Demographic risk factors in pesticide related suicides in Sri Lanka

Pesticide Practices and Suicide among Farmers of the Sundarban Region in India

Background

Deliberate self-poisoning by ingesting pesticides is a serious health problem among farmers, especially in low- and middle-income countries. Preventing these suicides is a priority for a public mental health agenda.

Objective

To examine the role of pesticide poisoning in suicide and nonfatal deliberate self-harm, and clarify awareness of risks, safe practices concerning storage and use of pesticides, and associated self-injury, both unintentional and intentional, within farmer households of the Sundarban region, India.

Methods

Retrospective record review of adult cases of deliberate self-poisoning at the Block Primary Health Centres of 13 Sundarban Blocks was performed to analyze the relative roles of various methods of self-harm and their lethality. Focus group discussions, questionnaires, and in-depth interviews were undertaken in a community study of farmer households to examine pesticide-related views and practices, with particular attention to storage, use, and health impact.

Results

Pesticide poisoning was the most common method of deliberate self-harm in both men and women. Pesticide storage in most households was unsafe and knowledge was inadequate concerning adverse effects of pesticides on health, crops, and the environment.

Conclusions

An intersectoral approach linking the interests of public health, mental health, and agriculture is well suited to serve the collective interests of all three agendas better than each in isolation. Such an approach is needed to reduce morbidity and mortality from unintentional and intentional self-injury in low-income agricultural communities like those of the Sundarban region.

Psychiatric comorbidity and its impact on mortality in patients who attempted suicide by paraquat poisoning during 2000-2010

BACKGROUND

Paraquat poisoning is a lethal method of suicide used around the world. Although restricting its accessibility had been widely discussed, the underlying psychopathological mechanism of paraquat self-poisoning and its association with mortality have not yet been explicitly evaluated.

METHODS

We included all patients admitted to a tertiary general hospital in Taiwan between 2000 and 2010 following a suicide attempt by paraquat self-administration. Diagnoses were made upon psychiatric consultation based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The risk of mortality was calculated by logistic regression with various psychiatric or medical covariates.

RESULTS

The consultation-liaison psychiatry team assessed 157 patients who attempted suicide by paraquat poisoning. Mood disorders (54.0%), including dysthymic (26.7%) and major depressive disorders (24.7%), were the most common psychiatric diagnoses among the self-poisoning patients. Among those who attempted suicide, 87 patients (58.0%) died and dysthymic disorder (OR = 5.58, 95% CI: 1.13-27.69; p < 0.05) significantly increased the mortality risk after adjustment for relevant medical variables, including age, gender, severity index of paraquat poisoning (SIPP), and risk for respiratory failure.

CONCLUSIONS

Awareness of comorbid psychiatric illnesses, especially dysthymic disorder, is vital in the prevention and treatment of suicide by paraquat poisoning.

A review of the literature on rural suicide: risk and protective factors, incidence, and prevention

BACKGROUND

Suicide is a major cause of mortality worldwide. Differences in rates of suicide exist between urban and rural areas; however, little rigorous research has examined the phenomena of rural suicide.

OBJECTIVE

This review examines the current body of literature on rural suicide and investigates differences between rural and urban suicide, including socioeconomic, psychological, and cultural variables. Prevention and intervention strategies specific to rural communities are discussed. DESCRIPTION OF STUDIES: All empirical and epidemiological studies of rural suicide were included in the review regardless of study design or methodology.

RESULTS

Although findings are mixed, research and epidemiological data indicate that suicide is a public health concern in rural areas, with suicide rates often greater than in urban areas.

DISCUSSION

Rural locale may create geographic, psychological, and sociocultural barriers to treatment of suicide. A better understanding of the role of rurality in the development and maintenance of suicidal thoughts and behaviors is needed and may inform prevention and intervention efforts.

Prevention of Deaths from Intentional Pesticide Poisoning

Abstract. Ingestion of pesticides is the most common suicide method worldwide, accounting for one third of all suicides, predominantly in Asia, Africa, Central and South America. Case fatalities are high, particularly in rural areas. This high case fatality may explain the similar numbers of male and female suicides in Asia, since more women die from their attempts. In Asia, pesticide suicides are mostly impulsive acts with little advance planning and they are less often associated with mental illness than in Western countries. Pesticides are generally chosen for their easy access. Prevention strategies include treating the problems leading to suicidal behaviors involving pesticides; changing attitudes, knowledge, and beliefs about pesticides; controlling access to dangerous pesticides, including developing secure storage practices (which are currently being evaluated); and improving the medical treatment of poisonings. More research is needed to better understand suicides involving pesticides in their cultural contexts and to evaluate the effectiveness of intervention programs, including assessment of possible substitution of methods. Also, more knowledge about protective factors may help suggest innovative prevention strategies.

Identification of strategies to prevent death after pesticide self-poisoning using a Haddon matrix

Despite pesticide self-poisoning causing around 300 000 deaths each year in the rural Asia Pacific region, no comprehensive public health response has yet been formulated. The authors have developed a Haddon matrix to identify factors that increase the risk of fatal rather than non-fatal pesticide self-poisoning in Sri Lanka. Many important host factors such as age, gender, and genetics are not alterable; factors that could be changed-alcohol use and mental health-have previously proved difficult to change. Interventions affecting agent or environmental factors may be easier to implement and more effective, in particular those limiting the human toxicity and accessibility of the pesticides, and the quality, affordability, and accessibility of health care in the community. Controlled studies are required to identify effective strategies for prevention and harm minimization and to garner political support for making the changes necessary to reduce this waste of life. Lessons learnt from Sri Lanka are likely to be highly relevant for much of rural Asia.