IN1kCDUC1ICN

Pumans have aLLempLed and successfully commlLLed sulclde slnce Llme lmmemorlal 1he
reasons for kllllng or harmlng oneself vary wlLh culLures and socleLles and ln urban or rural seLLlngs ln
anclenL Luropean culLures sulclde was common wlLh women uslng hanglng and men uslng varlous
Lools for dellberaLe selfharm ConsequenLly Lhere seems Lo be no reason Lo presuppose any slmllarlLy
of moral [udgmenL regardlng Lhe kllllng of oLhers and sulclde ln any rellglous LradlLlon 8aLher lL ls Lhe
unlque feaLures of Lhe respecLlve worldvlew as a whole LhaL wlll deLermlne wheLher Lhe answer wlll be
ln Lhe afflrmaLlve or negaLlve Powever noL only Lhe quesLlon wheLher llfe has a meanlng buL also Lhe
quesLlon wheLher lL has lnLrlnslc value lnevlLably arlses whenever someone Lhlnks serlously of endlng hls
own llfe premaLurely uoes Lhe mere facL of belng and remalnlng allve carry much welghL? Are Lhere
superlor values whlch can make lL preferable Lo choose deaLh? AnoLher quesLlon resulLs dlrecLly from
Lhe very naLure of sulclde and may Lherefore be addressed Lo all rellglous and phllosophlcal LradlLlons
allke Pas sulclde Lo be valued ln Lhe same way as Lhe kllllng of oLhers slnce lL Loo alms aL Lhe exLlncLlon
of a llfe? Cr has sulclde Lo be [udged dlfferenLly because by commlLLlng lL one does aL leasL lmmedlaLely
only harm Lo oneself?
ApproxlmaLely one mllllon people per year dle by sulclde worldwlde (World PealLh CrganlzaLlon
WPC 2006) ln Lhe unlLed SLaLes alone over 32600 lndlvlduals dled by sulclde ln 2003 Lhe equlvalenL
of 89 deaLhs per day or one deaLh every 16 mlnuLes (CuC 2003) 1he number of lndlvlduals who
aLLempL sulclde ls even greaLer aL leasL 10 Llmes greaLer Lhan Lhe number of deaLhs by sulclde (WPC
2006) unLll recenLly Malaysla does noL have offlclal sulclde raLes 1he naLlonal SLaLlsLlcs ueparLmenL
quoLed flgures as low as 1 per 100000 sulcldes per year(ueparLmenL of SLaLlsLlcs Malaysla 2003) whlle
cross secLlonal research ln dlfferenL parLs of Lhe counLry suggesLed hlgher flgures (Manlam 1988 PayaLl
Sallna eL al 2004) ln response Lo Lhls Lhe naLlonal Sulclde 8eglsLry Malaysla was offlclaLed ln 2007 Lo
complle Lhe census of sulcldal deaLhs LhaL occur ln Malaysla vla lLs neLwork of forenslc servlces lL ls
sponsored by Lhe sychlaLrlc and MenLal PealLh Servlces and Lhe lorenslc Medlclne Servlces of Lhe
MlnlsLry of PealLh Malaysla (MCP)





DLIINING SUICIDL

Sulclde ls generally descrlbed as Lhe lnLenLlonal Laklng of ones own llfe lor Lhe lndlvldual who
commlLs sulclde Lhe acL usually represenLs a soluLlon Lo a problem or llfe clrcumsLance LhaL Lhe
lndlvldual fears wlll only become worse ln deflnlng sulclde Lhe World 8eporL on vlolence and PealLh
quoLed a wellknown deflnlLlon by Lncyclopaedla 8rlLannlca (1973) and quoLed by Shneldman le ''Lhe
human acL of self lnfllcLlng one's own llfe cessaLlon" (World PealLh CrganlzaLlon 2002) Accordlng Lo
Shneldman (1983) sulclde ls o cooscloos oct of selfloJoceJ ooolbllotloo besL undersLood as a
mulLldlmenslonal malalse ln a needful lndlvldual who deflnes an lssue for whlch Lhe sulclde ls percelved
as Lhe besL soluLlon Also Marls (1981) deflnes a sulclde as any deaLh LhaL ls Lhe Jltect ot loJltect resulL
of posltlve ot oeqotlve acLs accompllshed by Lhe vlcLlm hlm or herself whlch she or he knows or
belleves wlll produce Lhls resulL llnally 8lazer koenlg (1996) deflnes sulclde by lLs scope Lo lnclude
Lhe ocote ooJ Jltect octs such as hanglng shooLlng polsonlng eLc and Lhe loJltect ooJ cbtoolc octs
such as refusal Lo eaL or Lo Lake medlcaLlons for poLenLlally faLal medlcal condlLlons
1he deflnlLlon of sulclde ls compllcaLed by Lhe facL LhaL by lLs scope sulclde conslsLs of far
ranglng emoLlonal and behavloural phenomena LhaL ln Llme perspecLlve mlghL occur lmpulslvely or
oLherwlse reflecL careful plannlng Sulclde and sulcldal behavlour ls Lyplcally grouped lnLo Lhree
caLegorles namely solclJe lJeotloo such as deaLh wlshes and sulclde feellngs and LhoughLs solclJe
ottempt or dellberaLe selfharm (also Lermed as parasulclde) and completeJ solclJe or successful sulclde
(ue Leo ulkesLra 1990) ln addlLlon Lo Lyplcal sulcldes compleLed sulclde can furLher be caLegorlsed
lnLo olJeJ solclJes LhaL lnclude eotboooslo and lbyslcloo osslsteJ solclJes (8lazer koenlg 1996)
Sulclde ls lnLrapsychlc lL ls noL slmply Lhe sLress or even Lhe paln buL Lhe persons lnablllLy Lo
cope wlLh Lhe evenL or paln 1he lssue of any scheme abouL human personallLy le personology
(Murray 1938) ls one LhaL makes an lndlvldual an lndlvldual lL should be Lhe sLudy of Lhe whole
organlsm noL only Lhe sLress or paln eople do noL slmply commlL sulclde because of paln buL because
lLs unbearable Lhey are menLally consLrlcLed Lhey cannoL cope and much more Powever from a
psychologlcal vlew sulclde ls noL only lnLrapsychlc lL ls also lnLerpersonal lndlvlduals are lnLerwoven
Sulclde occurs beLween people (or relaLlonshlps Lo some slmllar ldeal) MeLhaphorlcally speaklng
sulclde ls an lnLrapsychlc drama on an lnLerpersonal sLage
lL ls obvlous LhaL ln any deflnlLlon of sulclde Lhe lnLenLlon Lo dle ls a key elemenL Powever
unless Lhe deceased have made clear sLaLemenLs before Lhelr deaLh abouL Lhelr lnLenLlons or lefL a
sulclde noLe lL ls exLremely dlfflculL Lo reconsLrucL Lhe LhoughLs of people who commlLLed sulclde 1hus
Lhere has been a loL of dlsagreemenL abouL Lhe mosL sulLable Lermlnology Lo descrlbe sulcldal
behavlour
1ypes of su|c|de
O Lgo|st|c su|c|de ls commlLLed when Lhe glven lndlvldual uses sulclde as a means Lo escape faclng
Lhe consequences of hls acLlons Permann Crlng for example commlLLed sulclde before he was
Lo be execuLed
O tru|st|c su|c|de 1he person ls so embedded lnLo socleLy LhaL Lhey are convlnced LhaL sulclde ls
Lhe only means Lo conLrlbuLe Lo Lhe glven soclal groups exlsLence lor example !apanese
haraklrl
O om|c su|c|de 1he person has losL all Lhelr soclal conLacLs and commlLs sulclde as Lhe resulL of
noL belonglng anywhere
O Iata|st|c su|c|de 1he person ls convlnced LhaL Lhey cannoL ablde by Lhe rules of Lhe glven soclal
group whlch Lhey vlew as unchangeable and lrrefuLable

DIS1kI8U1ICN CI CSLS CCCkDING 1C S11LS
1he prevalence of sulclde ls reporLed as sulclde raLes per year" of a glven populaLlon 1he
sulclde raLe per year ls Lhe number of resldenLs' sulcldal deaLhs recorded durlng Lhe calendar year
dlvlded by Lhe resldenL populaLlon (CenLers for ulsease ConLrol and revenLlon 2003) as reporLed ln Lhe
offlclal Malayslan naLlonal SLaLlsLlcs ueparLmenL census flgures and mulLlplled by 100000 (CenLers for
ulsease ConLrol and revenLlon 2003) As menLloned earller daLa collecLlon ln 2007 can only be sLarLed
ln !uly Lhus daLa was avallable for 6 monLhs only and could noL be used Lo generaLe sulclde raLes
noLwlLhsLandlng LhaL Lhe number of cases reglsLered durlng Lhls perlod was 113 whlch may
seem raLher low 1hls may be due Lo Lhe facL LhaL evenLs wlLh lndeLermlnaLe lnLenL were noL capLured ln
Lhls reglsLry (llgure 1) llgure 1 shows Lhe dlsLrlbuLlon of cases accordlng Lo sLaLes uaLa ls noL avallable
for flve sLaLes erlls kedah negerl Sembllan Malacca and kelanLan 1here are no daLa for Lhose sLaLes
because nS8M was offlclaLed ln early 2007 and Lhe daLa collecLlon ls a very early aLLempL and mosL of
Lhe problems were relaLed wlLh manpower So Lhe Lop Lhree hlghesL ln sulclde cases are Selangor (22
cases) enang (21 cases) and erak (19 cases) 1he gender dlsLrlbuLlon of sulclde cases shows female 31
vlcLlms (27) and male 82 vlcLlms (73) 1he age dlsLrlbuLlon also shows LhaL Lhe average age who
commlLed sulclde are around age 23 Lo 40 1he youngesL case was 12 years old and Lhe oldesL was 93
years old ulsLrlbuLlon of eLhnlclLy among sulclde ls 11 for Malays 43 for Chlnese and 27 for
lndlans ConLrary Lo lnLernaLlonal llLeraLure where sulclde ls usually commlLLed by people who are
slngle (World PealLh CrganlzaLlon 2002) Lhe daLa showed LhaL a slgnlflcanL number of marrled person
commlLLed sulclde 31 slngle 47 wldowed 1 and cohablLlng 1 1he ma[orlLy of sulclde vlcLlms
(37) were fullLlmeemployed whlle 27 were unemployed Speclflc employmenL was ldenLlfled ln 46
cases 1he hlghesL employmenL were sLudenLs 9 cases(20) 3 buslnessman(7) drlvers 3 cases (7)
and oLhers ln flgure 7 lrom 113 cases of sulclde 88 of Lhe cases were 8roughL ln uead" (8lu) by Lhe
pollce for posLmorLem examlnaLlon 11 of cases dled ln Lhe ward and 1 dled ln Lhe emergency
deparLmenL MosL of Lhe cases whlch were admlLLed Lo Lhe wars had used polsonlng meLhods A large
ma[orlLy of paLlenLs 646 chose Lo commlL sulclde aL home seLLlngs as shown ln 1able 3
ln general Lhe soclo demographlc proflle of sulclde vlcLlms was slmllar Lo prevlous sLudles
Accordlng Lo WealLh PealLh CrganlzaLlon Lhe sulclde raLes worldwlde for Lhe year 2007 were
conslsLenLly hlgher among males compared Lo females (World healLh CrganlzaLlon 2008) 1he age group
was also conslsLenL wlLh prevlous sLudles where Lhe predomlnanL age group Lo commlL sulclde were
among Lhe young (McClure 2000) 1he eLhnlc dlsLrlbuLlon were slmllar Lo Lhe flndlngs from oLher local
sLudles (nadesan 1999 PayaLl Sallna eL Al 2004 1eo 1he eL al 2008) where lndlans were conslsLenLly
reporLed Lo have Lhe hlghesL sulclde raLe 1hls Lrend needs Lo be observed on a longer Lerm before any
concluslons can be mad abouL Lhe assoclaLlon beLween gender and marlLal sLaLus amongsL Lhose who
commlLLed sulclde ln Malaysla

,CDLS CI SUICIDL
ln general lndlvlduals who aLLempL sulclde dlffer from Lhose who compleLe sulclde Sulclde
aLLempLers are llkely Lo be female and generally aLLempL sulclde by Laklng an overdose of medlcaLlon
Sulclde compleLers by conLrasL are more ofLen male and Lend Lo use more leLhal means ApproxlmaLely
40 percenL of paLlenLs who commlL sulclde have made prevlous sulclde aLLempLs 1houghLs abouL
sulclde referred Lo as sulcldal ldeaLlon are an lmporLanL rlsk facLor for sulclde Powever many
lndlvlduals experlence sulcldal ldeaLlon buL never commlL or aLLempL sulclde 1hls ls especlally Lrue for
paLlenLs wlLh advanced Lermlnal lllness or deblllLaLlng chronlc lllness 1here ls huge varlaLlon ln Lhe use
of meLhods for sulclde all over Lhe world ln uSA 60 percenL of all sulcldes are commlLLed wlLh flrearms
whlle ln SouLheasL Asla a slmllar flgure accounLs for pesLlclde sulcldes LddlesLon eL al 1998 Cunnell
and LddlesLon 2003 1he mosL favoured sulclde meLhods amongsL Malayslan are hanglng
sLrangulaLlon and suffocaLlon 8oLh male and female favoured Lhls meLhod for sulclde As shown ln a
sLudy by ! Penderson eL al (Penderson Mellln eL al2003) Lhe ma[orlLy of sulcldes were by hanglng
1echnlcally lL may also be Lhe easlesL meLhod Lo be dlagnosed 1he second mosL wldely chosen meLhod
ls exposure Lo pesLlclde followed by [umplng from helghL whlch conLrlbuLed 14163 of Lhe sulclde cases
Panglng ls Lhe prevalenL means of sulclde ln prelndusLrlal socleLles and ls more common ln
rural areas Lhan ln urban areas lL ls also a common means of sulclde ln slLuaLlons where maLerlals are
noL readlly aL hand (such as ln prlsons) WlLh Lhls Lechnlque Lhe paLlenL aLLempLs Lo use some form of
devlce around Lhe LhroaL Lo sLrangle and/or break Lhe neck ln Lhe evenL of deaLh Lhe acLual cause of
deaLh depends upon Lhe Lype of hanglng used where Lype usually refers Lo Lhe lengLh of Lhe drop ln a
shorL drop Lhe vlcLlm may dle from sLrangulaLlon ln whlch Lhe deaLh may resulL from a lack of alr
asphyxlaLlng Lhe braln lf Lhe former ls Lrue Lhe paLlenL ls llkely Lo experlence hypoxla skln Llngllng
dlzzlness vlslon narrowlng convulslons shock and acuLe resplraLory acldosls lf Lhe laLLer ls Lrue one or
boLh caroLld arLerles and or Lhe [ugular veln may be compressed sufflclenLly Lo cause cerebral lschemla
and a hypoxlc condlLlon ln Lhe braln whlch wlll evenLually resulL ln or conLrlbuLe Lo Lhe deaLh ln Lhe case
of a sufflclenLly long drop Lhe paLlenL ls llkely Lo suffer a fracLured 2nd and 3rd and or 4Lh and 3Lh
cervlcal verLebrae whlch may cause paralysls or deaLh Sulclde by suffocaLlon ls Lhe acL of lnhlblLlng
ones ablllLy Lo breaLhe or llmlLlng oxygen upLake whlle breaLhlng causlng hypoxla and evenLually
asphyxla 1hls may lnvolve an exlL bag (a plasLlc bag flxed over Lhe head) or conflnemenL ln an enclosed
space wlLhouL oxygen 1hese aLLempLs lnvolve uslng depressanLs Lo make Lhe user pass ouL due Lo Lhe
oxygen deprlvaLlon before Lhe lnsLlncLlve panlc and Lhe urge Lo escape due Lo Lhe hypercapnlc alarm
response Pellum argon and nlLrogen are commonly used ln sulcldes by suffocaLlon 8reaLhlng lnerL gas
qulckly renders a person unconsclous and may cause deaLh wlLhln mlnuLes
Worldwlde ln comparlson 30 of sulcldes are from pesLlclde polsonlngs 1he use of Lhls meLhod
however varles markedly ln dlfferenL areas of Lhe world from 4 ln Lurope Lo more Lhan 30 ln Lhe
aclflc reglon olsonlng by farm chemlcals ls very common among females ln Lhe Chlnese counLryslde
and ls regarded as a ma[or soclal problem ln Lhe counLry ln llnland Lhe hlghly leLhal pesLlclde araLhlon
was commonly used for sulclde ln Lhe 1930s When access Lo Lhe chemlcal was resLrlcLed oLher
meLhods replaced lL leadlng researchers Lo conclude LhaL resLrlcLlng cerLaln sulclde meLhods does llLLle
Lo lmpacL Lhe overall sulclde raLe
!umplng from helghL ls Lhe acL of [umplng from hlgh alLlLudes for example from a wlndow (self
defenesLraLlon or auLodefenesLraLlon) balcony or roof of a hlgh rlse bulldlng cllff dam or brldge ln Lhe
unlLed SLaLes [umplng ls among Lhe leasL common meLhods of commlLLlng sulclde (less Lhan 2 of all
reporLed sulcldes ln Lhe unlLed SLaLes for 2003) ln Pong kong [umplng ls Lhe mosL common meLhod of
commlLLlng sulclde accounLlng for 321 of all reporLed sulclde cases ln 2006 and slmllar raLes for Lhe
years prlor Lo LhaL 1he CenLre for Sulclde 8esearch and revenLlon of Lhe unlverslLy of Pong kong
belleves LhaL lL may be due Lo Lhe abundance of easlly accesslble hlgh rlse bulldlngs ln Pong kong

1nLCkILS CI SUICIDL
1he |terpersoapsychoog|ca theory
1he lnLerpersonalpsychologlcal Lheory of sulcldal behavlor (!olner 2003) holds LhaL an
lndlvldual wlll dle by sulclde lf he or she has boLh Lhe deslre for sulclde and capablllLy Lo acL on LhaL
deslre Accordlng Lo Lhe Lheory sulcldal deslre resulLs from Lhe convergence of Lwo lnLerpersonal sLaLes
percelved burdensomeness and LhwarLed belonglngness Powever deslre alone ls noL sufflclenL Lo
resulL ln deaLh by sulclde because a Lhlrd componenL musL be presenL Lhe acqulred capablllLy for
sulclde whlch develops from repeaLed exposure and hablLuaLlon Lo palnful and provocaLlve evenLs

ercelved burdensomeness ls Lhe vlew LhaL one's exlsLence burdens famlly frlends and/or socleLy 1hls
vlew produces Lhe ldea LhaL my deaLh wlll be worLh more Lhan my llfe Lo famlly frlends socleLy eLc"
a vlew lL ls lmporLanL Lo emphaslze LhaL represenLs a poLenLlally faLal mlspetceptloo Lvldence lndlcaLes
LhaL when lndlvlduals dle by sulclde Lhey ofLen feel dlsconnecLed from oLhers 1hls feellng can reflecL a
sense on Lhe parL of Lhe lndlvlduals LhaL nobody Lruly cares abouL Lhem or alLernaLlvely lL can reflecL a
sense LhaL whlle oLhers mlghL care nobody can relaLe Lo Lhem and undersLand Lhelr slLuaLlon 8oLh
sensaLlons leave lndlvlduals feellng lnLolerably lsolaLed ln reallLy lndlvlduals who dle by sulclde rarely
lf ever Lruly lack oLhers who care abouL Lhem buL Lhe dysfuncLlonal auLomaLlc LhoughLs LhaL are
characLerlsLlc of menLal lllness skew Lhe lndlvlduals percepLlons of Lhe world around Lhem
Meanwhlle a low sense of belonglngness ls Lhe experlence LhaL one ls allenaLed from oLhers noL an
lnLegral parL of a famlly clrcle of frlends or oLher valued group
O We musL dlfferenLlaLe beLween Lhe Jeslte for deaLh by sulclde and Lhe copoblllty for deaLh by
sulclde
O lew who deslre have Lhe capablllLy and few wlLh Lhe capablllLy have Lhe deslre
O 1he deslre ls comprlsed of Lwo varlables LhwarLed belonglngness and percelved
burdensomeness 1he former refers Lo a dlsLorLed bellef of an lndlvldual LhaL he or she has no
meanlngful connecLlons Lo oLhers and Lhe laLLer refers Lo a dlsLorLed bellef of an lndlvldual LhaL
he or she makes no meanlngful conLrlbuLlons Lo Lhe world
O 1he acqulred capablllLy for sulclde ls comprlsed of a dlmlnlshed fear of deaLh and a helghLened
Lolerance for physlcal paln 1hls ls developed Lhrough repeaLed exposure Lo palnful and/or
provocaLlve evenLs

Structura 1heor|es ]Durkhe|m's theory of Su|c|de
Lmll uurkhelm ls Lhe founder of Lhe sLrucLural funcLlonallsL perspecLlve 1hls ls essenLlally Lhe
vlew LhaL everyLhlng ln socleLy has a glven funcLlon LhaL lL musL perform wlLhln LhaL socleLy ln order for
lL Lo conLlnue Lo survlve ln a generallsed vlew uurkhelm's Lheory sLaLes LhaL solclJe votles lovetsely
wltb tbe Jeqtee of loteqtotloo of tbe soclol qtoop of wblcb tbe loJlvlJool fotms o pott (1897/1931 209)
Accordlng Lo uurkhelm Lhen Lhe lower rlsk for sulclde ls experlenced ln Lhe relaLlvely welllnLegraLed
socleLy (le Lhe normal socleLy) Lhe characLerlsLlc of whlch ls a balance or equlllbrlum wlLh regard Lo
boLh soclal lnLegraLlon and soclal regulaLlon uslng egolsm alLrulsm and anomle as lndlcaLors of Lhe
soclal equlllbrlum uurkhelm argued LhaL some degree of all Lhe Lhree lndlcaLors do noL only always exlsL
ln any socleLy buL ls also necessary for Lhe wellbelng of Lhe socleLy
uurkhelm esLabllshed LhaL
O Sulclde raLes are hlgher ln men Lhan women (alLhough marrled women who remalned chlldless
for a number of years ended up wlLh a hlgh sulclde raLe)
O Sulclde raLes are hlgher for Lhose who are slngle Lhan Lhose who are marrled
O Sulclde raLes are hlgher for persons wlLhouL chlldren Lhan persons wlLh chlldren
O Sulclde raLes are hlgher among roLesLanLs Lhan CaLhollcs and !ews
O Sulclde raLes are hlgher among soldlers Lhan clvlllans
O Sulclde raLes are hlgher ln Llmes of peace Lhan ln Llmes of war (War also reduced Lhe sulclde
raLe afLer war broke ouL ln 1866 beLween AusLrla and lLaly Lhe sulclde raLe fell by 14 ln boLh
counLrles)
O Sulclde raLes are hlgher ln Scandlnavlan counLrles
O Lhe hlgher Lhe educaLlon level Lhe more llkely lL was LhaL an lndlvldual would commlL sulclde
however uurkhelm esLabllshed LhaL rellglon was more lmporLanL Lhan educaLlon !ewlsh people
were generally hlghly educaLed buL had a low sulclde raLe
lrom a soclal change polnL of vlew LhaL rural elders are aL a hlgher rlsk for sulclde Lhan Lhelr
urban ln conLrasL Lo Lhe rural elder Lhe urban elder may depend less on Lhelr chlldren be more
lndependenL and less confllcLed abouL soclal change prlnclpally because Lhey Lhemselves have opLed
for Lhe nuclearfamlly sysLem ln an agelng perspecLlve ?ampey (1973) observes LhaL ln Lhe early sLages
of soclal LransformaLlon Lhe young are aL a greaLer rlsk for sulclde as Lhey Lry Lo cope wlLh Lhe
challenges polsed by mlgraLlon urbanlsaLlon and lndusLrlallsaLlon uurlng Lhls perlod ln Llme he
suggesLs LhaL Lhe elderly mlghL be aL a lesser rlsk slnce Lhey may sLlll have some sLaLus and respecL
remalnlng from Lhe LradlLlonal sLrucLures ln laLer sLages of Lhe LransformaLlon Lhe balance shlfLs Lo
render Lhe elderly more vulnerable as Lhe LradlLlonal supporLlve sLrucLures wlLher away Lhus renderlng
Lhelr lnLegraLlon and regulaLlon lnLo Lhe changed or dlsorganlzed socleLy problemaLlc 8esldes Lhe
urban soclal envlronmenL provldes opporLunlLles for recreaLlon and supporLlve servlces whlch are llkely
Lo make urban elders feel less lsolaLed or abandoned and Lherefore conLrlbuLlng Lo Lhelr lower rlsk for
sulclde (WaLanabe eL al 1996)

1he ,oder|sat|o 1heory
ln soclologlcal llLeraLure Lhe concepL of modernlsaLlon ls deflned varlously wlLh auLhors agreelng
LhaL lL ls a process of soclal change buL dlfferlng on Lhe characLerlsLlc feaLures emphaslsed as
dlfferenLlaLlng Lhe modern from Lhe LradlLlonal Cowglll offers Lhe deflnlLlon modernlsaLlon as

@be ttoosfotmotloo of o totol soclety ftom o telotlvely totol woy of llfe boseJ oo oolmote powet llmlteJ
tecbooloqy telotlvely ooJlffeteotloteJ lostltotloos potocblol ooJ ttoJltloool ootlook of voloes towotJ o
pteJomloootly otboo woy of llfe boseJ oo looolmote sootces of powet blqbly JevelopeJ scleotlflc
tecbooloqy blqbly JlffeteotloteJ lostltotloos motcbeJ by seqmeoteJ loJlvlJool toles ooJ o cosmopolltoo
ootlook wblcb empboslses efflcleocy ooJ ptoqtess (1974 127)




kISk IC1CkS
1here are 3 facLors LhaL appear when examlnlng sulclde deaLhs reLrospecLlvely ln Malaysla
n|story of rev|ous Su|c|de ttempts
8ecks's Lheory sLaLes LhaL prevlous sulcldal experlence senslLlzes sulclderelaLed LhoughLs and
behavlours such LhaL Lhese ldeas become more accesslble and acLlve 1he more accesslble and acLlve
Lhese schemes and modes become Lhe more easlly Lhey are Lrlggered and Lhe more severe are Lhe
subsequenL sulcldal eplsodes (1easdale 1988) ApproxlmaLely onehalf of persons who dled by sulclde
have a hlsLory of selfharm (losLer 1997)

n|story of Substace buse
LlLLle ls known abouL Lhe Lypes of subsLance mosL sLrongly relaLed Lo sulclde aLLempLs Sulclde
aLLempLs could be assoclaLed wlLh a pasL hlsLory of subsLance dlsorder or could be assoclaLed wlLh
havlng an acLlve dlsorder only SubsLance users wlLh sulcldal ldeaLlons have an elevaLed rlsk of flrsL
sulclde aLLempLs even ln Lhe absence of a plan SLudles have shown LhaL Lhere ls an assoclaLlon beLween
Lhe number of subsLance used and Lhe onseL of sulcldal ldeaLlon a doserelaLed manner lrom Lhe daLa
obLalned lL was found LhaL ma[orlLy of Lhe vlcLlms gave a poslLlve hlsLory of Lobacco use ln conLrasL Lo
Lhe currenL flndlngs or mlsuse has been assoclaLed wlLh hlgher lncldence of sulclde (lawceLL eL al
1990uuggan eL al8ronlsch PechL 1992) 1he posslble explalnaLlon for Lhe flndlngs ln Lhls counLry
LhaL Lhere ls hlgher prevalence of Lobacco use raLher Lhan alcohol alcohol abuse could be overlooked ln
women whlch would resulLs ln loss of vlLal lnformaLlon

hys|ca Iessn|story ad 1ype of |ess
CompleLed sulclde osslblllLles are LhaL persons wlLh physlcal lllness are more llkely Lo be
depressed and depressed lndlvlduals are more llkely Lo be sulcldal 1herefore Lhe depresslon could fully
explaln Lhe assoclaLlon beLween physlcal lllness by a general medlcal condlLlon and sulclde Pence lL ls
vlLal Lo undersLand wheLher such relaLlonshlp exlsL afLer conLrolllng for depresslve lllness Pavlng more
Lhan one medlcal lllness conferred a parLlcular hlgh rlsk (uruss 2000) 1he presence of a physlcal lllness
may represenL proxles for oLher lnLermedlaLe facLors such as funcLlonal dlsablllLy dlsrupLlon of soclal
supporL chronlc paln whlch may lead Lo a lower quallLy llfe 1hus lndlvldual may regard Lhelr llfe as no
longer worLh llvlng Seven cases (62) were reporLed Lo be havlng a physlcal lllness Sub[ecLs gave
ahlsLory of medlcal lllness such as dlabeLes (2 vlcLlms) and cerebroascular accldenLs(2 vlcLlms) and
oLhers one vlcLlms such as coronary arLerlal dlsease malarlal lnfecLlon and abdomlnal dlscomforL

,eta |ess
1he presence of menLal lllness has been ldenLlfled as a sLrong predlcLor of sulclde compleLlons
1hree ma[or menLal dlsorders wlLh hlgh rlsk for sulclde are Ma[or uepresslve Lplsode uependenL use of
subsLance and emoLlonally unsLable ersonallLy ulsorder (Cheng Chen eL al 2000) eople wlLh more
Lhan one of Lhese dlagnose ln Lhe severlLy of Lhe dlsorder Powever lnLervlews wlLh nexLofkln afLer
sulclde deaLhs ln nS8M revealed LhaL 77 of all sulcldes have no hlsLory of menLal lllness and only 71
have hlsLory of menLal lllness Among Lhe deceased who had hlsLory of menLal lllness 2 (18) of Lhem
were dlagnosed Lo have depresslon 2(18) had Schlzophrenla and 3 (27) were undlagnosed and
unLreaLed

L|fe Lvets r|or to su|c|de
A hlgh proporLlon of sulcldes 38(336) had experlenced llfe evenLs wlLhln Lhree monLhs before
sulclde Among Lhls group 60 or 23 of Lhe deceased had lnLlmaLe parLner problem and 13 or 3 had
flnanclal problem lnLeresLlngly 36 of Lhe deceased had no llfe evenL Lhree monLhs prlor Lo suclcede
and 36 of Lhem were noL known wheLher llfe evenLs preclplLaLed Lhelr sulclde MosL of prevlous
sLudles ln lnvesLlgaLlng Lhe relaLlonshlp beLween recenL llfe evenLs and sulclde have had small sample
slze and have focused on psychlaLrlc paLlenLs(Pelkklnen Aro eL al 1993) whlch makaes lL dlfflculL Lo
examlne Lhe power of an assoclaLlon(8unch 1972losLer Clllessple eL al1999) 1hese sLudles have
generally found LhaL recenL evenLs have a slgnlflcanL conLrlbuLlon Lo Lhe rlsk of sulclde

5chitophrenio
Schlzophrenla ls a llfeshorLenlng dlsease as sLaLed by Allebeck ln 1989 Allebeck 1989 Much
aLLenLlon has been pald Lo Lhe rlsk of sulclde ln schlzophrenla Slnce Mlles Mlles 1977 ln a revlew
esLlmaLed LhaL Lhe rlsk of sulclde was 10 percenL Lhls flgure had been repeaLed many Llmes ln revlews
and commenLs SLaLemenLs llke 10 percenL dle from sulclde" were someLlmes based on Lhe calculaLlon
of Lhe proporLlon of sulcldes ln relaLlon Lo all deaLhs buL slnce followup perlods are noL llfelong Lhere
ls an obvlous rlsk of overesLlmaLlng Lhe sulclde rlsk slnce sulcldes ofLen occur early ln Lhe course of
schlzophrenla whereas naLural deaLhs occur laLer ln llfe lnsklp eL al 1998 Paw eL al conducLed a
sysLemaLlc revlew of schlzophrenla and dellberaLe selfharm and ldenLlfled pasL or recenL sulcldal
ldeaLlon prevlous dellberaLe selfharm pasL depresslve eplsode drug abuse or dependence and hlgh
number of psychlaLrlc admlsslons as rlsk acLors for dellberaLe selfharm among paLlenLs wlLh
schlzophrenla Paw eL al 2003

coho|sm ad affect|ve d|sorder
Also affecLlve dlsorder and alcohollsm have been consldered Lo have hlgh llfeLlme rlsk of sulclde
Mlles Mlles 1977 esLlmaLed LhaL Lhe llfeLlme rlsk of sulclde ln alcohollsm would be 13 percenL oplaLe
addlcLlon flve percenL and depresslon 13 percenL lnsklp eL al lnsklp eL al 1998 esLlmaLed Lhe llfeLlme
rlsk ln alcohol dependence Lo be seven percenL and slx percenL ln affecLlve dlsorder 8osLwlck and
ankraLz 8osLwlck and ankraLz 2000 dlvlded Lhe sulclde rlsk ln affecLlve dlsorder ln several dlfferenL
rlsk groups wlLh dlfferenL esLlmaLlon of llfeLlme rlsk for sulclde 1helr esLlmaLe of llfeLlme rlsk for
paLlenLs wlLh affecLlve dlsorder hosplLallzed for sulcldallLy was 86 percenL whlle for paLlenLs wlLh
affecLlve dlsorder wlLh no speclflc hlsLory of sulcldallLy Lhe llfeLlme rlsk esLlmaLlon was 40 percenL and
for ouLpaLlenLs wlLh affecLlve dlsorder 22 percenL

Depress|o
uepresslon lncludlng ma[or depresslon and depresslve sympLoms ls a crlLlcal rlsk facLor for
compleLed sulcldes Malayslan adolescenL are reporLed as follows Sulclde seems Lo be Lhe hlghesL rlsk
percelved Sulclde whlch ls Lhe dellberaLe acLlon of Laklng of ones own llfe ls consldered a sln ln every
ma[or rellglon ln Malaysla buL adolescenLs seem Lo be Lhlnklng of sulclde qulLe serlously 8esearchers
ofLen dlsLlngulsh beLween Lhose who compleLely succeed ln commlLLlng sulclde and Lhose who aLLempL
buL are unsuccessful1he research here ls abouL Lhose who Lhlnk abouL lL 8esearchers suggesL LhaL for
many Lhere ls a naLural progresslon from Lhlnklng or percelvlng abouL Lhe posslblllLy of commlLLlng
sulclde Lo formlng a plan and flnally Lo aLLempLlng sulclde (kessler 8orges WalLers 1999)

Drug dd|ct|o
AnoLher rlsk LhaL ls seen as llkely Lo be Laken by Lhe adolescenLs ln Malaysla ls drugs addlcLlon
urug users can be descrlbed as people wlLh dlfferenL noLlon when Lhey do so 1here are Lhe
advenLurous and Lhe Llmld Lhe weak and Lhe sLrong Lhe deluded and Lhe raLlonal 1he Amerlcan
sychlaLrlc AssoclaLlon dlfferenLlaLes a number of drug use Lerms urug abuse refers Lo Lhe
recreaLlonal use of drugs 8hugra et ol (1999b) found LhaL Aslan women were more llkely Lo repeaL
overdoses whlch suggesLs LhaL adequaLe prevenLlve sLraLegles may be successful As a slgnlflcanL
proporLlon of aLLempLed sulcldes by Aslan females are lmpulslve any assessmenL and lnLervenLlon
should also Lake lmpulslve acLs lnLo accounL

SLLLC1IVL kLVLN1ICN IN kISk GkCUS
WPlCP A8L 1PL 8lSk C8CuS?
Sulclde rlsk dlffers accordlng Lo age and sex groups buL ln Lhe followlng Lhese groups are noL
consldered as rlsk groups 1he mosL lmporLanL are Lhe menLally lll alcohol and drugs abusers Lhose
wlLh a newly dlagnosed severe somaLlc dlsease prlsoners lnsLlLuLlonallzed persons and sulclde
survlvors lL ls well documenLed LhaL menLal lllness ln all dlagnosLlc groups ls a rlsk facLor for sulclde
MorLensen eL al 2000

1he koe of Govermet
1he Malayslan governmenL ls always senslLlve Lo Lhe needs of lLs socleLy 1hus pollcles are
creaLed and socleLles enable such pollcles Lo be lmplemenLed Powever pollcles musL be conslsLenL and
revlewed from Llme Lo Llme ln 2004 an anLlsmoklng campalgn Lhemed 1ak nak was launched Puge
blllboards were puL up ln sLraLeglc places such as shopplng complexes bus sLaLlons and oLher people
orlenLed places unforLunaLely Lhe adolescenLs who were Lhe maln LargeL of Lhls campalgn pald no or
leasL aLLenLlon and wenL on wlLh Lhelr smoklng behavlor
Selfharm ls a healLh lssue harm Lo oLhers ls a crlme 1he governmenL ls able Lo use leglslaLlon
Lo prevenL lndlvlduals and organlzaLlons from lmposlng unaccepLable rlsks of harm on oLhers and on
Lhemselves 1he governmenL should LargeL on educaLlon encouraglng lndlvldual and organlzaLlonal
responslblllLy Lhrough lnformed cholce AdolescenLs who percelve and are wllllng Lo Lake rlsk relaLed
acLlvlLles need Lo undersLand Lhe consequences of Lhelr acLlon lf such a rlsk ls underLaken A soclal cosL
ln Lerms of healLh LreaLmenL ls lmposed by selfharm CovernmenL can lmpose hlgher Lax Lo Lrades
relaLed Lo acLlvlLles LhaL rlsk selfharm 1axaLlon of alcohol and clgareLLes should cover Lhe cosL of all
requlred drugrelaLed servlces Plklng up prlces of harmful subsLances can hlnder adolescenLs from
consumlng such rlsk relaLed maLerlals as Lhey wlll reallze LhaL obLalnlng Lhem ls noL an easy Lask
1he governmenLs modernlzaLlon program wlll evenLually lead Lo lnLegraLed evldencebased
drug regulaLlons urug relaLed regulaLlons ln Malaysla show convergence upon Lhe LargeLlng of
leglslaLlon agalnsL harm Lo oLhers as well as on ones own self 1hese are clearly sLaLed ln Lhe uangerous
urug AcL under SecLlon 37 of Lhe uangerous urug AcL any person who ls found ln possesslon of 13
grams or more of heroln morphlne or monoaceLy morphlnes or 200 grams or more of cannabls or
cannabls resln or 1000 grams or more of raw oplum or prepared oplum ls presumed Lo be Lrafflcklng ln
drugs under SecLlon 398 (2) of Lhe uangerous urug AcL Lhe drug Lrafflcker shall be punlshed on
convlcLlon wlLh deaLh 1hus adolescenLs should be clear of Lhe consequences lf Lhelr percepLlon of
Laklng drugs conLlnue Lo Lhe acLual acL A ma[or challenge Lo Lhe governmenL ls Lo encourage rlsk
percepLlon conslsLenL wlLh sclenLlflc evldence 1hls ls a problem faced by noL only Lhe governmenL buL
also all organlzaLlons and lndlvlduals 1he governmenL has a responslblllLy Lo correcL faulLy rlsk
percepLlon Lhrough evldencebased educaLlon An educaLed adolescenL wlll be ln a beLLer poslLlon Lo
raLlonallze Lhe dangers of smoklng and drugs compared Lo an uneducaLed adolescenL who can be easlly
lnfluenced by adverLlsemenLs and medla

Voutary ad Commu|ty Crga|zat|osNogovermeta Crga|zat|os
ln Malaysla volunLary and communlLy organlzaLlons/nongovernmenLal organlzaLlons (nCCs)
are under Lhe umbrella of naLlonal and lnLernaLlonal bodles Lhelr roles lnclude creaLlng awareness
helplng Lroubled groups or lndlvlduals and maklng Lhe counLry a beLLer place Lo sLay CLher acLlons
Laken may lnclude lnlLlaLlng slmple buL effecLlve warnlng slgns ln rlsk behavlor lor example alongslde
healLh warnlngs on producLs could be conLacL deLalls for an umbrella organlzaLlon concerned wlLh LhaL
producL 1hese volunLary and communlLy organlzaLlons and nCCs may provlde an lmporLanL llnk
beLween adolescenLs socleLy and Lhe governmenL An adolescenL who percelves premarlLal sex and
ls unsure of lLs consequences can always call up nCCs Lo clear doubLs or dlscuss Lhe rlsk he or she plans
Lo underLake ulLlmaLely a slgnlflcanL proporLlon of pollcymaklng as suggesLed earller mlghL be devoLed
Lo Lhese umbrella organlzaLlons whlch would Lhen aLLempL Lo resolve confllcLlng vlews 1hls lndlrecLly
helps ln reduclng Lhe burden on Lhe governmenL

1he Ifuece of Iam|y
1he famlly ls a powerful lnfluence on Lhe menLal healLh of adolescenLs lamlly members
especlally parenLs and slbllngs become lmporLanL moLlvaLlng facLors for adolescenLs noL Lo lndulge ln
rlsk acLlvlLles Lhey percelve Laklng 1hey reallze LhaL such acLs mlghL brlng shame Lo Lhe famlly Such gullL
keeps Lhem away from pursulng Lhe rlsk acL Cn Lhe oLher hand famlly facLors such as parenLlng
behavlor and sLyle mlghL lnfluence an adolescenL Lo commlL a rlsk acL lor example a son who ls always
challenged by a bruLal faLher Lo show he ls a man mlghL end up smoklng or [olnlng a gang [usL Lo prove lL
Lo hls faLher Accordlng Lo a 23 ?ear SLudy by Lhe naLlonal lnsLlLuLe of MenLal PealLh alLhough
numerous facLors ouLslde famlly can lnfluence menLal healLh Lhere are cerLaln famlly envlronmenLs LhaL
were sLrongly assoclaLed wlLh serlous menLal dlsorders subsLance abuse and sulcldal behavlors 8lsk
facLors lnfluenclng adolescenLs Lo Lake rlsk lnclude famlly confllcL and vlolence noL feellng valued as a
famlly member or feellng llke a dlsappolnLmenL Lo Lhelr famlly deaLh of a parenL before age 13 parenLs
dlvorce and worklng moLhers 1hough famlly composlLlon has changed over Lhe years Lhe famlly has
a powerful lnfluence over adolescenLs LranslLlon Lo percelvlng and Laklng rlsks acLlvlLles

Cosequeces of k|sk 1ak|g
1he consequence of rlsk Laklng by adolescenLs puLs a of socleLy aL rlsk Lhrough lessened
poLenLlal for our collecLlve fuLure (Lerner 1997) lL ls Llme Lo come LogeLher Lo ponder and Lo wonder
why a mulLlculLural naLlon llke Malaysla wlLh all lLs ma[or rellglons and lnbullL values soclal norms and
sLrlcL leglslaLlon can have adolescenLs who are percelvlng rlsks LhaL are noL a norm Lo an eLhlcal socleLy
WlLh Lhe resources avallable and Lhe knowledge galned a common vlslon and a unlfled efforL are
needed lurLher researches can focus on evaluaLlng campalgns and programs and ensure LhaL efforLs
produce Lhe deslred resulLs besldes ldenLlfylng whaL works besL aL dlfferenL sLages of adolescence wlLh
dlfferenL lssues and wlLh dlfferenL LargeL populaLlons Larly conLlnuous and conslsLenL lnLervenLlon ls
Lhe key (8ogenschnelder 1996) Larly ldenLlflcaLlon of Lhose adolescenLs mosL aL rlsk wlll need serlous
aLLenLlon revenLlon efforLs Lo reduce rlsk Laklng and aL Lhe same Llme enhanclng proLecLlve facLors
look favorable aL Lhls sLage


kI,k SLCCNDk ND 1Lk1Ik kLVLN1ICN
A common model of dlsease prevenLlon ls Lo spllL prevenLlve measures lnLo prlmary secondary
and LerLlary measures Caplan 1964 rlmary prevenLlon ls almed aL lndlvlduals who have noL yeL
shown any slgns of lllness 1he alm ls Lo prevenL Lhe dlsease process from sLarLlng lmmunlzaLlon
campalgns seaL belLs and learnlng a healLhy llfe sLyle durlng upbrlnglng are examples of prlmary
prevenLlon Secondary prevenLlon LargeLs lndlvlduals who have had subLle slgns of Lhe sLarL of a dlsease
process 1he alm of secondary prevenLlon ls Lo sLarL LreaLmenL durlng Lhe early sLages of Lhe dlsease
process MosL screenlng programmes are based on secondary prevenLlon 1erLlary prevenLlon LargeLs
lndlvlduals who have a dlagnosed dlsease and who need LreaLmenL and supporL Lo prevenL
compllcaLlons from Lhe dlsease 1hls lncludes monlLorlng Lhe dlsease relapse prevenLlon followup
programmes
Sllverman has suggesLed LhaL LerLlary prevenLlon should be undersLood as lnLervenLlon afLer Lhe flrsL
sulclde aLLempL Sllverman 1996 lf sulclde should be compared Lo a dlsease an acuLe condlLlon llke
pneumonla mlghL be a beLLer comparlson As prevlously menLloned sulcldal acLs can be consldered Lo
be a severe and prevenLable compllcaLlon of a range of dlseases or condlLlons ln whlch soclal facLors
play an lmporLanL role 1he problem of sulclde flLs lnLo a suscepLlble due Lo some Lemporary or more
permanenL condlLlon

8ecommendaLlon (speclflc Lo malaysla)
Cllnlclans musL be aware of Lhe dlfferences beLween Lhose who conslder sulclde Lhose who
aLLempL lL and Lhose who are successful 1he assoclaLlon beLween Lhese Lhree groups and Lhelr
relaLlonshlp wlLh oLher facLors needs Lo be furLher clarlfled Sulcldal behavlour needs Lo be sLudled
across Lhe llfe cycle ln relaLlon Lo gender roles and culLural and soclal expecLaLlons ueflnlLlons of Lhe
self also dlffer and are lnfluenced by culLure and socleLy Pence lL becomes lmporLanL LhaL Lhe
lndlvlduals' percepLlons of self are ldenLlfled ln Lhe conLexL of Lhelr culLure AdolescenLs who are newly
aware of Lhelr much renowned power and smlLLen wlLh a sense of compeLence and lnvulnerablllLy need
proper guldance Lo be lnsLllled wlLh a seL of values accepLed ln Malayslan socleLy
1he sLudy on Malayslan adolescenLs rlsks percepLlon has helped Lo generaLe a caLalogue of
ecologlcallyvalld acLlvlLles and behavlors LhaL lnvolve adolescenLs Laklng rlsks ln Malaysla 1he lssues or
rlsk acLlvlLles percelved by adolescenLs ln Malaysla can be furLher sLudled Lhrough dlfferenL
perspecLlves 1he culLural soclal economlc rellglons reglonal and ecologlcal lnfluence can also be
researched Lo ldenLlfy and undersLand Lhe adolescenLs who are noL [usL under Lhe umbrella of a naLlon
buL a global communlLy
Malaysla ls raclng Lowards developlng counLry sLaLus by Lhe year 2020 lndusLrlal developmenL
musL come hand ln hand wlLh lndlvldual developmenL 1hls condlLlon brlngs loLs of change ln one's
llfesLyle ln general and women's llfesLyle ln parLlcular Changes ln one's soclal llfesLyle for example
LranslLlon from LradlLlonal exLended famlly Lo nuclear famlly also embarks more sLress among women
Soclal supporL and supporL from slgnlflcanL oLhers wlll become less ln addlLlon a rlslng awareness on
equal opporLunlLy among men and women resulLs ln more compeLlLlon and sLress 1hls ls anoLher
responslblllLy Lhe modern world women have Lo bear ln Lhls slLuaLlon a woman who ls vulnerable Lo
sLress flnds lL dlfflculL Lo share her problems wlLh oLhers and by Lhe Llme she Lurns for professlonal help
her problems have become chronlc lf she belongs Lo a nuclear famlly she feels lonely when she faces a
problem Soclal sLlgma sLops her from consulLlng menLal healLh professlonals 1hls affecLs Lhe well belng
of a woman ln general parLlcularly woman ln Aslan counLrles
lL ls approprlaLe Lo embark on more awareness program on general and poslLlve wellbelng of
women as prlmary prevenLlon always proves beLLer resulLs 1he awareness program should concenLraLe
on parenLlng skllls healLhy llfesLyle sLress managemenL and soclal supporL groups lnvolvemenL of non
governmenLal organlzaLlon ln creaLlng awareness and supporL group wlll enhance woman's self
confldence self awareness and self esLeem LhaL wlll deflnlLely lead Lo wellbelng of a woman
Sulclde and parasulclde raLes are lmporLanL markers of Lhe menLal healLh of a populaLlon 8oLh
pose a Lremendous burden Lo lndlvlduals famllles and socleLy 8eslde Lhe currenL newly launched
MlnlsLry of PealLh Sulclde 8eglsLry a naLlonal sLudy on parasulclde would be very useful Lo lncrease our
undersLandlng of Lhese phenomena 8y ldenLlfylng Lhe common modes of self harm and Lhe changlng
Lrends lnLervenLlon program can be planned and lnsLlLuLed accordlng lL ls lmporLanL Lo noLe LhaL lL ls
noL [usL pharmacologlcal approach Lo Lhe LreaLmenL of depresslon LhaL's should reduce sulcldal
behavlour
8evlews of Lhe effecLlveness of sulclde prevenLlon cenLres of sLrlcL cognlLlve behavloural
approaches for speclflc paLlenLs such as Lhose wlLh borderllne personallLles and novel approaches such
as Lhose uLlllslng Lelephone followup of vulnerable elderly paLlenLs have also shown promlse Powever
Lhe sLrongesL evldence for effecLlveness for cllnlcal purposes appears Lo be for Lhe prompL dlagnosls and
vlgorous LreaLmenL of Lhose wlLh depresslve lllnesses and lL ls worLh summarlslng Lhe polnLs whlch
lndlcaLe Lhls
llrsL depresslon ls Lhe mosL common dlagnosls assoclaLed wlLh sulcldal behavlour second Lhere
are sample daLa whlch lndlcaLe LhaL depresslon ls very prevalenL ln all communlLles and Lhlrd Lhere are
daLa whlch lndlcaLe LhaL someLlmes depresslon ls noL well dlagnosed and LreaLed 8earlng ln mlnd LhaL
Lhere are now well esLabllshed LreaLmenLs for depresslon wlLh emerglng daLa demonsLraLlng Lhelr
efflcacy ln reduclng sulcldal ldeaLlon and behavlour all cllnlclans who have conLacL wlLh poLenLlally
depressed paLlenLs should ensure LhaL an accuraLe dlagnosls ls made and LhaL adequaLe LreaLmenL for
depresslon ls provlded 8y so dolng lnroads lnLo Lhe unaccepLable raLe of sulclde and aLLempLed sulclde
ln all socleLles should be made




LI,I11ICNS

1ralnlngwlse alLhough efforLs had been made Lo Lraln all Lhe offlcers managlng Lhe Su
cenLres Lhere had been some communlcaLlon and loglsLlcs problems ln geLLlng Lhem Lo come Cenerally
Lhere ls a Lendency Lo assoclaLe sulclde wlLh psychlaLry resulLlng ln hosplLal admlnlsLraLors sendlng
sLaffs from Lhe psychlaLrlc deparLmenLs Lo Lhe Lralnlng sesslon lnsLead of Lhe forenslc unlLs as
requesLed A loL of followlngLhrough needs Lo be done Lo enhance Lhe ouLreach of Lralnlng sesslons
As menLloned earller human resource ls a ma[or problem and mlghL noL be remedlable
lmmedlaLely 1he ma[orlLy of sLaffs mannlng Lhe forenslcs unlLs ln dlsLrlcL hosplLals are also ln charge of
Lhe Lmergency ueparLmenL 1ransporL eLc 1hls mlghL dlsLracL Lhem from effecLlvely screen for cases
and allocaLe Llme Lo lnLervlew Lhe nexLofkln Slnce Lhe shorLage of paramedlcal sLaff ls ublqulLous
nowadays Lhe forenslc fraLernlLy mlghL conslder oLher alLernaLlves llke havlng sclenLlflc offlcers Lo asslsL
ln lnformaLlon gaLherlng
rocesswlse a ma[or challenge ls when paLlenLs dle due Lo compllcaLlons of Lhe sulcldal acL
afLer belng admlLLed Lo Lhe ward AL Llmes Lhe sLaffs ln Lhe forenslcs unlL are noL aware of Lhe hlsLory
and had released Lhe body before Lhe Lralned offlcer had a chance Lo lnLervlew Lhe famlly members
Cne of Lhe ways Lo check for Lhls ls by worklng closely wlLh Lhe 8oyal Malaysla ollce and comparlng Lhe
ouLcome of Lhelr sudden deaLh reporL lnvesLlgaLlons wlLh cases capLured by Lhe nS8M
1he lnLervlew also poses some problems Lhe lnformanL who came Lo collecL Lhe bodles
someLlmes has noL meL Lhe deceased for a lengLhy perlod prlor Lo Lhe laLLer's deaLh 1hls may affecL Lhe
accuracy of daLa ln Lhe case of forelgners fellow workers or employers were usually unable Lo glve any
valuable lnformaLlon lor Malayslans efforLs should be made Lo carry ouL psychologlcal auLopsy sLudles
Lo glean more lnformaLlon from relaLlves AlLhough Lhere are dlfferlng vlews lL was generally agreed
LhaL Lhe lnLervlew should be carrled ouL abouL 3 monLhs followlng Lhe deaLh (oulloL and Leo 2006)
lnfrasLrucLure wlse some forenslc unlLs ln dlsLrlcL hosplLals are very small and hardly has any
space for lnLervlewlng Lhe grlevlng famlly members noLwlLhsLandlng Lhe nS8M provldlng beLLer
lnLervlewlng faclllLles ln forenslc unlLs would cerLalnly beneflL Lhe cllenLs as well as Lhe sLaffs lL wlll
provlde a more conduclve seLLlng when sLaffs have Lo break bad news" or carry ouL any form of
lnformaLlon gaLherlng wlLh famlly members
1here had been some dlfflculLy ln capLurlng Lhe acLual Llme of sulcldal acL whlch was
supposed Lo be recorded ln mlllLary hours lL had been suggesLed LhaL ln Lhe fuLure wlder Llmeframes
be used eg mldnlghL Lo 6am 6am Lo 12 noon 12noon Lo 6pm 6pm Lo 12mldnlghL
AL Lhe momenL Lhe nS8M does noL have sufflclenL manpower Lo closely monlLor Lhe quallLy of daLa
collecLlon by Sus MosL of Lhe supervlslon ls carrled ouL by Lhe forenslc physlclan or nS8M_!uluec 07
rellm reporL senlor medlcal asslsLanL Powever slLe vlslLs have been planned so LhaL some form of
supervlslon from S8u and feedback sesslons can be carrled ouL more effecLlvely
AlLhough Lhe onllne reglsLraLlon sysLem ls envlsloned Lo lmprove daLa collecLlon Lhls wlll be
dependenL on Lhe avallablllLy of lnLerneL resources LhaL ls avallable ln each hosplLal We cerLalnly hope
LhaL pollcy makers would conslder developlng/ upgradlng l1 resources ln forenslc seLups Lo ensure
beLLer daLa collecLlon


CCNCLUSICN

1he efforL of nS8M Lo aLLempL daLa collecLlon on sulclde raLe ln Malaysla ls a rlghL paLh Lo sLarL
a serlously concern ln sulclde phenomena ln Lhls counLry AlLhough Lhere are some communlcaLlon
problems lL also offers advanLages ln Lhe form of poollng of resources and experLlse AfLer all sulclde ls
a very complex phenomenon 8elng a reglsLry Lhe nS8M mlghL noL be able Lo provlde ln depLh deLalls
abouL Lhe causaLlon of sulclde Powever lL would cerLalnly ldenLlfy Lrends and form Lhe basellne for
oLher research ln Lhls area 1hls klnd of research ls lmporLanL Lo provlde lnformaLlon on Lhe naLural
hlsLory and causaLlon of sulclde Lhe conLrlbuLlng facLors mosL amenable Lo prevenLlve efforLs and Lhe
mosL approprlaLe LargeL populaLlon 1hls lnformaLlon wlll ald ln plannlng and place prevenLlve efforLs on
a more solld foundaLlon (World PealLh CrganlzaLlon 2002) 8eLLer and evldencebased efforLs aL sulclde
prevenLlon may be able Lo reduce sulclde raLes ln Malaysla AparL from LhaL a sLrucLured lnvesLlgaLlon
lnLo Lhe process of ldenLlflcaLlon and reporLlng of nonnaLural deaLhs (speclflcally sulclde) wlll asslsL ln
sLreamllnlng Lhe managemenL of dead bodles and ascerLalnlng Lhe manner of deaLh lndlrecLly lL wlll
also provlde a Lralnlng exerclse for medlcal offlcers ln reporLlng deaLhs by sulclde Popefully LhaL wlLh
beLLer supporL lnfrasLrucLure and human resource Lralnlng Lhese Lrends can be lnvesLlgaLed furLher







8LlL8LnCLS



uurkhelm Sulclde (1897) 1he lree ress reprlnL 1997
klemo k (2004) @owotJs A 5oclocooomlc ooJ uemoqtopblc @beoty of lJetly 5olclJe A compotlsoo
of 49 cooottles At votloos 5toqes of uevelopmeot uppsala lS8n 9130617478