High rate of suicide attempt and associated psychological traits in an isolated tribal population of North-East India

Prevalence of Psychiatric Morbidity and Alcohol use Disorders Among Adolescent Indigenous Tribals from Three Indian States

Background

Among the Indian adolescents, the prevalence of psychiatric morbidity and alcohol use disorders (AUD) are 7.3% and 1.3%. However, no separate data are available for indigenous tribal populations. This study estimated the prevalence of psychiatric morbidity and AUD and associated socio-demographic factors among adolescents in the tribal communities in three widely varying states in India.

Methods

Using validated Indian versions of the MINI 6.0, MINI Kid 6.0, and ICD-10 criteria, we conducted a cross-sectional survey from January to May 2019 in three Indian sites: Valsad, Gujarat (western India); Nilgiris, Tamil Nadu (south India); and East Khasi Hills district of Meghalaya (north-east India) on 623 indigenous tribal adolescents.

Results

Aggregate prevalence of any psychiatric morbidity was 15.9% (95% CI: 13.1-19.0) (males: 13.6%, 95% CI: 10.0-18.1; females: 17.9%, 95% CI: 13.9-22.6), with site-wise statistically significant differences: Gujarat: 23.8% (95% CI: 18.1-30.2), Meghalaya: 17.1% (95% CI: 12.4-22.7), Tamil Nadu: 6.2% (95% CI: 3.2-10.5). The prevalence of diagnostic groups was mood disorders 6.4% (n = 40), neurotic- and stress-related disorders 9.1% (n = 57), phobic anxiety disorder 6.3% (n = 39), AUD 2.7% (n = 17), behavioral and emotional disorders 2.7% (n = 17), and obsessive-compulsive disorder 2.2% (n = 14). These differed across the sites.

Conclusion

The prevalence of psychiatric morbidity in adolescent tribals is approximately twice the national average. The most common psychiatric morbidities reported are mood (affective) disorders, neurotic- and stress-related disorders, phobic anxiety disorder, AUD, behavioral and emotional disorders, andobsessive-compulsive disorder.

A systematic review of community-based studies on mental health issues among tribal populations in India

Background & objectives

Globally, mental disorders are rising with increasing urbanization. India has the world's second-largest tribal population and it is critical to appreciate the mental health problems in this population. However, the extent of mental health issues among tribal populations is unknown. Against this background, we systematically reviewed community-based studies on mental health issues among tribal populations in India.

Methods

Online databases PubMed, Embase, ProQuest databases and Google Scholar were searched and articles published between January 1990 and May 2021 including primary community-based quantitative observational studies focused exclusively on tribal population were retrieved. PRISMA guidelines were followed and this review was registered on PROSPERO (CRD42020178099).

Results

A total of 935 articles were identified, of which 63 were selected for full-text review, and finally, 11 studies were included. Seven studies examined alcohol use disorder with a pooled prevalence of 40 per cent. Two studies reported on suicidal attempts. A few studies mentioned anxiety, depression and other mental health conditions.

Interpretation & conclusions

: This systematic review established that a few community-based primary studies were conducted on mental health issues among tribal populations over the last three decades. Among these, fewer studies focused exclusively on tribal communities. The studies differed in their study design and the tools used. The findings of these investigations highlighted a limited range of mental health issues, primarily alcoholism, anxiety, depression and suicide.

Mental health research on scheduled tribes in India

BACKGROUND

The burden of mental illness among the scheduled tribe (ST) population in India is not known clearly.

AIM

The aim was to identify and appraise mental health research studies on ST population in India and collate such data to inform future research.

MATERIALS AND METHODS

Studies published between January 1980 and December 2018 on STs by following exclusion and inclusion criteria were selected for analysis. PubMed, PsychINFO, Embase, Sociofile, Cinhal, and Google Scholar were systematically searched to identify relevant studies. Quality of the included studies was assessed using an appraisal tool to assess the quality of cross-sectional studies and Critical Appraisal Checklist developed by Critical Appraisal Skills Programme. Studies were summarized and reported descriptively.

RESULTS

Thirty-two relevant studies were found and included in the review. Studies were categorized into the following three thematic areas: alcohol and substance use disorders, common mental disorders and sociocultural aspects, and access to mental health-care services. Sociocultural factors play a major role in understanding and determining mental disorders.

CONCLUSION

This study is the first of its kind to review research on mental health among the STs. Mental health research conducted among STs in India is limited and is mostly of low-to-moderate quality. Determinants of poor mental health and interventions for addressing them need to be studied on an urgent basis.

Re-testing reported significant SNPs related to suicide in a historical high -risk isolated population from north east India

Background

Genetic diathesis of suicide is supported by family and twin studies. Few candidate gene pathways are known, but does not explain fully the complexity of suicide genetic risk. Recent investigations opting for Genome-Wide Association Studies (GWAS) resulted in finding additional targets, but replication remained a challenge. In this respect small isolated population approach in several complex disease phenotypes is found encouraging. The present study is an attempt to re-test some of the reported significant SNPs for suicide among a small historical high- risk isolated population from Northeast India.

Methods

Two hundred ten cases (inclusive of depressed, suicide attempter and depressed + suicide attempter) and 249 controls were considered in the present study which were evaluated for the psychiatric parameters. Sixteen reported significant SNPs for suicide behaviour were re-tested using association approach under various genetic models. Networking by GeneMANIA tool was used for function prediction of the associated genes.

Results

Seven SNPs (of 6 genes) remained significant in different genetic models. On networking genes with significant SNPs IL7, RHEB, CTNN3, KCNIP4, ARFGEF3 are found in interaction with already known candidate gene pathways while SNP rs1109089 (RHEB) gained further support from earlier expression studies. NUGGC gene is in complete isolation.

Conclusions

Small population approach in replicating significant SNPs is useful in complex phenotypes like suicide. This study explored the region-specific demographics of India by identifying vulnerable population for suicide via genetic association analysis in bringing into academic and administrative forum, the importance of suicide as a disease and its biological basis.

Substance use and suicidal ideation and behaviour in low- and middle-income countries: a systematic review

Background

Understanding relationships between substance use and suicidal ideation and behaviour (SIB) has important public health implications for suicide prevention in low- and middle-income countries (LMICs), where 75% of suicides occur. This systematic review explored the associations between substance use and SIB in LMICs.

Methods

We searched five databases using a combination of keywords for substance use, SIB and LMICs to identify English-written quantitative studies published between January 2006 and February 2016. Data were extracted to provide an overview of what is known about the topic, highlight gaps in the literature, and explore the implications of current knowledge for suicide prevention. Studies included in the review were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network checklist.

Results

Analysis of included studies (N = 108) demonstrated a consistent positive association between substance use and SIB across all substances (i.e. alcohol, tobacco, cannabis, illicit drugs, non-medical use of prescription drugs), all substance use dimensions (i.e. intoxication, use, and pathological use) and all SIB dimensions (i.e. suicidal ideation, non-fatal suicidal behaviour, and suicide). Most of the available research evidence comes from upper-middle-income countries, only 22% comes from lower-middle-income and low-income countries. Most studies focused on alcohol and tobacco, while neglecting substances such as cannabis, opioids, sedatives, stimulants, misuse of prescription medication, inhalants, and hallucinogens. Most of the studies employed a cross-sectional design, were conducted within a risk-factor paradigm, and provided little information about the potential interaction between variables.

Conclusions

Public health suicide prevention policy and research in LMICs should take account of the fact that: substance use is a potentially modifiable risk factor; assessment and management of substance use is integral to the care of at-risk patients; reducing consumption and hazardous use of substances in LMICs is important for suicide prevention; and research needs to be expanded to include more theory driven research that focuses on all substance use dimensions and SIB dimensions, while employing more sophisticated statistical methods.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5425-6) contains supplementary material, which is available to authorized users.

Explaining suicide attempt with personality traits of aggression and impulsivity in a high risk tribal population of India

Introduction

Suicide is a spectrum of behavior including suicide ideation and suicidal attempt and is undoubtedly the outcome of the interaction of several factors. The role of two main constructs of human nature, aggression and impulsivity, has been discussed broadly in relation to suicide, as endophenotypes or traits of personality, in research and in clinical practice across diagnoses. The objective of our study was to assess impulsive and aggressive behaviors among primitive people of the Idu Mishmi tribe, who are known for high suicide completer and attempter rates.

Methods

The study group was comprised of 177 unrelated Idu Mishmi participants divided into two sets: 39 suicide attempters and 138 non-attempters. Data on demographic factors and details of suicide attempts were collected. Participants completed a set of instruments for assessment of aggression and impulsivity traits.

Results

In the Idu Mishimi population we screened (n = 177), 22.03% of the individuals had attempted suicide, a high percentage. The suicide attempters also showed a significant sex difference: 35.9% were male and 64.10% were female (p = .002*). The suicide attempters (A) scored significantly higher than non-attempters (NA) on aggression (A = 23.93,NA = 18.46) and impulsivity (A = 75.53,NA = 71.59, with p value = 0.05). The trait impulsiveness showed a significantly higher difference (F (1, 117) = 7.274) in comparison to aggression (F (1, 117) = 2.647), suggesting a profound role of impulsiveness in suicide attempts in the Idu Mishmi population. Analysis of sub-traits of aggression and impulsivity revealed significant correlations between them. Using different models, multivariate logistic regression implied roles of gender (OR = 1.079 (0.05)) and impulsiveness (OR = 3.355 (0.013)) in suicide attempts.

Conclusion

Results demonstrate that gender and impulsivity are strong risk factors for suicide attempts in the Idu Mishmi population.

Association between restriction of activity related to chronic diseases and suicidal ideation in older adults in Korea

AIM

The aim of the present study was to show an association between restricted activity related to chronic diseases and suicidal ideation (SI) in elderly Korean adults after adjusting for age, sex, mental health status, socioeconomic position and health behavior factors.

METHODS

The study sample included 3545 Korean men (n=1473) and women (n=2073), aged over 65 years from the 2007-2009 Korea National Health and Nutrition Examination Survey carried out by the Ministry of Health and Welfare of Korea. Participants were classified into two groups based on whether they had previously experienced suicidal thoughts. Restricted activity was related to chronic conditions, such as cardiovascular diseases, cerebrovascular accident and so on. We analyzed the data using Student's t-test or χ(2) -test. Multiple logistic regression analysis was used to determine the association between restricted activity as the independent variable and SI as the dependent variable after adjustment for confounders.

RESULTS

The proportion of participants with SI population was 29.1%. People with SI reported a significantly higher proportion of restrictive activity (62.3%) than those who did not have SI (34.5%). The adjusted risk excess (OR) of SI was statistically significant with regard to restricted activity (2.11, 95% CI 1.65-2.70; 2.85, 95% CI 1.95-4.15) in males; 1.69 (95% CI 1.22-2.34) in females after adjustment for potential confounders. In particular, women who lived alone showed high adjusted OR (1.50, 95% CI 1.01-2.24).

CONCLUSIONS

Statistical analyses from this community-based, random sample drawn from a selected sample of the elderly Korean population showed that restricted activity appears to be significantly associated with SI.