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Devaraj V, Rose A, Abraham VJ. Nature, prevalence, and risk factors for self-neglect among older people: a pilot study from Vellore, South India. BMC Public Health 2024; 24:948. [PMID: 38566119 PMCID: PMC10986042 DOI: 10.1186/s12889-024-18029-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/07/2024] [Indexed: 04/04/2024] Open
Abstract
Changes in demography in developing countries haves led to new issues among older rural populations, such as self-neglect which is under researched.Self-neglect identified as poor self-care, unsafe living quarters, inadequate medical care and poor utilization of services increase the odds of morbidity and mortality.Methods Our study was conducted in Kaniyambadi, a rural block in Vellore district in the state of Tamil Nadu, India. Ten villages were randomly selected. The study was conducted among people older than 60 years who were selected by random sampling using a computer-generated list. The following assessments were done: (i) A 19-item questionnaire was used to assess self-neglect, (ii) Katz index of daily living to assess functional activity, (iii) Mini Mental State Examination to evaluate cognition, (iv) Geriatric Depression Scale to identify depression, (v) Duke Social Support Index to measure social supports. Clinical data and anthropometric data were also collected. Data were entered into Epidata v3.1. All analyses were performed using SPSS v23.0.Results One hundred fourteen people above 60 years of age participated. The prevalence of self-neglect was 21.1% (95% CI 14.9%-29%); about half of the elderly population (47.38%) refused to seek or follow medical advice. Lower levels of education (OR 3.678, 95% CI 1.017 - 13.301), lower social class (OR 4.455, 95% CI 1.236 - 16.050) and functional impairment (3.643, 95% CI 1.373 - 9.668) were found to be significant factors associated with self-neglect. Though prevalence of comorbidities (70%) and depression (27%) were high, there was no statistical evidence of association with self-neglect.
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Affiliation(s)
- Vibisha Devaraj
- Christian Medical College Vellore, Vellore, Tamil Nadu, India.
| | - Anuradha Rose
- Christian Medical College Vellore, Vellore, Tamil Nadu, India
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Arafat SMY, Ali SAEZ, Menon V, Hussain F, Ansari DS, Baminiwatta A, Saleem T, Singh R, Varadharajan N, Biyyala D, Kar SK, Khan MM. Suicide methods in South Asia over two decades (2001-2020). Int J Soc Psychiatry 2021; 67:920-934. [PMID: 34027683 DOI: 10.1177/00207640211015700] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- S M Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Savar, Dhaka, Bangladesh
| | | | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, PY, India
| | - Fahad Hussain
- Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Daniyal Shabbir Ansari
- Department of Critical Care Unit (Anesthesia and ICU), Civil Hospital, Bahawalpur, Pakistan
| | | | - Tamkeen Saleem
- Department of Psychology, International Islamic University, Islamabad, IS, Pakistan
| | - Rakesh Singh
- Department of Community Health Sciences, PatanAcademy of Health Sciences, Lalitpur, BA, Nepal
| | - Natarajan Varadharajan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, PY, India
| | - Deepika Biyyala
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, PY, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Murad M Khan
- Department of Psychiatry, Aga Khan University, Karachi, SD, Pakistan
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Karunarathne A, Bhalla A, Sethi A, Perera U, Eddleston M. Importance of pesticides for lethal poisoning in India during 1999 to 2018: a systematic review. BMC Public Health 2021; 21:1441. [PMID: 34294076 PMCID: PMC8296580 DOI: 10.1186/s12889-021-11156-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/27/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Poisoning is a major problem in India. However, there is little systematic information on the key poisons responsible for most deaths by geographical area and over time. We aimed to review the literature to identify the poison classes causing the greatest number of deaths in India over the last 20 years. METHODS We performed a systematic literature review in Medline, Embase and Google Scholar (1999-2018), and Indian online medical journals, to find papers that reported deaths from all forms of poisoning in India, with last search 20 April 2020. We included epidemiological studies, observational studies, randomised trials, interventional studies, and case series published from 1999 to 2018 that showed the number of deaths and autopsy studies indicating the specific poisons or poison classes. Studies providing the case fatality for specific poisons or classes, which enabled calculation of the number of deaths, were also included. We excluded deaths due to animal bites and stings, ethanol or methanol poisoning, and gas inhalation as well as papers reporting a single death (case study of single patient). We grouped the papers into 5-year intervals and identified the two most common poison classes in each paper. We used descriptive statistics to summarise the findings over time based on the causative poison and the location of the study. RESULTS We identified 186 papers reporting 16,659 poisoning deaths between 1999 and 2018. The number of publications per 5-year interval showed no clear trend over the period (48, 38, 67, and 36 for consecutive periods). Half of the deaths (n = 8338, 50.0%) were reported during the first 5 years of the study (1999-2003), the number of deaths declining thereafter (to n = 1714 in 2014-2018). Deaths due to pesticide poisoning (94.5%) were dominant across the study period compared to other classes of poison [hair dye paraphenylenediamine poisoning (2.6%), medicine overdose (1.4%) or plant poisoning (1.0%)]. Among the pesticides, aluminium phosphide was the most important lethal poison during the first 10 years before declining markedly; organophosphorus insecticides were important throughout the period, becoming dominant in the last decade as aluminium phosphide cases declined. Unfortunately, few papers identified the specific organophosphorus insecticide responsible for deaths. CONCLUSION Use of the published literature to better understand the epidemiology of lethal poisoning in India has clear limitations, including secular variation in publishing practices and interest in poisoning. Unfortunately, there are no long-term detailed, combination hospital and community studies from India to provide this information. In their absence, our review indicates that pesticides are the most important poison in India, with organophosphorus insecticides replacing aluminium phosphide as the key lethal poison after government regulatory changes in 2001 reduced the latter's lethality. Plant and hair dye poisoning and medicines overdose caused few deaths. Aluminium phosphide deaths mostly occurred in northern Indian states, whereas deaths from organophosphorus insecticide poisoning occurred throughout India. Paraquat poisoning has become a clinical problem in the last 10 years. Lethal pesticide poisoning remains alarmingly common, emphasising the need for additional regulatory interventions to curtail the burden of pesticide poisoning deaths in India. More detailed reporting about the specific pesticide involved in lethal poisoning will be helpful to guide regulatory decisions.
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Affiliation(s)
- Ayanthi Karunarathne
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Ashish Bhalla
- Department of Internal Medicine, Nehru Hospital, Institute of Medical Education and Research, Chandigarh, India
| | - Aastha Sethi
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Government of Maharashtra, Mumbai, Maharashtra, India
| | - Uditha Perera
- Usher Institute for Population Health Sciences & Informatics, University of Edinburgh, Edinburgh, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
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Andoh-Arthur J, Adjorlolo S. Macro-level mental health system indicators and cross-national suicide rates. Glob Health Action 2021; 14:1839999. [PMID: 33465014 PMCID: PMC7833019 DOI: 10.1080/16549716.2020.1839999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The relationship between macro-level mental health system indicators and population suicide rates is an area of contention in the literature, necessitating an analysis of current cross-national data to document any new trend in the relationship. Objective This study investigated whether mental health system indicators are associated with national suicide rates. Method Using an ecological study design and multivariate non-parametric robust regression models, data on suicide rates and mental health system indicators of 191 countries retrieved from WHOs 2017 Mental Health Atlas were compared. Results Findings revealed that the average suicide mortality rate was significantly higher in high- income countries, relative to low-income countries. High-income countries are significantly more likely to have high number of mental health professionals, mental health policies and legislation, independent mental health authority and suicide prevention programs. These mental health system indicators demonstrated significant and positive association with suicide, suggesting that countries scoring high on these factors have higher odds of being categorized as high suicide risk countries. Conclusion The findings have several implications for policy and practice, including the need to make existing mental health systems very responsive to suicide prevention.
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Affiliation(s)
- Johnny Andoh-Arthur
- Department of Psychology, School of Social Sciences, University of Ghana , Accra, Ghana
| | - Samuel Adjorlolo
- Department of Mental Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana , Accra, Ghana.,Research and Grant Institute of Ghana , Accra, Ghana
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Colucci E, Lester D. A cross-cultural study of attitudes toward suicide among young people in India, Italy and Australia. Int J Soc Psychiatry 2020; 66:700-706. [PMID: 32552260 DOI: 10.1177/0020764020926551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND An understanding of the cultural aspects of suicidal behavior is essential for the development of culturally appropriate suicide prevention and intervention strategies. AIMS This study explored the attitudes toward youth suicide in 686 Italian, Indian and Australian undergraduate students (18-24 years old). METHOD A 21-item suicide attitude inventory titled Attitude towards Youth Suicide (AtYS) scale, included in this paper, was used in the three samples. RESULTS Four factors were extracted, labeled negative attitudes toward suicide, belief that suicide was not preventable, suicide as acceptable and normal, and the existence of risk signs for suicide. Country differences were found for all four subscales, with Indian students having the most negative attitudes toward suicide. Sex differences were found in all three countries with women, on the whole, having less negative attitudes toward suicide, more belief in the preventability of suicide in India and more belief in risk signs for suicide in Italy. CONCLUSION Attitudes are linked to suicide in a complex manner. More quantitative and qualitative studies, including in lower-income and non-English speaking Western societies, are needed.
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Menon V, Varadharajan N, Bascarane S, Subramanian K, Mukherjee MP, Kattimani S. Psychological autopsy: Overview of Indian evidence, best practice elements, and a semi-structured interview guide. Indian J Psychiatry 2020; 62:631-643. [PMID: 33896967 PMCID: PMC8052872 DOI: 10.4103/psychiatry.indianjpsychiatry_331_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/19/2020] [Accepted: 08/29/2020] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Natarajan Varadharajan
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Sharmi Bascarane
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Karthick Subramanian
- Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | | | - Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Patel NS, Choudhary N, Choudhary N, Yadav V, Dabar D, Singh M. A hospital-based cross-sectional study on suicidal poisoning in Western Uttar Pradesh. J Family Med Prim Care 2020; 9:3010-3014. [PMID: 32984164 PMCID: PMC7491854 DOI: 10.4103/jfmpc.jfmpc_306_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/19/2020] [Accepted: 04/02/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Poisoning is most common method of committing suicide in India. Objectives of this study to assess prevalence of suicidal poisoning among all poisoning cases, its socio-demographic profile and its reasons in all admitted cases of suicidal poisoning in hospital. METHODS A cross-sectional study was conducted on cases of poisoning of any age group admitted in the Chhatrapati Shivaji Subharti Hospital, Meerut. Poisoning cases with history or evidence of suicide were further interviewed. A semi-structured interview schedule in Hindi was used to collect data. Microsoft Excel 365 and R software version 3.6.0 were used for data entry and analysis respectively. RESULTS Among total 135 poisoning cases admitted in hospital, 126 provided consent and included in the study. Prevalence of suicidal poisoning was 77.7% (98). Most common age group involved was 11-20 years (36.7%) and 21-30 years (35.7%) and most of the participants were males (59.2%). Most suicidal poisoning cases took Aluminum Phosphide (31.6%), followed by Organophosphates (20.4%) as poison. Most frequent reasons for suicide as described by participants were 'Family quarrel or family unhappiness' (29.6%), 'failure in examination or interview or business' (23.5%), 'ill treatment by spouse or in laws' (16.3%) and 'unemployment' (9.2%). CONCLUSION Our study shows that consuming Agriculture poisons (Aluminum Phosphide and Organophosphates) are most common (52%) poisons consumed by suicidal poisoning cases. Agriculture poisons (Aluminum Phosphide and Organophosphates) are easily available in markets in India. There should be some restriction on their purchase to reduce suicidal incidences.
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Affiliation(s)
- Narendra Singh Patel
- Department of Forensic Medicine and Toxicology, Atal Bihari Vajpayee Government Medical College, Vidisha, Madhya Pradesh, India
| | - Nidhi Choudhary
- Department of Dermatology, RKDF Medical College Hospital and Research Center, Bhopal, Madhya Pradesh, India
| | - Nitin Choudhary
- Department of Endocrinology, AIIMS, Bhopal, Madhya Pradesh, India
| | - Vikas Yadav
- Department of Community Medicine, Atal Bihari Vajpayee Government Medical College, Vidisha, Madhya Pradesh, India
| | - Deepti Dabar
- Department of Community and Family Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Mahendra Singh
- Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India
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Bonvoisin T, Utyasheva L, Knipe D, Gunnell D, Eddleston M. Suicide by pesticide poisoning in India: a review of pesticide regulations and their impact on suicide trends. BMC Public Health 2020; 20:251. [PMID: 32075613 PMCID: PMC7031890 DOI: 10.1186/s12889-020-8339-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/10/2020] [Indexed: 01/20/2023] Open
Abstract
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.
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Affiliation(s)
- Toby Bonvoisin
- Hull University Teaching Hospitals NHS Trust, Hull, UK
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Leah Utyasheva
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Duleeka Knipe
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
- Population Health Sciences Institute, Bristol Medical School, Bristol, UK
| | - David Gunnell
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
- Population Health Sciences Institute, Bristol Medical School, Bristol, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
- Population Health Sciences Institute, Bristol Medical School, Bristol, UK.
- Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science University of Edinburgh, Edinburgh, UK.
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Karunarathne A, Gunnell D, Konradsen F, Eddleston M. How many premature deaths from pesticide suicide have occurred since the agricultural Green Revolution? Clin Toxicol (Phila) 2019; 58:227-232. [PMID: 31500467 DOI: 10.1080/15563650.2019.1662433] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Ayanthi Karunarathne
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science University of Edinburgh, Edinburgh, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Flemming Konradsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science University of Edinburgh, Edinburgh, UK
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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. Indian J Psychol Med 2019; 41:173-177. [PMID: 30983667 PMCID: PMC6436406 DOI: 10.4103/ijpsym.ijpsym_297_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Aleena M Shajan
- MBBS Students, Christian Medical College, Vellore, Tamil Nadu, India
| | - Adeline Hephzibah
- MBBS Students, Christian Medical College, Vellore, Tamil Nadu, India
| | - Akhila S Jones
- MBBS Students, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jerlyn Susanna
- MBBS Students, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sunil Neethu
- MBBS Students, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sharon Poornima
- MBBS Students, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sarah M Jala
- MBBS Students, Christian Medical College, Vellore, Tamil Nadu, India
| | - D Arputharaj
- MBBS Students, Christian Medical College, Vellore, Tamil Nadu, India
| | - David John
- MBBS Students, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nehemiah Natta
- MBBS Students, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dolorosa Fernandes
- Community Health Department, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shalini Jeyapaul
- Community Health Department, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dimple Jamkhandi
- Community Health Department, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Anu M Oommen
- Community Health Department, Christian Medical College, Vellore, Tamil Nadu, India
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Ramamurthy P, Thilakan P. Geographical and Temporal Variation of Suicide in India, 2006-2015: An Investigation of Factors Associated with Suicide Risk Difference across States/Union Territories. Indian J Psychol Med 2019; 41:160-166. [PMID: 30983665 PMCID: PMC6436417 DOI: 10.4103/ijpsym.ijpsym_569_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
| | - Pradeep Thilakan
- Department of Psychiatry, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
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Dandona R, Bertozzi-Villa A, Kumar GA, Dandona L. Lessons from a decade of suicide surveillance in India: who, why and how? Int J Epidemiol 2018; 46:983-993. [PMID: 27255440 DOI: 10.1093/ije/dyw113] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, Gurgaon, National Capital Region, India
| | - Amelia Bertozzi-Villa
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - G Anil Kumar
- Public Health Foundation of India, Gurgaon, National Capital Region, India
| | - Lalit Dandona
- Public Health Foundation of India, Gurgaon, National Capital Region, India.,Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Gill SK, Muñoz RF, Leykin Y. The Influence of Perceived Stress and Depression on Suicide-Related Beliefs in Caucasian and Indian Adults. CRISIS 2018; 39:127-136. [DOI: 10.1027/0227-5910/a000492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Supria K. Gill
- Clinical Psychology Program, Palo Alto University, Palo Alto, CA, USA
| | - Ricardo F. Muñoz
- Clinical Psychology Program, Palo Alto University, Palo Alto, CA, USA
- Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Yan Leykin
- Clinical Psychology Program, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
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Arya V, Page A, River J, Armstrong G, Mayer P. Trends and socio-economic determinants of suicide in India: 2001-2013. Soc Psychiatry Psychiatr Epidemiol 2018; 53:269-278. [PMID: 29209745 DOI: 10.1007/s00127-017-1466-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate trends and socio-economic determinants of suicide in India over the period of 2001-2013. METHOD Suicide rates between 2001 and 2013 were calculated using suicide statistics provided by National Crime Records Bureau (NCRB) and census data provided by Census of India, stratified by sex, age group, and geographical region, to investigate trends in suicide over the study period. Multilevel negative binomial regression models were specified to investigate associations between state-level indicators of economic development, education, employment and religious factors and sex-specific suicide rates. RESULTS Male suicide rates remained relatively steady (~ 14 per 100,000) while female suicide rates decreased over the study period (9 to 7 per 100,000). The age group of 45-59 years had the highest suicide rate among males while the age group of 15-29 years had the highest suicide rate among females. On average, higher male and female suicide rates were observed in states with: higher levels of development, higher levels of agricultural employment, higher levels of literacy, and higher proportions of people identifying with Hinduism. Higher male suicide rates were also observed in states with higher levels of unemployment. CONCLUSION The process of modernization might be contributing towards higher suicide risk in more developed parts of India. Also, increase in farmer suicides since economic liberalization might be contributing towards higher suicide rates among more agricultural regions. Furthermore, ancient sanctions towards religious suicide are possibly still influencing modern Hindu suicides.
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Affiliation(s)
- Vikas Arya
- Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Jo River
- Sydney Nursing School, The University of Sydney, Camperdown, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Peter Mayer
- Politics and International Studies, The University of Adelaide, Adelaide, Australia
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Joshi R, Faruqui N, Nagarajan SR, Rampatige R, Martiniuk A, Gouda H. Reporting of ethics in peer-reviewed verbal autopsy studies: a systematic review. Int J Epidemiol 2018; 47:255-279. [PMID: 29092034 DOI: 10.1093/ije/dyx216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/14/2022] Open
Abstract
Introduction Verbal autopsy (VA) is a method that determines the cause of death by interviewing a relative of the deceased about the events occurring before the death, in regions where medical certification of cause of death is incomplete. This paper aims to review the ethical standards reported in peer-reviewed VA studies. Methods A systematic review of Medline and Ovid was conducted by two independent researchers. Data were extracted and analysed for articles based on three key areas: Institutional Review Board (IRB) clearance and consenting process; data collection and management procedures, including: time between death and interview; training and education of interviewer, confidentiality of data and data security; and declarations of funding and conflict of interest. Results The review identified 802 articles, of which 288 were included. The review found that 48% all the studies reported having IRB clearance or obtaining consent of participants. The interviewer training and education levels were reported in 62% and 21% of the articles, respectively. Confidentiality of data was reported for 14% of all studies, 18% did not report the type of respondent interviewed and 51% reported time between death and the interview for the VA. Data security was reported in 8% of all studies. Funding was declared in 63% of all studies and conflict of interest in 42%. Reporting of all these variables increased over time. Conclusions The results of this systematic review show that although there has been an increase in ethical reporting for VA studies, there still remains a large gap in reporting.
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Affiliation(s)
- Rohina Joshi
- George Institute for Global Health
- University of New South Wales
- University of Sydney, Sydney, NSW, Australia
| | - Neha Faruqui
- George Institute for Global Health
- University of Sydney, Sydney, NSW, Australia
| | | | | | - Alex Martiniuk
- George Institute for Global Health
- University of Sydney, Sydney, NSW, Australia
| | - Hebe Gouda
- School of Public Health
- Queensland Centre for Mental Health Research, University of Queensland, Brisbane, QLD, Australia
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Benjamin RN, David T, Iyadurai R, Jacob KS. Suicidal Nonorganophosphate Poisoning in a Tertiary Hospital in South India: Nature, Prevalence, Risk Factors. Indian J Psychol Med 2018; 40:47-51. [PMID: 29403130 PMCID: PMC5795679 DOI: 10.4103/ijpsym.ijpsym_223_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND People who deliberately ingest poisons commonly present to emergency departments of hospitals in India. However, there is a dearth of information on poisoning using nonorganophosphorus pesticides. METHODS This prospective, hospital-based study attempted to examine the nonorganophosphorus poisons used to attempt suicide. Data on sociodemographic characteristics of patients, site and source of poisons, co-ingested substances, premeditation, and reason for poisoning were collected. A multinomial logistic regression was performed to determine association between poison class and these exposure characteristics. RESULTS Three hundred and forty-one cases of attempted suicide presented during the 6-month period (1.7% of all emergency room admissions). The majority was predominantly male and was young adults. Poisoning was the most common mode (91.7%), followed by hanging (7.3%) and self-injury (3, 0.9%). Pesticides (44.3%) including organophosphates (25.5%) were the predominant poisons, followed by pharmaceuticals (27.9%), caustics/chemicals (12.0%), and plant poisons (7.0%). One hundred and nine were available for prospective interview as the others who presented were not detained for prolonged observation the emergency department. Most patients who ingested such poisons were women, from rural backgrounds and were educated. The majority sourced the poisons from home, consumed poison at home, and mixed the poison with water; these attempts were impulsive and seemed to be in response to relationship conflicts. In the multivariate analysis, education (P = 0.08) and poison source (outside the home) were significant predictors of pesticide ingestion. CONCLUSIONS Suicidal poisoning results from a complex synthesis of socioeconomic and psychological factors; certain patterns of poisoning are likely to be more prevalent in demographic niche groups.
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Affiliation(s)
| | - Thambu David
- Department of Medicine, Unit 2, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Iyadurai
- Department of Medicine, Unit 5, Christian Medical College, Vellore, Tamil Nadu, India
| | - K S Jacob
- Department of Psychiatry, Unit 1, Christian Medical College, Vellore, Tamil Nadu, India
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Bhanu KU, Khandelwal N, Vyas S, Singh P, Prabhakar A, Mittal BR, Bhalla A. Evaluation of MR perfusion abnormalities in organophosphorus poisoning and its correlation with SPECT. Indian J Radiol Imaging 2017; 27:36-42. [PMID: 28515582 PMCID: PMC5385771 DOI: 10.4103/0971-3026.202961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM Acute organophosphate (OP) pesticide poisoning causes substantial morbidity and mortality worldwide. Many imaging modalities, such as computerized tomography (CT), magnetic resonance imaging (MRI), and single photon emission computed tomography (SPECT) of the brain, have been used for quantitative assessment of the acute brain insult caused by acute OP poisoning. Perfusion defects on SPECT in acutely poisoned patients with OPs have been described, however, MR perfusion abnormalities have not been described in the literature. MR perfusion Imaging has the advantage of having higher spatial resolution, no radiation, and better availability. MATERIALS AND METHODS In this prospective study, 20 patients who ingested OP compounds were included. All the patients underwent brain SPECT on a dual head SPECT gamma camera and MRI brain on a 1.5T MR system. Neurocognitive tests were performed for all patients. RESULTS SPECT showed perfusion defects in 7 patients and total number of perfusion defects were 29. On MR perfusion, based on the cut-off values of normalized cerebral blood volume (nCBV) ratios and normalized cerebral blood flow (nCBF) ratios, the total number of patients showing perfusion defects were 6 and 8; and the total number of perfusion defects were 29 and 45, respectively. There was significant difference of the nCBV ratios and nCBF ratios between the control group (n = 20) and positive patients group (n = 6 and n = 8, respectively) (P > 0.05). All the defects seen on SPECT were well appreciated on nCBF maps (MRI perfusion) suggestive of 100% correlation. CONCLUSION MR perfusion imaging can be used as an effective modality for evaluation in acute OP poisoning.
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Affiliation(s)
- K Uday Bhanu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Paramjeet Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuj Prabhakar
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - B R Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Shahnaz A, Bagley C, Simkhada P, Kadri S. Suicidal Behaviour in Bangladesh: A Scoping Literature Review and a Proposed Public Health Prevention Model. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/jss.2017.57016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Spectrum of unnatural deaths associated with positive toxicology findings in Eastern Province, KSA: An autopsy based study. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2016. [DOI: 10.1016/j.ejfs.2016.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Issa SY, Aldossary M, Almazroua MK, Youssef MAS, Ghaleb S, Alsowayigh K, Hamd MA, Kharoshah M. Patterns of violent deaths associated with positive ethanol finding in Eastern Province, Saudi Arabia. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2016. [DOI: 10.1016/j.ejfs.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
BACKGROUND Suicide and suicidal attempt are an important cause of mortality and denotes severe morbidity among the population. Successful suicide attempt is associated with previous suicide attempts. Identifying factors in suicide attempters will help in formulating a comprehensive response to these issues. OBJECTIVE To identify the sub group who are more vulnerable and the factors associated with this group. SETTING AND DESIGN A cross sectional observational study of this sub group was carried out. MATERIAL AND METHODS study was conducted on patients who were referred to the Psychiatry department for attempted suicide. They were assessed to identify those with high suicidal intent and study the factors associated with high suicidal intent. STATISTICS Epiinfo by CDC was used to analyze the results. RESULTS High intent was associated with history of psychiatric illness, history of previous attempts and family history of suicidal attempts. CONCLUSIONS A sub group was identified which had a high intent and possibly higher chance of repeating an attempt.
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Affiliation(s)
- Rajkumar Ramanathan
- Department of Psychiatry, SRM Medical College Hospital and Research Centre, Kanchipuram, Tamil Nadu, India
| | | | - Kalaivani Periasamy
- Department of Psychology, SRM Medical College Hospital and Research Centre, Kanchipuram, Tamil Nadu, India
| | - Kala Saminathan
- Department of Psychiatry, SRM Medical College Hospital and Research Centre, Kanchipuram, Tamil Nadu, India
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Abstract
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.
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Abstract
Recent studies from India have challenged the fact that the majority of the people who die by suicide have severe mental illness; they have demonstrated its frequent links to environmental stress, social, cultural, economic, and political correlates. Suicide, a complex phenomenon, is a final common pathway for a variety of causal etiologies. Nevertheless, psychiatry continues to argue for curative solutions based on the reductionistic biomedical model, rather than support public health measures to manage the larger sociocultural, economic, and political context. While psychiatry and curative medicine help many people in distress, specific mental health interventions are unlikely to impact secular trends in the rates of suicide. The reduction of population rates of suicide requires a range of public health measures.
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Affiliation(s)
- K S Jacob
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract
Suicide is a conscious act of the will with personal and societal ramifications. Its conscious and volitional nature deepens its tragic impact. India has high suicide rates compared to the other countries and also has intriguing distinctiveness due to the reports of higher rates from areas with better health indices and gender opportunities. In this article, I present a broader paradigm, in contrast to the usual 'mental disorder paradigm', which puts forward practical points for a multi-level engagement of healthcare service, community and policy makers.
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Affiliation(s)
- Lakshmi Vijayakumar
- Sneha - Suicide Prevention Centre, Voluntary Health Services, Chennai, Tamil Nadu, India
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Issa SY, El Dossary M, Abdel Salam M, Al Madani O, AlMazroua MK, Alsowayigh K, Hamd MA, AboZayed AH, Kharoshah M. Suicidal deaths in depth-Eastern Province-Saudi Arabia. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2016. [DOI: 10.1016/j.ejfs.2016.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Azizpour Y, Asadollahi K, Sayehmiri K, Kaikhavani S, Abangah G. Epidemiological survey of intentional poisoning suicide during 1993-2013 in Ilam Province, Iran. BMC Public Health 2016; 16:902. [PMID: 27576701 PMCID: PMC5006274 DOI: 10.1186/s12889-016-3585-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 08/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is an important social tragic phenomenon which occurs by different tools or methods in different communities. Considering deliberate poisoning as a common and important method in Ilam province for suicide, the present study was launched to epidemiologically assess committing suicide in Ilam province, Iran, based on intentional poisoning. METHODS By a retrospective study, all the recorded data associated with intentional poisoning suicide in Ilam Province during 1993-2013 were analyzed. All the demographic variables and the suicides' outcomes were analyzed using the Chi-Square test, and the univariate and multivariate logistic regression models. RESULTS Totally, 6794 cases of suicide (annual incidence rate of 87.28/ 100, 000) associated with poisoning were evaluated. The incidence rate of suicide attempts was 84.63/ 100, 000 (94.51 in female and 74.98 in male) and the incidence rate of completed suicide was 2.17/ 100, 000 (1.94 in female and 2.40 in male). Also, the highest rates of attempted and completed suicide (annual incidence rate of 172.42 and 4.14, respectively) were attributed to the age group of 15-24 year. CONCLUSION Females had a greater tendency to commit suicide by poisoning, and the lower level of education, the age group of 15-24 years and single individuals were more associated with suicide using poisonings. The incidence of attempted suicide in females and completed suicide in males was higher in this method. Considering the high rate of suicide by poisoning, further attention and supervision on the sale and reserve of drugs and poisons is necessary. Meanwhile, it seems that due to momentary emotions during the pubertal stage, the risk of committing suicide is increased especially among unemployed individuals; therefore, performing an extensive psychotherapy intervention is needed in the societies with younger populations.
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Affiliation(s)
- Yosra Azizpour
- Department of Clinical Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Khairollah Asadollahi
- Department of Social Medicine, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
- Psychosocial Injuries Researches Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Kourosh Sayehmiri
- Psychosocial Injuries Researches Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Satar Kaikhavani
- Department of Clinical Psychology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Ghobad Abangah
- Department of Internal Medicine, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
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Ma J, Jing H, Zeng Y, Tao L, Yang Y, Ma K, Chen L. Retrospective analysis of 319 hanging and strangulation cases between 2001 and 2014 in Shanghai. J Forensic Leg Med 2016; 42:19-24. [DOI: 10.1016/j.jflm.2016.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/18/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
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Merriott D. Factors associated with the farmer suicide crisis in India. J Epidemiol Glob Health 2016; 6:217-227. [PMID: 27080191 PMCID: PMC7320464 DOI: 10.1016/j.jegh.2016.03.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 03/08/2016] [Accepted: 03/14/2016] [Indexed: 11/25/2022] Open
Abstract
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.
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Rajkumar AP, Senthilkumar P, Gayathri K, Shyamsundar G, Jacob KS. Associations Between the Macroeconomic Indicators and Suicide Rates in India: Two Ecological Studies. Indian J Psychol Med 2015; 37:277-81. [PMID: 26664075 PMCID: PMC4649809 DOI: 10.4103/0253-7176.162917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Anto P Rajkumar
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India ; Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - P Senthilkumar
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - K Gayathri
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - G Shyamsundar
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - K S Jacob
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract
Suicide is a global public health problem. Asia accounts for 60% of the world's suicides, so at least 60 million people are affected by suicide or attempted suicide in Asia each year. The burden of female suicidal behavior, in terms of total burden of morbidity and mortality combined, is more in women than in men. Women's greater vulnerability to suicidal behavior is likely to be due to gender related vulnerability to psychopathology and to psychosocial stressors. Suicide prevention programmes should incorporate woman specific strategies. More research on suicidal behavior in women particularly in developing countries is needed.
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Affiliation(s)
- Lakshmi Vijayakumar
- Voluntary Health Services, Sneha - Suicide Prevention Centre, Chennai, Tamil Nadu, India
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Abstract
SOURCES OF DATA The current report reviews the data from the series Accidental Death and Suicide in India published by India's National Crime Records Bureau (NCRB) reporting official suicide rates based on police reports over the period of 10 years from 2004 to 2013. A reference to wider literature is made to present a comprehensive picture. AREAS OF AGREEMENT Suicide in India is more prevalent in young, is likely to involve hanging and ingestion of pesticides and is related to social and economic causes. Reducing alcohol consumption, unemployment, poverty, social inequities, domestic violence and improving social justice are essential to reduce suicide in India. AREAS OF CONTROVERSY NCRB data might underreport suicide. Discrepancy in farmers' suicide rate between reports suggests that this might be overrepresented in NCRB data. GROWING POINTS An integrated suicide prevention programme with a multidimensional approach is needed. Mental health care bill and the recent launch of first national mental health policy are welcome measures. Decriminalization of suicide is likely to positively influence mental health practice and policy in India. AREA TIMELY FOR DEVELOPING RESEARCH Nationally representative studies investigating fatal and non-fatal suicidal behaviours, evaluation of models of service delivery for the vulnerable population, investigating suicide following different treatment services and effects of decriminalization of suicide on suicide rates should be the focus of future research.
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Affiliation(s)
- Shilpa Aggarwal
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
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Ambade VN, Kolpe D, Tumram N, Meshram S, Pawar M, Kukde H. Characteristic Features of Hanging: A Study in Rural District of Central India. J Forensic Sci 2015; 60:1216-23. [DOI: 10.1111/1556-4029.12772] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 06/03/2014] [Accepted: 07/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Vipul Namdeorao Ambade
- Department of Forensic Medicine; Government Medical College; Nagpur 440 003 Maharashtra India
| | - Dayanand Kolpe
- Department of Forensic Medicine; Vasantrao Naik Government Medical College; Yeotmal 445 001 Maharashtra India
| | - Nilesh Tumram
- Department of Forensic Medicine; Government Medical College; Nagpur 440 003 Maharashtra India
| | - Satin Meshram
- Department of Forensic Medicine; Government Medical College; Nagpur 440 003 Maharashtra India
| | - Mohan Pawar
- Department of Forensic Medicine; Vasantrao Naik Government Medical College; Yeotmal 445 001 Maharashtra India
| | - Hemant Kukde
- Department of Forensic Medicine; Vasantrao Naik Government Medical College; Yeotmal 445 001 Maharashtra India
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Kosaraju SKM, Vadlamani LN, Mohammed Bashir MS, Kalasapati LK, Rao GLVC, Rao GP. Risk factors for suicidal attempts among lower socioeconomic rural population of telangana region. Indian J Psychol Med 2015; 37:30-5. [PMID: 25722509 PMCID: PMC4341307 DOI: 10.4103/0253-7176.150813] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Suicide is an act of intentionally causing one's own death. Number of suicidal incidences is proportional to attempted suicide cases hence if attempt cases are reduced, number of suicidal death can also be decreased and for that purpose risk factors should be identified and reduced. Therefore, this study is planned to identify risk factors among lower socioeconomic rural population of surrounding areas of Hyderabad in India. MATERIALS AND METHODS This was a prospective study in which all the suicide attempt cases reported at Bhaskar Medical College and General Hospital were included. The study period was from January 2013 to July 2013. They were undergone a detailed psychiatric interview, including their demographic details, and complete suicide risk assessment was done using Beck's suicide intent scale. RESULTS It was found that females in the age group of 20-30 years, uneducated, married and daily laborers by occupation had higher incidence of suicidal attempts. Depressive disorder is the most common associated psychiatric disorder in both the genders, followed by alcohol use related problems. Family disputes are the other major risk factors. Most common mode for attempt was organophosphorous poisoning followed by ingestion of calotropis. CONCLUSION Risk of suicide attempt is almost equal in terms of medium and high category of suicide assessment scale in both genders. We suggest that all individuals with alcohol related disorders must be screened for suicidal ideation so that appropriate methods can be adopted to reduce the risk.
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Affiliation(s)
| | | | | | | | - G L V Chalapathi Rao
- Department of Psychiatry, Bhaskar Medical College and General Hospital, Hyderabad, India
| | - G Prasad Rao
- Department of Psychiatry, Bhaskar Medical College and General Hospital, Hyderabad, India
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Abstract
BACKGROUND Studies conducted in several countries have found an increase in suicide rates in custody than the general population. AIMS The aim was to assess the trends of suicide in custody and to identify characteristics. MATERIALS AND METHODS We examined all available files of the death of people in custody through 2001 to 2010. Information collected included age, sex, type of custody, place of death, presence of any associated disease, history of any psychiatric illness, substance abuse, and cause of death. RESULTS A total 173 autopsies was performed out of which 14 cases were of suicide. The mean age was 31.71 years. 71.42% deaths were noted in police lock-ups while 28.57% were recorded in prison. Hanging was the common method of suicide followed by poisoning. CONCLUSION Suicide in custodial setting is preventable problem in India. Preventing suicide in custody needs cooperation and coordination from various agencies.
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Affiliation(s)
- Rajesh V Bardale
- Department of Forensic Medicine, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Pradeep G Dixit
- Department of Forensic Medicine, Government Medical College and Hospital, Nagpur, Maharashtra, India
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Jordans MJD, Kaufman A, Brenman NF, Adhikari RP, Luitel NP, Tol WA, Komproe I. Suicide in South Asia: a scoping review. BMC Psychiatry 2014; 14:358. [PMID: 25539951 PMCID: PMC4299381 DOI: 10.1186/s12888-014-0358-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Mark JD Jordans
- Research and Development Department, HealthNet TPO, Amsterdam, The Netherlands ,Center for Global Mental Health, Institute of Psychiatry, King’s College London, London, UK
| | - Anne Kaufman
- Research and Development Department, HealthNet TPO, Amsterdam, The Netherlands.
| | - Natassia F Brenman
- Research and Development Department, HealthNet TPO, Amsterdam, The Netherlands.
| | - Ramesh P Adhikari
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, G.P.O Box 8974/ C.P.C. Box 612, Baluwatar, Kathmandu, Nepal.
| | - Nagendra P Luitel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, G.P.O Box 8974/ C.P.C. Box 612, Baluwatar, Kathmandu, Nepal.
| | - Wietse A Tol
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Ivan Komproe
- Research and Development Department, HealthNet TPO, Amsterdam, The Netherlands. .,Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands.
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36
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Badiye A, Kapoor N, Ahmed S. An empirical analysis of suicidal death trends in India: a 5 year retrospective study. J Forensic Leg Med 2014; 27:29-34. [PMID: 25287796 DOI: 10.1016/j.jflm.2014.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/07/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
Abstract
Suicide, a major problem worldwide, continues to be a criminal offence in most of the developing countries of the world, including India. This paper retrospectively examines the latest trends and the relevant determinants of the suicidal deaths in one of the most important city of central India- Nagpur of Maharashtra state, carried out for a period of 5 years i.e. 2009-2013. Total 2036 cases were analyzed. An alarmingly increasing trend in the rate of suicides has been observed in the region, which increased from 16% to 22.68% during the study period. The male to female suicide ratio was found to be 2.50:1. The rate of suicidal deaths ranged from 15.34 to 21.74 per 100,000 populations. Hanging was found to be the most preferred mean adopted for suicide by males (54.77%) and females (47.65%), while, Family problems was the most common cause of suicide among both male (38.25%) and female (52.65%). The Suicides were concentrated in the age group of 30-44 years for males (35.76%), while in the age group of 15-29 years for females (51.75%). The prevalence was higher among the people who were married, being as high as 1099 (66.73%) males and 372 (56.45%) females. Highest trend has been found among the people with matriculate/secondary education level. The males with job in private sector accounted for 1007 suicides (61.14%) and 434 (65.86%) females in the category of housewives (non-working, homemakers) committed the same.
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Affiliation(s)
- Ashish Badiye
- Govt. Institute of Forensic Science, Nagpur, Maharashtra, India.
| | - Neeti Kapoor
- Govt. Institute of Forensic Science, Nagpur, Maharashtra, India.
| | - Shagufa Ahmed
- Govt. Institute of Forensic Science, Nagpur, Maharashtra, India
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37
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Rane A, Nadkarni A. Suicide in India: a systematic review. SHANGHAI ARCHIVES OF PSYCHIATRY 2014; 26:69-80. [PMID: 25092952 PMCID: PMC4120287 DOI: 10.3969/j.issn.1002-0829.2014.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/01/2014] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Anil Rane
- Institute of Psychiatry & Human Behaviour, Goa, India
| | - Abhijit Nadkarni
- London School of Hygiene & Tropical Medicine, London, United Kingdom ; Sangath, Goa, India
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38
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Peiris-John R, Kafoa B, Wainiqolo I, Reddy RK, McCaig E, Ameratunga SN. Population-based characteristics of fatal and hospital admissions for poisoning in Fiji: TRIP Project-11. Inj Prev 2013; 19:355-7. [PMID: 23353079 PMCID: PMC3786648 DOI: 10.1136/injuryprev-2012-040651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/02/2012] [Accepted: 12/14/2012] [Indexed: 11/23/2022]
Abstract
This study investigated the incidence and characteristics of poisoning fatalities and hospital admissions among indigenous Fijians and Indians in Viti Levu, Fiji. Individuals with a mechanism of injury classified as poisoning were identified using the Fiji injury surveillance in hospitals system, a population-based registry established for 12 months in Viti Levu, and analysed using population-based denominators. The mean annual rates of fatalities and hospitalisations were 2.3 and 26.0 per 100 000, respectively. Over two-thirds of poisonings occurred among people of Indian ethnicity. Most intentional poisoning admissions occurred among women (58.3%) and in 15-29-year-old individuals (73.8%). Unintentional poisoning admission rates were highest among Indian boys aged 0-14 years. While over 75% of events occurred at home, the substances involved were not systematically identified. The findings indicate the need for a strategy that addresses the differing contexts across age group, gender and ethnicity, and a lead agency responsible for implementing and monitoring its effectiveness.
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Affiliation(s)
- Roshini Peiris-John
- Section of Epidemiology & Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Berlin Kafoa
- College of Medicine, Nursing and Health Science, Fiji National University, Suva, Fiji
| | - Iris Wainiqolo
- College of Medicine, Nursing and Health Science, Fiji National University, Suva, Fiji
| | - Ravi Krishnan Reddy
- Section of Audiology, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Eddie McCaig
- Department of Surgery, College of Medicine, Nursing and Health Science, Fiji National University, Suva, Fiji
| | - Shanthi N Ameratunga
- Section of Epidemiology & Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
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39
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Menon V. Suicide risk assessment and formulation: an update. Asian J Psychiatr 2013; 6:430-5. [PMID: 24011694 DOI: 10.1016/j.ajp.2013.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 07/07/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
There continues to be a lack of clarity on how to assess individual cases for suicidal risk. Though a surfeit of information regarding patient risk factors for suicide is available, clinicians and mental health professionals face difficulties in integrating and applying this information to individuals, in order to come up with an assessment report that is at once comprehensive, operational and easily communicable. This article outlines the basic steps involved in risk assessment with a focus on applying and integrating them. Illustrative questions and examples are used to aid understanding where appropriate. The three major domains emphasized across all contemporary models of risk assessment are specific suicidal thoughts, risk factors and protective factors. Evidence based warning signs associated with near term risk of suicide are reviewed and various approaches proposed for risk formulation are discussed with the aim of providing usable and practical information regarding assessment and formulation of suicide risk. The importance of following a structured, systematic approach is highlighted.
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Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India.
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40
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Rajkumar AP, Brinda EM, Duba AS, Thangadurai P, Jacob KS. National suicide rates and mental health system indicators: an ecological study of 191 countries. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2013; 36:339-342. [PMID: 23870280 DOI: 10.1016/j.ijlp.2013.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
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.
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Affiliation(s)
- A P Rajkumar
- Department of Biomedicine, Aarhus University, Aarhus - 8000, Denmark.
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Chrispal A. Cleistanthus collinus poisoning. J Emerg Trauma Shock 2013; 5:160-6. [PMID: 22787347 PMCID: PMC3391841 DOI: 10.4103/0974-2700.96486] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 01/10/2011] [Indexed: 11/17/2022] Open
Abstract
Cleistanthus collinus, a toxic shrub, is used for deliberate self-harm in rural South India. MEDLINE (PUBMED) and Google were searched for published papers using the search/ MeSH terms “Cleistanthus collinus,” “Euphorbiaceae,” “Diphyllin,” “Cleistanthin A,” Cleistanthin B” and “Oduvanthalai.” Non-indexed journals and abstracts were searched by tracing citations in published papers. The toxic principles in the leaf include arylnaphthalene lignan lactones — Diphyllin and its glycoside derivatives Cleistanthin A and B. Toxin effect in animal models demonstrate neuromuscular blockade with muscle weakness, distal renal tubular acidosis (dRTA) and type 2 respiratory failure with conflicting evidence of cardiac involvement. Studies suggest a likely inhibition of thiol/thiol enzymes by the lignan-lactones, depletion of glutathione and ATPases in tissues. V-type H+ ATPase inhibition in the renal tubule has been demonstrated. Mortality occurs in up to 40% of C. collinus poisonings. Human toxicity results in renal tubular dysfunction, commonly dRTA, with resultant hypokalemia and normal anion gap metabolic acidosis. Aggressive management of these metabolic derangements is crucial. Acute respiratory distress syndrome (ARDS) is seen in severe cases. Cardiac rhythm abnormalities have been demonstrated in a number of clinical studies, though the role of temporary cardiac pacemakers in reducing mortality is uncertain. Consumption of decoctions of C. collinus leaves, hypokalemia, renal failure, severe metabolic acidosis, ARDS and cardiac arrhythmias occur in severe poisonings and predict mortality. Further study is essential to delineate mechanisms of organ injury and interventions, including antidotes, which will reduce mortality.
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Affiliation(s)
- Anugrah Chrispal
- Department of Medicine, Unit 2, Christian Medical College, Vellore, Tamil Nadu, India
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42
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Madadin M, Mahmoud A, Alsowayigh K, Alfaraidy M. Suicide deaths in dammam, kingdom of Saudi Arabia: Retrospective study. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2013. [DOI: 10.1016/j.ejfs.2013.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Armstrong G, Nuken A, Samson L, Singh S, Jorm AF, Kermode M. Quality of life, depression, anxiety and suicidal ideation among men who inject drugs in Delhi, India. BMC Psychiatry 2013; 13:151. [PMID: 23711075 PMCID: PMC3680014 DOI: 10.1186/1471-244x-13-151] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 05/21/2013] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Gregory Armstrong
- Nossal Institute for Global Health, University of Melbourne, Victoria, Australia
| | - Amenla Nuken
- Nossal Institute for Global Health, University of Melbourne, Victoria, Australia
| | - Luke Samson
- The Society for Service to Urban Poverty (SHARAN), Delhi, India
| | - Shalini Singh
- The Society for Service to Urban Poverty (SHARAN), Delhi, India
| | - Anthony F Jorm
- Population Mental Health Group, Melbourne School of Population Health, University of Melbourne, Victoria, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, Victoria, Australia
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Jacob KS. Psychosocial adversity and mental illness: Differentiating distress, contextualizing diagnosis. Indian J Psychiatry 2013; 55:106-10. [PMID: 23825841 PMCID: PMC3696230 DOI: 10.4103/0019-5545.111444] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- K S Jacob
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
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Dhyani M, Trivedi JK, Nischal A, Sinha PK, Verma S. Suicidal behaviour of Indian patients with obsessive compulsive disorder. Indian J Psychiatry 2013; 55:161-6. [PMID: 23825851 PMCID: PMC3696240 DOI: 10.4103/0019-5545.111455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND SETTING AND DESIGN The chronicity, distress, high rates of comorbidity and varying degree of non response to treatment in Obsessive Compulsive Disorder (OCD) may contribute to suicidal behavior. There is relatively little information on suicidal behavior in OCD subjects. Our study design is Single point non-invasive, cross sectional, clinical study of new and follow up cases. MATERIALS AND METHODS Assessment of Suicidal Behavior in patients of OCD attending the adult Psychiatry O.P.D. of Chatrapati Shahuji Maharaj Medical University (CSMMU) U.P. Lucknow using (DSM-IV) criteria for diagnosis of Obsessive Compulsive Disorder, Structured Clinical Interview for DSM-IV Axis-I disorders, Yale Brown Obsessive Compulsive Rating Scale, Scale for Suicidal Ideation (SSI), Beck's Hopelessness Scale (BHS). STATISTICAL ANALYSIS Mean standard deviation and t test for independent samples, Pearson's correlation coefficient. RESULTS Statistically significant differences were seen in the SSI score between the "Clinical" and "Sub-Clinical" cases with Clinical group having higher scores. Value of correlation coefficient between YBOCS score and SSI and BHS score is positive and statistically significant (P<0.01). CONCLUSION "Clinical" group of patients had significantly higher scores of suicidal ideation measured by Scale of Suicidal Ideation (SSI). There was a significantly positive correlation between disease severity (YBOCS Score) and degree of suicidal ideation (SIS Score).
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Affiliation(s)
- Mohan Dhyani
- Department of Psychiatry, Chatrapati Shahuji Maharaj Medical University, U.P. (Formerly K. G. Medical University), Lucknow, Uttar Pradesh, India
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Abstract
This study set out to explore the epidemiology of suicide in Bangladesh. A cross-sectional study was carried out during 2003 (January to December). This encompassed a population of 819,429 of all age-groups and sexes. Data was collected by face-to-face interviews at a household level. Suicide was found to be the leading cause of death by injury in the age group of 10-19 years. Adolescent females (10-19 year age group) were found to be the most vulnerable. Overall, the suicide rate was 7.3 (95% CI 5.6-9.5) per 100,000 per year and the highest rate was found in the age group of 60+ years. The rate of suicide was found to be 17-fold higher (95% CI 5.36-54.64) in the rural population, compared to urban rates. Adolescent suicide rate in rural areas was 20.1 (95% CI 12.6-31.7) per 100,000. The rate was 17.7 (95% CI 8.6-34.9) and 22.7(95% CI 12-42) among males and females respectively. Poisoning was found as the most frequent method of suicide. The majority of the suicide victims were found to be very poor and illiterate. Suicide is a major public health problem in Bangladesh. Age, place of residence, economic status and literacy were the major associating factors related to suicide. Adolescents, elderly and those residing in rural regions were the most vulnerable groups.
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Abstract
Suicide is the third leading cause of death among young adults worldwide. There is a growing recognition that prevention strategies need to be tailored to the region-specific demographics of a country and to be implemented in a culturally-sensitive manner. This review explores the historical, epidemiological and demographic factors of suicide in India and examines the strategies aimed at the prevention of suicide. There has been an increase in the rates of suicide in India over the years, although trends of both increases and decline in suicide rates have been present. Distinct from global demographic risk factors, In India, marital status is not necessarily protective and the female: male ratio in the rate of suicide is higher. The motives and modes of suicide are also distinct from western countries. Preventive strategies implemented at a community level and identifying vulnerable individuals maybe more effective than global strategies.
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Affiliation(s)
- Rajiv Radhakrishnan
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Vishnuvardhan G, Saddichha S. Psychiatric comorbidity and gender differences among suicide attempters in Bangalore, India. Gen Hosp Psychiatry 2012; 34:410-4. [PMID: 22542051 DOI: 10.1016/j.genhosppsych.2012.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/19/2012] [Accepted: 03/21/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Suicides are an entirely preventable cause of death, with current suicide rates being 11.4 per 100,000 population in India. The city of Bangalore in India is often called the suicide capital of India because of its high suicide and attempted suicide rate. This study attempted to evaluate the psychiatric comorbidity and gender differences among suicide attempters presenting to a general hospital in the city of Bangalore, India. METHODS Using a structured questionnaire [Structured Clinical Interview for DSM-IV (SCID)-I and SCID-II], the study gathered data on the psychiatric diagnoses as well as the reasons for and mode of attempted suicides on 100 suicide attempters after taking written informed consent. In addition, the Beck Depression Inventory was also used to evaluate the severity of depression, the most commonly detected psychiatric comorbidity. RESULTS Forty-two percent of the sample had a psychiatric comorbidity, with depression (14%) and dysthymia (12%) being the most common disorders. Among personality disorders (PDs), borderline PD (5%) and dependent PD (3%) were the most commonly detected. Severe depression was detected in 15% of those with a mood disorder. Gender differences were found in both mode and reasons for attempted suicide. CONCLUSION The presence of any psychiatric comorbidity was observed to confer a high risk of suicide. All attempters should therefore be comprehensively evaluated by a qualified health care professional, and attempts should be made for continuous follow-up.
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Abstract
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.
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Affiliation(s)
- Alexandra Pitman
- University College London Mental Health Sciences Unit, London, UK.
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Patel V, Ramasundarahettige C, Vijayakumar L, Thakur JS, Gajalakshmi V, Gururaj G, Suraweera W, Jha P. Suicide mortality in India: a nationally representative survey. Lancet 2012; 379:2343-51. [PMID: 22726517 PMCID: PMC4247159 DOI: 10.1016/s0140-6736(12)60606-0] [Citation(s) in RCA: 289] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND WHO estimates that about 170,000 deaths by suicide occur in India every year, but few epidemiological studies of suicide have been done in the country. We aimed to quantify suicide mortality in India in 2010. METHODS The Registrar General of India implemented a nationally representative mortality survey to determine the cause of deaths occurring between 2001 and 2003 in 1·1 million homes in 6671 small areas chosen randomly from all parts of India. As part of this survey, fieldworkers obtained information about cause of death and risk factors for suicide from close associates or relatives of the deceased individual. Two of 140 trained physicians were randomly allocated (stratified only by their ability to read the local language in which each survey was done) to independently and anonymously assign a cause to each death on the basis of electronic field reports. We then applied the age-specific and sex-specific proportion of suicide deaths in this survey to the 2010 UN estimates of absolute numbers of deaths in India to estimate the number of suicide deaths in India in 2010. FINDINGS About 3% of the surveyed deaths (2684 of 95,335) in individuals aged 15 years or older were due to suicide, corresponding to about 187,000 suicide deaths in India in 2010 at these ages (115,000 men and 72,000 women; age-standardised rates per 100,000 people aged 15 years or older of 26·3 for men and 17·5 for women). For suicide deaths at ages 15 years or older, 40% of suicide deaths in men (45,100 of 114,800) and 56% of suicide deaths in women (40,500 of 72,100) occurred at ages 15-29 years. A 15-year-old individual in India had a cumulative risk of about 1·3% of dying before the age of 80 years by suicide; men had a higher risk (1·7%) than did women (1·0%), with especially high risks in south India (3·5% in men and 1·8% in women). About half of suicide deaths were due to poisoning (mainly ingestions of pesticides). INTERPRETATION Suicide death rates in India are among the highest in the world. A large proportion of adult suicide deaths occur between the ages of 15 years and 29 years, especially in women. Public health interventions such as restrictions in access to pesticides might prevent many suicide deaths in India. FUNDING US National Institutes of Health.
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Affiliation(s)
- Vikram Patel
- The London School of Hygiene and Tropical Medicine, UK
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