Sociocultural context of suicidal behaviour in the sundarban region of India.

A N Chowdhury,S Banerjee,A Brahma,M G Weiss,A Hazra

doi:10.1155/2013/486081

A N Chowdhury, S Banerjee + Show 3 more

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https://doi.org/10.1155/2013/486081

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Abstract

The role of mental illness in nonfatal deliberate self-harm (DSH) is controversial, especially in Asian countries. This prospective study examined the role of psychiatric disorders, underlying social and situational problems, and triggers of DSH in a sample of 89 patients hospitalised in primary care hospitals of the Sundarban Delta, India. Data were collected by using a specially designed DSH register, Explanatory Model Interview Catalogue (EMIC), and clinical interview. Psychiatric diagnosis was made following the DSM-IV guidelines. The majority of subjects were young females (74.2%) and married (65.2%). Most of them (69.7%) were uncertain about their “intention to die,” and pesticide poisoning was the commonest method (95.5%). Significant male-female differences were found with respect to education level, occupation, and venue of the DSH attempt. Typical stressors were conflict with spouse, guardians, or in-laws, extramarital affairs, chronic physical illness, and failed love affairs. The major depressive disorder (14.6%) was the commonest psychiatric diagnosis followed by adjustment disorder (6.7%); however 60.7% of the cases had no psychiatric illness. Stressful life situations coupled with easy access to lethal pesticides stood as the risk factor. The sociocultural dynamics behind suicidal behaviour and community-specific social stressors merit detailed assessment and timely psychosocial intervention. These findings will be helpful to design community-based mental health clinical services and community action in the region.

Highlights

Both fatal and nonfatal deliberate self-harm (DSH) are major public health concerns globally
The role of mental illness in nonfatal deliberate self-harm (DSH) is controversial, especially in Asian countries. This prospective study examined the role of psychiatric disorders, underlying social and situational problems, and triggers of DSH in a sample of 89 patients hospitalised in primary care hospitals of the Sundarban Delta, India
Unlike some western studies [9,10,11] in which psychiatric and personality disorders are referred to as predominant DSH antecedents, some Indian urban studies [12, 13] have pointed out that many people who come to clinical attention after DSH do not have any designated Axis I (DSM IV) psychiatric disorder; rather they are stressed by psychosocial factors like adjustment problems or social and situational factors

Summary

Introduction

Both fatal and nonfatal deliberate self-harm (DSH) are major public health concerns globally. The rate of non-fatal DSH is 10 times more than fatal DSH [2]. Several studies document psychiatric illness, especially major depression, as associated with DSH behaviour [7, 8]. The relationship between suicidal behaviour and designated psychiatric illnesses is a matter of great controversy. Few recent western and other studies highlighted the fact that mental health factors are “not the sole indicators of risk of self-harm” [14, 15]; on the contrary, the life events and psychosocial factors [16] play a significant role in DSH behaviours. Detailed psychiatric assessment of self-harm patients is always difficult, and especially so at the primary care level. There is no convincing data available till date to comment on the relation of designated

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