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Bandara P, Wickrama P, Sivayokan S, Knipe D, Rajapakse T. Reflections on the trends of suicide in Sri Lanka, 1997-2022: The need for continued vigilance. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003054. [PMID: 38630779 PMCID: PMC11023397 DOI: 10.1371/journal.pgph.0003054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/03/2024] [Indexed: 04/19/2024]
Abstract
Despite reductions in suicide rates in Sri Lanka during the past decades, largely by introduction of national bans on highly hazardous pesticides, the country continues to record a higher than global average rate of suicide. With the changing availability of methods of suicide over time, we aimed to examine the age-standardized suicide rates in Sri Lanka by sex, age, and method between 1997 to 2022 using national police suicide data to identify trends. The rate of suicide in Sri Lanka in 2022 was 27/100,000 and 5/100,000, in males and females respectively, with an overall suicide rate of 15/100,000 population. When considering the previous decades, the overall rate of suicide has declined from 1997 until about 2015, in both sexes, driven by a drop in the numbers of suicides due to pesticide ingestion. In females the overall rates of suicide plateaued around 2015, but in males there has been an upward trend in overall suicide that started in 2016, mostly due to an increase in rates of hanging. Since 2016 rates of suicide by hanging have increased among older males, and young females (17-25 years). Whilst the current suicide rate in Sri Lanka is substantially lower than it was during the 1990s, the upward trend in hanging seen in the last few years, particularly among older men and young women, is of concern. Ongoing monitoring of suicide rates should be a priority during the next few years, to detect and respond to changes as soon as possible. There is an urgent need to address current risk factors for suicide in Sri Lanka, such as significant financial insecurity, unemployment, depression, alcohol misuse, and domestic violence, and to minimize media glamourization of hanging by suicide.
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Affiliation(s)
- Piumee Bandara
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Prabath Wickrama
- Department of Psychiatry, University of Jaffna, Jaffna, Sri Lanka
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Haregu T, Chen Q, Arafat SMY, Cherian A, Armstrong G. Prevalence, correlates and common methods of non-suicidal self-injury in South Asia: a systematic review. BMJ Open 2023; 13:e074776. [PMID: 37993150 PMCID: PMC10668266 DOI: 10.1136/bmjopen-2023-074776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/27/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION The dynamics of self-harm vary substantially around the world, yet it is severely under-researched outside of a small number of high-income 'Western' countries. South Asia is disproportionately impacted by suicide, yet we know less about non-suicidal self-injury (NSSI) in the region. OBJECTIVE To review and summarise evidence on the prevalence, correlates and common methods of NSSI in South Asia. METHODS We searched Medline, Embase and PsycINFO for the period 1 January 2000 to 31 August 2023, for peer-reviewed observational studies. A total of 11 studies from eight South Asian countries that reported prevalence and/or correlates of NSSI were included in this review. We assessed the quality of the studies using the Study Quality Assessment Tools for Observational Cohort and Cross-Sectional Studies. We used meta-regression to describe the sources of heterogeneity. Abstracted data were summarised using thematic synthesis. RESULTS For non-clinical populations, the 12-month prevalence of NSSI ranged from 3.2% to 44.8%, and the lifetime prevalence ranged from 21% to 33%. For clinical populations, the 12-month prevalence of NSSI ranged from 5% to 16.4%, while the lifetime prevalence ranged from 2% to 27%. Male sex, unemployment, financial stress, history of suicidal behaviour and depression were associated with a higher risk of NSSI. Better access to counselling services, higher self-esteem and self-knowledge were associated with a lower risk of NSSI. CONCLUSION The burden of NSSI in South Asia appears to be high in both clinical and non-clinical populations. Further research, especially with general population samples, is needed to build evidence on the epidemiology, context and meaning of NSSI in South Asia to inform the design of context-specific interventions. PROSPERO REGISTRATION NUMBER CRD42022342536.
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Affiliation(s)
- Tilahun Haregu
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Quan Chen
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - S M Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Savar, Bangladesh
| | - Anish Cherian
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Gregory Armstrong
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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Arya V, Page A, Vijayakumar L, Onie S, Tapp C, John A, Pirkis J, Armstrong G. Changing profile of suicide methods in India: 2014-2021. J Affect Disord 2023; 340:420-426. [PMID: 37573889 DOI: 10.1016/j.jad.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Restricting access to suicide methods is one of the most effective suicide prevention approaches. METHODS Trends in method specific suicide rates (2014-2021) in India were calculated using National Crime Records Bureau data (NCRB) by sex and geographical region. Joinpoint regression analysis was used to empirically identify any changes in suicide trends. RESULTS Suicide rates by hanging increased from 6.08 to 10.0 per 100,000 population among males and from 2.55 to 3.56 per 100,000 among females over the study period. Insecticide poisoning suicide rates also increased from 1.51 to 2.73 per 100,000 among males and from 0.74 to 1.14 per 100,000 among females. Suicide by self-immolation decreased over the study period among both sexes. In general, these national trends were mirrored among different regions. Joinpoint regression indicated an increase in suicide by hanging (annual percentage change (APC) of 12.3 among males between 2018 and 2021 and 4.9 among females between 2014 and 2021) and an increase in male suicide by insecticide poisoning between 2014 and 2021 (APC of 4.2) while a decrease in self-immolation rates was noted among males (APC of -12.7 between 2014 and 2021) and females (APC of -16.5 between 2016 and 2021). LIMITATION The NCRB data might underestimate true suicide rates. CONCLUSION Hanging suicides and insecticides poisoning suicides observed an increasing trend between 2014 and 2021. Self-immolation rates decreased during the study period which might be, in part, associated with the initiative to provide clean cooking fuel to households. Ban on lethal pesticides must be prioritised which might help lower insecticide poisoning suicide rates.
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Affiliation(s)
- Vikas Arya
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Australia
| | | | | | - Caley Tapp
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Ann John
- Swansea University Medical School, UK
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
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Yadav S, K K A, Cunningham SA, Bhandari P, Mishra US, Aditi A, Yadav R. Changing pattern of suicide deaths in India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 16:100265. [PMID: 37649643 PMCID: PMC10462819 DOI: 10.1016/j.lansea.2023.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Suryakant Yadav
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, India
| | - Aathavan K K
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, India
| | | | - Pravat Bhandari
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, India
| | - Udaya Shankar Mishra
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, India
| | - Aditi Aditi
- Department of Survey Research and Data Analytics, International Institute for Population Sciences (IIPS), Mumbai, India
| | - Ravita Yadav
- Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, India
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Arya V, Page A, Mayer P, Vijayakumar L, Shin S, Pirkis J, Armstrong G. Insights from use of police data for suicide surveillance in India: An interim step toward suicide surveillance in low- and middle-income countries. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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Rajkumar RP. Cultural collectivism, intimate partner violence, and women's mental health: An analysis of data from 151 countries. FRONTIERS IN SOCIOLOGY 2023; 8:1125771. [PMID: 37066068 PMCID: PMC10098113 DOI: 10.3389/fsoc.2023.1125771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
Culture, defined as the distinctive, learned beliefs and patterns of behavior that are particular to a given group or community, is a key determinant of mental health. The cultural dimension of individualism-collectivism, which measures the extent to which a given society accords importance to individuals as opposed to larger groups, has been associated with cross-national variations in mental health outcomes such as depression and suicide. However, this cultural dimension is also associated with variations in the frequency of intimate partner violence (IPV), which has a significant and sustained adverse impact on women's mental health. This study examines the relationships between individualism-collectivism, the frequency of IPV, and rates of depression and suicide in women, based on data from 151 countries. In this data set, IPV was significantly associated with age-standardized rates of depression and suicide in women, even after adjusting for demographic variables. Cultural collectivism was positively correlated with IPV, but this relationship was significantly influenced by national income and women's educational attainment. In multivariate analyses, IPV, but not cultural collectivism, remained significantly associated with depression in women. These results highlight the importance of screening for and addressing IPV in women seeking mental health care, particularly in low- and middle-income countries where cultural and economic factors may both increase the risk of IPV and delay or impede its reporting.
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Arya V, Page A, Spittal MJ, Dandona R, Vijayakumar L, Munasinghe S, John A, Gunnell D, Pirkis J, Armstrong G. Suicide in India during the first year of the COVID-19 pandemic. J Affect Disord 2022; 307:215-220. [PMID: 35395323 PMCID: PMC8983610 DOI: 10.1016/j.jad.2022.03.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND There has been substantial discussion as to whether the mental health and socio-economic consequences of the COVID-19 pandemic might impact suicide rates. Although India accounts for the largest proportion of global suicides, the early impacts of the COVID-19 pandemic on suicide rates in this country are unknown. METHODS National Crime Records Bureau (NCRB) data were used to calculate annual suicide rates for the period 2010-2020, stratified by sex and state. Rate Ratios (RRs) stratified by sex and state were calculated to estimate the extent of change in suicide rates. RESULTS Suicide rates in India generally showed a decreasing trend from 2010 until 2017, with the trend reversing after this period, particularly for males. Among males and females, the highest increase post 2017 was noted in 2020 (compared to 2017) (males: RR = 1.18 95% UI 1.17-1.19; females: RR = 1.05 95% UI 1.03-1.06). LIMITATION Suicide rates based on the NCRB data might be an underestimation of the true suicide rates. CONCLUSION Suicide rates in India increased during the first year of the COVID-19 pandemic, and although the increase in suicide rates, especially among males, predates the pandemic, the increase in suicide rates was highest in 2020, compared to increases in previous years. Further research is warranted to understand the potential ongoing impact of the COVID-19 pandemic on suicide in India.
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Affiliation(s)
- Vikas Arya
- Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Rakhi Dandona
- Public Health Foundation of India, India; Institute for Health Metrics and Evaluation, University of Washington, USA
| | - Lakshmi Vijayakumar
- SNEHA, - Suicide Prevention Centre, Voluntary Health Services, Chennai, India
| | - Sithum Munasinghe
- Translational Health Research Institute, Western Sydney University, Australia
| | - Ann John
- Swansea University Medical School, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, National Institute of Health Research Biomedical Research Centre at the University Hospitals, Bristol and Weston NHS Foundation Trust and the University of Bristol, UK
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
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Ramesh P, Taylor PJ, McPhillips R, Raman R, Robinson C. A Scoping Review of Gender Differences in Suicide in India. Front Psychiatry 2022; 13:884657. [PMID: 35669273 PMCID: PMC9165759 DOI: 10.3389/fpsyt.2022.884657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Much of the published literature on suicide comes from high income countries. In countries such as India, female suicide rates exceed the global suicide rate and suicide rates found in their male counterparts. Results from previous studies indicate that factors related to suicide among men and women in India are different from those seen in high-income countries. To date, no reviews have considered the relationship between gender and suicide in India. Therefore, the aim of this scoping review is to provide a comprehensive understanding of existing literature reporting gender differences in suicide rates, methods, risk factors and antecedent factors in India by reviewing published studies. METHOD A scoping review was conducted to map the existing literature on gender differences in suicide in India. To identify peer-reviewed publications, online databases PsycINFO and Embase were searched. The search terms were [suicid* AND India*]. The searches took place in November 2020 and May 2021, with no language restrictions. Articles published from 2014 onwards from India were included. Reference lists of selected studies were searched for studies that could meet the inclusion criteria. RESULTS This review identified 17 studies that met the inclusion criteria. The ratio between women and men who die by suicide in India is much lower than in high-income countries. Hanging was found to be a more commonly used method of suicide among both men and women, in comparison to high-income countries where hanging is more common among men. This review also identified several gaps in the literature. There were few studies that examined suicide among transgender Indians. There was limited literature on gender differences in risk and protective factors for suicide. Limitations such as the omission of a lack of gender-based analyses in several studies and under-reporting of suicide rates were identified. CONCLUSION Understanding suicide within the context of individual countries is essential in designing culture-appropriate suicide prevention strategies. This review identified an urgent need to establish and evaluate suicide surveillance systems in India. Furthermore, additional research is warranted to understand suicide among individuals who identify outside the gender binary, and gender-specific risk and protective factors.
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Affiliation(s)
- Parvathy Ramesh
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Peter J Taylor
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Rebecca McPhillips
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Rajesh Raman
- Department of Psychiatry, JSS Medical College, JSS University, Mysore, India
| | - Catherine Robinson
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
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Singh P, Das A, William J, Bruckner T. Fertility, economic development, and suicides among women in India. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1751-1759. [PMID: 33721038 DOI: 10.1007/s00127-021-02054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Indian states at greater levels of economic development report more suicides. This relation appears stronger among women relative to men. We test the hypothesis, suggested in the literature, that conflict between rapid economic growth and inadequate female autonomy (approximated using total fertility rate) varies positively with female suicides. METHODS We used state-level data on female suicides for all 35 Indian states and union territories, from 2001 to 2011, from the National Crime Records Bureau. We specified, as our outcome, age-adjusted female suicides per 100,000 population per state-year. We retrieved data on key covariates, namely, gross state domestic product (GSDP) per capita, total fertility rate (TFR), and other control variables from multiple national surveys and publicly available data sources. We examined whether and to what extent age-adjusted female suicides (per 100,000 population) correspond with total fertility rate (lower TFR indicates greater female autonomy and vice versa) within the context of greater economic development (GSDP per capita). Linear longitudinal mixed effect regressions controlled for state-specific random intercepts, son preference (male:female sex ratio at birth), literacy gap (percentage difference between literate males and females), access to health systems (institutional deliveries), female to male employment ratio, and linear time trends. RESULTS At constant levels of GSDP per capita, a one unit decline in TFR corresponds with 0.27 fewer female suicides per 100,000 population (P value = 0.008). Sensitivity tests indicate that this relation does not hold for male age-adjusted suicides (per 100,000 population). CONCLUSION Our findings, if replicated, indicate that at constant levels of economic development, lower TFR (indicating greater female autonomy) may reduce suicide risk among women.
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Affiliation(s)
- Parvati Singh
- Program in Public Health, University of California, 653 E. Peltason Drive, Irvine, CA, 92617, USA.
| | - Abhery Das
- Program in Public Health, University of California, 653 E. Peltason Drive, Irvine, CA, 92617, USA
| | - Jenesca William
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Tim Bruckner
- Program in Public Health, University of California, 653 E. Peltason Drive, Irvine, CA, 92617, USA.,Center for Population, Inequality, and Policy (CPIP), University of California, Irvine, USA
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Armstrong G, Vijayakumar L, Cherian A, Krishnaswamy K, Pathare S. Indian media professionals' perspectives regarding the role of media in suicide prevention and receptiveness to media guidelines: a qualitative study. BMJ Open 2021; 11:e047166. [PMID: 34011600 PMCID: PMC8137173 DOI: 10.1136/bmjopen-2020-047166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Crime reports of suicide incidents routinely feature in the Indian mass media, with minimal coverage of suicide as a broader public health issue. To supplement our recently published content analysis study, we undertook qualitative interviews to examine media professionals' perspectives and experiences in relation to media reporting of suicide-related news in India. DESIGN AND SETTING In 2017-2018, we undertook semistructured qualitative interviews with media professionals with experience reporting on suicide-related news. A semistructured interview guide was designed to initiate discussions around their perspectives and experiences in relation to reporting on suicide. Interviews were digitally audio-recorded and transcribed, and a deductive and inductive approach to thematic analysis was used. PARTICIPANTS Twenty-eight interviews were undertaken with media professionals in Delhi, Chandigarh and Chennai. RESULTS A clear role for media in suicide prevention framed around educating and informing the public was articulated by several participants and a majority of participants also reported concerns and anecdotal accounts that their reporting may negatively influence vulnerable people in the population. Nonetheless, a fatalistic attitude towards suicide was evident among several participants including dismissing or minimising concerns around imitation suicides. Several participants also expressed doubts around the quality of suicide helplines in India and were hesitant to add such contact details to their reports. Participants were largely very receptive to the idea of developing voluntary media guidelines for the Indian context, although doubts were raised around compliance unless additional initiatives were taken to engage media professionals at the highest levels. CONCLUSIONS Our findings reveal the perspectives of media professionals operating in the Indian context and can be used to support constructive partnerships between media professionals and suicide prevention experts. There is a clear need for a genuine and sustained partnership between suicide prevention experts and media professionals at all levels.
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Affiliation(s)
- Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Lakshmi Vijayakumar
- Department of Psychiatry, Voluntary Heath Services, Chennai, Tamil Nadu, India
- SNEHA Suicide Prevention Centre, Chennai, Tamil Nadu, India
| | - Anish Cherian
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | | | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, Maharashtra, India
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