|Year : 2013 | Volume
| Issue : 2 | Page : 114-117
Nursing students' attitude toward suicide prevention
Naresh Nebhinani1, Mamta2, Achla D Gaikwad3, L Tamphasana4
1 Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
2 Silver Oaks College of Nursing, Mohali, Punjab, India
3 College of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
4 Dr. Syamala Reddy College of Nursing, Bangalore, Karnataka, India
|Date of Web Publication||21-May-2014|
Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan - 342 005
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Preventing suicide depends upon different health professionals' knowledge regarding suicide, attitude toward suicide attempters, skills to assess and manage suicidal risk. Objectives: This study was aimed to assess the attitude of nursing students toward suicide prevention. Materials and Methods: 308 nursing students were recruited from the two institutions through total enumeration method. Attitude toward suicide prevention scale was administered. Study design was cross-sectional. Results: Majority were single females, from urban locality, who were pursuing BSc Nursing with the mean age of 20 years. Only minority had previous exposure to suicide prevention programs or workshops. Nearly half of the subjects had positive attitude toward working with suicidal patients. Again half of the subjects considered unemployment and poverty as main causes of suicide and were quite hopeless about it and they also perceived that most of the suicidal people would not reveal their suicidal plans to others. Conclusions: Merely half of the students had positive attitude toward working with suicidal patients. Hence, there is strong need to organize more educational and training programs on suicide prevention so that these budding health professionals could be more equipped and trained to manage these suicidal patients.
Keywords: Attitudes, nursing students, self-harm, suicide, suicide prevention
|How to cite this article:|
Nebhinani N, Mamta, Gaikwad AD, Tamphasana L. Nursing students' attitude toward suicide prevention. Ind Psychiatry J 2013;22:114-7
Similar to global trends, India has also witnessed significant increase in suicide in last three decades. Current suicide rate in India is 11.2 per 1,00,000 people  and nearly three-fourth of suicide is reported in persons <44 years, which further contributes to significant social and economic burden.  Despite suicide being the most preventable causes of death among the top 20 leading causes of mortality for all ages.  Suicide attempters usually become victim of health professionals' negative attitude. Repeated suicide attempters, who have the highest risk for subsequent suicide attempts, face the most unfavorable attitude of health professionals. , Consequently health professionals' attitude influences their skills to assess and manage suicide risk  as well as the quality and impact of care. 
Suicide is a multifaceted problem and hence suicide prevention programs should also be multidimensional.  Nursing staff and students play a crucial role in suicide prevention as they have the first level of contact and greater opportunities to build closer relationships with patients presenting with suicide risk and attempts. They may not have appropriate knowledge about suicide, and attitude toward suicide prevention, which may further influence their competence and willingness to serve this population.  Thus, the information about nurses' attitude toward suicide prevention is tremendously important in designing and implementing suicide preventive strategies.
Most of the studies have described health professionals' attitudes toward suicide and suicide attempters ,,,,,, rather than suicide prevention. ,, With our best efforts we could not find any of such study from India. Health professionals' awareness, attitude, and skill regarding suicide risk assessment and management are reported to be of paramount importance in achieving successful suicide prevention.  Hence, this study was aimed to assess the attitude of nursing students' toward suicide prevention.
| Materials and methods|| |
Nursing students pursuing either General Nursing and Midwifery (GNM) or Bachelor of Science (BSc) course were recruited from two nursing colleges of North India in May, 2012. Total enumeration method was employed, in which all the students were recruited to maintain high level of accuracy and to provide a complete statistical coverage. Study was approved by the college authorities. Study proforma, containing sociodemographic profile sheet and attitude toward suicide prevention scale, were distributed in classroom setting. Students were explained about the study aim and subsequently written informed consent was taken from all the subjects. They were also asked to read the questionnaire first and ask in case of problem in understanding any question. After answering their queries, they were asked to fill the following instruments, for which they took nearly 30 min.
Sociodemographic profile sheet
It includes demographic details along with their additional information about attending any suicide prevention workshop as well as experience of managing subjects with suicide risk and attempts.
Attitude toward suicide prevention scale 
It is a 14 items, self-rated, 5-point Likert scale. It has good internal consistency (Cronbach's alpha = 0.77) and high test-retest reliability.  It has been used in several studies. ,
SPSS version 14.0 for Windows (Chicago, Illinois, USA) was used. Frequencies with percentages were calculated for categorical variables and mean, standard deviation and median were calculated for continuous variables. Comparisons were done by using the Chi-Square test, and t-test.
| Results|| |
As detailed in [Table 1], total sample consist 308 nursing students pursuing either GNM or BSc course. Majority were single females, from nuclear family, who were pursuing BSc Nursing course with the mean age of 20 years (range 18-29 years). Nearly half were Hindu by religion and from urban locality. Only minority had attended suicide prevention programmes and had professional experience of managing suicide attempters. Nearly one-fifth have managed or observed the patients with suicide risk or attempt. Students from both institutes were comparable for all demographic parameters.
Attitude toward suicide prevention
As detailed in [Table 2], Majority considered suicide prevention as their responsibility. Nearly half were comfortable on assessing suicide risk and had some idea on suicide risk prediction. Again nearly half had positive attitude toward working with suicidal patients and considered it rewarding.
On the darker side, nearly two-third were agreed for following statements 'if people are serious about committing suicide they do not tell anyone' and 'there is little impact of any suicide prevention measure, as unemployment and poverty are the main causes'. Half of the subjects were defensive on peoples' efforts for suicide prevention and mentioned that people have the right to take their lives. One-third of students considered suicide attempt as a play for attention if somebody survives from such attempt. One-fourth of students also mentioned suicide prevention measures as drain on resources.
The students from both the institutes had positive attitudes toward patients who self-harm, though significant differences were apparent on three of the 14 attitudinal items. Lesser proportion of students from one institute was resented on being asked to do more about suicide and felt no way of knowing who is going to commit suicide. They also mentioned that it is easier to make judgments about suicide prevention for somebody not involved in clinical practice.
| Discussion|| |
Repeated suicide attempts point toward health professionals' failure to recognize and respond the needs of patients with suicide risk and attempt.  There are several barriers in management of suicide attempters such as improper knowledge about suicide, negative attitude toward suicide attempters, incompetence in assessing and managing suicidal risk, inadequate manpower and other resources, insufficient time and setting, inadequate supervision and support, and lack of clear treatment protocols. 
Nurses' positive attitudes toward suicide prevention is found to be associated with exposure of suicide prevention workshops, greater age, and clinical experience. ,,,,, But we could not find any of such association as our subjects was nearly of same age group, with limited clinical experience and minority has attended any workshop or lecture on suicide prevention. There are only few studies available on the attitude of health professionals' toward suicide prevention ,, and one study  had used similar instrument in a clinical group, mainly nursing staff. This made us convenient to compare our findings with that study.  Brunero et al.  conducted a survey in health professionals (nurses, midwives, allied health professionals, N = 143) to assess their attitude toward suicide prevention. Our findings are different for six items compared to Brunero et al.  Our findings are more or less similar to Brunero et al.,  except greater proportion of our subjects knew about risk factors and predictors for suicide and they were also comfortable for assessing suicide risk. Compared to earlier an study,  majority of our subjects opined that individual could do little for suicide prevention since the unemployment and poverty remained the main causes of suicide. This finding is in line with an earlier report,  which mentioned social factors as major determinants of suicide and suicide as a personal matter. However, majority of suicide attempters manifest impaired problem solving skills at least for time being, as they fail to recognize alternative solutions to their concerned problem. 
Half of the students in this study believed that people do not have right to take their life. Such attitude reflects their personal, religious, and moral beliefs. It may be indirectly colored with the existing law (IPC 309) in India, which allows the punishment of suicidal behavior. 
The results of our study must be seen within its limitations. Attitude toward suicide prevention scale is not adapted for Indian population. Our findings cannot be generalized as the samples were recruited from only two nursing institutes. As minority of students attended suicide prevention programs and had experience of managing suicidal patients, we could not establish any association between these variables and their attitude toward suicide prevention.
However, within these limitations the study leads to the following conclusions. Misconceptions were widely prevalent regarding suicide. Majority were not optimistic with impact of any individual suicide prevention measure as unemployment and poverty were reported as main underlying factors. Half were comfortable on assessing suicidal risk and also had positive attitude toward working with suicidal patients.
Future studies should assess various health professionals' attitude to suicide prevention in different populations and settings. With larger sample size, researchers should also find associations between professionals' attitude toward suicide prevention and their demographic, clinical, and other parameters such as spiritual values, religious beliefs etc., Finally there is a vital need to translate our knowledge about suicide and suicide attempters in to suicide prevention measures and strategies.
The findings have implications for enhancing educational exposure of nursing students, for the introduction of measures to improve both awareness and adoption of proper clinical strategies for the patients with self-harm, and for improving their attitudes toward these patients. The therapeutic alliance between the nurse and nursing student and the suicide attempter prepares the ground for secondary suicide prevention. This study has also attempted to establish a baseline of attitudinal measures against which the effects of a subsequent educational program for nursing students and staff can be assessed.
Nursing students reflect a group of future gatekeepers, insofar as they will be the first line of contact as well as key resource to manage the subjects with suicidal ideas and attempts. To better equip these budding health professionals, regular educational and training programs on suicide assessment, risk reduction and prevention of suicide, supervision, and ongoing support should be provided to new staff and students at the earliest opportunity.
| References|| |
|1.||National crime records bureau. Accidental deaths and suicides in India: ADSI 2011. Available from: http://ncrb.nic.in/CD-ADSI2011/suicides-11.pdf. [Last accessed on 2012 Nov 10]. |
|2.||Vijayakumar L. Indian research on suicide. Indian J Psychiatry 2010;52:S291-6. |
|3.||Ram D, Darshan MS, Rao TS, Honagodu AR. Suicide prevention is possible: A perception after suicide attempt. Indian J Psychiatry 2012;54:172-6. |
|4.||Owens D, Horrocks J, House A. Fatal and non-fatal repetition of self-harm: Systematic review. Br J Psychiatry 2002;181:193-9. |
|5.||Zahl DL, Hawton K. Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11583 patients. Br J Psychiatry 2004;185:70-5. |
|6.||Brunero S, Smith J, Bates E, Fairbrother G. Health professionals' attitudes towards suicide prevention initiatives. J Psychiatr Ment Health Nurs 2008;15:588-94. |
|7.||Saunders KE, Hawton K, Fortune S, Farrell S. Attitudes and knowledge of clinical staff regarding people who self-harm: A systematic review. J Affect Disord 2012;139:205-16. |
|8.||Vijaykumar L. Suicide and its prevention: The urgent need in India. Indian J Psychiatry 2007;49:81-4. |
|9.||Anderson M, Standen P, Noon J. Nurses' and doctors' perceptions of young people who engage in suicidal behaviour: A contemporary grounded theory analysis. Int J Nurs Stud 2003;40:587-97. |
|10.||McCann T, Clark E, McConnachie S, Harvey I. Accident and emergency nurses' attitudes towards patients who self-harm. Accid Emerg Nurs 2006;14:4-10. |
|11.||McCann TV, Clark E, McConnachie S, Harvey I. Deliberate self-harm: Emergency department nurses' attitudes, triage and care intentions. J Clin Nurs 2007;16:1704-11. |
|12.||Anderson M, Standen P, Nazir S, Noon J. Nurses' and doctors' attitudes towards suicidal behaviour in young people. Int J Nurs Stud 2000;37:1-11. |
|13.||Anderson M, Standen PJ. Attitudes towards suicide among nurses and doctors working with children and young people who self-harm. J Psychiatr Ment Health Nurs 2007;14:470-7. |
|14.||Wheatly M, Austin-Payne H. Nursing staff knowledge and attitudes towards deliberate self-harm in adults and adolescents in an inpatient setting. Behav Cogn Psychother 2009;37:293-309. |
|15.||Kim SN, Lee KS, Lee SY, Yu JH, Hong AR. Awareness and attitude toward suicide in community mental health professionals and hospital workers. J Prev Med Public Health 2009;42:183-9. |
|16.||Srivastava M, Tiwari R. A comparative study of attitude of menal health vs nonmental health professionals toward suicide. Indian J Psychol Med 2012;34:66-9. |
|17.||Appleby L, Moriss R, Gask L, Roland M, Perry B, Lewis A, et al. An educational intervention for front-line health professionals in the assessment and management of suicidal patients (The STORM Project). Psychol Med 2000;30:805-12. |
|18.||Herron J, Ticehurst H, Applebury L, Perry A, Cordingley L. Attitudes toward suicide prevention in front line health staff. Suicide Life Threat Behav 2001;31:342-7. |
|19.||Ouzouni C, Nakakis K. Attitudes towards attempted suicide: The development of a measurement tool. Health Sci J 2009;3:222-31. |
|20.||Chan SW, Chien WT, Tso S. Evaluating nurses' knowledge, attitude and competency after an education programme on suicide prevention. Nurs Educ Today 2009;29:763-9. |
|21.||McLaughlin C. Casualty nurses' attitudes to attempted suicide. J Adv Nurs 1994;20:1111-8. |
|22.||Anderson M. Nurses' attitudes towards suicidal behaviour - a comparative study of community mental health nurses and nurses working in an accident and emergency department. J Adv Nurs 1997;25:1283-91. |
|23.||Etzersdorfer E, Vijayakumar L, Schony W, Grausgruber A, Sonneck G. Attitudes towards suicide among medical students: Comparison between Madras (India) and Vienna (Austria). Soc Psychiatry Psychiatr Epidemiol 1998;33:104-10. |
[Table 1], [Table 2]
|This article has been cited by|
||Attitudes of under graduate nursing students to suicide and their role in caring of persons with suicidal behaviors
| ||Vijayalakshmi Poreddi, Shamala Anjanappa, SaiYathin Reddy |
| ||Archives of Psychiatric Nursing. 2021; 35(6): 583 |
|[Pubmed] | [DOI]|
||Nursing students' attitudes towards suicide and suicidal patients: A multicentre cross-sectional survey
| ||Paolo Ferrara, Stefano Terzoni, Federico Ruta, Alessandro Delli Poggi, Anne Destrebecq, Orsola Gambini, Armando D'agostino |
| ||Nurse Education Today. 2021; : 105258 |
|[Pubmed] | [DOI]|
||Attitudes Toward Suicide: Examining Qualitative Data
| ||Susan L. Glodstein |
| ||Journal of Psychosocial Nursing and Mental Health Services. 2021; 59(3): 35 |
|[Pubmed] | [DOI]|
||Differences in attitude toward prevention of suicide between nursing and medicine students: A study in Mexican population
| ||María Lilia López-Narváez, Yudy Merady Escobar-Chan, Juan Pablo Sánchez de la Cruz, Carlos Alfonso Tovilla-Zárate, Isela Esther Juárez-Rojop, Ana Fresan, Thelma Beatriz González-Castro, Andrea Carolina Montanee-Sandoval, Samuel Suarez-Méndez |
| ||Archives of Psychiatric Nursing. 2020; 34(3): 159 |
|[Pubmed] | [DOI]|
||Effectiveness of Brief Educational Training on Medical Students' Attitude toward Suicide Prevention
| ||Naresh Nebhinani, Pooja Patnaik Kuppili, Karandeep Paul |
| ||Journal of Neurosciences in Rural Practice. 2020; 11(04): 609 |
|[Pubmed] | [DOI]|
||The impact of suicide prevention education programmes for nursing students: A systematic review
| ||Monika Ferguson, Julie Reis, Lyn Rabbetts, Tara McCracken, Mark Loughhead, Kate Rhodes, Dianne Wepa, Nicholas Procter |
| ||International Journal of Mental Health Nursing. 2020; 29(5): 756 |
|[Pubmed] | [DOI]|
||A descriptive study of baccalaureate nursing studentsć responses to suicide prevention education
| ||Julie M. Pullen,Fredricka Gilje,Emily Tesar |
| ||Nurse Education in Practice. 2016; 16(1): 104 |
|[Pubmed] | [DOI]|