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Year : 2016  |  Volume : 38  |  Issue : 6  |  Page : 510-513  

Reducing suicide rates: Need for public health and population interventions


Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication30-Nov-2016

Correspondence Address:
K S Jacob
Department of Psychiatry, Christian Medical College, Vellore - 632 002, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7176.194915

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   Abstract 

Recent studies from India have challenged the fact that the majority of the people who die by suicide have severe mental illness; they have demonstrated its frequent links to environmental stress, social, cultural, economic, and political correlates. Suicide, a complex phenomenon, is a final common pathway for a variety of causal etiologies. Nevertheless, psychiatry continues to argue for curative solutions based on the reductionistic biomedical model, rather than support public health measures to manage the larger sociocultural, economic, and political context. While psychiatry and curative medicine help many people in distress, specific mental health interventions are unlikely to impact secular trends in the rates of suicide. The reduction of population rates of suicide requires a range of public health measures.

Keywords: Deliberate self-harm, India, prevention, suicide


How to cite this article:
Jacob K S. Reducing suicide rates: Need for public health and population interventions. Indian J Psychol Med 2016;38:510-3

How to cite this URL:
Jacob K S. Reducing suicide rates: Need for public health and population interventions. Indian J Psychol Med [serial online] 2016 [cited 2017 Dec 13];38:510-3. Available from: http://www.ijpm.info/text.asp?2016/38/6/510/194915


   Introduction Top


Suicide has been recognized as a major public health problem affecting all nations in general and low- and middle-income countries in particular.[1] It has an adverse impact on individuals, families, communities, and on society as a whole.[2] The WHO Mental Health Action Plan 2013 − 2020[3] foregrounds the prevention of suicide and has included indicators that measure progress.


   Correlates, Focus, And Inadequacies Top


Research has identified a diverse group of risk factors for suicide. The results have been used to argue for specific preventive strategies. However, part perceptions, which highlight particular correlates, argue for specific solutions while ignoring others, are partial responses to a complex, multidimensional problem. Psychiatry continues to focus on the individual when the need is for a change in contexts, environments, and populations. The issues are briefly highlighted in [Table 1].
Table 1: Isolated research findings, individual treatments, public health strategies

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   Need For A Comprehensive Approach Top


Suicide, behavior, is a final common pathway for a variety of factors: predisposing, precipitating, and perpetuating causes.[2] Nevertheless, each of the risk factors and condition associated with suicide is neither necessary nor sufficient for suicide. Consequently, there are no single or simple solutions to preventing suicide. While interventions have shown a reduction in method-specific or site-specific rates, there is no firm evidence to suggest an overall reduction in suicide. A national strategy encompassing diverse approaches needs to be in place to achieve any degree of success.[22] Multi-sectoral and comprehensive approaches are required. On the other hand, medicalizing suicide or reducing it to a psychiatric label will prove inadequate for reducing population rates.


   Suicide And Public Health Top


The poor health status of populations in the poorest countries is related to chronic poverty working through a lack of basic needs and access to health services, social discrimination, economic insecurity, and political exclusion.[2] Suicide is also associated with many of these sociodemographic, cultural, and economic correlates and demands comprehensive population-based strategies.[22] Many of the risk factors associated with suicide require a social security net provided by the state. Without a social security net many vulnerable individual face significant socioeconomic distress, which can easily propel them toward the option of suicide. The egalitarian society promised in the Indian constitution requires the provision of basic needs such as clean water, nutrition, housing, health care, education, and employment. In addition, it should provide gender justice and protect against social exclusion. Without such public health approaches, suicide prevention would remain on paper with the medical and psychiatric approaches currently advocated completely inadequate for the task of reducing suicide rates. Multidimensional problems like suicide require large-scale public health interventions to reduce suicide rates of populations.[2]


   Conclusion Top


Many risk factors associated with suicide are neither necessary nor sufficient for death making the search for single and direct solutions impossible.[2] Nevertheless, experts tend to identify causal mechanisms operating in a minority of suicides and suggest single and simplistic solutions to manage the complex individual and social phenomenon of suicide. They rarely push for comprehensive national responses. Comprehensive solutions demand a package of macroeconomic policies that reduce the impact of free-markets, schemes which meet basic human needs and rights, psychosocial interventions that organize local support within communities, an essential pesticide list that excludes lethal compounds, gender justice, universal primary health care, legal and social protection for the vulnerable and increasing awareness and education through mass media.[2]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
World Health Organization. Preventing Suicide: A Global Imperative. Geneva: World Health Organization; 2014. Available from: http://www.apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua = 1. [Last accessed on 2016 May 10].  Back to cited text no. 1
    
2.
Jacob KS. Suicide in India: Part perceptions, partial insights, and inadequate solutions. Natl Med J India 2016.   Back to cited text no. 2
    
3.
World Health Organization. Mental Health Action Plan 2013-2020. Geneva: World Health Organization; 2013. Available from: http://wwwapps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf?ua = 1. [Last accessed on 2016 May 10].  Back to cited text no. 3
    
4.
Abraham VJ, Abraham S, Jacob KS. Suicide in the elderly in Kaniyambadi block, Tamil Nadu, South India. Int J Geriatr Psychiatry 2005;20:953-5.  Back to cited text no. 4
    
5.
Government of India. The Maintenance and Welfare of Senior Citizens Act, 2007. New Delhi: Government of India; 2007. Available from: http://www.socialjustice.nic.in/oldageact.php?pageid = 3. [Last accessed on 2015 Sep 29].  Back to cited text no. 5
    
6.
Patel V, Ramasundarahettige C, Vijayakumar L, Thakur JS, Gajalakshmi V, Gururaj G, et al. Suicide mortality in India: A nationally representative survey. Lancet 2012;379:2343-51.  Back to cited text no. 6
    
7.
Aaron R, Joseph A, Abraham S, Muliyil J, George K, Prasad J, et al. Suicides in young people in rural southern India. Lancet 2004;363:1117-8.  Back to cited text no. 7
    
8.
Jacob KS. Alcohol and public health policies in India. Natl Med J India 2010;23:224-5.  Back to cited text no. 8
    
9.
Dongre AR, Deshmukh PR. Farmers' suicides in the Vidarbha region of Maharashtra, India: A qualitative exploration of their causes. J Inj Violence Res 2012;4:2-6.  Back to cited text no. 9
    
10.
Joseph A, Abraham S, Muliyil JP, George K, Prasad J, Minz S, et al. Evaluation of suicide rates in rural India using verbal autopsies, 1994-9. BMJ 2003;326:1121-2.  Back to cited text no. 10
    
11.
Eddleston M, Adhikari S, Egodage S, Ranganath H, Mohamed F, Manuweera G, et al. Effects of a provincial ban of two toxic organophosphorus insecticides on pesticide poisoning hospital admissions. Clin Toxicol (Phila) 2012;50:202-9.  Back to cited text no. 11
    
12.
Jegannathan B, Dahlblom K, Kullgren G. Outcome of a school-based intervention to promote life-skills among young people in Cambodia. Asian J Psychiatr 2014;9:78-84.  Back to cited text no. 12
    
13.
Jacob KS, Patel V. Classification of mental disorders: A global mental health perspective. Lancet 2014;383:1433-5.  Back to cited text no. 13
    
14.
Insel TR. The NIMH research domain criteria (RDoC) project: Precision medicine for psychiatry. Am J Psychiatry 2014;171:395-7.  Back to cited text no. 14
    
15.
Manoranjitham SD, Rajkumar AP, Thangadurai P, Prasad J, Jayakaran R, Jacob KS. Risk factors for suicide in rural south India. Br J Psychiatry 2010;196:26-30.  Back to cited text no. 15
    
16.
Ghaemi SN. The rise and fall of the biopsychosocial model. Br J Psychiatry 2009;195:3-4.  Back to cited text no. 16
    
17.
Shaffer D, Pfeffer CR, Gutstein J. Suicide and attempted suicide in children and adolescents. In: Gelder MG, Andreasen NC, Lopez-Ibor JJ, Geddes JR, editors. New Oxford Textbook of Psychiatry. 2nd ed.. Oxford: Oxford University Press; 2009. p. 1702-10.  Back to cited text no. 17
    
18.
Jacob KS. Psychiatric education for medical students. Natl Med J India 1998;11:287-9.  Back to cited text no. 18
    
19.
Brainerd E. Economic Reform and Mortality in the Former Soviet Union: A Study of the Suicide Epidemic in the 1990s, IZA Discussion Paper Series, No. 243; 2001.  Back to cited text no. 19
    
20.
Manoranjitham S, Charles H, Saravanan B, Jayakaran R, Abraham S, Jacob KS. Perceptions about suicide: A qualitative study from southern India. Natl Med J India 2007;20:176-9.  Back to cited text no. 20
    
21.
Times of India. (2015) Love Affairs, Impotency among Reasons Behind Farmer Suicides, Union Agriculture Minister Says. Times of India; 24 July, 2015. Available from: http://www.timesofindia.indiatimes.com/india/Love-affairs-impotency-among-reasons-behind-farmer-suicides-Union-agriculture-minister-says/articleshow/48203971.cms. [Last accessed on 2015 Sep 29].  Back to cited text no. 21
    
22.
Manorantjtham S, Abraham S, Jacob KS. Towards a national strategy to reduce suicide in India. Natl Med J India 2005;18:118-22.  Back to cited text no. 22
    



 
 
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