Suicide in India: Distinct Epidemiological Patterns and Implications

Suicide research in India: An overview of four decades

BACKGROUND

Suicide is a global phenomenon and a major public health concern and 'it is possibly preventable if it is well understood'.

AIM

The article is an attempt to understand 'suicide in India' with the existing literature and the lacuna for the four decades.

METHODS

The information is collected from 270 articles on suicide research in India, published in various electronic data bases and different official sites as surprisingly the nation is with highest suicide mortality rate among all regional countries.

RESULTS

The review shows an increase in the number of articles on suicide in India over the period of time. Though the suicide mortality rate in India is significantly high, the number of intervention studies remains very minimal. India's understanding about 'the concept' remains questionable as the data from different sources for the same time period shows a huge disparity. Sex, age, socio-economic status, substance abuse, mental illness, medical illness, psychological and environmental stressors etc make individuals vulnerable to end their lives.

CONCLUSION

Appropriate official documentation and more qualitative studies would help in understanding the phenomena better. Intervention studies and policy level changes are the need of the hour to save the nation from the dangerous 'iceberg of suicide'.

Prevalence of suicidal ideation, plan, attempts and its associated factors in selected rural and urban areas of Puducherry, India

BACKGROUND

The Union Territory of Puducherry has a high rate of suicide in India. This study aims to find the prevalence of suicidal ideation, plan and suicide attempts and the risk factors of suicidal behaviours.

METHODS

This community-based cross-sectional study was conducted among adults aged 18 years and above in rural and urban areas of Puducherry, India. Columbia Suicide Severity Rating Scale questionnaire was used. Prevalence ratio was estimated to assess the factors associated.

RESULTS

The 12-month and lifetime prevalence of suicidal ideation was reported to be 12.5% (95% CI: 10.4-15.0%) and 20% (95% CI: 17.4-22.9%), respectively. About 0.7% (95% CI: 0.3-1.5%) and 2.1% (95% CI: 1.2-3.3%) of the participants had suicide plan in past 12 months and ever in their lifetime, respectively. Around 1% (95% CI: 0.5-2.0%) and 5.7% (95% CI: 4.3-7.6%) of the participants had attempted suicide in past 12 months and ever in their lifetime, respectively. Family issues, physical abuse, unemployment and place of residence were significantly associated with suicidal ideation in multivariable analysis.

CONCLUSION

Prevalence of suicidal ideation and suicide attempt were very high in the study area. Unemployment, physical abuse and family issues were significantly associated with suicidal behaviour.

Study of Risk Factors Associated with Suicide Attempt in Patients with Bipolar Disorder Type I

Background  Suicide is the leading contributor to mortality in bipolar disorder (BD). A history of suicidal attempt is a robust predictive marker for future suicide attempts. Personality profiles and coping strategies are the areas of contemporary research in bipolar suicides apart from clinical and demographic risk factors. However, similar research in developing countries is rarer.

Objectives  The present study aimed to identify the risk factors associated with suicidal attempts in BD type I (BD-I).

Materials and Methods  Patients with BD-I currently in clinical remission ( N = 102) were recruited. Sociodemographic details and the clinical data were collected using a semistructured pro forma. The psychiatric diagnoses were confirmed using the Mini-International Neuropsychiatric Interview 5.0. The National Institute of Mental Health–Life Chart Methodology Clinician Retrospective Chart was used to chart the illness course. Presumptive Stressful Life Events Scale, Coping Strategies Inventory Short Form, Buss–Perry aggression questionnaire, Past Feelings and Acts of Violence, and Barratt Impulsivity scale were used to assess the patient’s stress scores, coping skills, aggression, violence, and impulsivity, respectively.

Statistical Analysis  Descriptive statistics were used for demographic details and characteristics of the illness course. Binary logistic regression analyses were performed to identify the predictors for lifetime suicide attempt in BD-I.

Results  A total of 102 patients (males = 49 and females = 53) with BD-I were included. Thirty-seven subjects (36.3%) had a history of suicide attempt. The illness course in suicide attempters more frequently had an index episode of depression, was encumbered with frequent mood episodes, especially in depression, and had a higher propensity for psychiatric comorbidities. On binary logistic regression analysis, the odds ratios (ORs) for predicting a suicide attempt were highest for positive family history of suicide (OR: 13.65, 95% confidence interval [CI]: 1.28–145.38, p = 0.030), followed by the presence of an index depressive episode (OR: 6.88, 95% CI: 1.70–27.91, p = 0.007), and lower scores on problem-focused disengagement (OR: 0.72, 95% CI: 0.56–0.92, p = 0.009).

Conclusion  BD-I patients with lifetime suicide attempt differ from non-attempters on various course-related and temperamental factors. However, an index episode depression, family history of suicide, and lower problem-focused engagement can predict lifetime suicide attempt in patients with BD-I.

The association between intimate partner violence onset and gender-specific depression: A longitudinal study of a nationally representative sample

BACKGROUND

Intimate partner violence (IPV) is a serious social problem that is often hidden, unnoticed or ignored. However, few studies have explored the effects of partner violence onset and/or persistence on the mental health of individuals. Thus, we aimed to investigate the association between IPV onset and depressive symptoms in both married men and women.

METHODS

In this study, nationally representative data from the Korea Welfare Panel Study were employed to track 1040 men and 3732 women for a period of six years (2010-2015). Depressive symptoms were scored according to the 11-item Center for Epidemiologic Studies Depression Scale (CES-D-11).

RESULTS

Of our study population, 415 men (39.9%) and 866 women (23.2%) suffered from continuous intimate partner violence, meaning that they reported experience of IPV in both the previous and current year of investigation. Such subjects had significantly higher CES-D-11 scores (men β: 1.745, p ≤  0001; women β: 1.970, p  ≤  0001) as did subjects whose partners turned violent from non-violent (men β: 1.623, p  ≤  0001; women β: 1.594, p  ≤  0001) than those with continuously non-violent partners (reference group). Subjects whose partners turned non-violent from violent continued to be more depressed (men β: 0.312, p  ≤  009; women β: 0.880, p  ≤  000) than those with continuously non-violent partners. Through subgroup analysis, we also found that lower SES, as a covariate relative to educational attainment, household income, and economic status, was associated with worsened depression following IPV onset. Unemployed women with consistently violent partners (β: 2.957, p  ≤ .0001) and unemployed men with newly violent partners (β: 3.010, p  ≤ .0001) were more depressed than the employed or self-employed.

CONCLUSION

Our findings reveal that continuous IPV, as well as its onset, can have serious consequences for the mental health of its victims.

Profile and Outcome of Near-hanging Patients Presenting to Emergency Department in a Tertiary Care Hospital in South India - A Retrospective Descriptive Study

BACKGROUND

Hanging is one of the common modes of deliberate self-harm presenting to emergency departments (EDs) across the world. Early intervention and aggressive resuscitation can decrease the morbidity and mortality associated with near-hanging. Our aim was to study the profile of patients presenting with near-hanging and their outcome to our adult ED.

MATERIALS AND METHODS

Medical records of patients with age more than 15 years presenting with near-hanging to the ED was reviewed retrospectively. The following profile data such as age, gender, marital status, material used for hanging, and type of hanging were collected. The information regarding the outcome of the patients from the hospital also analyzed. The data were analyzed to express the mean (±standard deviation) for the quantitative variables and frequency for the qualitative variables (±percent) using SPSS statistical software.

RESULTS

The analysis of 2 years data from August 2014 to July 2016 revealed 77 patients reached the ED with near-Hanging. The mean age of the patients - 31.1 years. Approximately, 43% were complete hanging, while rest were partial hanging. Majority of the patients used dressing materials for hanging themselves. Out of 77 patients, 64 were discharged alive while 2 patients died in the hospital and 11 were left against medical advice.

CONCLUSIONS

Hanging is still a major mode of deliberate self-harm in South India both among men and women. The outcome of near-hanging is positively influenced by early admission and active treatment.

Suicidal behaviour is associated with decreased esterified cholesterol in plasma and membrane fluidity of platelets

BACKGROUND

Altered cholesterol levels in body fluids and brain tissues have been shown to be associated with suicidal behaviour, violence and aggression. But the biological underpinnings of this association in the pathophysiology of suicide are not clear. Cholesterol plays a crucial role in maintaining the cellular membrane fluidity and alterations in cellular membrane fluidity may impair serotonergic neurotransmission in the central nervous system.

METHODS

We measured plasma esterified cholesterol and platelet membrane fluidity using fluorescence anisotropy and estimated flow activation energy which is a measure of order of membrane lipid bilayer in patients with recent suicidal attempt and compared with age and gender matched controls.

RESULTS

The plasma esterified cholesterol, platelet membrane fluidity and flow activation energy was found to be significantly lower in patients with recent suicidal attempts compared to controls.

CONCLUSION

Altered levels of plasma esterified cholesterol which is in equilibrium with membrane cholesterol might have resulted in decreased membrane fluidity and an increase in the order of membrane lipid bilayer. This might impair the serotonergic neurotransmission, which has been implicated in the pathophysiology of suicide.