Wednesday, 5 December 2012

The etiology of Suicide in Adolescence is Multifactorial; Depression- one of leading cause of Suicide becomes less who has regular Muscular Exercises and may be a therapeutic modality


 Authors
Professor Pranab kumar Bhattacharya MD(cal) FIC Path(Ind), Professor and Head , Department of Pathology; Professor and Head Department of Pathology; Course Coordinator ,convener, In charge Diploma of Clinical Pathology & Diploma in Laboratory Technology of West Bengal University of Health Sciences ; DD36 Salt Lake City; Kolkata, School of Tropical Medicine Kolkata; 108 CR Avenue Kolkata-73; West Bengal; India 
Miss Upasana Bhattacharya; Mr Rupak Bhattacharya; Mr Ritwik Bhattacharya; Mrs Dalia Mukherjee; Miss Oaindrila Mukherjee; Mr Debasis Mukherjee; Miss Rupsa Bhattacharya; of 7/51 Purbapalli Po-Sodepur Dist 24 Parganas(N) W.B  Dr Pijush Kanti Roy IPGMER; Dr Anuradha De  MD(AIIMS) DCP (cal); Associate Professor  Pathology  Soma Das MBBS Demonstrator Kolkata, School of Tropical Medicine Kolkata; 108 CR Avenue Kolkata-73; West Bengal; India  


3 December 2012
 India in 2013 has a massive boom of population. During last half of 20th century ,in the beginning of 1975s every one was frightened of threat of population explosions. Today in 2013, Indian population exceeded 1.25 billion[  in 2001 census of India,  it was 102,86.1 Lacks having percentage of urban population 27.82 and 933 female per1000 male, having birth rate 23.1 and death rate 7.4; fertility rate 2.8] and in West Bengal province alone it is more then 9.11 cores [ 2001 census it was 8.01 cores] . In modern west Bengal society, married educated, servicing women trying to avoid living together with their husband’s parents, family members in metropolis cities, districts,  towns, urban areas, while in rural west Bengal the picture is  still just  reverse.  Mental health of men becoming  so unstable when couple chooses to live with bride’s parents or in a unit family, than to live with his family. Very few percentage of people can adjust such situations  and  family economics & moral support breaks, putting other family members in great  trouble& mental and economic distress. There is trend of nuclear family, where things are often under control of wife, artificial, economic market  value contract, individualism, and status competiveness in life style, with expensive in education  for children, transport through car, purchasing flat, interior decoration, and consuming goods from  shopping malls with bank or personal loan from market. These are inevitable in nuclear family in open bazzar  economy and globalization market. These nuclear families  are making communications between husband’s or wife’s family members more difficult as well disrupting communications between family and local society, where he had friends, schooling, and brought up. Today marriage in educated middle class, upper middle class society is looked with market values. In middle class modern educated boys tries to avoid marriage as institution or sharing responsibilities (40%) in their fertile age range 30-35 years and total marital fertility rate so dropped from 4.1 in 2001 to 2.9 in 2006. They prefer to live alone or make live together. The members of nuclear families are eager to show false impression to peers pretending that no problems exist between themselves, while all members husband-wife-children try to hide their own problems, own worries and insecurities to neighbours, husband’s family members or rather chose to tell ,where from they do not receive any assistance when in real needs. As a result no one knows what others think. Children from these families have difficulties in personal relationship, being impeded in their social adaptation, in their interplay with other children. They are not allowed to mix with children of bellow level status or children of neighbours. When children members are few one or two[ gross reproduction rate in urban areas of West Bengal in 2006 was 0.7,when in 2001 it was 1.3] it makes parents( mainly a graduate mother) enormous expectation and herculous  tasks and burden on children with school education, private tuitions bag full syllabus, home tasks, Dance classes, drawing classes, music classes and children today are an important  tactic in human rat race of growing up. What a foolish ideology! In the case child is born. In the case the child is born under investment in education ( high tuition cost schools) are done in excess, This is in order to increased demands of mother of child to increase false market value of the child. All these are done by parents to enrich their own ego and they demand directly or indirectly that the duties to be set up by father. This trend is especially more strong in case mother having bestowed up on fathers’ duty towards the child. The role of Child is then like a puppet to deserve of his/her mother. Thirty cores (30 cores) of people in India are in middle class group and as per demands of parents and expectation as “Good Boy (?) or “Good Girl (?)” children are mostly concentrated on unscientific education work intensively( full of haphazard information whose meaning in local mother languages they do not understand in fact ) for upper middle class Indian school certificate or central board school certificate affiliated mush rooming private schools or first class five or three stars hotel like costly schools( where teachers have no vigilance on their quality teaching, in promotion neither have  national accreditation credentials as teacher) but rewards for their effort are very few. How many of them get university level gold medal in future carrier? I have never came across single one from these first class metropolis schools. Personally I as long 30 years teaching experience in undergraduate (MBBS) Post Graduate diplomas (DCP,DGO, DTMH) Post Graduate degrees(MD/PhD) or Post doctoral (DM/Mch) in Pathology subject or as a few of members of  Board of Studies of WBUHS & of Calcutta University know what the end products of these ISC or CBSC schools in west Bengal who are somehow becoming successful ( Though few numbers) in Joint entrance Examinations for Medical and Engineering degrees. They are probably worst of lot with most superficial knowledge in subject, smartness in English gesture, orator, debaters, other extra curricular activities and jack of all trades, without any depth in subject , or creative minds, or attitude to work  hard or study the book as a whole, panicky, with often psychotic behaviour- needs often psychiatric  counselling. Their High expectation put the child finally in disappointment and guilt in the adolescence period resulting perplexity, anxiety disorders, schizoid mood, manic depressive psychosis(MDP), Obsessive disorders, Phobic disorder,  Dissociative disorders, eating disorders sexual abuse, Traumatic experience; Depression and finally Suicide by hanging or drug or jump from a height or  under local train or metro train Of Course there are some suicide which are  for protest against a state or country, political cause, or to draw attention of  rulers/government /or norms of the society- but they are committed often in front of public with often a note sheet for his/her committing suicide  and  are numbered. They cannot accept their fault, their failure , their unsuccessful in examination which is often the result and involve in drug abuse, crime and commits suicide .Suicide in Medicos students and Engineering students increasing years after years.
 The Mental health of people depends thus on economic class, character of population changes, basically on house hold economic structure, degree of poverty in family and age of family members. Of these most important is economic structure and security and family people as a joint family living under one roof is most useful buffer system for the presentence of any psychological disturbances as a facilitator for self soul respect, sense of growing psychological and social well being, regardless one or two persons share of contribution to the total amount of family resources. In family elderly, middle aged, retired people, jobless people, house wives(<40 yrs) suffer more psychological endogenous depressions or disturbances, chronic diseases and are often reluctant  to involve themselves in public affairs or community programme and their depression is leading cause of suicide.
 Extreme poverty, sudden loss of Job ,depression, MDP, Florid  Perkinsons long standing Diabetics mellitus, Schizoid mood disorder, Divorce, Widow, single living bachelors, elderly people, COPD, Cancer, terminal illness are major etiological factors of Suicide. Suicide is more common in middle aged and can be a main denominator for joblessness in globalization open market economy. In 1970s-1980s suicide was more common in adolescence , teenaged, when today suicide is more seen in middle aged men and women and this is because middle aged people are contained in a solitary situation ,because of stress both from upper and lower position of nuclear family or organizational demands. A 2001 data in west Bengal provinces of India shows 2,70,500 people suffered from psychological disorders( DSM IV) of which in rural areas 1,81,981 and in urban areas it  was 88,900 people and 1,56,500 males and 1,14,390 were women(M:F ratio 2.5:2.04) and suicide in west Bengal more common in women rural west Bengal while vice versa in metropolis, cities. This is because in metropolis, cities middle aged educated working class or middle class or upper middle class women are enjoying more economic & social opportunities, hidden Extramarital affairs & sex and involvement with various public  affairs due to laws & acts in favour of women. The laws shows a tendency to obtain a position in society equal to man, often more than a man, rather than to manage the house hold efficiently. A good wife and good mother is pillar  for a family, society, nation. For example there is increasing numbers of middle aged house wives working ladies in upper or middle class society who spend their spare time with much younger boy friend’s with physical or mental involvement (40% divorce is due to EMA) or to NGOs or to private companies or to open schools for adults or in theatre, cinema or  as insurances agents and sales representatives and engage themselves for easy money making. Today the suicidal rate is 20-25% amongst depressed and mentally or physically disabled persons according to one of my colleague friend in psychiatric department of IPGME&R/SSKM hospital.
 The rate of divorce is in steep raise in west Bengal since 1990s. The crude divorce rate was 2.5% in 2001 and ratio between marriage and divorce are in increase trends. The mean age of divorce in west Bengal for male is around 36 years while for female 30 years. The median age of marriage in female is 20.6 years. The basic cause of divorce can be domestic difference, marital conflicts, family troubles, adultery’s, economic problems, impotency, infertility,. The death and suicidal rate for divorced men and women are also high. Divorce causes mental health problems such as excessive smoking, alcoholism, depression, and secede .The divorce for married women tends to result feminization of poverty, unemployment, less income which detoriate mental health and suicide. Divorce has a negative impact on children and children from divorced families are more likely to experience academic as well psychologically imbalanced or maladjusted then peers.
 Privatization ,Globalization is a double  aged sword with both good side for middle class, upper class and rich people but bad side for lower economic class people. Globalization and bazzar economy are to cut employment from both government and private sector and results unemployment & in west Bengal one and half cores(1.5 million) people are today unemployed(64% non workers) and in India about 61% non workers. The bread winner of a family in India is usually a male. So when unemployment increases family income decreases, loan debt  from market increases. In terms of recession, the rich tends to get even richer and poor even poorer. Richer family have more resources for  higher education and when resources are distributed unevenly, it becomes hard to maintain the social integrity & harmony and social values torn into pieces and when the gap between rich, upper class, middle class widens greatly the integrity of society decreases, the society will be in disordered state, dangers threatening the personal security will raise and crime and suicide rate increases as mental health being threatened. Areas primarily occupied by lower economic class residents tends to detoriate & vicious cycle of crime and suicide & poverty further induces social withdrawal behaviour among the residents and influence their desire to avoid participating in community activities and in turn the community residents become distressful and there will be fewer opportunities for interaction and less social maintenance, less respect and detoriation of community security. All these increases rate of Succeed in the community
 Elderly People(< 65 years) are high risk of Suicide. As the number of elderly people in West Bengal increases there is gradual decrease in social productivity and competiveness and increase in the demand and support of elderly. Who will take care olds and oldest of old? The depressive disorder, depressed mood thus become higher among older persons, female, widows and those suffering from Chronic disorders, cancer. Prevention of their depression is the key to reduce suicide rate amongst elderly
 So depression and suicide is always multi factorial and based on economic structure of family, diseases, chronic diseases, family norms, social value, society, community and many things. Depression is major cause of suicide. Mode of Suicide in West Bengal is either by hanging, or by  self poisoning, or jump from high rise building or under train & rarely by drugs. In 2001 data amongst hospitalized patients in Medical colleges of Kolkata 4.26%( Study was done with 53,0026 patients admitted)  were from suicidal attempt by various poisons when in rural areas ,district hospitals amongst 1,15,652 cases admitted suicidal case by poisoning were 5.12%

Physical activity is known to have a variety of positive effects on the overall functioning of human beings.  the counsellors, psychiatrists, should  understand  the effects of physical activity on mental health is of special concern. In order to understand the specific effects of physical activity on adolescents and emerging adults, an analysis of recent literature was conducted. It was found that physical activity has a profound impact on various aspects of development in these stages. Regular muscular exercise releases increased DOPAMINE in brain synapses and inhibits serotonin synthesis within brain, which is the culprit enzyme for depression. SRI drugs are today choice of treatment in the endogenous depression, depression in MDP. Schizophrenia,  depression in Diabetes mellitus. So Increase muscle mass, Increase muscle tone through exercise, daily half an hour running or brisk walking, jogging or swimming can be an alternative  therapeutic approach for treatment of Depression and suicide

 The opinion expressed in this article is  completely Personal opinion of Professor Prnab kumar Bhattacharya and is under copy right as per IPR copy right Act & laws.  This article is dedicated to prof.pranab kumar Bhattacharya's a Female known   soul who  had severe grade depression, high blood sugar, had several suicidal tendency very often,  had long standing struggle  in middle class society,  lived alone, was driven out from  home separated from  only child, tortured  by  own family , lost her  job had enough debt in market  and did  unexpected suicide all on a sudden by drowning herself in a pond 
Competing interests: None declared

 Copy Right- 2012-22 The Copy Right of this article The etiology of Suicide in Adolescence is Multifactorial; Depression- one of leading cause of Suicide becomes less who has regular Muscular Exercises and may be a therapeutic modality"  is strictly reserved to all authors  only, as per Copy Right rules of Intellectual Property Right act (IPR) of World Intellectual Property Right organization (WIPO),  of 2012 amended in 1996 in this country and applicable from 2006 January, in India and  also as per Protection of Intellectual Property Right Act( PIP) of USA 2012  . No person, No NGOS [ except the authors& first degree relatives]  in the state of West Bengal or in any states of India or in any abroad countries are authorized to use this article, with any meaning full,  scientific sentences or with scientific and meaning full words laid out in this article either in the class room/  or in mass teaching programme including CME  or  in any form what so ever it is with any content of this article or while in writing any book or for his/her personal/ home use, or collective works or for any future Research or implementation as a policy matter or,[ except the authors ]or  by Xeroxing and distributing the article/ or by printing/saving/broadcasting the article from any website of internet services,displayed without proper copy right clearance from the authors or from his family members or future copy right owner by written forrm. Every attempt has been made to provide references of the authors when the material has been taken from other authors. Be care full to infringe

Dear Professor Bhattacharya,

Thank you for your rapid response (copied below). Please would you reduce to a maximum of 1000 words and resubmit.

Best wishes,

Sharon Davies
Letters editor

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