Suicide in farmers in India

Profile of risk factors associated with suicide attempts: A study from Orissa, India

CONTEXT

Periodic systematic profiling of suicidal risk factors in developing countries is an established need.

AIMS

It was intended to study the risk factors associated with suicide attempts in Orissa, one of the most economically compromised states of India.

SETTINGS AND DESIGN

Cross-sectional study in a general hospital.

MATERIALS AND METHODS

Consecutive 149 suicide attempters were evaluated for psychosocial, situational, and clinical risk factors using the Risk Rescue Rating scale, Suicide Prevention Center scale, Lethality of Suicide Rating scale, and Presumptive Stressful Life Event scale. They were compared with healthy and psychiatric controls who had never attempted suicide.

STATISTICAL ANALYSIS

Chi-square for comparison of categorical variables, t-tests for comparison of means.

RESULTS

The male-to-female ratio was closer to one in adults and around 1:3 in adolescents. Younger age, lower-middle economic group, rural background, unemployed, school educated were more represented in this study. Compared to the controls, significantly more number of attempters had a family history of psychiatric illness and suicide, childhood trauma, medical consultation within one month, had experienced stressful life events and had expressed suicidal ideas. In a considerable proportion of attempts, risk was high and rescuability least; 59.1% had more than 50% chance of death. Suicide potential was high in almost half the cases. More than 80% of all attempters had psychiatric disorder; however, only 31.5% had had treatment. Factors like middle age, family history of psychiatric disorders, past psychiatric history, current psychiatric illness, communication of suicidal ideas, the use of physical methods, and high potential attempts, differentiated repeaters significantly from the first-timers. Major physical illness, family and marital conflicts, financial problems, and failure in examinations were more frequent life events. Childhood trauma, noted in around 40% of the attempters, was considerably associated with adolescent suicide attempts.

CONCLUSIONS

Modifiable risk factors identified in this study have preventive implications.

Stigma and discrimination limit access to mental health care

This editorial provides an overview of how far access to mental health care is limited by perceptions of stigma and anticipated discrimination. Globally over 70% of young people and adults with mental illness receive no treatment from healthcare staff. The rates of non-treatment are far higher in low income countries. Evidence from some descriptive studies and epidemiological surveys suggest that potent factors increasing the likelihood of treatment avoidance, or long delays before presenting for care include: (i) lack of knowledge about the features and treatability of mental illnesses; (ii) ignorance about how to access assessment and treatment; (iii) prejudice against people who have mental illness, and (iv) expectations of discrimination against people who have a diagnosis of mental illness. The associations between low rates of help seeking, and stigma and discrimination are as yet poorly understood and require more careful characterisation and analysis, providing the platform for more effective action to ensure that a greater proportion of people with mental illness are effectively treated in future.

Lethality of suicidal organophosphorus poisoning in an Indian population: exploring preventability

BACKGROUND

Suicide by organophosphorus poisoning is common in India. Study of factors associated with lethality may suggest methods for prevention.

METHODS

Severity of symptoms, biochemical manifestation of poisoning, degree of lethality and the outcome were studied with an aim to explore the modifiable factors associated with lethality and to discuss preventability. Clinical variables were collected; symptoms were rated by the physicians using global impression of severity; and the lethality was assessed by scale for assessment of lethality of suicide attempt (SALSA), in 100 consecutive patients with suicidal organophosphorus poisoning attending a medical college hospital in South India.

RESULTS

Fatal outcome (n = 26) was significantly associated with higher mean age, lower mean pseudocholinesterase level, longer duration between organophosphorus compound ingestion and specific intervention. All those who died had respiratory failure. Physicians' assessment of symptom severity and lethality as assessed by the SALSA could differentiate those succumbed and survived in a significant proportion.

CONCLUSION

Majority of cases of organophosphorus poisoning were associated with severe symptoms and higher lethality. Intervention facilities decreasing the period between the ingestion of poison and initiation of treatment might prevent many deaths. Measures like restricting availability and banning more toxic organophosphorus compounds may help.