Suicidal behavior in Indian adolescents

Suicide Attempt by Hanging - A Study on Patients Admitted in Tertiary Care Hospital in Eastern India

Background

Suicide is defined as a fatal self-injurious act with some evidence of intent to die. Despite the evolution of sophisticated methods to commit suicide, hanging remains one of the commonest methods to commit suicide across the world. To evaluate the individuals using hanging as a method of suicide and identify the contributing factors for this behaviour.

Material and Methods

The study was carried out in a tertiary care hospital, over a period of 1 year on the suicide attempters using the method of hanging. Semi-structured in-depth interviews were conducted with all the 46 attempters. The questions focused on the precipitating events present before the attempt. After the in interview the risk factors of the conversations were identified, tabulated and categorized using descriptive analysis.

Results

Findings from descriptive analysis reveals that significant age group using this method was below 19 years followed by 20-29 age group, female attempters were more compared to male. Psychiatric diagnosis was present in 8 attempters and 4 attempters had alcohol/substance dependence. The most common personality component in attempters was impulsivity. The most common immediate stressor found were financial stress, conflict with family, spouse, humiliation, substance abuse, exam stress and domestic violence.

Conclusion

This study demonstrates that the reasons for suicide attempt by hanging is multifactorial. which includes, psychiatric diagnosis, personality factors, immediate stressors, ease of use, and accessibility, Overall, our study adds to understanding the intricates of this method and will help in developing effective suicide prevention strategies.

Youth Suicide in India: A Critical Review and Implication for the National Suicide Prevention Policy

Youth suicide is a significant public health problem in Low-and middle-income countries (LMIC), including India. It is a distinct phenomenon with various bio-psycho-social determinants. Despite this, comprehensive literature on this topic is lacking from India. Thus, the current paper aimed to review the available literature on youth-suicide from India and other LMIC, discusses the contentious issues, including potential solutions for the possible roadblocks, and provides recommendations for the national suicide-prevention policy and strategy (NSPPS) in the Indian context. We found that the magnitude of youth suicide in India is substantial with the distinct bio-psycho-social determinants. Although, youth-specific suicide prevention and therapeutic intervention do exist; its feasibility and effectivity in the Indian context are yet to be established. The is an urgent need for the NSPPS; experiences from other LMIC should be incorporated while framing such policies. More research is required from India in this area.

Prevalence of suicidal behavior in adolescents in India: A systematic review and meta-analysis

BACKGROUND

Suicidal behaviour (SB) in adolescents is an emerging public health issue globally. The present study was undertaken to estimate the overall prevalence of SB among the adolescents (10-19 years of age) in India.

DATA SOURCES

In this systematic review and meta-analysis (SRMA), an extensive literature search in PubMed, Scopus, EBSCO, Web of Science, ProQuest, Embase, Cochrane, and preprint servers (medRxiv, arXiv, bioRxiv, BioRN, ChiRxiv, ChiRN, and SSRN) and assessment of all published articles until 28th February 2023 as per the PROSPERO registration protocol (CRD42023385550), was undertaken.

STUDY SELECTION, DATA EXTRACTION, AND SYNTHESIS

Studies from India which reported the prevalence of suicidal ideation, suicide attempt, and suicidal plan were included. The quality of the included studies was assessed by risk of bias assessment tool. R version 4.2 was used to conduct all the relevant analyses. Heterogeneity was assessed, and a random effects model for estimating the pooled prevalence of the outcomes was applied. Subgroup analyses were planned based on region, locality (urban/rural) and the study settings (educational institutions/community-based). A meta-regression to analyze the effects of potential moderators on outcomes was done. Sensitivity analyses were planned based on the removal of outliers and poor-quality studies. Publication bias was tested by Doi plot and LFK index.

MAIN OUTCOMES

Pooled prevalence of suicide attempts, suicide ideations and suicide plans RESULTS: A total of 20 studies were identified as eligible for the systematic review, and 19 studies were identified as eligible for the meta-analysis. The pooled prevalence of suicidal ideation was estimated to be 11% (95 % CI 7-15); heterogeneity between the studies was high (I² 98 %, p < 0.01). The pooled prevalence of suicidal attempts and suicidal plan was estimated to be 3 % each (95 % CI 2-5); with heterogeneity being high (I² 96 %, p < 0.01). Subgroup analysis revealed a significant variation in suicidal ideation and attempts between different regions of India (South > East > North), and higher prevalence among the educational-institute-based settings and urban areas.

CONCLUSION

Overall, the prevalence of suicidal behavior among the adolescents in India is high, and they experience all types of suicidal behavior (ideations, plans and attempts).

FASE-family and social engagement model for prevention and management of self harm behavior-a study protocol for cluster randomized control trial in India

BACKGROUND

Suicide is a substantial public health concern for countries worldwide. Effective preventive and curative interventions for self-harm behavior (SHB) are imperative for nations with an alarmingly high rate of suicide and self-harm behaviors. The intervention protocol named FASE (Family and Social Engagement) consists of comprehensive assessment, Attachment-Based Family Therapy (ABFT), and community linkages for people presenting with suicide or self-harm in emergency departments of tertiary hospitals.

METHODS

This article reports the design and protocol for a cluster randomized control trial for suicide prevention and management. After the developed intervention is pilot tested in a tertiary hospital in Kerala, the intervention will be scaled up to be implemented in various tertiary hospitals in Kerala. Each hospital emergency department will be considered a cluster, and these clusters will be randomized to the intervention group and control group in a 1:1 ratio. The eligible people from the intervention clusters will undergo a baseline assessment, a structured moderate intense intervention with twelve sessions spread across 6 months by the trained social workers supervised by the Mental health team, and a follow-up assessment at the end. Participants will be recruited after obtaining consent and explaining the study. The primary outcome includes suicidality measured by the Depressive Symptom Inventory-Suicidality Subscale (DSI-SS), Depression, Anxiety and Stress Scale (DASS), MOS Social Support Survey, and Brief resilience scale (BRS).

DISCUSSION

Knowledge generated from this trial can significantly affect new programmatic policy and clinical guidelines that will improve the reduction of suicide rates in the country.

TRIAL REGISTRATION

Prospectively registered in Clinical Trial Registry India (ICMR-NIMS) on 18/10/2021 (ref number- REF/2021/10/048264).

Suicide prevention in childhood and adolescence: a narrative review of current knowledge on risk and protective factors and effectiveness of interventions

INTRODUCTION

Suicide is a global mental health problem for people of all ages. While rates of suicide in children and adolescents are reported as lower than those in older populations worldwide, they represent the third leading cause of death in 15-19-year-olds. The rates are higher among boys than girls worldwide, though the death rates for girls exceed those for boys in Bangladesh, China, India, and Nepal. There has been a general decrease in adolescent suicide rates over recent decades. However, increases are reported in South East Asia as well as South America over the same time period.

METHODS

A narrative review method has been used to summarize current knowledge about risk and protective factors for suicide among children and adolescents and to discuss evidence-based strategy for suicide prevention in this age group.

RESULTS

Identified suicide risk and protective factors for children and adolescents largely overlap with those for adults. Nevertheless, developmental characteristics may strengthen the impact of some factors, such as decision-making style, coping strategies, family and peer relationships, and victimization. The implementation of evidence-based suicide preventive strategies is needed. Restricting access to lethal means, school-based awareness and skill training programs, and interventions delivered in clinical and community settings have been proven effective. The effectiveness of gatekeeper training and screening programs in reducing suicidal ideation and behavior is unproven but widely examined in selected settings.

DISCUSSION

Since most studies have been conducted in western countries, future research should assess the effectiveness of these promising strategies in different cultural contexts. The use of more rigorous study designs, the use of both short- and long-term follow-up evaluations, the larger inclusion of individuals belonging to vulnerable groups, the evaluation of online intervention, and the analysis of programs' cost-effectiveness are also required.

Suicidal Ideation Among Adolescents-The Role of Sexual Abuse, Depression, and Impulsive Behavior

Suicide is the second leading cause of death among adolescents. With every fifth Indian to be an adolescent, the cost of an adolescent dying by suicide is enormous. This necessitates an understanding of the potential risk factors of suicidal ideation among adolescents. Secondary data analysis is performed on cross-sectional survey data obtained from Understanding the Lives of Adolescents and Young Adults. The survey was conducted in two Indian states of Bihar and Uttar Pradesh. Descriptive statistics, bivariate analysis and logistic regression are done to examine the results. Adolescent girls reported more suicidal ideation than boys. The odds of suicidal ideation are significantly higher among adolescents whose mother faced physical abuse and adolescents who themselves experienced sexual abuse. Adolescent boys and girls who have moderate depressive symptoms and impulsive behavior are significantly more likely to report suicidal ideation. The results help in identifying the adolescents who are at a particular risk for suicidal ideation while planning for intervention program for prevention of suicide.

Unnatural death in India

Rising adult mortality is an essential feature of the mortality transition. Vulnerability to disease and infection decreases with age, and adult mortality is more likely to be from unnatural causes such as suicide, homicide and road traffic accidents. This study aimed to assess the patterns of unnatural deaths in India as a whole and for various population subgroups. Data were obtained from the fourth wave of the National Family Health Survey (NFHS-4) conducted in 2015-16 in 29 states and 7 union territories of India. The survey collected information on deaths in households occurring in the 3 years before the survey. Rate of unnatural mortality and years of life lost were calculated separately for males and females as well as for urban and rural populations. Unnatural mortality in India was found to make up 10.3% of total deaths, and was greater among the population aged 10 to 45 years. The unnatural mortality rate in India was 0.67 per 1000 population: 0.84 per 1000 among the male population and 0.49 per 1000 among the female population. A strict positive association was found between the unnatural mortality rate and a state's development level. In addition, a substantial loss of person-years of life due to unnatural mortality was observed. The results serve as a reminder of the need to adopt measures to reduce this avoidable loss of life in India. Prevention strategies should be targeted at the most vulnerable populations to limit young-age fatality, with its resulting loss of productive years of life.

Asian Indians in America: The influence of values and culture on mental health

Asian Indians represent a significant portion of the largest growing race of Asians in the past decade in the United States. This selective review examines major cultural themes related to first- and second-generation Asian Indians living in the United States as they impact psychological and psychiatric dysfunction in this population. Specifically, we review the impact of Asian Indian culture on mental health, discuss the impact of acculturation and ethnic identity development on the mental health of Indian-Americans, and focus on typical mental health problems of Asian Indian adolescents, women and elderly in America. Finally, we provide a brief overview of empirically-supported treatment approaches and cultural considerations for additional treatments relevant to this population. This review is intended to provide an important foundation for more systematic empirically-driven investigation into better understanding how Asian Indian cultural themes impact mental health for Indian-Americans, and how to develop effective treatments for these issues in this cultural group.

The Feasibility, Acceptability, and Efficacy of Delivering Internet-Based Self-Help and Guided Self-Help Interventions for Generalized Anxiety Disorder to Indian University Students: Design of a Randomized Controlled Trial

BACKGROUND

Generalized anxiety disorder (GAD) is one of the most common mental disorders among university students; however, many students go untreated due to treatment costs, stigma concerns, and limited access to trained mental health professionals. These barriers are heightened in universities in India, where there are scant mental health care services and severe stigma surrounding help seeking.

OBJECTIVE

To evaluate the feasibility, acceptability, and efficacy of Internet-based, or "online," cognitive behavioral therapy (CBT)-based unguided and guided self-help interventions (using the programs GAD Online and Lantern, respectively) to reduce GAD symptoms in students with clinical and subthreshold GAD and, ultimately, reduce the prevalence and incidence of GAD among the student population.

METHODS

Students will be recruited via 3 colleges in Hyderabad, India, and referred for a campus-wide online screening. Self-report data will be collected entirely online. A total of 300 qualifying students will be randomized in a 1:1:1 ratio to receive GAD Online, Lantern, or to be in a wait-list control condition, stratified by clinical and subthreshold GAD symptomatology. Students will complete a postintervention assessment after 3 months and a follow-up assessment 6 months later, at which point students in the wait-list control condition will receive one of the programs. The primary outcome is GAD symptom severity at 3 months postintervention. Secondary outcomes include GAD caseness at 9 months, other anxiety and depression symptoms, self-efficacy, and functional measures (eg, sleep, social functioning) at 3 and 9 months, respectively. Primary analyses will be differences between each of the intervention groups and the wait-list control group, analyzed on an intention-to-treat (ITT) basis using mixed-design ANOVA.

RESULTS

The study commenced in February 2015. The sample was recruited over a 3-week period at each college. The trial is expected to end in December 2015.

CONCLUSIONS

This trial will be the first to evaluate the use of Internet-based CBT programs compared with a wait-list control group for the treatment of GAD among students in Indian universities. If effective, these programs have the potential to reduce the mental health care treatment gap by providing readily accessible, private, and cost-effective evidence-based care to students with GAD who do not currently receive the treatment they need.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02410265 http://clinicaltrials.gov/ct2/show/NCT02410265 (Archived by WebCite at http://www.webcitation.org/6ddqH6Rbt).

The pattern of suicide in the western Kingdom of Saudi Arabia: a retrospective study from 2008 to 2012

Suicide represents the dramatic end of human life mostly in young age. In a 5-year retrospective study in Jeddah in the western Kingdom of Saudi Arabia, 200 successful suicidal attempts demonstrated that hanging was the most common method of suicide with 72% of the cases, and males represented 77% of the total loses. Most fatalities were of the age range from 20s to 40s. Saudi cases constituted 18.5% of the death cases representing the second most common nationality of successful suicidal attempt in Jeddah after Indians who represented 23% of the entire study. Saudi fatalities were induced by hanging in 56% of the all Saudi deaths in contrast to about 83% in the Indian fatalities.