Academic journal article General Psychiatry

Suicide in India: A Systematic Review

Academic journal article General Psychiatry

Suicide in India: A Systematic Review

Article excerpt

1. Introduction

Suicide is the final outcome of complex interactions of biological, genetic, psychological, sociological and environmental factors. It is an increasingly important public health issue: from 1990 to 2010 the number of global suicides increased by 32%. It is particularly important among young adults 15 to 49 years of age among whom it accounts for 4.8% of all female deaths and 5.7% of all male deaths. [1] Eighty-four percent of global suicides occur in low and middle-income countries (LMICs); India and China alone account for 49% of global suicides. [2] There is substantial variability both in the prevalence of suicide and in the factors that influence the occurrence of suicide between geographic regions, cultures, and over time, so country-specific analyses are needed to develop targeted suicide prevention efforts.

The World Health Organization (WHO) estimates that of the nearly 900,000 people who die from suicide globally every year, 170,000 are from India. [3] However, India's National Crime Records Bureau (NCRB)--which report official suicide rates based on police reports estimated only 135,000 suicides in 2011. [4,5] One possible reason for under-reporting of suicide by the NCRB is that suicide remains a crime in India. [6] Detailed independent verbal autopsy investigations of all unnatural deaths in several rural areas of the country report suicide rates that are up to five-fold higher than the official national average. [7] Despite the importance of suicide both as a health problem and as a social problem, the issue receives little attention from Indian policy makers. This neglect of the issue is reinforced by cultural influences, religious sanctions, stigmatization of the mentally ill, competing political imperatives, and socio-economic factors. [8]

This systematic review aims to provide a more balanced assessment of the prevalence and correlates of suicide in India by identifying and integrating all available reports on the subject.

2. Methods

We searched the following electronic databases: PubMed, PsycINFO, EMBASE, Global Health, Google Scholar and IndMED (database of articles published in Indian biomedical journals). The combination of search terms (in the title or abstract fields) used included 'suicide' OR 'suicidal' OR 'suicidality' OR 'hanging' OR 'drowning' OR 'self-poisoning' OR 'overdose' OR 'self-injury' AND 'India' OR 'Indian'. The titles of the papers identified through the database search were screened and the abstracts of papers that reported on suicide or self-harm in India were retrieved. These abstracts were examined and the full text of papers that reported on the prevalence or correlates of suicide or self-harm were retrieved. These full texts were then examined to determine their compliance with the following eligibility criteria: papers published prior to June 2012 that reported the prevalence or correlates of suicide in any part of India for either gender in any age group. The reference lists of selected papers were hand-searched for additional eligible papers, but no additional papers were identified. The screening and selection of papers was independently conducted by both authors; in the cases where different papers were selected the paper was re-assessed and discussed by both authors to arrive at a consensus decision.

We extracted the following data from included papers: date of publication, study design, setting, center (state, city), methods, sampling technique, sample size, definition of suicide, prevalence, and correlates of suicide. Data extraction was conducted by one reviewer (AR). We present the results as prevalence rates and, where available, corresponding 95% confidence intervals (CI).

3. Results

The selection of included articles is shown in Figure 1. Thirty-six papers were selected for the review, of which 6 were published between 1971 and 1980, 3 between 1981 and 1990, 3 between 1991 and 2000, and 24 between 2001 and 2010. …

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