Intentional Self-Harm Seen in Psychiatric Referrals in a Tertiary Care Hospital
Das, Partha, Grover, Sandeep, Avasthi, Ajit, Chakrabarti, Subho, Malhotra, Savita, Kumar, Suresh, Indian Journal of Psychiatry
Byline: Partha. Das, Sandeep. Grover, Ajit. Avasthi, Subho. Chakrabarti, Savita. Malhotra, Suresh. Kumar
Background: Intentional self-harm is common, through out the world; however, there is scanty data from India. Aims: To study the sociodemographic and clinical profile of subjects with "intentional self-harm" referred to consultation-liaison psychiatric services for evaluation in a tertiary care hospital. Design: Retrospective chart review. Materials and Methods: For this study, the consultation-liaison register of Department of Psychiatry was screened to obtain data of all patients who were referred to psychiatry referral services and were diagnosed as "intentional self-harm" while they were admitted in Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh during the period of 2000-2005. The case notes of these patients were reviewed for obtaining the sociodemographic profile and clinical profile for the current study. Results: Majority of the subjects were married (61%), educated beyond matriculation (75%), were employed or retired (53.6%), belonged to Hindu (87%), nuclear family (64.5%) of middle socioeconomic status (85%) and came from urban background (53%). Most common reasons/precipitating events prior to intentional self-harm were interpersonal problems with family members (39.2%), followed by interpersonal problems with spouse (16.9%). The most common method of intentional self-harm used was consumption of insecticides (44.6%), followed by use of corrosives (17.5%). Half of the sample (48.2%) did not fulfill criteria for any axis-1 or axis-2 psychiatric diagnosis at the time of assessment and most common psychiatric diagnosis was depression (30.7 %). Conclusions: Nearly half of the subjects who present to a tertiary care hospital with intentional self-harm do not have diagnosable psychiatric illness.
Various terms like "attempted suicide," "deliberate self-poisoning," "deliberate self-injury," and "parasuicide" have been used interchangeably,[sup]  to define subjects who present with self-harm. Although some of the authors[sup] , have tried to separate these categories based on the suicidal intent at the time of the act, clinically it is not possible to do so in every case and hence, the most accepted term in recent times to describe such behavior is "Deliberate Self-Harm," which is defined as "self-poisoning or injury, irrespective of the purpose of the act"[sup]  and it is one of the top five causes of acute medical admissions for both men and women.[sup]  As in many countries, deliberate self-harm in India is an unrecognized, hidden, and a silent epidemic. Although the literature is very scant from Indian subcontinent, yet the available data suggest that the number is rising steadily[sup] , and that the risk factors associated and methods employed for suicide attempt/self-harm are strikingly different from those reported in Western data.[sup] 
The psychosocial milieu of the developing countries is different from that of the developed countries. Indian society is nontolerant to suicide, views it as an act of cowardice and betrayal.[sup]  Compared to the West, many of Indian patients suffering from various mental illnesses live with their families[sup]  are married.[sup]  In India, poverty, illiteracy, and unemployment are much more common and social security system is not existent compared to the West.[sup]  Another important precipitant for suicide/self-harm in India is dowry disputes, which is not seen in Western culture. Further, compared with the west there is scarcity of mental health services. Indians also rely heavily on religious beliefs, prayers, fasting, and faith in divine to provide solace and maintain hope. The basic tenet of Hindu philosophy is to maintain a fatalistic attitude, and consequently many resign themselves to their current situation rather than striving actively to change it. …