A prospective study of suicidal behaviour in Sundarban delta, West Bengal, India.

Background. Deliberate self-harm is a challenging public health issue but there is a paucity of data on non-fatal deliberate self-harm in the literature. We aimed to understand the behaviour of deliberate self-harm, both fatal and nonfatal, in a primary care setting. Methods. A year-long prospective study of all admitted patients of deliberate self-harm at 13 block primary health centres of the Sundarban region was done to examine the sociodemographic profile and clinical outcome of suicidal behaviour. Data were collected by using an especially devised deliberate self-harm register. Each subject was administered a 20-item case history sheet by trained medical officers and nursing staff. Results. A total of 1614 deliberate self-harm subjects (619 men, 995 women) were admitted during the year, of whom 143 (62 men, 81 women) died. Although women, especially in the younger age groups, constituted the majority of subjects (61.6%), the fatality trend was higher among men than among women (10% v. 8.1%). Poisoning was the commonest (98.4%) method of self-harm, particularly using pesticide. Easy availability of pesticides was a risk factor. Psychosocial stressors, such as conflict with spouse, guardian or in-laws, failed love affairs and economic distress, were the common underlying reasons. The majority of acts of deliberate self-harm (92.6%) were committed inside the home, especially by women. Only a small proportion of subjects had a past or family history of attempt at deliberate self-harm. The overall incidence of fatal and non-fatal deliberate self-harm was 5.98 and 61.51 per 100 000 population, respectively. Conclusion. Both fatal and non-fatal pesticide-related deliberate self-harm is a major public health issue in the Sundarban region. An intersectoral approach involving primary health, administration and agriculture may help in developing an effective preventive programme to reduce the morbidity and mortality from deliberate self-harm.

A study on mortality and morbidity pattern of acute childhood poisoning cases admitted in block primary health centres of Sundarban, West Bengal.

A hospital - record based study was conducted in Sundarban of West Bengal to explore the profile of mortality and morbidity pattern of acute accidental poisoning among children. Sundarban is an underdeveloped coastal region of West Bengal. Three years retrospective (1999 - 2001) data of childhood accidental poisoning cases were collected from the indoor admission registers and case history sheets of 11 Block Primary Health Centers (BPHC) of the region. A total of 1056 children with accidental poisoning were admitted during those three years of which 58% were males. Mean age of males was slightly higher than females in all the three years. Organophosphorus pesticide poisoning was the commonest.

Media influenced imitative hanging: a report from West Bengal.

Media influences behaviour, especially of the young children and adolescents in various ways. The present study examined the media coverage of a judicial hanging and its immediate social effect. In a qualitative study the media coverage of a case of a judicial hanging was thoroughly discussed and the media influence, for over a period of ten weeks of the incident, in terms of suicide and copying of hanging among children, was collected and analysed. Eighteen cases were reported as an aftermath of this hanging: 1 suicide and 17 imitative hanging in children with 5 deaths. This report calls for attention that media should be cautious and responsible in presenting the news items that have potential social impact.

Community Psychiatry Clinics at Sundarban: a clinical and cultural experience.

A series of Community Psychiatric Clinics were conducted in different blocks of Sundarban region of West Bengal. One of the primary objectives of this was to collect clinical epidemiological data on psychiatric morbidity in the region. A total of 26 clinics were conducted in Sagar, Kakdwip, Canning and Gosaba block of the Sundarban region during the period from end 1998 to end 2000. A total of 451 psychiatric cases with diagnostic categories (male 239, female 212) and 215 non-psychiatric cases (male 107 and female 108) were seen in these clinics. Diagnostic Interview Schedules (SCID) and Clinical rating scales like Hamilton Depression Rating Scale and Brief Psychiatric Rating Scales were used to ascertain clinical diagnosis quantitatively. Special emphasis was given on common psychiatric disorders.

Prominence of symptoms and level of stigma among depressed patients in Calcutta.

A pilot study of 29 patients for research on clinical depression employed the framework of cultural epidemiology to examine illness-related experience, meaning, behaviour with a Bengali version of the explanatory Model Interview Catalogue (EMIC). This report examined patterns of distress and stigma with reference to the most troubling patient-specified symptom. All subjects were psychiatric outpatients in the Institute of Psychiatry, Calcutta, and met Diagnostic and Statistical Manual (DSM)-IV criteria for a major depressive episode. Only 5 patients (17.2%) identified sadness as the most troubling problem, and 48.3% specified pains and other somatic symptoms instead. An internally consistent stigma scale with Cronbach's alpha of .67, comprised 13 items, was used to assess stigma. In addition to the scale score for each subject, the contribution of each item was reported and compared. A suggestive, though not significantly lower value of the stigma score for patients reporting somatic symptoms as most troubling, compared with sadness, was consistent with findings from prior studies showing a positive relationship between the magnitude of depression and stigma. These findings are discussed with reference to their impact on recognition and help seeking among patients, and recognition and management of depression by general practitioner. Culturally distinctive presentations and social contexts of depression and other mental illnesses should be addressed in professional training and public health communications.

Torture and mental health.

Torture has reached an epidemic proportion throughout the globe. The most common psychological symptoms are insomnia and nightmare, memory losts and poor concentration. There are 20 million official refugees in the world today. Torture in different dimensions is always attached with the refugee experience. Torture by definition creates a severe form of psychosomatic distress because of the person's lack of control over the basic bodily functions. Torture in women (16% to 52%) is perpetrated by male counterparts. Increasing awareness of professional obligation for prevention of torture will play a definite role in promoting a peaceful world.