Men, but not women, are placed at a higher risk of suicide following injury or prolonged illness, claims a study led by Boston University School of Public Health (BUSPH) and published in JAMA Psychiatry.
“Suicide is incredibly challenging to predict, because every suicide death is the result of multiple interacting risk factors in one’s life,” said lead study author Dr Jaimie Gradus, associate professor of epidemiology at BUSPH. However, certain trends may be observed.
In India, there are a few notable groups that are known for having higher rates of suicide. Farmers, along with farm workers are a group known to have a risk higher than the general public, as are students.
In many cases, these deaths tie in directly with economic issues. Farmers as a group are typically prone to poverty. For many, a poor crop in any given year can mean a significant impact on their finances for a prolonged period. This lack of stability forms a consistent stressful environment that greatly impacts mental health. Typically living in rural areas, these individuals are unlikely to be able to avail mental health treatment. Indeed, the mental health treatment gap affects the majority of Indians in need of such care.
Against a population of 150 million experiencing mental health difficulties, just 898 clinical psychologists and 3,800 psychiatrists are available to respond to their needs. Mental health services are typically found only within India’s cities, forming a considerable urban/rural divide in terms of mental health treatment.
Dr Gradus and her colleagues looked at thousands of factors in the health histories of 14,103 individuals who died from suicide in Denmark between 1995 to 2015. Along with this, the health histories of 265,183 other Danes in the same period were analysed using a machine-learning system to look for patterns.
The authors of the study acknowledge that the system is not perfect, as suicide cannot be accounted for in the same manner as other conditions due to the unique circumstances each individual faces. They did, however, confirm a number of patterns: both new and previously confirmed.
Among those previously confirmed was the elevated risk of suicide among those with prior mental health conditions, as well as those on related prescriptions. This is not unexpected. However, what was additionally noted was that those with diagnoses or prescriptions dating back four years or more were found to have a higher risk than those recently diagnosed within the last four months. The implication of the finding is that the longer a person is diagnosed, or even treated for a mental health issue, the higher the risk of suicide — warranting further investigation as to whether current treatments and therapy methods need reevaluation.
A newly discovered trend was that physical health diagnoses can play a major role in suicide risk — though the research indicates that this is the case only if the affected individual is a man. The authors note the only identifiable factors used within the study were those found on medical records. Therefore, other factors that could be linked to physical diagnoses that would not appear on the medical record could be involved. A possible link here may be employment factors.
In the example of India’s farmers and farm workers, employment and financial stability was a key factor behind mental health issues and suicide. Should a worker receive a diagnosis of a physical ailment, particularly one which may put them out of work, the resultant financial hardship is likely to cause a severe amount of stress. For those living on the edge of poverty, unemployment can lead to severe economic hardships.
“There are substantially more suicide deaths in India each year than AIDS-related deaths (62,000 in 2016) and maternal deaths (45,000 in 2015) combined…suicide prevention has attracted considerably less public health attention,” claims a previous study published in the Lancet.
This in itself encompasses part of the problem in India. The subject of mental health is still a social taboo. Often those with mental health conditions — those at a greater risk of suicide — are pressured, either by those they know or a self-imposed pressure, to keep quiet on the issue.
For those who suffer mental health problems, this means that they will often suffer in silence. For the minority that are able to avail healthcare, the stigma may make them opt to ignore it. More must be done to raise awareness and alleviate stigma in India, and considerable efforts are needed on the part of the government to increase access.
Contact details for mental health support in India can be accessed here.
If you are suicidal or experiencing suicidal thoughts, visit your nearest hospital or contact AASRA on 91-22-27546669 or Sneha India on 91 44 24640050 helpline. A list of other suicide helplines can be accessed here.