Farmers' suicide in Vidarbha region of Maharashtra state: A myth or reality?

A study of attitudes and experiences relating to alcohol use in a community of family farmers from Southern India

Problematic drinking is found to be common among Indian farmers. This study aims to improve our understanding of the causes, consequences, and culture surrounding drinking in Indian farming communities. 36 semi-structured interviews with male and female farmers were thematically analyzed. Problematic drinking in male farmers was found to significantly impact farmer's relationships, work, finances, and health, and to be related to spousal abuse and neglect. Drinking to cope with mental and physical pain was common, and stigma around drinking appears to be a barrier to social support. Implications for future research and treatment efforts for Indian farmers are discussed.

Short-Term and Long-Term Replenishment of Water Storage Influenced by Lockdown and Policy Measures in Drought-Prone Regions of Central India

Central India faces a freshwater shortage due to its diverse terrain, sudden change in precipitation patterns and crystalline rock covered subsurface. Here, we investigate the patterns in terrestrial water storage anomaly (TWSA) over the last two decades, and also study the influence of the COVID-19 lockdown on TWSA in the drought-prone regions of central India, mostly covering the Vidarbha region of the Indian state of Maharashtra. The Vidarbha region is arguably the most drought-affected region in terms of farmer suicides due to crop failure. Our forecast data using multiple statistical approaches show a net TWSA rise in the order of 3.65 to 19.32 km3 in the study area in May 2020. A short-term rise in TWSA in April–May of 2020 is associated with lockdown influenced human activity reduction. A long-term rise in TWSA has been observed in the study region in recent years; the rising TWSA trend is not directly associated with precipitation patterns, rather it may be attributed to the implementation of water management policies.

Psychosocial aspects of suicide in largest industry of farmers in Vidarbha Region of Maharashtra

India consists of 16% of the world's population, but sustains only 2.4% of land resources. The agriculture sector is the only livelihood to two-third of its population, which gives employment to 57% of the workforce and is a raw material source to a large number of industries. Farmer suicides account for approximately 10% of all suicides in India. The national suicide rate is 10.6/lac, whereas in Maharashtra it is 14.2/lac, in Andhra Pradesh 12.1/lac, in Telangana 27.7/lac, and in Chhattisgarh 27.7/lac. The National Crime Records Bureau data from 1995 to 2006 show that 200,000 farmers had committed suicide, with an average rate of 16,000/year. Every 7^th suicide in the country is a farmers' suicide. The first state where suicides were reported was Maharashtra with particularly in the Vidarbha region. In Maharashtra, farmers' suicide rate is 60% higher than the general suicide rate. Every 5^th farmers' suicide committed in the country had occurred in Maharashtra, Vidarbha being a particularly sensitive region but also in Punjab, Uttar Pradesh, Kerala, and Karnataka. In a country of 70 million farmers, 10 in every 100,000 farmers commit suicide. Many inquiry commissions were formed and recommendations were implemented, especially in Punjab. The problem of suicide is not only reported in India but also reported in different parts of the world like England and Wales. We adopted the psychological autopsy approach to offer some insight into the reason why these individuals resorted to such a drastic step.

Suicidal Ideation and Pesticide Exposure in Rural Communities of Central India

Background  This study aims to evaluate association between suicidal ideation and pesticide exposure in rural communities of Wardha district of Central rural India compared with villagers who are not exposed to it. Method  It was a cross-sectional study done in rural community of Wardha district in Central India. About 100 farmers who were exposed to pesticides and 100 controls who were not exposed to pesticides were included. A Semistructured proforma to record sociodemographic variables and Indian version of the Self Reporting Questionnaire-20 was used. Results  Of these 200 subjects, data were available for 85 farmers in study group and 74 in control group. In the farmers group, 31% of farmers had suicidal ideas, while 8% of controls felt like ending their life. Conclusion  Measures must be taken to store pesticides at a safer place thus reducing long-term exposure. Organic farming is a better choice to avoid suicidal ideas.

Effectiveness of Psychological Intervention by Videoconference for Family Members with Depression of Farmers Who Have Committed Suicide

BACKGROUND

In India two thirds of the population is directly or indirectly dependent on agriculture. The suicide rate for farmers throughout the world is higher than the non-farming population with India being no exception. Family members of the household where a member has committed suicide are at an increased risk for depression, anxiety and suicide. There is a paucity of trained counsellors in India, while there is sufficient research showing counselling and therapy through videoconferencing is just as effective as in-person therapy. It is however, not commonly practiced in India, especially in rural settings. We propose to evaluate psychiatric morbidity and assess feasibility and effectiveness of videoconferencing for family members of farmers who had committed suicide.

OBJECTIVES

The objective is to evaluate family members of farmers who have committed suicide for psychiatric morbidity and psychosocial risk factors. We aim to identify depression, anxiety and suicidal risk in family members and then administer psychological intervention through video-conferencing for depression to study its effectiveness in the cohort.

METHODOLOGY

The data on completed farmer suicide would be collected from district authorities and police departments. Home visit would be made by research staff to assess the risk factors for the farmers who completed suicide. Family members would be screened for anxiety and depression and severity of depression and suicidal ideas would be rated. The family members having mild to moderate depression would be randomised and CBT based psychological intervention (5 sessions) over three months would be given by trained psychologist through videoconferencing. The outcome would be measured at the end of six months.

CONCLUSIONS

Psychological interventions through video-conference might be beneficial in the treatment of mild to moderate depression in family members of the farmers who have committed suicide.

Psychological autopsy: Overview of Indian evidence, best practice elements, and a semi-structured interview guide

BACKGROUND

No review has been attempted, so far, on Indian psychological autopsy (PA) literature. There is also a dearth of interview guides which is at the heart of a PA procedure.

MATERIALS AND METHODS

Electronic searches of MEDLINE through PubMed, PsycINFO, and Google scholar databases were carried out from inception till February 2020 to identify relevant English language peer-reviewed articles from India, as well as global literature that provided information on best practice elements in PA. Abstracts generated were systematically screened for eligibility. Relevant data were extracted using a predesigned structured proforma, and a semi-structured interview guide was developed.

RESULTS

A total of 18 original articles, one case report, and three reviews/expert opinion articles which tried to give a description of PA procedure were found from India. Most Indian studies are of suicide PA (SPA), done to assess risk factors associated with suicide. There was a wide variation in reported rates of psychiatric morbidity among suicide decedents, while the other major risk factor for suicide in the Indian setting was stressful life events. An optimal approach to PA involves systematically collecting information from key informants and other sources using a narrative interviewing method, supplemented with psychological measures, and is probably best carried out within 1-6 months after the death.

CONCLUSION

There have been limited attempts to standardize PA. Most Indian studies use SPA. We propose a semi-structured PA interview guide, suitable for both research and investigational purposes.

Leukocyte count: A reliable marker for the severity of organophosphate intoxication?

INTRODUCTION:

Organophosphorus poisoning (OPP) is a major public health problem in developing countries like India. Leukocyte count is a simple and inexpensive test, and elevated count is associated with acute inflammation and increased oxidative stress-like OPP. This study was done to correlate the severity of acute OPP with leukocyte count and also to assess the prognosis.

MATERIALS AND METHODS:

A prospective, observational clinical study was done on 80 patients suspected of OPP of age >15 years admitted to emergency unit at a tertiary rural teaching health-care center of Central India. Serum cholinesterase level and leukocyte count were estimated at the time of admission in all patients and severity of OPP was assessed according to Peradeniya organophosphorus poisoning (POP) scale.

RESULTS:

The mean age of the patients was 33.52 years (standard deviation [SD] 11.62) in males and 27.30 years (SD 7.33) in females. Among them, 57 (71.25%) were males and 23 (28.75%) were females. The severity of poisoning was directly correlated with serum cholinesterase level (P = 0.0001). Leukocyte count had a sensitivity of 60%, specificity of 76%, and negative predictive value of 85% if counts were more than 12,000 and 30% sensitivity, 95% specificity, and 80% negative predictive value if counts were more than 15,000 in predicting mortality in patients with OPP.

CONCLUSION:

Leukocyte count levels on admission can be used a prognostic marker in patients with OP poisoning.

Groundwater Storage Trends and Their Link to Farmer Suicides in Maharashtra State, India

Threats posed by land degradation and desertification continue to destabilize India's agriculture productivity and food security. The enduring negative environmental consequences of the agricultural intensification that started during the 1960s have further contributed to the depletion of soil nutrients in farmlands through heavy input of chemical fertilizers and pesticides. More than half of India's population depends on farming. When crop productivity fails, the economically-depressed farmers are unfortunately pushed toward suicide. The news of farmers committing mass suicide in Maharashtra state of India has lately received world attention. Although suicide may involve various psychological, social and economic factors, access to irrigation water remains a contentious matter in the agriculture business. The groundwater (GW) data from government sources are limited and not displayed in the public domain for verification. Hence, this study used the Gravity Recovery and Climate Experiment (GRACE) satellite data to compare farmer suicide rate in Maharashtra with GW storage estimates at broad spatiotemporal scales. The results show significant correlations (r = -0.85, p < 0.005) between water storage and suicide rate when time lags of 2 years are introduced between them. Based on the new findings, this study recommends that the GW status needs to be monitored scientifically across India's suicide zone. By doing so, the worst case scenarios can be logically predicted well in advance. The government then may have the advantage to mobilize its resources on the ground to implement rapid emergency measures and farmer consultations to minimize future farmer suicide cases.

Impact of different sources of credit in creating extreme farmer distress in India

Purpose

According to the published report by the National Sample Survey 2014 the data says that the incidence of indebtedness among households in the rural areas of Maharashtra, India, is almost twice that of other rural places in India. Around 64 percent of rural households are indebted in Maharashtra as against 31 percent other households in India. The purpose of this paper is to examine which source of credit is creating more distress among the farmers. Further the researchers also wanted to find out the reasons why the farmers choose private moneylender over the formal financial institutions.

Design/methodology/approach

To achieve the objective, the authors used the mixed method methodology. The qualitative study was done using the ethnography approach .In depth interviews were conducted and coded accordingly to find out the themes. The interviews conducted were semi structured and had open ended questions in it, followed by a structured questionnaire. Different statistical tests were also applied on the responses obtained from the questionnaire to check the reliability and validity of the interviews. This methodology gave a robustness to the findings of the study.

Findings

The results show that sources of loan play a major role in causing farmer distress in Maharashtra. The findings also show major reasons like grapevine bureaucracy, lengthy documentation, etc. as the major reasons for choosing private lenders over the formal financial institutions. The most interesting finding of the study was a phenomena observed during the field study. The borrowers first borrow from financial institutions for their credit needs, when they fail to repay the debt borrowed they again borrow money from the private money lenders and with this borrowed money they try repaying a part of the old existing loan in order to make themselves eligible for the next loan cycle.

Research limitations/implications

The limitation of the study is that due to time constraint only two districts with high number of farmer suicide could be visited. Given more time and fund a comparative study can be done among different states of India.

Practical implications

This study will help the policy makers in identifying the real cause of farmer distress. The motive behind the policies made by the government is very noble but the implementation of these policies is inadequate and without a strong research base. The paper will be able to highlight how much the state intervention is required at multiple levels in order to ensure that the benefits reaches to those who deserve it.

Social implications

It is imperative that we have yet not realized the gravity of the situation where people belonging from a community which is so essential to the economy are killing themselves because of lack of money. This is not just about the fact that the people who give us food are unable to access food themselves.

Originality/value

The paper contains significant information with regard to indebtedness. It focuses on the issue troubling the authorities the most. It provides the ground realities of the incidence of indebtedness in Maharashtra, one of the most distressed states of India. Lot of studies have been done in the past but very few studies have used mixed methodology to study this incidence of debt among the farmers of Maharashtra. This study also unveils a new phenomena of borrowing happening among the farmers of Maharashtra.

Risk Factors for Farmers' Suicides in Central Rural India: Matched Case-control Psychological Autopsy Study

BACKGROUND

Despite more than two decades since recognition of suicides by farmers in India, systematic studies comparing various risk factors are lacking. This is major hurdle for the formulation of strategies for farmers' suicide prevention.

OBJECTIVE

To identify socioeconomic and psychological risk factors and their relative contribution in suicides by farmers.

MATERIALS AND METHODS

A matched case-control psychological autopsy was done on 98 farmers' suicide victims and 98 controls in Central India.

RESULTS

Economic problems, psychiatric illness, and stressful life events were found to be important contributors to farmers' suicides. Important economic risk factors were procurement of debt, especially from multiple sources and for nonagricultural reasons and leasing out farms. Psychiatric illness was present significantly in higher proportion among cases than controls. Crop failure, interpersonal problems, medical illness, and marriage of female family member were significant stressful life events.

CONCLUSIONS

There are socioeconomic and psychological risk factors for suicide by farmers which can be targets of prevention policy.

Prevalence and treatment coverage for depression: a population-based survey in Vidarbha, India

PURPOSE

VISHRAM is a community-based mental health program to address psycho-social distress and risk factors for suicide in a predominantly rural population in Central India, through targeted interventions for the prevention and management of Depression and Alcohol Use Disorders (AUD). The evaluation was designed to assess the impact of program on the contact coverage of evidence-based treatments for depression and AUD through a repeated survey design. This paper describes the baseline prevalence of depression among adults in rural community, association of various demographic and socio-economic factors with depression and estimates contact coverage and costs of care for depression.

METHODS

Population-based cross-sectional survey of adults in 30 villages of Amravati district in Vidarbha region of Central India. The outcome of interest was a probable diagnosis of depression which was measured using the Patient Health Questionnaire (PHQ-9). Data were analyzed using simple and multiple logistic regression.

RESULTS

The outcome of current depression (PHQ-9 ≥ 10) was observed in 14.6 % of the sample (95 % CI 12.8-16.4 %). The contact coverage for current depression was only 4.3 % (95 % CI 1.5-7.1 %). Prevalence of depression varied greatly between the two sites of the study; higher age, female gender, lower education, economic status below poverty line and indebtedness were associated with depression; and while a contact coverage with formal health care was very low, a large proportion of affected persons had consulted family members.

CONCLUSIONS

Our findings clearly indicate that psycho-social distress in rural communities in Maharashtra is strongly associated with social determinants such as gender, poverty and indebtedness and affects the entire population and not just farmers.

Factors associated with the farmer suicide crisis in India

Background: In India, it is estimated that ∼16,000 farmers die by suicide each year, and at rates far above those of the general population. This paper reviews much of the literature concerning the factors associated with this crisis.

Methods: A literature search was undertaken from multiple databases on Ovid, as well as more elementary searches of Google, Google Scholar, and PubMed. This paper presents a review of the key results.

Results: Socioeconomic factors, rather than mental health problems, are associated with farmer suicides, with increased indebtedness playing the predominant role. Available research suggests this has arisen to a greater extent recently, due to an agrarian crisis affecting the most vulnerable farmers. This has multiple manifestations, including a lack of agricultural investment and irrigation improvement, use of cash crops, the increased use of noninstitutional credit sources, and the reduction of trade barriers. Bt cotton is unlikely to be an important factor and no studies reported a significant burden of mental health problems.

Conclusion: Indebtedness and numerous factors relating to this are clearly identified as the most important risk factors. Further large-scale assessments are required to further understand the situation.

A case-control study of psychological distress in survivors of farmers' suicides in Wardha District in central India

CONTEXT

Lack of literature on psychological aspects of survivors of farmers' suicides is hurdle in devising effective helping strategies for rising number of survivors across the country.

AIMS AND OBJECTIVES

To assess the psychological distress and its correlates in survivors of farmers' suicides.

SETTINGS AND DESIGN

Case-control study design was used in Wardha District of Vidarbha region in the central India.

MATERIALS AND METHODS

A predesigned and pretested semistructured questionnaire was used to assess sociodemographic variables. Self-Reporting Questionnaire-20 was used to evaluate psychological distress in 98 survivors of farmers' suicides and 98 age, sex, and occupation-matched controls.

STATISTICAL ANALYSIS

Significance of differences between case and control groups were assessed using Chi-square test or Fisher's two-tailed exact test for class variables. For continuous variables, Student's t-test was used P < 0.05 was considered significant.

RESULTS

Significantly higher proportion of survivors had psychological distress than controls. Female survivors, spouse and parents of suicide victims had a high risk of distress. Psychological distress was commonly expressed by depressive and somatic symptoms.

CONCLUSIONS

Survivors of farmers' suicides are suffering from significant psychological distress.

Sociodemographic profile of suicide attempters among the rural agrarian community of central India

BACKGROUND

Suicides, attempted suicides and different form of suicidal behaviors are on the rise in most part of the world. It is generally assumed that official suicidal rate are underestimated from the true rate by 20-100 % due to prevailing socio-cultural issues, religious attitude, stigma attached, and legal process involved. Attempted suicides occur 8-20 times more frequently than complete suicide. Statistics on attempted suicide or deliberate self harm are not usually available officially.

MATERIALS AND METHODS

All the cases of attempted suicide who were admitted and referred for psychiatric evaluation and management to a rural medical college of central India during a period of one Year (April 13-March-14), following initial recovery they were evaluated on a semi-structured performa on socio demographic profile, mode of attempt and reason for attempt. Data collected was analyzed using suitable statistical methods.

RESULTS

Total 68 cases were evaluated during the study period. 43% of the cases were involved in farming. Among 85% of the study population pesticide consumption was the common mode of attempt, which is easily available among the agrarian community of rural India. Interpersonal conflict in the family due to indebtedness, financial loss due to crop failure was the commonest reason for attempt.

CONCLUSION

Though there is reduced reporting in the incidents of suicide cases in media from this region, still quite a number of people attempt suicide due to financial constraint from crop failure, ongoing indebtedness, and poor socioeconomic condition culminating into poor mental health among the rural agrarian community of central Maharashtra.

Epidemiology and clinical characteristics of traumatic brain injuries in a rural setting in Maharashtra, India. 2007-2009

Context:

Though some studies have described traumatic brain injuries in tertiary care, urban hospitals in India, very limited information is available from rural settings.

Aims:

To evaluate and describe the epidemiological and clinical characteristics of patients with traumatic brain injury and their clinical outcomes following admission to a rural, tertiary care teaching hospital in India.

Settings and Design:

Retrospective, cross-sectional, hospital-based study from January 2007 to December 2009.

Materials and Methods:

Epidemiological and clinical data from all patients with traumatic brain injury (TBI) admitted to the neurosurgery service of a rural hospital in district Wardha, Maharashtra, India, from 2007 to 2009 were analyzed. The medical records of all eligible patients were reviewed and data collected on age, sex, place of residence, Glasgow Coma Scale (GCS) score, mechanism of injury, severity of injury, concurrent injuries, length of hospital stay, computed tomography (CT) scan results, type of management, indication and type of surgical intervention, and outcome.

Statistical Analysis:

Data analysis was performed using STATA version 11.0.

Results:

The medical records of 1,926 eligible patients with TBI were analyzed. The median age of the study population was 31 years (range <1 year to 98 years). The majority of TBI cases occurred in persons aged 21 - 30 years (535 or 27.7%), and in males (1,363 or 70.76%). Most patients resided in nearby rural areas and the most frequent external cause of injury was motor vehicle crash (56.3%). The overall TBI-related mortality during the study period was 6.4%. From 2007 to 2009, TBI-related mortality significantly decreased (P < 0.01) during each year (2007: 8.9%, 2008: 8.5%, and 2009: 4.9%). This decrease in mortality could be due to access and availability of better health care facilities.

Conclusions:

Road traffic crashes are the leading cause of TBI in rural Maharashtra ffecting mainly young adult males. At least 10% of survivors had moderate or more severe TBI-related disabilities. Future research should include prospective, population based studies to better elucidate the incidence, prevalence, and economic impact of TBI in rural India.

Toward a typology of health-related informal credit: an exploration of borrowing practices for paying for health care by the poor in Cambodia

Background

Borrowing money is a common strategy to cope with health care costs. The impact of borrowing on households can be severe, leading to indebtedness and further impoverishment. However, the available literature on borrowing practices for health is limited. We explore borrowing practices for paying for health care by the poor in Cambodia and provide a typology, associated conditions, and the extent of the phenomenon.

Methods

In addition to a semi-structured literature review, in-depth interviews were conducted with representatives of 47 households with health-related debt and 19 managers of formal or informal credit schemes.

Results

A large proportion of Cambodians, especially the poor, resort to borrowing to meet the cost of health care. Because of limited cash flow and access to formal creditors, the majority take out loans with high interest rates from informal money lenders. The most common type of informal credit is locally known as Changkar and consists of five kinds of loans: short-term loans, medium-term loans, seasonal loans, loans for an unspecified period, and loans with repayment in labour, each with different lending and repayment conditions and interest rates.

Conclusion

This study suggests the importance of informal credit for coping with the cost of treatment and its potentially negative impact on the livelihood of Cambodian people. We provide directions for further studies on financial protection interventions to mitigate harmful borrowing practices to pay for health care in Cambodia.

Suicide: An Indian perspective

Suicide is the third leading cause of death among young adults worldwide. There is a growing recognition that prevention strategies need to be tailored to the region-specific demographics of a country and to be implemented in a culturally-sensitive manner. This review explores the historical, epidemiological and demographic factors of suicide in India and examines the strategies aimed at the prevention of suicide. There has been an increase in the rates of suicide in India over the years, although trends of both increases and decline in suicide rates have been present. Distinct from global demographic risk factors, In India, marital status is not necessarily protective and the female: male ratio in the rate of suicide is higher. The motives and modes of suicide are also distinct from western countries. Preventive strategies implemented at a community level and identifying vulnerable individuals maybe more effective than global strategies.

Farmers' suicides in the Vidarbha region of Maharashtra, India: a qualitative exploration of their causes

Background:

To explore the various perceived reasons for farmers’ suicides in the Vidarbha region of Maharashtra, their common factors, and to suggest solutions.

Methods:

The present formative research was undertaken in the 23 villages surrounding the Anji Primary Health Centre, located in the Vidarbha region of Maharashtra, India. A triangulation of free list and pile sort exercises was used. The data was analyzed by Anthropac 4.98.1/X software. This was followed by a semi-structured focus group discussion. To increase the validity of the results, these findings were presented to the participants and later they were circulated to the 26 farmers’ clubs in the villages for comment and discussion during their monthly, village based meetings.

Results:

Farmers perceived debt, addiction, environmental problems, poor prices for farm produce, stress and family responsibilities, government apathy, poor irrigation, increased cost of cultivation, private money lenders, use of chemical fertilizers and crop failure as the reasons for farmers’ suicides. Participants suggested solutions such as self-reliance and capacity building among farmers, a monitoring and support system for vulnerable farmers, support and counseling services, a village-level, transparent system for the disbursement of relief packages.

Conclusions:

Farmers’ suicides in Vidarbha are caused by the complex interplay of social, political and environmental constraints. Hence, a comprehensive intervention to ensure self reliance and capacity building among farmers in modern farming techniques , monitoring and support system for vulnerable farmers, a village-level, transparent system for disbursement of relief packages is required to prevent farmer suicides in the near future. Apart from this, there is a need to strengthen the National Mental Health Program at primary health care level to offer support and counseling to vulnerable farmers in rural area.

Suicide in selected occupations in Queensland: evidence from the State suicide register

OBJECTIVE

Prior research has suggested an association between suicide and certain occupations. The aim of the present study was to report on suicide rates in selected occupations in Queensland (QLD).

METHOD

Suicide mortality data from the QLD Suicide Register and population data from the Australian Bureau of Statistics were obtained for the period 1990-2006. Suicide rates were calculated for each occupational group and compared to rates within the general population (15-64 year age group) and the employed population of QLD.

RESULTS

There was significantly higher risk of suicide for male subjects in the agricultural, transport and construction sectors of QLD. High suicide rates were also found in female nurses, artists, agricultural workers and cleaners, while education professionals (of both genders) appeared at lower risk.

CONCLUSIONS

The significantly higher suicide rates for employees of the agriculture, construction, and transport industries indicate a need for further research into the occupation-specific conditions and individual or other social-environmental factors that may accentuate suicide risk within these professions. Use of higher quality occupational data is also warranted in future studies.

Indian research on suicide

The suicide rate in India is 10.3. In the last three decades, the suicide rate has increased by 43% but the male female ratio has been stable at 1.4 : 1. Majority (71%) of suicide in India are by persons below the age of 44 years which imposes a huge social, emotional and economic burden. Fifty four articles on suicides have been published in IJP. Several studies reveal that suicidal behaviours are much more prevalent than what is officially reported. Poisoning, hanging and self immolation (particularly women) were the methods to commit suicide. Physical and mental illness, disturbed interpersonal relationships and economic difficulties were the major reasons for suicide. The vulnerable population was found to be women, students, farmers etc. A social and public health response in addition to a mental health response is crucial to prevent suicidal behaviour in India.