Deliberate self-harm and domestic violence: Some answers needed.

Sir,

Chowdhury and his colleagues[1] have dealt with an important area of emergency psychiatry, that is, deliberate self harm (DSH) and domestic violence. The content of this Bhagawat Award winning article is more relevant to the current scenario where agro-based societies[2] report more DSH attempts. The cultural epidemiology of deliberate selfharm (DSH) is critical[3] in planning for suicide prevention, community mental health, and psychiatric practice. The study is also very important in developing countries such as India, where domestic violence[4] is frequently reported.

However, a few concerns about the study persist. Although the authors have aimed to investigate the risk factors associated with non-fatal DSH, among admitted self-harm attempters in the Sunderban region of West Bengal, their results about the study do not seem to clearly reflect this. The authors have admitted the problem of generalization of the data in their limitations, but the practicality and feasibility of the study among three disjointed block PHCs is not clear. There is a need to highlight more on the assessments and details about raters and their interrater reliability. It is difficult to understand the ‘ethical permission from the Block Medical Officer’ (page 97)[1] rather from the patients / relatives. There is a need to highlight the medicolegal status of DSH attempters. There is a need for more clarifications about the DSH prevention program. There are repetitions of the results in the text that appear in the tables too.

The clinical findings of the cases are omitted in the research article, although they appeared in the conference abstract[5] of the award paper section (Major depressive disorder (14.6%); adjustment disorder (6.7%); no psychiatric problem (60.5%). These findings will definitely give a clearer picture about the study results. There are some typographic errors that appear in the article, e.g. the titles of Tables 3 and 4 [1] interchanged with respect to content appeared in the tables. The points that appear in the discussion section should be cautiously judged with respect to the results obtained, such as harassment by in-laws on the issue of dowry (although only males admitted dowry as a cause of DSH in Table 1, page 97)[1].

Undoubtedly we feel that the authors have taken a useful step in this relatively neglected area of research. However, further studies are required on the relationship between domestic violence and DSH.