Rates and factors associated with suicide in Kaniyambadi Block, Tamil Nadu, South India, 2000-2002

Socio-demographic profile of suicidal hanging deaths in Delhi and the National Capital Region - a retrospective study

The aim of this retrospective socio-demographic analysis is to identify those at higher risk of suicidal hanging in the region of Delhi and the National Capital Region. All deaths due to suicidal hanging from January 2016 to December 2019 reported in the Vardhman Mahavir Medical College and Safdarjung Hospital were included. Suicidal hanging accounted for 2.67% of total autopsied cases; 21-30 years old represented 42.62% of the victims. Male:female ratio was 1.7:1 and 38.37% of cases were from the adjoining areas of Vasant Kunj and Vasant Vihar. Therefore, a preventive strategy should focus concern on young adults, the male sex, and areas of Vasant Kunj and Vasant Vihar.

Risk Factors for Suicide in Pakistan: A Mixed Methods Study of Psychological Autopsies and Perspectives of Health Professionals

BACKGROUND

Suicide is a significant but understudied public health concern in developing nations like Pakistan, where risks factors have not been investigated by mixed methods studies. Hence, we aimed to explore the risk factors for suicide based on a mixed methodology.

METHODS

This study followed a mixed methods convergent component design. A retrospective case-control psychological autopsy with a semistructured interview protocol was performed. Additionally, health professionals' opinions on the psychiatric risk factors for suicide were assessed through qualitative interviews. Data were collected between 2021 and 2022 and analyzed by SPSS (V-25) and thematic analysis (NVIVO-12 Plus).

RESULTS

Based on the mixed methods meta-inferences, suicidal ideation; depression; hopelessness; social isolation; previous history of self-harm and traumatic experiences; lack of motivation; purposelessness; feeling like a burden; substance abuse; impulsivity; anger; anxiety; psychiatric disorders such as personality disorders, bipolar disorder, schizophrenia, gaming addiction, and eating disorders; and family history of psychiatric illness were identified as risk factors for suicide.

CONCLUSION

More must be learned about the mental health components contributing to suicide and the culturally appropriate prevention methods used in Pakistan. This study reveals novel targets for suicide prevention and may aid policymaking by providing a better understanding of predictors and specific psychiatric characteristics of suicide in Pakistan.

Impact of Pesticide Residues on the Gut-Microbiota–Blood–Brain Barrier Axis: A Narrative Review

Accumulating evidence indicates that chronic exposure to a low level of pesticides found in diet affects the human gut-microbiota–blood–brain barrier (BBB) axis. This axis describes the physiological and bidirectional connection between the microbiota, the intestinal barrier (IB), and the BBB. Preclinical observations reported a gut microbial alteration induced by pesticides, also known as dysbiosis, a condition associated not only with gastrointestinal disorders but also with diseases affecting other distal organs, such as the BBB. However, the interplay between pesticides, microbiota, the IB, and the BBB is still not fully explored. In this review, we first consider the similarities/differences between these two physiological barriers and the different pathways that link the gut microbiota and the BBB to better understand the dialogue between bacteria and the brain. We then discuss the effects of chronic oral pesticide exposure on the gut-microbiota-BBB axis and raise awareness of the danger of chronic exposure, especially during the perinatal period (pregnant women and offspring).

The Demographic Profile of Suicidal Hanging Deaths in North India

BACKGROUND

Suicidal hanging is the most prevalent means of suicide worldwide, particularly among young people, and reveals the state of mental health in certain indigenous populations. According to the National Crime Records Bureau, hanging was the most frequent cause of suicide in India in 2019 and 2020, accounting for 53.6% and 57.8% of total suicidal deaths.

AIM

The current study examines the seasonal distribution of suicide-hanging fatalities in Rishikesh, Uttarakhand, as well as the male and female incidence.

METHODS

A four-year retrospective examination of autopsy data at the All India Institute of Medical Sciences (AIIMS), Rishikesh, from October 2018 to July 2022. A total of 1720 autopsies were performed during this period with 130 (7.56%) suicidal hangings.

RESULTS

Males were disproportionately impacted (n=100, 76.92%). The ratio of men to women is 3.33:1. The mean ages of the males and females were 33.09 ± 12.59 and 24.9 ± 7.84 years, respectively. The majority of deaths occur in the third decade of life. The summer months saw the highest number of deaths (April-June).

CONCLUSION

This data may be used to identify persons with a higher chance of committing suicide by hanging and can be utilized to help people through a nationwide suicidal prevention program that employs a multi-disciplinary team approach. Epidemiological studies should evaluate the psychosocial characteristics of men and women separately to identify the population at risk and develop preventative approaches.

LIMITATIONS

This is a single-center, retrospective study.

The national suicide prevention strategy in India: context and considerations for urgent action

India reports the highest number of suicide deaths in the world. At this time when the Indian Government is formulating a national suicide prevention strategy, we have reviewed the current status of suicides in India, focusing on epidemiology, risk factors, and existing suicide prevention strategies to identify key challenges and priorities for suicide prevention. The suicide rate among Indian girls and women continues to be twice the global rate. Suicide accounts for most deaths in the 15-39 years age group compared with other causes of death. Hanging is the most common method of suicide, followed by pesticides poisoning, medicine overdose, and self-immolation. In addition to depression and alcohol use disorders as risk factors, several social and cultural factors appear to increase risk of suicide. The absence of a national suicide prevention strategy, inappropriate media reporting, legal conflicts in the interpretation of suicide being punishable, and inadequate multisectoral engagement are major barriers to effective suicide prevention. A scaffolding approach is useful to reduce suicide rates, as interventions provided at the right time, intensity, and duration can help navigate situations in which a person might be susceptible to and at risk of suicide. In addition to outlining research and data priorities, we provide recommendations that emphasise multilevel action priorities for suicide prevention across various sectors. We call for urgent action in India by integrating suicide prevention measures at every level of public health, with special focus on the finalisation and implementation of the national suicide prevention strategy.

Laryngeal Dysfunction in Acute Organophosphorus and Carbamate Poisoning

Background

Organophosphorus (OP) and carbamate pesticides are widely used for crop protection. We describe the spectrum of laryngeal abnormalities in patients admitted to the intensive care unit (ICU) with acute OP and carbamate poisoning as there is limited information on it.

Materials and methods

Consecutive patients admitted to the ICU with acute OP and carbamate poisoning over 20 months (December 2014–July 2016) were recruited. Patients were followed up post-discharge if they had undergone tracheostomy or developed hoarseness of voice or stridor following extubation. Asymptomatic individuals who consented underwent laryngoscopy after ICU discharge. The primary outcome was the development of laryngeal dysfunction. Other outcomes included length of stay, need for ventilation, mortality, tracheostomy, and time to decannulation of tracheostomy.

Results

Of the 136 patients recruited, 71 (52%) underwent laryngoscopy. The overall mortality rate was 9.6%. Of the 71 patients who underwent laryngoscopy, 18 had abnormal findings, which included unilateral or bilateral vocal cord paresis or palsy (n = 14) and/or aspiration (n = 9), subglottic stenosis (n = 1), tracheal stenosis (n = 1), or arytenoid granuloma (n = 1). Laryngeal dysfunction was associated with the ingestion of a dimethyl OP compound (p = 0.04) and quantum consumed (p <0.001). Patients with laryngeal dysfunction had significantly (p = 0.004) longer hospital stay (19.1 ± 10.7 vs 11.8 ± 8.3 days).

Conclusion

Laryngeal dysfunction is not uncommon in OP and carbamate poisoning and is associated with the ingestion of larger quantity of a dimethyl OP compound and longer hospital stay. Otorhinolaryngologists could be involved early to help identify these abnormalities and initiate an appropriate treatment to ensure a functional voice and good airway.

How to cite this article

Mani GS, Mathews SS, Victor P, Peter JV, Yadav B, Albert RRA. Laryngeal Dysfunction in Acute Organophosphorus and Carbamate Poisoning. Indian J Crit Care Med 2022;26(2):167–173.

Suicide methods in South Asia over two decades (2001-2020)

BACKGROUND

Suicide is a global preventable public health problem. About a quarter of all suicides in the world occur in South Asia. As means restriction is an important suicide prevention strategy, gaining knowledge of the common suicide methods and their changing trends in each country and region is crucial.

AIMS

We aimed to assess the suicide methods in South Asian countries over the last two decades.

METHODS

A search was performed in PubMed, PubMed Central, Scopus, and Google Scholar with the search terms. Original articles of quantitative studies, published in the English language, from 2001 to 2020, with full-accessible text, that rank different methods of suicide in eight South Asian countries, were included.

RESULTS

A total of 68 studies were found eligible for review. The Maximum number of studies were found from India (n = 38), followed by Bangladesh (n = 12), Pakistan (n = 9), Sri Lanka (n = 6), and Nepal (n = 3). Hanging (n = 40, 55.8%) and poisoning (n = 24, 35.3%) were the two most common suicide methods reported, in that order. Hanging followed by poisoning were the commonest suicide methods in Bangladesh, India, and Pakistan while in Sri Lanka, poisoning was the preferred method to hanging. There is a decline in suicide by poisoning and an increase in suicide by hanging in Sri Lanka, Bangladesh, and India. Although hanging is still the commonest method in Pakistan, the use of firearms is growing in recent years (2011-2020).

CONCLUSIONS

There is a steady decline in the incidence of suicides by poisoning following pesticide regulations in South Asian countries. However, there is heterogeneity of study methods, probable under-reporting of suicide, and lack of robust suicide data.

Impact of COVID-19 pandemic related lockdown on Suicide: Analysis of newspaper reports during pre-lockdown and lockdown period in Bangladesh and India

The economic and social devastation wrought by the COVID-19 crisiscoupled with the unavailability of traditional coping resources is a "perfect storm" for suicide. Evidence suggests that its impact may be disproportionately high in low-and-middle-income countries. The study aimed to assess and compare nature and correlates of suicidesfrom news reportsduring the immediate pre-lockdown and lockdown phase of COVID-19 in Bangladesh and India. We performed analysis of suicide reports from purposively selected online vernacular and English newspapers of Bangladesh and two states/union territory in India, between January to June 2020. We divided the time period of observation into two phases: pre-lockdown and lockdown phase. Country wise findings between the two phases were compared in terms of demographic and characteristics of the reported suicide. A total of 769 news reports wereanalysed; 141 from Bangladesh and 628 from India. When compared to the pre-lockdown period, the odds of suicide by hanging was significantly higher during lockdownin India (adjusted Odds Ratios [aOR] = 3.8, p = 0.018) and Bangladesh (aOR = 3.1, p = 0.048). Suicide demographics in India were different from Bangladesh during lockdown; more males died by suicide in India (aOR = 2.7, p = 0.023) and more people died by hanging (aOR = 2.6, p = 0.029). The pandemic restrictions impacted suicide demographics in the studied regions of India and Bangladesh. Further research using population-based time-series data are warranted to investigate the issue.

Psychological autopsy: Overview of Indian evidence, best practice elements, and a semi-structured interview guide

BACKGROUND

No review has been attempted, so far, on Indian psychological autopsy (PA) literature. There is also a dearth of interview guides which is at the heart of a PA procedure.

MATERIALS AND METHODS

Electronic searches of MEDLINE through PubMed, PsycINFO, and Google scholar databases were carried out from inception till February 2020 to identify relevant English language peer-reviewed articles from India, as well as global literature that provided information on best practice elements in PA. Abstracts generated were systematically screened for eligibility. Relevant data were extracted using a predesigned structured proforma, and a semi-structured interview guide was developed.

RESULTS

A total of 18 original articles, one case report, and three reviews/expert opinion articles which tried to give a description of PA procedure were found from India. Most Indian studies are of suicide PA (SPA), done to assess risk factors associated with suicide. There was a wide variation in reported rates of psychiatric morbidity among suicide decedents, while the other major risk factor for suicide in the Indian setting was stressful life events. An optimal approach to PA involves systematically collecting information from key informants and other sources using a narrative interviewing method, supplemented with psychological measures, and is probably best carried out within 1-6 months after the death.

CONCLUSION

There have been limited attempts to standardize PA. Most Indian studies use SPA. We propose a semi-structured PA interview guide, suitable for both research and investigational purposes.

Suicide by pesticide poisoning in India: a review of pesticide regulations and their impact on suicide trends

BACKGROUND

Pesticide self-poisoning is a common means of suicide in India. Banning highly hazardous pesticides from agricultural use has been successful in reducing total suicide numbers in several South Asian countries without affecting agricultural output. Here, we describe national and state-level regulation of highly hazardous pesticides and explore how they might relate to suicide rates across India.

METHODS

Information on pesticide regulation was collated from agriculture departments of the central government and all 29 state governments (excluding union territories). National and state-level data on suicides from 1995 to 2015 were obtained from the National Crime Records Bureau (NCRB). We used joinpoint analysis and negative binomial regression to investigate the trends in suicide rates nationally and in Kerala, in view of the robust measures Kerala has taken to restrict a number of HHPs, to identify any effect on suicides.

RESULTS

As of October 2019, 318 pesticides were registered for use in India, of which 18 were extremely (Class Ia) or highly (Class Ib) hazardous according to World Health Organization toxicity criteria. Despite many highly hazardous pesticides still being available, several bans have been implemented during the period studied. In our quantitative analyses we focused on the permanent bans in Kerala in 2005 (of endosulfan) and 2011 (of 14 other pesticides); and nationally in 2011 (of endosulfan). NCRB data indicate that pesticides were used in 441,918 reported suicides in India from 1995 to 2015, 90.3% of which occurred in 11 of the 29 states. There was statistical evidence of lower than expected rates of pesticide suicides (rate ratio [RR] 0.52, 95% CI 0.49-0.54) and total suicides nationally by 2014 (0.90, 0.87-0.93) after the 2011 endosulfan ban. In Kerala, there was a lower than expected rate of pesticide suicides (0.45, 0.42-0.49), but no change to the already decreasing trend in total suicides (1.02, 1.00-1.05) after the 2011 ban of 14 pesticides. The 2005 ban on endosulfan showed a similar effect - lower than expected pesticide suicides (0.79, 0.64-0.99), but no change to the decreasing trend of total suicides (0.97, 0.93-1.02) in 2010. There was no evidence of a decline in agricultural outputs following the bans.

CONCLUSION

Highly hazardous pesticides continue to be used in India and pesticide suicide remains a serious public health problem. However, some pesticide bans do appear to have impacted previous trends in the rates of both pesticide suicides and all suicides. Comprehensive national bans of highly hazardous pesticides could lead to a reduction in suicides across India, in addition to reduced occupational poisoning, with minimal effects on agricultural yield.

The Effect of Entomopathogenic Fungi on Enzymatic Activity in Chlorpyrifos-Resistant Mosquitoes, Culex quinquefasciatus (Diptera: Culicidae)

Culex quinquefasciatus Say is an important pest species and a vector of multiple pathogens. Insecticide applications are necessary for the effective control of mosquitoes. In the current study, a laboratory population of Cx. quinquefasciatus was exposed to chlorpyrifos for 15 consecutive generations and then assessed for the changes in detoxification enzyme activities before and after exposure to Metarhizium anisopliae (Metschn.) Sorokin and Beauveria bassiana (Bals.) Vuill. during 14th-15th generations. Activities of acetylcholinesterase (AChE), glutathione S-transferase (GST), esterase (EST), acid phosphatases (ACP), and alkaline phosphatases (ALP) were increased in the chlorpyrifos-selected (Chlor-SEL) population in relation to an unselected (Un-SEL) population. The resistance ratio of Chlor-SEL 15th generation (G15) was increased 3,583-fold against first generation (G1) and 6,026-fold against the Un-SEL population. The results depicted maximum activities of ACP (83.48), ALP (65.54), GST (13.047), EST (10.42), and AChE (4.86) μmol/min of mg/ml protein at G15 after consecutive chlorpyrifos applications. The Chlor-SEL populations at G14-G15 were treated with different concentrations of M. anisopliae and B. bassiana for possible suppression of enzymatic activities. Activities of ACP were suppressed to 24.22 μmol/min of mg/ml protein at G15 when exposed to B. bassiana and 22.40 μmol/min of mg/ml protein at G14 after exposure to M. anisopliae. The suppression of detoxification enzymes by application of fungi in resistant population of Cx. quinquefasciatus will aid in the mosquito's management programs.

Suicides in Greece before and during the period of austerity by sex and age group: Relationship to unemployment and economic variables

BACKGROUND

There is disagreement on the specific mechanism through which the economic recession increased suicides in Greece. Unemployment is considered by many authors to be the determining factor but the data are inconclusive and often negative, especially concerning the temporal relationship between onset of increase in unemployment and increase in suicides AIMS: The aim of this paper was to clarify the specific role of unemployment as well as of other socioeconomic variables on specific age-by-gender groups concerning the increase in suicides.

METHODS

Data of the Hellenic Statistical Authority ELSTAT (www.

STATISTICS

gr) were analyzed with Linear Regression Analysis and Bonferroni correction for multiple testing RESULTS: Unemployment correlates with suicide rates only in males aged 20-24, 50-54 and 60-64 years (p < 0.001). Unemployment could held responsible for an additional 148 male deaths during the period 2009-2015, which accounts for 5.3% of the total (29 additional deaths per year). The changes in all the socioeconomic conditions could held responsible for 317 cases of suicide or 9.4% of total CONCLUSIONS: The results of the current study suggest that there was a 33% increase in deaths by suicide in Greece during the early years of recession (2009-2015); one third could be directly attributed to unemployment, one third to other consequences of recession while another third is of unknown origin. The effect of unemployment is specifically restricted to males at the beginning of their working career (20-24 years old) and to middle aged (45-49 and 55-59 years old).

How many premature deaths from pesticide suicide have occurred since the agricultural Green Revolution?

Introduction: The agricultural Green Revolution in the 1950s and 60s is thought to have averted many deaths from famine. However, it also introduced highly hazardous pesticides such as parathion and endrin into poor rural communities that were totally unequipped to store or use them safely. Pesticide self-poisoning rapidly became one of the two most common global means of suicide. Thus far, no attempt has been made to enumerate the total number of deaths that have occurred subsequent to the Green Revolution.Objective: To calculate plausible estimates for the total global number of pesticide suicides that have occurred since 1960.Methods: We performed a literature review on Medline and Embase databases to July 2019 to find papers that reported national or global numbers of pesticide suicides. We restricted our search to papers published in English. We used the search terms: pesticide) OR insecticide) OR paraquat) OR organophosphate) OR organophosphorus) OR agrochemical) AND suicide) OR "") OR deliberate) AND poison in all fields. These searches identified 2,144 papers; a further 8 citations were added through the searching of reference lists and our own paper collections. 2,136 papers were excluded as they contained no data on pesticide suicide, or were case reports, case series, or related to specific socio-demographic groups, or were non-human studies. This left 16 papers giving country specific or global pesticide suicide data.Long-term national trend in pesticide suicides: We found studies from one low- and middle-income country (Sri Lanka) that recorded long-term trends in suicide throughout the Green Revolution. These data showed a steady increase in suicides from 1960 to the early 1970s, with a more rapid increase from 1979 to 1984. The number of suicides plateaued until 1995, when they started a steady almost linear decrease that has continued at least until 2015. We used the Sri Lankan epidemiology as a model of the incidence of pesticide suicides in other low- and middle-income countries. Data from Bangladesh suggested that the decrease might have started in 2002.Estimating global numbers since 1960: Starting from a conservative estimate of zero deaths in 1960, the best estimate of the total global burden of pesticide suicides from 1960 to 2018 is 14,272,105 or 14,936,000 (depending on whether a fall in incidence began in 1995 or 2002), with a plausible range of 9,859,667 to 17,303,333 deaths. These are likely underestimates because suicide is illegal in many countries, and most pesticide suicides occur in poor rural areas without effective death registration systems.Conclusions: Pesticide self-poisoning has been a major clinical and public health problem in rural Asia for decades, while being long ignored. Most pesticide suicides are relatively impulsive with little planning: in the absence of highly hazardous pesticides, many people would have survived their suicidal impulse, gone on to find support amongst family, community, and health services, and lived a full life. Pesticide suicides must therefore be considered a category 4 occupation condition following Schilling's classification - if they had not been brought into rural communities for agricultural use, pesticide suicides would not have occurred. Preventing these deaths should be a global public health priority.

Guttikonda A, Shajan AM, Hephzibah A, Jones AS, Susanna J, Neethu S, Poornima S, Jala SM, Arputharaj D, John D, Natta N, Fernandes D, Jeyapaul S, Jamkhandi D, Prashanth HR, Oommen AM. Perceived Stigma Regarding Mental Illnesses among Rural Adults in Vellore, Tamil Nadu, South India

BACKGROUND

Stigma is an important factor that determines whether individuals seek treatment for mental illnesses. Studies assessing public perceptions regarding mental illnesses are scarce in India. This study documents the stigma perceived by a rural population toward patients with mental illness and their families.

MATERIALS AND METHODS

A cross-sectional pilot study was done in five villages, selected by simple random sampling, from a rural block in Vellore, Tamil Nadu. Households in each village were selected by systematic random sampling. From the selected households, 150 subjects aged 18-65 years, without known mental disorders, were chosen by convenience sampling, based on availability. Stigma was assessed using the Devaluation of Consumers Scale (DCS) and Devaluation of Consumer's Families Scale (DCFS).

RESULTS

The proportion with high perceptions of stigma associated with mentally ill persons was 63.8%, among the 150 interviewed rural respondents (women: 112, median age: 37 years). The proportion which perceived that there was public stigma toward families of those with mental illnesses was 43.4%. Older respondents (>37 years) had higher perceptions of stigma (odds ratio: 2.07; 95% confidence interval: 1.02-4.20) than others.

CONCLUSION

The high perception of stigma associated with persons who are mentally ill as well as their families needs to be kept in mind while planning interventions to decrease the treatment gap for psychiatric morbidity, especially in rural areas.

Geographical and Temporal Variation of Suicide in India, 2006-2015: An Investigation of Factors Associated with Suicide Risk Difference across States/Union Territories

BACKGROUND

In India, about 130,000 people died by suicide in the year 2015. It is important to understand the variation of suicide across different parts of India and the trend of suicide rates over the years. The objectives of this study were to determine whether suicide rates in India showed temporal variation in the last decade and to determine whether suicide rates in India showed geographical variation across different states and union territories (UTs).

METHODS

Data on suicide rates for the years 2006-2015 were collected from the official publication of the National Crime Records Bureau. This study looked for time trend in suicide rates over the years. Further, the variation in suicide rates across different states/UTs in India and the factors associated with the variation were also analyzed.

RESULTS

The average suicide rate in India for the years 2006-2015 was 10.9/100,000 population. Overall, there was no significant variation in the suicide rate over time in the years studied. The average suicide rate varied widely across the states and UTs, between 0.91 and 43.92 per 100,000 population. The analysis revealed a positive association between suicide rates and accident rates for the above years. In addition, for the year 2011, a positive association between suicide rate and per capita state domestic product was noted.

CONCLUSION

There was no variation in the suicide rate in India over time. However, there were significant regional differences. Reporting differences and economic factors could partially explain the differences.

Gender differentials and state variations in suicide deaths in India: the Global Burden of Disease Study 1990-2016

Background

A systematic understanding of suicide mortality trends over time at the subnational level for India's 1·3 billion people, 18% of the global population, is not readily available. Thus, we aimed to report time trends of suicide deaths, and the heterogeneity in its distribution between the states of India from 1990 to 2016.

Methods

As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, we estimated suicide death rates (SDRs) for both sexes in each state of India from 1990 to 2016. We used various data sources for estimating cause-specific mortality in India. For suicide mortality in India before 2000, estimates were based largely on GBD covariates. For each state, we calculated the ratio of the observed SDR to the rate expected in geographies globally with similar GBD Socio-demographic Index in 2016 (ie, the observed-to-expected ratio); and assessed the age distribution of suicide deaths, and the men-to-women ratio of SDR over time. Finally, we assessed the probability for India and the states of reaching the Sustainable Development Goal (SDG) target of a one-third reduction in SDR from 2015 to 2030, using location-wise trends of the age-standardised SDR from 1990 to 2016. We calculated 95% uncertainty intervals (UIs) for the point estimates.

Findings

There were 230 314 (95% UI 194 058–250 260) suicide deaths in India in 2016. India's contribution to global suicide deaths increased from 25·3% in 1990 to 36·6% in 2016 among women, and from 18·7% to 24·3% among men. Age-standardised SDR among women in India reduced by 26·7% from 20·0 (95% UI 16·5–23·5) in 1990 to 14·7 (13·1–16·2) per 100 000 in 2016, but the age-standardised SDR among men was the same in 1990 (22·3 [95% UI 14·4–27·4] per 100 000) and 2016 (21·2 [14·6–23·6] per 100 000). SDR in women was 2·1 times higher in India than the global average in 2016, and the observed-to-expected ratio was 2·74, ranging from 0·45 to 4·54 between the states. SDR in men was 1·4 times higher in India than the global average in 2016, with an observed-to-expected ratio of 1·31, ranging from 0·40 to 2·42 between the states. There was a ten-fold variation between the states in the SDR for women and six-fold variation for men in 2016. The men-to-women ratio of SDR for India was 1·34 in 2016, ranging from 0·97 to 4·11 between the states. The highest age-specific SDRs among women in 2016 were for ages 15–29 years and 75 years or older, and among men for ages 75 years or older. Suicide was the leading cause of death in India in 2016 for those aged 15–39 years; 71·2% of the suicide deaths among women and 57·7% among men were in this age group. If the trends observed up to 2016 continue, the probability of India achieving the SDG SDR reduction target in 2030 is zero, and the majority of the states with 81·3% of India's population have less than 10% probability, three states have a probability of 10·3–15·0%, and six have a probability of 25·1–36·7%.

Interpretation

India's proportional contribution to global suicide deaths is high and increasing. SDR in India is higher than expected for its Socio-Demographic Index level, especially for women, with substantial variations in the magnitude and men-to-women ratio between the states. India must develop a suicide prevention strategy that takes into account these variations in order to address this major public health problem.

Funding

Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Lessons from a decade of suicide surveillance in India: who, why and how?

Background

This paper investigates trends in suicide rate, the reasons for and means of suicide and the occupation of deceased, to prioritize suicide prevention activities in India and to highlight the limitations to data quality for surveillance.

Methods

Data available in the public domain from the National Crimes Record Bureau (NCRB) were analysed from 2001 to 2010 at the national and sub-national levels, split by age groups and sex for ages 15 years and above.

Results

The reported suicide rate was 14.9 and 15.4 suicides per 100 000 population in 2001 and 2010, respectively. More developed states reported significantly higher suicide rates than the less developed (mean 20.5 versus 8.16), but neither experienced large changes over time. Among males, the reported suicide rate changed slightly (17.8 to 19.5); it remained almost similar for females (11.9 to 11.1). Housewives accounted for the highest proportion of suicide deaths over the decade. Distribution of the reasons for suicide remained almost constant over time; most suicides (33.7%) were due to personal/social reasons, followed by health at 24.3% and unknown reasons at 16.4%; differences were observed between the more and less developed states. Marriage-related suicides were higher for females, and health reasons increased with increasing age. Nationally, poison/overdose with drugs/pesticides was the leading means of suicide through the decade, although the gap between this and hanging decreased over time. The state level data showed considerable heterogeneity in the quality of data across the indicators assessed.

Conclusions

These data provide a range of information to identify vulnerable groups, to formulate appropriate suicide prevention strategies. Addressing the limitations in data quality would facilitate further utility of surveillance data to prevent suicides.

The Influence of Perceived Stress and Depression on Suicide-Related Beliefs in Caucasian and Indian Adults

Abstract. Background and Aims: Suicidality research in developing countries, including India, faces logistical and cultural challenges. Technology may help address these challenges and offer data to providers treating a diverse clientele. Method: The relationship between perceived stress and suicide-related beliefs was examined in two populations: Indians in India (n = 374) and Caucasians in English-speaking countries (n = 326); the influence of depression on that relationship was also explored. The study was conducted via an Internet-based survey. Results: Three-way interactions (Ethnicity × Perceived stress × Depression status) were observed, predicting strength of the belief that suicide is a solution to problems, F(1,679) = 4.18, p < .05, and that suicide is a good option if quality of life worsens, F(1,675) = 9.53, p < .01. For both beliefs, Caucasians screening positive for depression exhibited the strongest relationship between stress and suicide-related beliefs; for Indians, that relationship was not moderated by depression status. Caucasians also exhibited a stronger association between higher stress and greater belief strength that suicide is a good option assuming a steady quality of life than did Indians, F(1,680) = 6.05, p < .05. Limitations: Participants were recruited through a depression screening website; results may not generalize to those who are uninterested in depression screening or to those who are unwilling or unable to use the internet for that purpose. Conclusion: Our findings may help to better target interventions to reduce suicidality, for example, employ stress reduction techniques for Caucasians who are depressed, and monitor suicidality for Indians reporting high stress regardless of depression.

Hanging Fatalities in Central Bangkok, Thailand: A 13-Year Retrospective Study

Hanging is violent asphyxial death. The objective of this study is to assess the data of hanging cases. A descriptive-retrospective study was conducted. We studied 244 hanging cases autopsied in Forensic Division, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, between January 2001 and December 2013. The study included 197 men (80.7%) and 47 women (19.2%). Their age ranged from 14 to 93 years. Most of these cases were incomplete hanging (83.6%). Features of hanging victims, such as tongue protrusion; congestion of face; petechial hemorrhage of face, conjunctiva, and internal organs; and neck injuries, significantly correlated with complete hanging. The predominant occupation of hanging victims was in the service industry (63.1%). Suicides usually occurred in private homes or apartments (84.8%). A suicide note was found in 6.1% of cases. The most common ligature material used was nylon rope, found in 61.1% of cases. The most underlying diseases of the victims in hanging cases were tuberculosis and human immunodeficiency virus infection, 9 cases each. Blood ethanol levels of 29 cases (11.8%) were detected to be higher than 150 mg%. Methamphetamine and benzodiazepine were detected in 5.3% and 3.3% of cases, respectively. This study provides comprehensive baseline data of hanging cases in central Bangkok.

Suicide in India: Distinct Epidemiological Patterns and Implications

Suicide is a societal crisis which also deeply impacts the personal and family realms. Indian suicidal data present distinctive epidemiological patterns when we compare it with the global suicide rates and trends. Higher proportions of young individuals are resorting to suicide compared to any other country in the world, and Indian suicide rates, especially South Indian rates, are one of the highest in the world. In this article, we present various historical aspects and theories of Indian suicide and review of available Indian research from various sources such as community, hospitals, schools and forensic settings. We discuss our findings which reveal the distinctiveness of Indian data when we compare these with global data and draw implications for practice and policy.

Indo-Canadian Collaboration for Suicide Prevention: Training Needs Assessment for Healthcare Professionals in India

The main purpose of the study was to conduct a comprehensive needs assessment of primary healthcare professionals in order to develop a training program aimed at enhancing competencies in suicide risk assessment and management. A total of 144 primary healthcare professionals (physicians = 46; primary care workers = 98) completed the needs assessment questionnaire. The majority of healthcare professionals rated their level of comfort and competence in assessing, treating, and referring suicidal patients as medium or high. However, their knowledge about suicide, risk factors for suicide, asking about suicidal behaviour, and helping a suicidal patient was rated low or medium. Overall, the scarcity of qualified healthcare professionals and the existing gaps in core competencies for suicide risk assessment and management was identified. Development of innovative and effective competencies-based suicide specific training for primary care providers in India is urgently required.

Factors associated with the farmer suicide crisis in India

Background: In India, it is estimated that ∼16,000 farmers die by suicide each year, and at rates far above those of the general population. This paper reviews much of the literature concerning the factors associated with this crisis.

Methods: A literature search was undertaken from multiple databases on Ovid, as well as more elementary searches of Google, Google Scholar, and PubMed. This paper presents a review of the key results.

Results: Socioeconomic factors, rather than mental health problems, are associated with farmer suicides, with increased indebtedness playing the predominant role. Available research suggests this has arisen to a greater extent recently, due to an agrarian crisis affecting the most vulnerable farmers. This has multiple manifestations, including a lack of agricultural investment and irrigation improvement, use of cash crops, the increased use of noninstitutional credit sources, and the reduction of trade barriers. Bt cotton is unlikely to be an important factor and no studies reported a significant burden of mental health problems.

Conclusion: Indebtedness and numerous factors relating to this are clearly identified as the most important risk factors. Further large-scale assessments are required to further understand the situation.

Gender Differences Related to Attitudes Toward Suicide and Suicidal Behavior

This descriptive study examined gender differences related to attitudes toward suicide among randomly selected urban residents. Data was collected using a standardized questionnaire through face-to-face interview. Our findings revealed that men hold more pro preventive attitudes to help persons with suicidal thoughts (80.3 %, p = 0.05) and agreed that suicidal attempts are impulsive (78.6 %, p = 0.01). However, they hold permissive attitude to help persons with incurable diseases and expressing death wishes to die (66 %, p = 0.05). A majority of men (78.6 %) than women agreed that "suicidal attempt is essentially a cry for help" (χ (2) = 11.798, p = 0.05). These gender differences need to be taken into consideration when developing appropriate programs to prevent suicide. Further, decriminalizing the law, high-quality research and raising awareness about suicide prevention among the general population is crucial in developing countries like India.

Associations Between the Macroeconomic Indicators and Suicide Rates in India: Two Ecological Studies

BACKGROUND

While western studies have focused on the importance of psychiatric illnesses in the complex pathways leading to suicides, several Indian studies have highlighted the important contributions by economic, social, and cultural factors. Hence, we tested the hypothesis that annual national suicide rates and suicide rates of the different states in India were associated with macroeconomic indices.

MATERIALS AND METHODS

Data from the National crime records bureau, Ministry of finance, labour bureau, Government of India, population commission, and planning commission official portals, World Bank and the United Nations were accessed. We assessed the correlations of annual national and state-wise suicide rates with macroeconomic, health, and other indices using ecological study design for India, and for its different states and union territories.

RESULTS

We documented statistically significant associations between the suicide rates and per capita gross domestic product, consumer price index, foreign exchange, trade balance, total health expenditure as well as literacy rates.

CONCLUSIONS

As recent economic growth in India is associated with increasing suicide rates, macroeconomic policies emphasizing equitable distribution of resources may help curtailing the population suicide rates in India.

Suicide in South Asia: a scoping review

BACKGROUND

Globally, suicide is an important cause of mortality. In low- and middle income settings, it is difficult to find unequivocal data to establish suicide rates. The objective of this review is to synthesize the reporting of suicide incidence in six south Asian countries.

METHODS

We conducted a scoping review combining peer-reviewed studies (PubMed, PsycINFO, EMBASE) with in-country searches for grey literature in Afghanistan, Pakistan, Sri Lanka, India, Nepal and Bangladesh. The review included mapping reported suicide rates, quality appraisals of the studies, use of definitions of suicide and means of committing suicide.

RESULTS

In total, 114 studies and reports were included in the review, including 50 peer-reviewed publications. Reported suicide rates varied widely from 0.43/100,000 to 331.0/100,000. The average suicide rate across studies was found to be high compared to the world average, however many studies were of poor quality or not representative. The majority of studies failed to explicitly define suicide (84% of the published articles and 92% of the grey literature documents). Poisoning and hanging were consistently the most common methods of committing suicide on the sub-continent.

CONCLUSIONS

The reported suicide rates in South Asia are high compared to the global average, but there is a paucity of reliable data on suicide rates in South Asia. Reports are likely to diminish rather than exaggerate the magnitude of suicide rates. There is an urgent need to establish new, or evaluate existing, national suicide surveillance systems in the South Asian countries.

Severity of suicidal intent, method and behaviour antecedent to an act of self-harm: a cross sectional study of survivors of self-harm referred to a tertiary hospital in Mysore, south India

BACKGROUND

Rates of self harm are high in south India, but little is known about the relationship between antecedent behaviour, suicidal intent and method. Aims: To identify clinical, social and behavioural antecedents preceding an act of self-harm.

METHODS

200 participants, consecutively presenting with deliberate self harm to a hospital in south India,were interviewed. Socio-demographic and clinical characteristics were recorded, together with behaviours preceding self-harm. The Pierce Suicidal Intent Scale and Mini International Neuropsychiatric Inventory were administered.

RESULTS

Pesticide poisoning was the most common method, especially amongst men, in rural areas, and amongst professionals. No particular antecedent behaviour or activity appears to be associated with higher levels of suicidal intent. Absenteeism from work was the most commonly reported change of behaviour in the month preceding an act of self-harm. Unskilled labourers and professionals had significantly greater suicidal intent (adjusted for age, gender and method) than skilled labourers and the unemployed. There were no differences in suicidal intent between different methods. Rural dwellers had significantly greater suicidal intent compared to urban dwellers, irrespective of the method. Major Depressive Disorder was associated with significantly greater suicidal intent compared with other diagnoses and no diagnosis.

CONCLUSIONS

Amongst people who harm themselves in south India, professionals and unskilled labourers, rural residents, and people with current major depressive disorder have higher levels of suicidal intent. Severity of suicidal intent does not appear to influence choice of method of self-harm. Behaviours predictive of self-harm in the west may not be relevant in south India.

Relationship of suicide rates to economic variables in Europe: 2000-2011

BACKGROUND

It is unclear whether there is a direct link between economic crises and changes in suicide rates.

AIMS

The Lopez-Ibor Foundation launched an initiative to study the possible impact of the economic crisis on European suicide rates.

METHOD

Data was gathered and analysed from 29 European countries and included the number of deaths by suicide in men and women, the unemployment rate, the gross domestic product (GDP) per capita, the annual economic growth rate and inflation.

RESULTS

There was a strong correlation between suicide rates and all economic indices except GPD per capita in men but only a correlation with unemployment in women. However, the increase in suicide rates occurred several months before the economic crisis emerged.

CONCLUSIONS

Overall, this study confirms a general relationship between the economic environment and suicide rates; however, it does not support there being a clear causal relationship between the current economic crisis and an increase in the suicide rate.

Suicide in India: a systematic review

BACKGROUND

Suicide is an important cause of death in India but estimated suicide rates based on data from India's National Crime Records Bureau are unreliable.

AIM

Systematically review existing literature on suicide and the factors associated with suicide in India.

METHODS

PubMed, PsycINFO, EMBASE, Global Health, Google Scholar and IndMED were searched using appropriate search terms. The abstracts of relevant papers were independently examined by both authors for possible inclusion. A standardized set of data items were abstracted from the full text of the selected papers.

RESULTS

Thirty-six papers met inclusion criteria for the analysis. The heterogeneity of sampling procedures and methods of the studies made meta-analysis of the results infeasible. Verbal autopsy studies in several rural locations in India report high suicide rates, from 82 to 95 per 100,000 population - up to 8-fold higher than the official national suicide rates. Suicide rates are highest in persons 20 to 29 years of age. Female suicide rates are higher than male rates in persons under 30 years of age but the opposite is true in those 30 years of age or older. Hanging and ingestion of organophosphate pesticides are the most common methods of suicide. Among women, self-immolation is also a relatively common method of suicide. Low socioeconomic status, mental illness (especially alcohol misuse) and inter-personal difficulties are the factors that are most closely associated with suicide.

CONCLUSION

The quality of the information about suicide in India is quite limited, but it is clearly an important and growing public health problem. Compared to suicides in high-income countries, suicide in India is more prevalent in women (particularly young women), is much more likely to involve ingestion of pesticides, is more closely associated with poverty, and is less closely associated with mental illness.

Pesticide poisoning trend analysis of 13 years: a retrospective study based on telephone calls at the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi

The study was designed to analyze the incidence and pattern of pesticide poisoning calls reported to the National Poisons Information Centre (NPIC), AIIMS, New Delhi and highlight the common classes of pesticides involved in poisoning. The telephone calls received by the Centre during the thirteen year period (1999-2012) were entered into a preset proforma and then into a retrievable database. A total of 4929 calls of pesticide poisoning were recorded. The data was analyzed with respect to age, gender, mode and type of poisoning. The age ranged from 1 to 65 years with the preponderance of males (M = 62.19%, F = 37.80%). The age group mainly involved in poisoning was 18-35 years. While 59.38% calls pertained to household pesticides, 40.61% calls related to agricultural pesticides. The common mode of poisoning was intentional (64.60%) followed by accidental (34.40%) and unknown (1%). Amongst the household pesticides, the highest number of calls were due to pyrethroids (26.23%) followed by rodenticides (17.06%), organophosphates (6.26%), carbamates (4.95%) and others (4.86%). In agricultural pesticides group, the organophosphates (9.79%) ranked the first followed by, aluminium phosphide (9.65%), organochlorines (9.31%), pyrethroids (3.87%), herbicides, weedicides and fungicides (3.20%), ethylene dibromide (2.82%), and others (1.70%). The data analysis shows a high incidence of poisoning due to household pesticides as compared to agricultural pesticides, clearly emphasizing the need for creating awareness and education about proper use and implementation of prevention programmes.

National suicide rates and mental health system indicators: an ecological study of 191 countries

PURPOSE

The relative contributions of psychiatric morbidity and psychosocial stress to suicide, and the efficacy of mental health systems in reducing population suicide rates, are currently unclear. This study, therefore, aimed to investigate whether national suicide rates are associated with their corresponding mental health system indicators.

METHODS

Relevant data were retrieved from the following sources: the World Health Organization, the United Nations Statistics Division and the Central Intelligence Agency World Fact book. Suicide rates of 191 countries were compared with their mental health system indicators using an ecological study design and multivariate non-parametric robust regression models.

RESULTS

Significant positive correlations between suicide rates and mental health system indicators (p<0.001) were documented. After adjusting for the effects of major macroeconomic indices using multivariate analyses, numbers of psychiatrists (p=0.006) and mental health beds (p<0.001) were significantly positively associated with population suicide rates.

CONCLUSIONS

Countries with better psychiatric services experience higher suicide rates. Although these associations should be interpreted with caution, as the issues are complex, we suggest that population-based public health strategies may have greater impact on national suicide rates than curative mental health services for individuals.

Bereavement after the suicide of a significant other

CONTEXT

It is estimated that approximately one in four people know someone who has taken their own life and that one suicide death leaves six or more suicide survivors.

AIMS

The aim of this paper was to review the literature regarding the association between suicide and bereavement, focusing also on the supportive and therapeutic resources available for survivors.

MATERIALS AND METHODS

Careful MedLine and PsycINFO searches for the period 1980-2013.

RESULTS

The review of the literature indicates that emotional turmoil in suicide survivors may last a long time and, in some cases, may end with their own suicide.

CONCLUSION

Future research should evaluate the efficacy of professional treatments and of support groups targeting suicide survivors.

PRACTICE IMPLICATIONS

It is crucial to understand the bereavement process after the suicide of a significant other in order to provide proper care, reduce stigma, and improve the outcomes of related psychiatric conditions.

Quality of life, depression, anxiety and suicidal ideation among men who inject drugs in Delhi, India

BACKGROUND

Mental disorders such as depression, anxiety and suicide represent an important public health problem in India. Elsewhere in the world a high prevalence of symptoms of common mental disorders have been found among people who inject drugs (PWID). Research in India has largely overlooked symptoms of common mental disorders among this high risk group. This paper reports on the results of a survey examining quality of life, depression, anxiety and suicidal ideation among adult males who inject drugs living in Delhi.

METHODS

Participants (n = 420) were recruited from needle and syringe programs using time location sampling and were interviewed using an interviewer-administered questionnaire. Self-report symptom scales were used to measure the severity of symptoms of depression (PHQ-9) and anxiety (GAD-2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts and attempts within the past 12 months.

RESULTS

The mean length of injecting career was 20.9 years indicating a sample of chronic injecting drug users, of whom only one-third (38%) were born in Delhi. The level of illiteracy was very high (62%), and just 2% had completed class 12. Scavenging / rag picking was the main form of income for 48%, and many were homeless (69%). One-third (33%) had been beaten up at least twice during the preceding 6 months, and many either never (45%) or rarely (27%) attended family events. We found a high prevalence of depressive (84%, cut-off ≥10) and anxiety (71%, cut-off score of ≥3) symptoms. Fifty-three percent thought about killing themselves in the past 12 months, and 36% had attempted to kill themselves.

CONCLUSIONS

Our findings revealed a socially excluded population of PWID in Delhi who have minimal education and are often homeless, leaving them vulnerable to physical violence, poverty, poor health, imprisonment and disconnection from family. The high prevalence of psychological distress found in this study has implications for programmes seeking to engage, treat and rehabilitate PWID in India.

Suicidal ideation and HIV risk behaviors among a cohort of injecting drug users in New Delhi, India

Background

Data on mental health among injecting drug users in South Asia is scarce yet poor mental health among users has significant implications for the success of HIV prevention and treatment programmes. A cohort of 449 injecting drug users in Delhi was examined on the following issues (1) examine trends in suicidal ideation, suicide plan and suicidal attempts over a 12-month period, (2) examine association between injecting practices (receive and give used syringes) and suicidal ideation over a 12 month study period.

Methods

An observational study was conducted providing phased interventions with follow up interviews every 3 months to 449 injecting drug users (IDUs), from August 2004 to November 2005. The study was conducted in Yamuna Bazaar, a known hub of drug peddling in Delhi. Interventions included nutrition, basic medical services, needle exchange, health education, HIV voluntary counseling and testing, STI diagnosis and treatment, oral buprenorphine substitution, and detoxification, each introduced sequentially.

Results

Suicidal ideation and suicide attempts, did not significantly change over 12 months of observation, while suicide plans actually increased over the time period. Keeping other factors constant, IDUs with suicidal ideation reported more giving and receiving of used syringes in the recent past. Conclusions: Mental health services are warranted within harm reduction programmes. Special attention must be paid to suicidal IDUs given their higher risk behaviours for acquiring HIV and other blood borne infections. IDU intervention programmes should assess and address suicide risk through brief screening and enhanced counseling.

Suicide in young men

Suicide is second to only accidental death as the leading cause of mortality in young men across the world. Although suicide rates for young men have fallen in some high-income and middle-income countries since the 1990s, wider mortality measures indicate that rates remain high in specific regions, ethnic groups, and socioeconomic groups within those nations where rates have fallen, and that young men account for a substantial proportion of the economic cost of suicide. High-lethality methods of suicide are preferred by young men: hanging and firearms in high-income countries, pesticide poisoning in the Indian subcontinent, and charcoal-burning in east Asia. Risk factors for young men include psychiatric illness, substance misuse, lower socioeconomic status, rural residence, and single marital status. Population-level factors include unemployment, social deprivation, and media reporting of suicide. Few interventions to reduce suicides in young men have been assessed. Efforts to change help-seeking behaviour and to restrict access to frequently used methods hold the most promise.

Suicide methods in Asia: implications in suicide prevention

As the largest continent in the World, Asia accounts for about 60% of World suicides. Preventing suicide by restricting access to suicide methods is one of the few evidence-based suicide prevention strategies. However, there has been a lack of systematic exploration of suicide methods in Asian countries. To amend this shortage, the current review examines the leading suicide methods in different Asian countries, their trend, their age- and sex- specific characteristics, and their implications for suicide prevention. In total, 42 articles with leading suicide methods data in 17 Asian countries/regions were retrieved. The epidemiologic characteristics and recent trends of common suicide methods reflect specific socio-cultural, economic, and religious situations in the region. Common suicide methods shift with the introduction of technologies and constructions, and have specific age- or sex-characteristics that may render the restriction of suicide methods not equally effective for all sex and age sub-groups. Charcoal burning, pesticide poisoning, native plant poisoning, self-immolation, and jumping are all prominent examples. In the information society, suicide prevention that focuses on suicide methods must monitor and control the innovation and spread of knowledge and practices of suicide "technologies". It may be more cost-effective to design safety into technologies as a way of suicide prevention while there is no rash of suicides yet by the new technologies. Further research on suicide methods is important for public health approaches to suicide prevention with sensitivity to socio-cultural, economic, and religious factors in different countries.

Suicide prevention is possible: A perception after suicide attempt

BACKGROUND

Suicide is a preventable cause of death, inspite of which its incidence is increasing worldwide. Very few studies are done to know the perception of suicide attempters regarding prevention of their suicide attempt. Such information may be helpful in implementing preventive strategies. This study was done to find out whether those who attempted suicide and recovered perceived that their suicide attempt could have been prevented or not.

MATERIALS AND METHODS

Fifty consecutive subjects were recruited by purposive sampling method. These subjects were admitted for suicide attempt and were stable after medical management. Subjects were assessed using socio-demographic and clinical proforma, Pierce suicide intent scale and structured questionnaire to assess their perception regarding suicide. Group differences for categorical variables were examined with the chi-square test, whereas an independent 't' test was used for continuous variables.

RESULTS

Analysis revealed that 80% of suicide attempters felt that their suicide attempt could have been prevented. 64% of the study subjects perceived that family members and near and dear ones could have helped in preventing their attempt while 16% of the study subjects perceived that society could have helped.

CONCLUSIONS

Majority of subjects on recovery from the suicide attempt perceived that their suicide attempt could have been prevented by family members, near and dear ones and society.

Behavioral emergencies in India: would psychiatric emergency services help?

INTRODUCTION

Behavioral emergencies constitute an important component of emergencies worldwide. Yet, research on behavioral emergencies in India has been scarce. This article discusses the burden, types, and epidemiology of behavioral emergencies in India.

METHODS

A computerized search of Medline, Psychinfo, and Cochrane from 1975 to 2009 was performed, and all articles were evaluated and collated. The results were summarized.

RESULTS AND CONCLUSIONS

There is an acute need for psychiatric emergency services in India. Suicides, acute psychoses, and substance-related problems form the major portion of behavioral emergencies, while current trends show a rise in disaster- and terrorism-related emergencies.

Profile and outcome of patients with acute toxicity admitted in intensive care unit: Experiences from a major corporate hospital in urban India

BACKGROUND AND AIM

There is scarcity of data from the Indian subcontinent regarding the profile and outcome of patients presenting with acute poisoning admitted to intensive care units (ICU). We undertook this retrospective analysis to assess the course and outcome of such patients admitted in an ICU of a tertiary care private hospital.

METHODS

We analyzed data from 138 patients admitted to ICU with acute poisoning between July 2006 and March 2009. Data regarding type of poisoning, time of presentation, reason for ICU admission, ICU course and outcome were obtained.

RESULTS

Seventy (50.7%) patients were males and majority (47.8%) of admissions were from age group 21 to 30 years. The most common agents were benzodiazepines, 41/138 (29.7%), followed by alcohol, 34/138 (24.63%) and opioids, 10/138 (7.2%). Thirty-two (23%) consumed two or more agents. Commonest mode of toxicity was suicidal (78.3%) and the route of exposure was mainly oral (97.8%). The highest incidence of toxicity was due to drugs (46.3%) followed by household agents (13%). Organ failure was present in 67 patients (48.5%). During their ICU course, dialysis was required in four, inotropic support in 14 and ventilator support in 13 patients. ICU mortality was 3/138 (2.8%). All deaths were due to aluminium phosphide poisoning.

CONCLUSIONS

The present data give an insight into epidemiology of poisoning and represents a trend in urban India. The spectrum differs as we cater to urban middle and upper class. There is an increasing variety and complexity of toxins, with substance abuse attributing to significant number of cases.

Human rights abuses and suicidal ideation among male injecting drug users in Delhi, India

BACKGROUND

Human rights abuses, denial of care, police surveillance, and violence directed at IDUs have been found to impact HIV prevention efforts due to decreased attendance in harm reduction programs. The association of mental health status with rights abuses has not been examined extensively among drug users. In India, drug control laws are often in conflict with harm reduction policies, thus increasing the likelihood of rights abuses against IDUs. The purpose of this study was to describe human rights abuses occurring among IDUs in Delhi and examine their association with suicidal ideation.

METHODS

343 IDUs were recruited in two research sites in Delhi through respondent driven sampling and were interviewed with a cross sectional survey questionnaire that included items on human rights and socio demographics.

RESULTS

IDUs in the study experienced many human rights abuses. Notably among these were denial of admission into hospital (38.5%), denial of needles and syringes (20%), police arrests for carrying needles and using drugs (85%), verbal abuse (95%) and physical abuse (88%). Several human rights abuses were associated with suicidal ideation. These include being denied needles and syringes (OR: 7.28, 95% CI: 3.03-17.49); being arrested by police for carrying needles and using drugs (OR: 2.53, 95% CI: 1.06-6.03), and being physically abused (OR: 1.66, 95% CI: 1.05-2.23). The likelihood of suicidal ideation is also strongly related to the cumulative number of abuses.

CONCLUSIONS

These findings demonstrate that there is a high prevalence of human rights abuses among IDUs in Delhi. Given the alarming rate of suicidal ideation and its close relationship with human rights abuses it is essential that IDU interventions are executed within a rights-based framework.

Farmers' suicide in India: implications for public mental health

Farmers' suicide in India is a cause of concern and government figures, though conservative, predict an impending epidemic. Various measures to curb this calamity are being made in a piecemeal manner. Considering it as an issue of social and mental health concern, this article attempts to evaluate the situation based on the tenet that health and illness are the result of a complex interplay between biological, psychological, social, environmental, economic and political factors. Thus in India the agrarian crisis, among other causes, has been largely debated as the major reason for the current state of farmers. It is important that (psychiatric) epidemiology and public mental health try to evolve mechanisms to understand and implement measures, and take this into consideration when attempting health promotion and prevention.

Verbal autopsy: methods in transition

Understanding of global health and changing morbidity and mortality is limited by inadequate measurement of population health. With fewer than one-third of deaths worldwide being assigned a cause, this long-standing dearth of information, almost exclusively in the world's poorest countries, hinders understanding of population health and limits opportunities for planning, monitoring, and evaluating interventions. In the absence of routine death registration, verbal autopsy (VA) methods are used to derive probable causes of death. Much effort has been put into refining the approach for specific purposes; however, there has been a lack of harmony regarding such efforts. Subsequently, a variety of methods and principles have been developed, often focusing on a single aspect of VA, and the resulting literature provides an inconsistent picture. By reviewing methodological and conceptual issues in VA, it is evident that VA cannot be reduced to a single one-size-fits-all tool. VA must be contextualized; given the lack of "gold standards," methodological developments should not be considered in terms of absolute validity but rather in terms of consistency, comparability, and adequacy for the intended purpose. There is an urgent need for clarified thinking about the overall objectives of population-level cause-of-death measurement and harmonized efforts in empirical methodological research.

Attempted suicides in India: a comprehensive look

Suicide continues to be one of the biggest killers in the world, with suicide rates varying between 8.1 and 58.3/100,000 population for different parts of India. Andhra Pradesh, the fourth largest state in India, is responsible for more than 11% of these. Unfortunately, most suicides are under-reported and there is scant data on attempted suicides. This study aimed to comprehensively study the characteristics of attempted suicides in Andhra Pradesh and using the primary data, make secondary projections for the forthcoming years. Using Patient Care Record (PCR) forms of all emergencies serviced by 108, the first comprehensive emergency service in India, an analysis of all cases was done to detect possible suicides during the period January-December 2007. A follow up 48 hours later was then done to confirm status and diagnosis. A total of 1007 cases were recorded as confirmed suicides. Hanging and insecticide poisoning (72%) were the most common methods used. Males preferred hanging and insecticide poisoning while females preferred self-immolation and hanging as common methods. Self-immolation and insecticide poisoning had the highest mortality (41.6%). Estimates of attempted suicides for the year 2008 revealed a mean of 3.2-3.8 per 1000 population for males, 3.3-3.7 per 1000 population for females and 6.4-7.6 per 1000 population combined. A serious epidemic of suicides seems to be in store in the coming years unless preventive steps in the form of policy changes are undertaken. Restricting access to poisonous substances or prescription drugs and taking into consideration the prevailing social, economic and cultural factors could help in reducing numbers. Starting tele-help services or offering brief interventions during hospital stays are other programs which may be considered.

Risk factors for suicide in rural south India

BACKGROUND

The relative contributions of psychosocial stress and psychiatric morbidity to suicide are a subject of debate.

AIMS

To determine major risk factors for suicide in rural south India.

METHOD

We used a matched case-control design and psychological autopsy to assess 100 consecutive suicides and 100 living controls matched for age, gender and neighbourhood.

RESULTS

Thirty-seven (37%) of those who died by suicide had a DSM-III-R psychiatric diagnosis. Alcohol dependence (16%) and adjustment disorders (15%) were the most common categories. The prevalence rates for schizophrenia, major depressive episode and dysthymia were 2% each. Ongoing stress and chronic pain heightened the risk of suicide. Living alone and a break in a steady relationship within the past year were also significantly associated with suicide.

CONCLUSIONS

Psychosocial stress and social isolation, rather than psychiatric morbidity, are risk factors for suicide in rural south India.

Global mental health: the role of psychiatry

Despite the huge personal and social impact of mental illnesses, mental health globally is widely neglected and marginalised. A conceptual change in thinking, from the biomedical to a public health model, is essential for integrating mental health services into health systems across the globe. This article discusses the burden of mental health globally, resources available to tackle the massive burden, WHO's mental health Gap Action Programme (mhGAP) on scaling up services with a special focus on low- and middle-income countries, and the paradigm shift required in psychiatry as the way forward.

Suicide in South India: A community-based study in Kerala

BACKGROUND

Studies from Tamil Nadu, South India, have reported the world's highest suicide rates. As per official reports, Kerala, another South Indian state has the highest suicide rate among the major states in India.

OBJECTIVE

The purpose of this analysis is to estimate the rates and age-specific incidence of suicide in a rural community in Kerala, under continuous observation for the last five years.

SETTINGS AND DESIGN

The study setting comprised of seven contiguous panchayats constituting a development block in Kerala. A prospective cohort study design was used.

MATERIALS AND METHODS

Through regular home visits, every death that occurred in the community was captured by local resident health workers and the cause of death assigned.

STATISTICAL ANALYSIS

Suicide rates by age and sex and relative share of suicide deaths to all-cause deaths in men and women were calculated.

RESULTS

During the five-year period from 2002 to 2007, 284 cases of suicide were reported. The suicide rates were 44.7/100,000 for males and 26.8/100,000 for females. Male to female suicide ratio was 1.7. Among females aged between 15 and 24, suicides constituted more than 50% of all deaths. Male to female ratio of suicide varied from 0.4 in children aged 14 years or less to 4.5 in the 45-54 year age group.

CONCLUSION

Our analysis shows that the level of under-reporting of suicides in rural Kerala is much less than that reported in Tamil Nadu.