Sumanth Mallikarjuna Majgi

In April 2019 I attended the SNEHA (http://www.snehasuicideupdate2019.com/) suicide update conference, at Chennai, India. This was a great opportunity to hear about recent developments in research and practice for suicide and suicide prevention, from around the world.

The first day of the conference focused on the burden of the suicide across the globe, and epidemiology of these difficulties, including age-group trends and how these varied across countries. It was noted that a drop in the incidence of suicide has been observed over time.

As part of my work within the SASHI project, I have been involved in trying to improve the monitoring of suicide and self-harm behaviour within India, including work on the development of hospital-based registers.I am therefore familiar with the challenges of collecting high quality, country-wide data on suicide, but I was astonished to know that it is not just India where this is a problem, but for many countries across the globe. High quality data on suicide and self-harm is vital to effectively track trends and patterns of risk, and so this is an important issue.

Overall, the rate of suicide remains high. In High Income Countries, the suicide rate is three times greater than the rate of homicide, although it was noted that a drop in the incidence of suicide has been observed over time. No, nationwide large scale community-based registry exist to date. The work within SASHI is a step towards this goal.

It was good to know about the mental health action plan 2013-20, which focuses on the preventing suicide deaths, with the goal of a 10% reduction in the number of suicide deaths (per 100000) by 2020. This target is also in-line with the WHO Sustainable Development Goals (SDG). Goal 3 of the SDGs is to ‘Ensure healthy lives and promote well-being for all at all ages’, whilst Target 3.4 is by 2030, to ‘reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being’. Within Target 3.4, the suicide rate is an indicator.

The conference enlightened me about a number of risk factors for self-harm and suicide, including many I am familiar with, and others I was less aware of. The social determinants of health are relevant risk factors for self-harm and suicide. These include problems of employment and education, health service access, and gender-related inequalities. There was also mention of how economic factors may relate to suicide risk. For example, there is an inverse relation between economic growth and suicidal rates in china.

The talks covered the risk of suicide related to pregnancy. Whilst there is evidence of lower suicide risk in women who have recently given birth, the incidence of self-harm and suicide is elevated during the perinatal period in many countries. In many countries (UK, Australia, Canada and Nordic countries) suicide is one of leading cause of death among the pregnant women. Here it is important to note that for purposes of perinatal self harm and suicide, the perinatal period is often defined as 1 year following delivery, instead of 42 days (Usual obstetrical definition). In these cases precipitating factors might include unemployment of the woman, an unplanned pregnancy, domestic violence and abuse.

There is a community based cohort study nowtaking place in Bangalore, India (Prospective Assessment of Maternal Mental Health Cohort Study; PRAMMS), conducted by the National Institute of Mental health and Neuro Sciences, where in, 909 women from lower socio-economic backgrounds are being assessed over time. Sixteen percent thought about suicide, 6% planned suicide attempt, 3% attempted suicide and 0.8% repeated a suicide attempt. For me, these staggering figures highlight the problem of suicide in women in India. The study is ongoing, not yet published.

The above research highlights the need for linking reproductive and child health with work on suicide prevention. During the conference I learned that Kerala state, in India, has already taken initiative with regard to this.

Another high risk group discussed at the conference was health professionals. Among these health professionals, those said to be at higher risk include practitioners who think excessively about their professional image, and those who experience perfectionism. Such characters put person on undue stress of performing well beyond reality. These patterns were more commonly seen with anaesthetists, GPs and psychiatrists. Other risk factors faced by these individuals included a lack of positive feedback from patients or negative or critical feedback. Emotional distress, lack of social support (including from family), long hours of working, systemic pressures within the working environment, and high working expectations were also noted as risk factors. For me this highlights how for health professionals looking after oneself , being humans, decreasing expectation, letting others know when we are struggling, seeking help, and spending time with family, can help preventthese problems .

Among adolescents, particular issues are the use of cell phone, bullying, early depression, unemployment and alcoholism in family. In the present day, the use of cell phones is vert prevalent amongst young people. It was discussed how cell phone overuse in young people may in turn can lead to problems with depression, anxiety, and eventually the risk of suicide. The conference also covered recent trends, including games that possibly encouraged risk-taking and suicidal behaviour.

Lastly, high risk amongst minority and marginalized groups was mentioned, including cultural and ethnic minority populations (this can also include native populations that have become marginalized, such as the Inuit population in Northern Canada). People who are homeless represent another high-risk marginalized group, where uncertainty and prevalent difficulties with depression and anxiety may also contribute to suicide risk.

With the above evidences it appears the social determinants have stronger hold on the occurrence of suicide. Hence, modifying these social determents may be the key strategy to reduce the incidence of this preventable cause of death.

Publication date: 27 June 2019