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.

Suicide, attempted suicide, and different form of suicidal behavior are on the rise worldwide. Suicide is the leading cause of death globally among all the age groups. According to World Health Organization (WHO) 2002 on violence on health, about 815,000 people died due to suicide all over the world in the year 2000 itself.[1]

It is generally assumed that official suicidal rate is underestimated from the true rate by 20–100% due to prevailing sociocultural issues, religious attitude, stigma attached, and legal process involved. Statistics on attempted suicide or deliberate self-harm are not usually available officially. Attempted suicides occur 8–20 times more frequently than completes suicide. It occurs more frequently among the younger people and tends to be 2–3 times higher in women than men.[2]

Agricultural industry provides livelihood to two-third of India's population. It gives employment to 57% of her workforce and provides raw materials to large number of industries. Although farming is portrayed as a healthy and happy way of life, agricultural industry experiences highest numbers of suicides among other industries.[3]

Suicide among rural agrarian community is now a universal phenomenon. Studies across the globe have identified farming as one of the most dangerous industries due to broad and changeable range of physical, biological, and chemical hazards. These factors are compounded by volatile market condition, limited availability of off-farm employment, growing cost of machinery, and loss of farm or livelihood due to crop failure.[4]

There was a steady rise in the farmer's suicide in India, between 1995 and 2010.[5] In Vidarbha region of Maharashtra itself where the main cotton grower's community of India resides, the suicide rate was more than national average. As per media report, an average of six farmers per day committed suicide in the Vidarbha region during 2003–2006.[6]

A study carried out in Vidarbha region in Maharashtra by Mishra showed associated indebtedness (87%) and deterioration in the economic status (74%) as major risk factors for suicide among the cotton grower community of Maharashtra.[7] The common mode of suicide and attempted suicide in rural India is by the methods to which they have easy access. In India, due to the easy availability of pesticides, lack of education, efforts on the part of the system to train the agrarian community in safe use of pesticide, and lack of control on over the counter sell have been the common methods of attempt in Indian subcontinent.[89]

Following the intervention by governmental, nongovernmental organization, and mental health professional, there is reduction in the reporting of incidents of suicide among the cotton grower community of Vidarbha region of Maharashtra.[10] On this background, we aimed at studying the sociodemographic profile and pattern of attempted suicide among the cases admitted to our rural medical college.

MATERIALS AND METHODS

We evaluated all the cases of attempted suicide admitted to our rural medical college during the period of 1-year (April 2013–March 2014). Following the initial recovery from the attempt, the cases were referred for psychiatric evaluation. After obtaining the Institutional Ethical Committee approval, all the cases were evaluated on a semi-structured pro forma after obtaining the written consent of the patient or the relatives when required. Details of demographic profile, mode of attempt, and reason for the attempt were evaluated. Appropriate treatment was offered by the treating psychiatrist depending on the clinical diagnosis of the cases. Data were analyzed using suitable statistical methods.

RESULTS

During the study period, total 68 cases of attempted suicide (n = 68) were referred for the psychiatric evaluation and management. Demographic pattern of the sample revealed that majority of the cases (82%) were in the age group of 16–40 years [Graph 1]. There was a male predominance of 63% versus 37% female [Graph 2]. Among cases, 59% were unmarried [Graph 3]. At least 43% of the study samples were involved in farming directly or indirectly (farmers 32.3%, laborer in farming industry 10.3%) [Graph 4]. Main reason for the attempt among the farmers was financial constraints and altercation among the family members due to financial loss in the farming (56%) [Graph 5]. The most common mode of attempt (85%) was poisoning by pesticide, followed by slashing of the wrist or hanging, which were just 7% and 4%, respectively [Graph 6]. Clinical diagnosis of the attempted cases diagnosed by different treating psychiatrist showed that at least 60% of the cases had depressive episodes of varied severity [Graph 7].

Graph 1

Age-wise distribution of data n = 68

Graph 2

Gender-wise distribution of data n = 68

Graph 3

Marital status of data n = 68

Graph 4

Occupation-wise distribution of subjects n = 68

Graph 5

Reason for suicides n = 68

Graph 6

Mode of suicide attempts n = 68

Graph 7

Psychiatric diagnosis n = 68

DISCUSSION

Our study was aimed to have a glimpse on the pattern of suicide attempt among the rural agrarian community (cotton grower community of central India) from the attempted suicide cases admitted to a rural medical college of Vidarbha region. In our study, majority of the cases (82%) were in the age range of 16–40 years. Our study findings corroborate with the National Crime Record Bureau data and the epidemiological study of Bangalore by Gururaj on completed suicide.[511] Gender ratio (male: female) in our study sample was 1.7:1, which is in accordance with most of the Indian studies in suicide where male: female ratio is 1.4:1.[11]

Stable marital relationship is generally considered as a protective factor against suicide. Being divorced, separated, widowed, or being single are considered to be a risk factor for suicide. In the USA studies, only 11% of married people commit suicide while rate of suicide was higher among divorced and widowed 33% and 21%, respectively.[2] In our study sample, 59% of attempter were unmarried and only 31% were married. Marriage definitely worked as a protective factor against suicide attempts.

The most common mode of attempt in our study sample was consumption of pesticides (85%), which was easily available among the agrarian community of rural population. In other Indian studies, pesticide consumption and hanging have been the most common method of suicide/attempted suicide.[812] Main reason for the suicide attempt among the study sample was financial constraint, and altercation among the family members due to financial debt in farmers’ community following crop failure. Similar reasons for suicide among the agrarian community of rural Maharashtra have been cited by other Indian studies.[1314]

Clinical diagnosis of the cases carried out by different psychiatrist showed at least 60% of the cases had depressive episodes of varied severity. A systematic review carried out by Bertolote and Fleischmann noted that 98% of the cases who committed suicide had a diagnosable psychiatric disorder.[15] Although Indian studies differ in this point, various physical illness, stressful life events, and disturbed interpersonal relationship act as a cumulative factor.

CONCLUSION

Although there is reduced reporting of incidents of suicide in the media from the Vidarbha region in the recent past, our study showed that still quite a number of agrarian population from this rural area of Maharashtra attempt suicide due to financial constrain and interpersonal conflict in the family due to loan repayment or crop loss. Easy availability of pesticide in the farming industry without any regulation to control on sale remains a common mode of attempt among rural agrarian population. In the present scenario of frequent change in the climatic condition, expected crop loss, volatile market condition, and lack of supervised government policies, there may be a rise in the incidents of suicide among the farming community those who mainly depend on cash crops. The preventive strategies used by other nations may not completely apply in our scenario, but that can be a guiding path for further research and formulation of policies toward primary prevention of suicide in our rural community.

Limitations

Our study being hospital-based may not give a true picture about the community. It is just the tip of the iceberg. Psychiatric diagnosis was primarily clinical based. Definite scales for the diagnosis of cases could not be used due to rapid turnover of the patients in the liaison psychiatric setup.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.