Sociocultural context of suicidal behaviour in the sundarban region of India

Unpacking the 'black box' of suicide: A latent class analysis predicting profiles of suicidal ideation in a longitudinal cohort of adolescent girls from India

INTRODUCTION

Indian women account for 37% of global suicide-related deaths. As suicide is a growing concern among adolescent girls, identifying the social determinants of suicide with this group targeted prevention. We selected social determinants that include intersectional identities and broader syndemics; we then used longitudinal data from a prospective cohort of adolescent girls from Northern India to classify them into unique profiles across multiple socioecological levels.

METHODS

Girls aged 10-19 (N = 11,864) completed self-report questionnaires measuring socio-demographic and trauma exposure variables. At three-year follow-up, they were asked to indicate current suicidal ideation (SI). We conducted latent class analysis (LCA) to classify profiles and then predicted risk of current SI at three-year follow-up.

RESULTS

LCA supported a four-class solution: a 'privileged' class (Class 1; n = 1,470), a 'modal' class (Class 2; n = 7,449), an 'intergenerational violence' class (Class 3; n = 2,113), and a 'psychological distress' class (Class 4; n = 732). Classes significantly predicted odds ratios (OR) for SI at follow up; women in Class 4 were associated with the greatest likelihood of SI (OR 1.84, 95% CI 1.38, 2.47), suggesting that psychological distress factors confer greatest risk.

CONCLUSION

Results of the distinct classes of risk and protective factors indicate targets for policy-level interventions. Disrupting cycles of psychological distress and substance use, increasing access to behavioral interventions, and intervening to mitigate intergenerational violence may be particularly impactful with this population.

Intimate partner violence, suicide and self-harm in Sri Lanka: Analysis of national data

There is increasing evidence from South Asia and internationally that intimate partner violence (IPV) is strongly associated with self-harm, however its association with suicide and self-harm has not been extensively examined, nor has this relationship been explored at a national level. Using national datasets, area-level variation in IPV, suicide and self-harm in Sri Lanka were examined. In addition, the association between individual level exposure to past-year IPV and non-fatal self-harm by any household member were explored in a series of multi-level logistic regression models, adjusting for age. Similar patterns in the distribution of suicide and IPV were found, with higher rates evident in post-conflict districts, specifically Batticaloa, Kilinochchi, and Mullaitivu. Experience of past year IPV and its various forms were strongly associated with household-level self-harm in the past year (adjusted odds ratio [AOR] = 3.83 95% CI 2.27-6.46). A similar magnitude was found for physical/sexual abuse (AOR 5.17 95% CI 2.95-9.05) and psychological abuse (AOR 4.64 95% CI 2.50-7.00). A dose-response association was also evident for frequency of abuse, with an increasing risk of household-level self-harm for women reporting abuse 'less often' (AOR 2.95 95% CI 1.46-5.92), and abuse experienced 'daily, weekly, or monthly' (AOR 4.83 95% CI 2.59-9.00), compared to no abuse. This study contributes to a growing body of evidence on the relationship between IPV and suicidal behaviour in South Asia. Addressing IPV and its various forms should be a priority for suicide prevention in Sri Lanka, alongside trauma-informed approaches in post-conflict settings.

Cultural Representations of Borderline Personality Disorder

BACKGROUND/OBJECTIVE

Borderline Personality Disorder (BPD) is characterized by unstable interpersonal relationships, impulsivity, and self-harm. There are many distinct stressors that predispose individuals to develop BPD or engage in self-harm behaviors. The objective of this systematic review was to compare methods of self-harm and psychological stressors in BPD across different cultures.

METHODS

A PubMed database search was conducted with the goal of capturing all articles (n = 22) that discussed methods of self-harm in BPD in any culture. Data extracted from the articles included methods of self-harm, psychological stressors, sample size, rurality, geographical location, and proportion of males to females.

RESULTS

Key differences were noted in the methods of self-harm. Eastern nations (n = 5) reported higher rates of self-poisoning (60%) than Western nations (11%). Western nations (n = 9) reported higher rates of skin-mutilating behavior (100%) than Eastern nations (80%). Two of the articles included participants from rural settings, one in the Sundarban region of India and the other in Mississippi. Notably, the Sundarban region reported the highest rate of poisoning (93%) whereas the Mississippi region reported high rates of skin mutilation. Differences were also noted in psychological stressors as the rates of interpersonal problems were higher in Western than in Eastern nations.

CONCLUSIONS

Additional research should be conducted into the presentation of BPD in different cultures. An improved understanding of the cultural presentations of BPD could improve diagnosis and treatment in various populations.

Depression and suicidal behavior in South Asia: a systematic review and meta-analysis

BACKGROUND

Estimates of depression in suicidal behavior in South Asia would help to formulate suicide prevention strategies in the region that hasn't been assessed yet.

OBJECTIVES

We aimed to systematically assess the prevalence of depression in fatal and non-fatal attempts of suicide in eight South Asian countries.

METHODS

We searched Medline, Embase, and PsychINFO by specific search terms to identify articles assessing depression in fatal and non-fatal attempts of suicide in South Asian countries published between 2001 and 2020. Two separate meta-analyses were conducted for fatal and non-fatal attempts. Due to the high heterogeneity of studies (96-98%), random-effects models were used to calculate pooled prevalence rates.

RESULTS

A total of 38 studies was identified from five south Asian countries (India [27], Pakistan [6], Sri Lanka [3], Nepal [1], and Bangladesh [1]). The majority of studies (n = 27) were published after 2010. Twenty-two studies reported non-fatal attempts, and sixteen reported suicide. The prevalence of depression among non-fatal attempts ranged from 14% to 78% where the pooled prevalence rate was 32.7% [95% CI 26-39.3%]. The prevalence of depression among suicides ranged from 8% to 79% where the pooled prevalence estimate was 37.3% [95% CI 26.9-47.6%].

CONCLUSIONS

This review revealed the pooled prevalence of depression among fatal and non-fatal suicidal attempts in South Asian countries, which seems to be lower when comparedto the Western countries. However, a cautious interpretation is warranted due to the heterogeneity of study methods, sample size, and measurement of depression.

An observational study on acute poisoning in a tertiary care hospital in West Bengal, India

Aim:

Poisoning is a preventable cause of morbidity and mortality in India. We undertook a prospective observational study to estimate the incidence, nature, severity and treatment outcome trends of acute poisoning in a tertiary care hospital in eastern India.

Methods:

All patients, admitted during the study period with acute poisoning, drug overdose and envenomation, were enrolled. Food poisonings, animal bites, chronic drug or chemical poisonings were excluded. Medical records were scrutinized and caregiver interviews served as source documents. Demographics, nature and circumstances of the poisoning event, treatment offered, duration of hospitalization and outcome data were collected.

Results:

Over 18 months, 592 cases of acute poisoning, accounting for 0.63% of all hospital admissions, were enrolled. Males comprised 57.09%, median age was 22 years, and 52.20% hailed from rural area. Occupation-wise, excluding students and children, patients were mostly daily wage workers followed by housewives, service holders and farm workers. Snake bites comprised the largest category of cases at 264 (44.6%) followed by corrosives (13.68%), sedatives/hypnotics (13.18%), pesticides (12.16%), hydrocarbon oils (8.61%) and others. Majority (60.64%) of the cases was accidental and occurred at home (66.72%) and most (87.33%) were referred from primary health centers. Median time between event and arrival at primary care center was 1 hour while median time to arrival at the hospital was 11 hours. There were 89 deaths (mortality 15.03%) in the series. Male gender, rural residence, referred status and non-use of specific antidotes had negative impact on survival.

Conclusion:

This large prospective study from eastern India from a hospital perspective, has captured data not only on the incidence and nature of poisoning but also on treatment trends and mortality outcomes. Field studies conducted in the light of these results will clarify additional issues.