactions it varies from anger, distress, ridicule, anxiety, tension, fear; sadness etc. in Indian context suicide is commonly referred to as Atmhatya. According to Hindu mythology, the death of lord Rama let to mass suicides in Ayodhya. Some parts of the Vedas emphasized suicide as a ritual; later the Upanishads condemned suicide. However, after the war of Mahabharata, king Yudhishtira thought of committing suicide by giving up food and water. In earlier days suicide acts by certain categories of people, such as widows, the terminally ill and the aged as well as death at holy places, was accepted in Indian culture. The practice of Sallekhana, by which a devotee ended his life by gradual starvation, exists in Jainism even today. The custom of Sati (self emollition by a women over the funeral pyre of her husband) and Johar (mass suicide among Rajput women to avoid molestation by soldiers invading their land), were practices for a long time in India. In 1820's Raja Ram Mohan Roy started a movement to abolish Sati and it was abolished in 1829 by the British government.

Suicide has been defined in number of ways, According to WHO, 2001 Suicide means an intentional or voluntary determination to end ones life. In suicide, the willingness to die originates within the person it is state in which choices or options are never considered before the act.

SYMPTOMS OR CHARACTERSTICS OF SUICIDE

According to WHO 2001, there are some common symptoms practices among suicide-prone individuals such as:

• Frequent Sadness
• Weeping spells
• Anxiety and restlessness
• Mood swings(extreme happiness to sadness)
• Excessive smoking or drinking
• Repetitive, continuous sleep disturbances
• Confusion and irritability
• Decreased interest in daily activities(hygiene, appearance, eating, sleeping)
• Hinting at suicide (eg. This is the last time we need, I will put an end to all this suffering)
• Difficulty in decision making
• Self injurious behavior(starving, injuring self)
• Having a strained and difficult relations with the spouse or other family members
• Becoming highly religious or atheist
• Exercising special care in distributing money or property

"High risk individuals" live in certain situations and are more prone to suicides as stated WHO (2001). These are the persons:

• Losing their status, jobs and income
• Facing certain economic loss such as crop failure, natural disaster
• Expressing their loss of confidence, self esteem and faith
• Feeling guilt, shame, hatred, worthlessness, hopelessness and helplessness
• Repeating that "destiny is calling them", "hearing words from God"
• With history of previous suicidal attempts
• Showing decreasing interest in hobby, sex and other activities which they enjoy earlier
• Recently discharged from hospitals such as cancer, HIV and other chronic diseases

These are the symptoms which are commonly found among suicidal person or high risk individuals. If we know an individual with these symptoms we must reach out and help as early as possible our intervention can save a life or prevent a suicidal act.

The Role of Valmiki Foundation in suicidal Prevention

Adolescent behavioral disturbances due to stress in education, failure in love, fear of fail in examinations, inter personal conflicts, family disturbances, sudden death of parents or siblings, sudden loss of family financial status.

Psychiatric disorders

CAUSES OF SUICIDE

As far as the causes of the suicide are concerned psychologists and other medical scientists have grouped a number of causes into socio economic factors religious and cultural factors, family system and bio-chemical imbalances.

Socio-Economic Factors:-

Behavioural scientists are of the view that cultural beliefs, social standards, gender bias, education problem, income levels, living status, growing aspirations, pressures of modern life, the need to excel and compete in the modern word, employment issues, marriage related factors, interpersonal conflict, breakdown of family values and systems, serious illness, social isolation and death of a loved one are all responsible for suicidal thoughts among the people. Frequently, these factors (financial losses, family conflict and failure in life etc) are cumulative, repetitive, and progressive may act as building blocks in the process of committing suicide.

Socio-Political Factors:-

There are some cases of suicide due to socio-political factors. Such factors are sudden demise of religious or political leaders. The recent example in this stream is the mass suicide in Andhra Pradesh as a result of death of Y.S.Rajashekar Reddy Chief Minister of the state. His plane crashed and when the news broke people were not ready to take it. Some had cardiac arrest some committed suicide deliberately and the toll rate rose to 124. (Source: The Times of India, 5 Sept, 2009)

Religious and cultural factors:-

Religious and cultural aspects of suicide emanate from strongly held beliefs and value systems. This association in some individuals is propelled more by tolerance, acceptance and respect. The notion that a person has reached his heavenly abode, is closer to God, has compiled with the wishes of elders, joined the family in heaven, taken the destined way of living earth, followed a self created path of life can only be explained by religious, spiritual and earthly modes of casualty.

Failing Systems:-

Studies reveal that the increasing economic turmoil, political unrest, social upheaval, communal disharmony are the major causal factors of suicide. In these situations serious losses or threats of loss of property, loved ones, job, pride, honor, status, independents and support systems operate in major way to push an individual to the state of despair and rejection. Studies reveal that merely 1000 farmers from the three southern states of India, Karnataka, Andhra Pradesh and Maharashtra have committed suicide

Bio-Chemical Imbalances:-

Some of the mental health problem such as depression, alcoholism and other substance abused problems and effective disorders cause biological imbalances by themselves it has been seen that suicidal behavior runs as distinct feature and requires triggering by dis-order or adverse psychological factors. The bio-chemical basis of suicide endorses the fact that the decline of certain neuro transmitters in the brain is a major cause.

Some mental health problems carry a high risk of suicide during the course of illness. Bio chemical imbalances in the brain of such individuals alter the rational thinking and judgment, contributing significantly to the occurrence of suicide. Depression is one of the commonest conditions leading to suicide. Alcoholism is known to be distinctly associated with suicides specially when drinking start at an early age. Alcoholism, depression and suicide are known to result in a vivacious circle. The drug users are also more prone to suicide.

Thus, suicide is influenced by ecological and environmental characteristics, the social fabric, individual predispositions and current circumstances the causes for suicide are multi factorial interlinked cumulative often repetitive and progressive over a period of time. It passes through stages of helplessness, hopelessness, and worthlessness.

Remedial measures:-

The prevention of suicide is a big challenge to the society and the nation as well. With the multiple approaches and meaningful interventions, many lives can be saved. Preventing suicide requires interventions at individual, family and societal levels.

At Individual Level

It is the responsibility of each and every individual of the society to save the life of people who are committing suicide. Individual should monitor the Behavioural tendency which is at higher risk. Whenever such people are encountered, one should try to establish contact and find out whom they are; listen carefully and allow them to talk about themselves and their feelings. Individual must try to recognize the problem and understanding of high risk individual. One should identify the best possible way of helping them in the crisis and release them from their circle of thoughts, be with them and continue to interact, listen and offer support. It is also advisable that the high risk individual should be engaged in social and recreational activities such as meeting people, talking friends, watching T.V.

Once a crisis situation has passed it is essential to offer continued support to enable them to overcome challenges in a positive way.

At Family Level

Role of a family is instrumental in molding a negative thought and obsession of high risk individual. The family is the nucleus of all activities in an individual's life. Interpersonal conflicts, disturbed relations and non-harmonious living are the principal triggering or precipitating factors for suicide. Family members can effectively intervene in a number of ways:

• Identifying warning signals of stress and suicidal tendencies
• Family members must establish a rapport with high risk individual in the family
• Establishing close relation with a person by caring, listening, respecting feelings and understanding emotions
• Trying to minimize conflict at home and developing problems solving exercises jointly with other family members
• Continuing to observe the reaction and behavior of the person enacting(fast) even at the slightest suspicion or the doubt
• Keeping a specific watch on those who are elderly terminally ill, mentally ill and disable

Thus Family member should encourage the person to see timely help from professional, suitable agencies or hospital. They should give love, understanding and support apart from prescribed medicines following suicidal attempts.

At Community Level

Communities, organizations and agencies have an extremely important goal in developing preventive services, emergency services, after care service and preventive programs. WHO has recommended following activities for preventing suicides:

• Area based help line can be established. 24 hours emergency direct telephone lines can be great help in this regard
• Greater publicity and awareness about these help line can be generated by encouraging people to access these services
• Local volunteer youth services can be developed to act as emergency help line in crisis situation
• Mental and social health promotional activities in schools and colleges, industries, hospitals and high risk communities can be organized through local programs
• Educational programs in local languages by using local dialects and communication strategies can be facilitated

Besides these high risk places such as hospitals, jails and lodging establishments should be monitored. It is important to develop mechanism for preventing suicides in these places by special efforts.

At Mass Media Level

Both print and electronic media have a profound impact on the lives of the people. Media can play a positive role in shaping people's thought and can show the direction, avenue or option to a depressed and high risk individual. There are following suggestions, if implemented by the media, could help in preventing suicide:

• Suicide statistics should be reported to stress the fact that every suicide is a loss to society
• Celebrity suicide should not be given undue emphasis. Special caution should be exercised reporting such incidents
• A realistic description of the impact of suicides on survivors, employers and families should be provided and in short term and long term consequences on individuals
• The mis-conceptions, culture, beliefs and myths about suicide should be explained
• The local press can be given wide publicity about help lines, crisis, prevention centres, poison treatment centres or agencies providing help to individuals and families
• The media should work closely with the local health personnel in ascertaining facts before reporting them

Thus, greater responsibility of media "as a gift to society" is to prepare and inform people that suicide can be prevented.

At Teachers Level

Among the major causes of suicide are examination failure, parental pressure, high expectation of school and colleges, disappointment in love and conflicts. Schools and colleges serve as building blocks of individual life and play a vital role in preventing such activities. Here the role of a teacher becomes instrumental in building value systems setting acceptable individual aspirations and inculcating appropriate goal setting mechanism are of prime importance of preventing suicide. The period of transition from childhood to adolescent is always a turbulent phase. A number of behavioral problems are frequently noticed at this stage such as mood swings, impulsive nature, difficulty in coping, angry behavior, attraction to the opposite sex etc. a teacher can provide proper supportive help and adequate buffer mechanisms for handling this transformation prices among children effectively.

Child abuse is an emerging problem in India and abroad such children are often traumatized, victimized and afraid to share their problems with others due to family and cultural reasons. Teachers can provide comfort and support in overcoming their mental stress. Teachers should also understand that certain adolescents require special attention in schools and colleges due to their high risk susceptibility to suicide.

Teachers should become more socially and psychologically adaptive to the changing realities. Teacher should identify crisis children at an early stage and school days counseling services should be provided to them. In countries where teachers are held in high esteem they can help in building better role models.

Making the school a healthy place through better development of school activities for greater interpersonal relations and preventing harmful behavior would promote better interaction amongst students and teachers. According to WHO (2003) setting up crisis intervention programs to resolve interpersonal conflicts, helping children with disorder of substance abuse and promoting trustful communication strategies are vital interventions required in educational institutions. Developing regular counseling and referral services in schools is a crucial step in providing timely help for many children when teachers alone are unable to handle the problem. It is also recommended that regular parent teacher interaction is essential for the development of child's personality in totality.

At Spiritual Level

Spiritual leaders and faith healers occupy a unique position in Indian societies owing to their stature, position, wisdom and capabilities to influence people beliefs and values. Faith healer should be involve in suicide prevention activities at the community level as they are the first level of contact for many health problems. If they play a positive a role in identifying suicidal thoughts, behavior, depressive states and other emotional support to the people it will be a step in the right direction. In India Sufis and saints have had vital role in providing comfort and emotional support to high risk individuals. These practices to visiting Sufis and saints have greater impact in the mind set of the people and resolve conflict in the families and community level.

Conclusion:

Suicide has emerged a global problem. It has socio-economic, cultural, religious, and psychological causes. It has greater impact on human society .suicide can be prevented by individual level, family level, teacher level, Mass media level and religious level.

Suicide Prevention:

We at Valmiki believe that suicide is preventable and that suicide prevention works. In order to accomplish our mission and goals, we use the public health model along with a media campaign to raise awareness of suicide. We use an educational approach to dispel the myths about suicide, and to let others know about the realities.

If you are suicidal or you think someone you know is, we want you to know that help is available and recovery is possible! Start by learning the warning signs, and do whatever you can to get yourself or someone you care about to the help they need so that they can return to living a fully functioning life.

Some one you know is suicidal:

The Journal of the Indian Medical Association has reported that 90% of all suicides occur during or following a depressive episode. Awareness, education, and treatment are the keys to suicide prevention.

Know What to Watch For

• Symptoms of Depression
• Warning signs of suicide

Know What to Do

Stigma associated with mental illnesses can prevent people from getting help. Your willingness to talk about depression and suicide with a friend, family member, or co-worker can be the first step in getting help and preventing suicide.

If You See the Warning Signs of Suicide...

Begin a dialogue by asking questions.

Suicidal thoughts are common with depressive illnesses and your willingness to talk about it in a non-judgmental, non-confrontational way can be the help a person needs to seek professional help. Questions okay to ask:

• "Do you ever feel so badly that you think about suicide?"
• "Do you have a plan to commit suicide or take your life?"
• "Have you thought about when you would do it (today, tomorrow, next week)?"
• "Have you thought about what method you would use?"

Asking these questions will help you to determine if your friend or family members is in immediate danger, and get help if needed. A suicidal person should see a doctor or mental health professional immediately. Going to a hospital emergency room are also good options to prevent a tragic suicide attempt or death. Remember always take thoughts of or plans for suicide seriously.

Never keep a plan for suicide a secret. Don’t worry about risking a friendship if you truly feel a life is in danger. You have bigger things to worry about-someone’s life might be in danger! It is better to lose a relationship from violating a confidence than it is to go to a funeral. And most of the time they will come back and thank you for saving their life.

Don't try to minimize problems or shame a person into changing their mind. Your opinion of a person's situation is irrelevant. Trying to convince a person suffering with a mental illness that it's not that bad, or that they have everything to live for may only increase their feelings of guilt and hopelessness. Reassure them that help is available, that depression is treatable, and that suicidal feelings are temporary. Life can get better!

If you feel the person isn't in immediate danger, acknowledge the pain as legitimate and offer to work together to get help. Make sure you follow through. This is one instance where you must be tenacious in your follow-up. Help find a doctor or a mental health professional, participate in making the first phone call, or go along to the first appointment. If you're in a position to help, don't assume that your persistence is unwanted or intrusive. Risking your feelings to help save a life is a risk worth taking.

Common misconceptions:

The following are common misconceptions about suicide:

Not True. Almost everyone who commits or attempts suicide has given some clue or warning. Do not ignore suicide threats. Statements like "you'll be sorry when I'm dead," "I can't see any way out," -- no matter how casually or jokingly said, may indicate serious suicidal feelings.

Not True. Most suicidal people are not psychotic or insane. They may be upset, grief-stricken, depressed or despairing, but extreme distress and emotional pain are always signs of mental illness and are not signs of psychosis.

Not True. Even the most severely depressed person has mixed feelings about death, and most waver until the very last moment between wanting to live and wanting to die. Most suicidal people do not want to die; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever.

Not True. Studies of suicide victims have shown that more then half had sought medical help within six month before their deaths and a majority had seen a medical professional within 1 month of their death.

Not True. You don't give a suicidal person morbid ideas by talking about suicide. The opposite is true -- bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do.

Symptoms and Danger Signs

Warning Signs of Suicide

• Ideation (thinking, talking or wishing about suicide)
• Substance use or abuse (increased use or change in substance)
• Purposelessness (no sense of purpose or belonging)
• Anger
• Trapped (feeling like there is no way out)
• Hopelessness (there is nothing to live for, no hope or optimism)
• Withdrawal (from family, friends, work, school, activities, hobbies)
• Anxiety (restlessness, irritability, agitation)
• Recklessness (high risk-taking behaviour)
• Mood disturbance (dramatic changes in mood)

Additional Warning Signs of Suicide

• Talking about suicide.
• Looking for ways to die (How to commit suicide, looking for pills, etc.)
• Statements about hopelessness, helplessness, or worthlessness.
• Preoccupation with death.
• Suddenly happier, calmer.
• Loss of interest in things one cares about.
• Visiting or calling people one cares about.
• Making arrangements; setting one's affairs in order.
• Giving things away, such as prized possessions.

A suicidal person urgently needs to see a doctor or mental health professional.

In an emergency, call the Valmiki Suicide Prevention Lifeline

Suicidal Thoughts: What to Do

If you have thoughts of suicide, these options are available to you:

• Dial to Valmiki helpline
• Check yourself into the emergency room.
• Tell someone who can help you find help immediately.
• Stay away from things that might hurt you.
• Most people can be treated with a combination of antidepressant medication and psychotherapy.
• Look in your local Yellow Pages under Mental Health and/or Suicide Prevention; then call the mental health organizations/crisis phone lines that are listed. There may be clinics or counseling centres in your area operating on a sliding or no-fee scale.
• Some pharmaceutical companies have "Free Medication Programs" for those who qualify. Visit the National Alliance for the Mentally Ill website at www.nami.org for more information

Suicide Statistics 2008

• 14 Suicides took place every hour.
• More than one lakh persons (1,25,017) in the country lost their lives by committing suicide during the year 2008
• It is observed that social and economic causes have led most of the males to commit suicides whereas emotional and personal causes have mainly driven females to end their lives
• Suicides because of ‘Family Problems’ (23.8%) and ’Illness’ (21.9%) combined accounted for 45.7% of total Suicides
• The number of suicides due to 'Illegitimate Pregnancy' and 'Ideological Causes/Hero worshipping' showed a significant increase of 50.6% and 50.2% respectively.
• 1 each in every 3 suicide victims was a youth (15-29 years) and middle aged (30-44 Years)
• The overall male: female ratio of suicide victims for the year 2008 was 64:36, however, the proportion of Boys: Girls suicide victims (up to 14 years of age) was 49:51
• Nearly 46.1% of the suicide victims were married males while 24.2% were married females
• Five States – Kerala, Tamil Nadu, Maharashtra, Karnataka and Andhra Pradesh– accounted for 64.6% of suicide victims in the age group 60 years and above
• 70.3% of the suicide victims were married while 22.1% were un-married.
• 25.3% of the suicide victims were primary educated and 23.7% were middle educated.
• 1 suicide for every 5 suicide is committed by a Housewife.
• 39.8% of suicide victims were self employed while only 7.2% were un-employed and 12.5% were salaried.
• Government servants were merely 1.7% of the total suicide victims.
• West Bengal (11.9%), Tamil Nadu (11.5%), Andhra Pradesh (11.5%), Maharashtra (11.5%) and Karnataka (9.8%) contributed 56.2% of total suicide victims. West Bengal has reported the highest number (accounting for 13.3%) of suicidal deaths during the year 2006, but its share went down to 12.1% in 2007 and went up to 11.9% of total suicides in 2008
• Southern States viz. Andhra Pradesh, Karnataka, Kerala and Tamil Nadu have accounted for 39.7% of total suicides reported in the country
• Sikkim has reported 48.2 suicidal deaths per one lakh of population as against the National average of 10.8.
• About half (52.0%) children suicide victims belonged to five states – West Bengal, Andhra Pradesh, Rajasthan, Orissa and Madhya Pradesh out of 2,381 suicide victims
• Sikkim reported the highest rate of suicide (48.2) followed by Pondicherry (46.9), A & N Islands (34.5), Kerala (25.0) and D & N Haveli (22.6)
• Sikkim has reported significant increase in Suicides in 2008 over 2007 (an increase of 135.2%) followed by Nagaland (75.0%).
• The highest number of Mass/Family Suicides cases were reported from Bihar (102) followed by Rajasthan (86) and Andhra Pradesh (40) out of 290 cases
• 34.8% of the suicide victims consumed poison; 32.2% of the victims died by hanging, 8.8% by Fire/Self-Immolation and 6.7% by Drowning. The trend of Suicide by Hanging has been mixed during last 3 years (32.8% in 2006, 31.7% in 2007 & 32.2% in 2008) while Suicide by Poisoning has shown static trend in 2007 and 2008 (35.5% in 2006, 34.8% in 2007 and 34.8% in 2008)
• Bangalore (2,396), Chennai (1,309), Mumbai (1,111) and Delhi (1,107) – the four cities together have reported 45.3% of the total suicides reported from 35 mega cities.
• Bangalore city has reported the highest rate of 42.1 and Kolkata reported the lowest rate at 1.4 only among 35 cities
• The pattern of suicides reported from 35 cities showed that ‘Hanging’ (45.7%), ‘Poisoning’ (21.3%) and ‘Fire/Self Immolation’ (13.2%) were the prominent means adopted by the suicide victims in the cities
• There is significant increase in number of suicides (69.2%) in Amritsar (from 26 in 2007 to 44 in 2008) while Chennai showed sharp decline of 43.4% (from 2,313 suicides in 2007 to 1,309 suicides in 2008)
• The suicide rate in cities (12.1) was higher as compared to All-India suicide rate (10.8)

Suicidal Statistics of Andhra Pradesh

DC 17th November 2009

Andhra Pradesh now has the dubious distinction of ranking second in the country in the number of reported suicides. On an average, 39 people a day end up killing themselves in the state.

According to the National Crime Records Bureau (NCRB), out of 1.22 lakh suicides every year in the country, Andhra Pradesh records around 14,224.

The large number of suicides among students and employees of IT companies has to do with increasing competition in the education and employment sectors, say experts.

NCRB analysts observe that while social and economic causes lead to most of the suicides committed by men, women are driven to suicide by emotional and personal causes.

According to the NCRB, in the past decade, there has been a 28 per cent increase in the number of suicides. Maharashtra accounts for the largest share at 12.4 per cent, followed by Andhra Pradesh and West Bengal at 12.1 per cent each.

Dr V. Pramod Kumar, the superintendent of the Mental Health Hospital, Erragadda, says, “Due to the changing economic scenario in the South, there is more competition to grab employment opportunities. Disappointed youth are developing suicidal tendencies. Mental illness can also cause people to commit suicide. The reason can also be genetic.” The NCRB report says that AP has been recording higher numbers of suicides in the past few years. The causes can vary from unemployment, to not being able to have children, to problems at work and non-settlement of marriage.

Osmania Medical College forensics department head, Dr M. Narayana Reddy, says that stress in students, failure in love affairs among the youth, poverty of farmers, unemployment, as among weavers, are “leading to frustration and the person takes recourse to death rather than life.”

Within the state, Karim Nagar district has recorded the highest number of suicides, with 1,363 persons ending their lives in 2008, and 840 till September 2009. Adilabad registered 1,334 suicides and next was Kurnool. Srikakulam with 158 suicides was the lowest.

The problems that Gulf immigrants face could account for the large number of suicides in Karim Nagar which has a large population of men employed in the Gulf, surmises CID IGP, Mr S. Umapathi.

Teenage suicides in India:

Teen suicides in India are among the highest in the world, say the authors of a report on suicides among certain population categories, with special reference to the country.” Suicides are a major problem worldwide with the highest rate being among the elderly in the West and among teens in India, bringing greater socio-economic loss due to the death of the young population in India," said J.K. Trivedi, a doctor at the department of psychiatry in C.S.M. Medical University, Lucknow. Trivedi along with Rohit Garg and Mohan Dhyani, doctors in the same department, has authored the article "Suicidal behaviour in special population: elderly, women and adolescents in special reference to India".

The report was published in the recent edition of the Delhi Psychiatry Journal and tries to analyse the category of children that is at higher risk and the ways to stop it.” Suicides among young women are the highest in two countries - in India and China. In India, suicides are very high in Kerala, Tamil Nadu and Pondicherry," Trivedi said.

Quoting a study conducted by the Christian Medical College (CMC) in Vellore, Tamil Nadu, and The report said that teens have the world's highest suicide rate.

Globally the suicide rate stands at 14.5 deaths per 100,000, with suicide being the fourth leading cause of death in the age group of 15 to 18. However, in the CMC study, suicide was the number one cause of death among Indian adolescents. Experts say adolescents whose parents do not understand what they are going through are the most vulnerable.” Though childhood is the time of great prospects, it can be a period of great confusion and anxiety as there is pressure to fit in socially, to perform academically, to act responsibly, growing self-identity and need for autonomy which often conflicts with the rules and expectations set by others," Trivedi said.

According to the National Crime Records Bureau, about 2,555 adolescents, among them 1,328 boys and 1,227 girls, up to the age of 14 years, ended their lives in 2005 in India. The suicide rate went up by 175 percent from 1967 to 1999, the figures said. "Children's suicidal behaviour is impulsive and their motives, particularly the ones which are impersonal, can be similar to adults," says the article. Psychologists divide the risk factors that force a child to commit suicide into four - biological, psychosocial, environmental and socio-cultural. All the factors - biological (mental disorders, alcohol or other substance abuse), psychosocial (poor personal problem solving ability, impulsive or aggressive tendencies, family history of suicide, history of trauma and abuse), environmental (difficulty in school, a drifter and death of a family member) and socio-cultural (lack of social support and violence at home) - play a crucial role in moulding a child's thinking.

"Imitation through exposure (friends or media publicity) makes adolescents more vulnerable to suicide (the copy cat phenomenon)," the report said. "Parents, school personnel and peers can recognise the warning signs and take immediate action to keep the child safe.” The article quoting experts said parents should start worrying when they see their child writing suicide notes, threatening to kill themselves, turning violent, becoming withdrawn, getting depressed, giving away their prized possessions, self-mutilating, unable to concentrate, unable to sleep or have sudden changes in their personality.

Also, they could complain about headaches, fatigue, try to run away from home, complain of being a bad person or be too cheerful. On seeing the signs, parents should remain calm, ask the child directly about what he/she is thinking, listen and not accuse them, show concern and assure them of help, not judge and provide constant supervision, the experts said. "Parents must continue to take threats seriously, access school supports, maintain communication with the school," the article said. The experts' advice for school authorities is that since a child spends considerable time in school, it is crucial for all school staff to be familiar with and watchful of risk factors and warning signs.