TY - JOUR
T1 - Why young people attempt suicide in India
T2 - A qualitative study of vulnerability to action
AU - Balaji, Madhumitha
AU - Mandhare, Kavita
AU - Nikhare, Kalyani
AU - Shah, Arjun K.
AU - Kanhere, Prajakta
AU - Panse, Smita
AU - Santre, Manjeet
AU - Vijayakumar, Lakshmi
AU - Phillips, Michael R.
AU - Pathare, Soumitra
AU - Patel, Vikram
AU - Czabanowska, Katarzyna
AU - Krafft, Thomas
N1 - Funding Information:
In line with the WHO's LIVE LIFE approach to suicide prevention (World Health Organization, 2021), we make the following recommendations for suicide prevention in India based on our findings: (1) teaching of life skills to young people, particularly emotional regulation, problem-solving, and conflict resolution; (2) engagement with high-risk groups (for example, those from broken or problematic homes), including assessment of suicide risk; monitoring and follow-up; and providing of specialised support for such individuals in the early stages of exposure, such as appropriate referral to health systems or community-based organizations; and (3) community-wide restrictions of access to alcohol, drugs, and means of suicide attempts such as pesticides. These strategies have also been advocated in India's first ever National Suicide Prevention Policy, which was launched last year (MoHFW 2022). As specified in the Policy, special attention also needs to be paid to young women. These efforts need to go beyond increasing health and other support services for vulnerable groups (for example, referral centres for victims of domestic violence), to encompass large scale social changes which aim at promoting gender equality and women's empowerment, such as the provision of education or employment opportunities for young women. Given that family dynamics play a significant role in suicide attempts, we recommend that the implementation of the specified strategies involve key family stakeholders at each step – first, as gatekeepers, in recognising indicators of suicide risk, and then later, in supporting vulnerable individuals, for example, through safe storage of pesticides at home, and monitoring high-risk behaviours such as ‘intoxication’. These efforts also need to address conflict with the family members, build resilience within the family, and target family-level risk factors, for example alcohol use in partners or fathers. Many of the factors in our study – for example, conflicts and violence, financial or job losses, anxiety, and substance use – were also identified in the COVID-19-related suicides in India (Balaji and Patel, 2021; Al-Mamun et al., 2023); given the increased rates of suicides and suicide attempts reported during this period (Arya et al., 2022; Pathare et al., 2020), and the potential for recurrence of COVID-19 and other pandemics, and/or continued increases in suicide rates, we recommend that prevention programmes in this post-COVID-19 world specifically target and prioritise these factors.This work was supported by DBT/Wellcome Trust India Alliance [IA_CPHE_16_1_502659].
Funding Information:
This work was supported by DBT/Wellcome Trust India Alliance [ IA_CPHE_16_1_502659 ].
Publisher Copyright:
© 2023 The Authors
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Suicidal behaviours among young people in India are a major public health problem. An understanding of the reasons for suicide attempts from survivor perspectives is essential to developing suicide prevention programs for this population, as these can provide valuable insights into concerns that are unique to young people, and direct the focus of such programs towards these specific concerns. Qualitative studies are best suited for eliciting such perspectives, but such studies in India are lacking. We conducted semi-structured interviews with 47 persons between the ages of 15 and 29 who had been admitted to a public hospital in Pune, India, following a suicide attempt. Participants were asked to describe in their own words, what they believed was the reason for the attempt. Data was analysed using inductive thematic analysis and summative content analysis. There were three broad factors that interacted to lead to suicide attempts – background factors (individual and environmental factors that increased vulnerability); psychological distress (emotional and cognitive states that led to suicidal ideation); and intervening factors (factors that facilitated transition from distress to the attempt). The most common pattern was the occurrence of an interpersonal stressor shortly before the attempt, which produced distorted cognitions, and overwhelming emotions – usually of anxiety or anger - with ready access to means and/or impulsivity being the final catalysts. This stressor was generally a trigger associated with long-standing problems involving partners or family members, which had already produced intolerable distress over time. Female participants appeared particularly vulnerable to these stressors, partly due to prevailing socio-cultural norms. Our findings suggest the need for suicide prevention programs in India to foster life skills for young people, engage with high-risk groups (for example, women), and restrict access to harmful substances. Family stakeholders need to be involved in the implementation.
AB - Suicidal behaviours among young people in India are a major public health problem. An understanding of the reasons for suicide attempts from survivor perspectives is essential to developing suicide prevention programs for this population, as these can provide valuable insights into concerns that are unique to young people, and direct the focus of such programs towards these specific concerns. Qualitative studies are best suited for eliciting such perspectives, but such studies in India are lacking. We conducted semi-structured interviews with 47 persons between the ages of 15 and 29 who had been admitted to a public hospital in Pune, India, following a suicide attempt. Participants were asked to describe in their own words, what they believed was the reason for the attempt. Data was analysed using inductive thematic analysis and summative content analysis. There were three broad factors that interacted to lead to suicide attempts – background factors (individual and environmental factors that increased vulnerability); psychological distress (emotional and cognitive states that led to suicidal ideation); and intervening factors (factors that facilitated transition from distress to the attempt). The most common pattern was the occurrence of an interpersonal stressor shortly before the attempt, which produced distorted cognitions, and overwhelming emotions – usually of anxiety or anger - with ready access to means and/or impulsivity being the final catalysts. This stressor was generally a trigger associated with long-standing problems involving partners or family members, which had already produced intolerable distress over time. Female participants appeared particularly vulnerable to these stressors, partly due to prevailing socio-cultural norms. Our findings suggest the need for suicide prevention programs in India to foster life skills for young people, engage with high-risk groups (for example, women), and restrict access to harmful substances. Family stakeholders need to be involved in the implementation.
KW - India
KW - Qualitative
KW - Suicide
KW - Suicide attempts
KW - Young people
U2 - 10.1016/j.ssmmh.2023.100216
DO - 10.1016/j.ssmmh.2023.100216
M3 - Article
SN - 2666-5603
VL - 3
JO - SSM - Mental Health
JF - SSM - Mental Health
IS - 1
M1 - 100216
ER -