COVID-19 and suicides in India: Where do we stand?

ABSTRACT

Introduction1 The Corona Virus Disease 2019 (COVID-19) has ignited many debates and has undoubtedly shaken up the core foundations of the health-care system worldwide. There has been plenty of evidence that pandemic and the effects of lockdown have Studies have resulted in elevated levels of psychological symptoms such as depression, anxiety, phobia, trauma, etc. Concerning the COVID-19 outbreak (since late January 2020 in India), the first case that was reported in India is stated to be due to fear of being infected with COVID-19. Similarly, COVID-19 suicide occurrences were reported as of fear of infection, economic crisis and social boycott in Bangladesh and Pakistan, from the neighbouring countries of India. Though the report of the National Crime Record Bureau (NCRB) was released as last as October’21 this year, many of the incidents were reported by press and over social media platforms. The NCRB Statistics - 20202 A total of 1,53,052 suicides were reported in the country during 2020 showing an increase of 10.0% in comparison to 2019 & the rate of suicides has increased by 8.7% during 2020 over 2019. Majority of suicides were reported in Maharashtra (13.0%) followed by Tamil Nadu (11.0%), Madhya Pradesh (9.5%), West Bengal (8.6%) & Karnataka (8.0%). These 5 States together accounted for 50.1% of the total suicides reported in the country. Family Problems (33.6%) & Illness (18.0%)’ were the major causes of suicides. Drug Abuse/Addiction (6.0%), Marriage Related Issues(5.0%), Love Affairs (4.4%), Bankruptcy or Indebtedness (3.4%), Unemployment (2.3%), Failure in Examination (1.4%) & Poverty (1.2%) were other causes. Daily wage earners accounted for the maximum percentage (24.6%). Hanging’ (57.8%), consuming ‘Poison’ (25.0%), ‘Drowning’ (5.2%) and ‘Fire/Self Immolation’ (3.0%) were the prominent means/mode. Beyond the NCRB Statistics3 The NCRB report has some significant limitations. NCRB underestimates suicide rates due to under- reporting of cases & this data is usually made available after a significant delay of between 12 and 24 months. Furthermore, NCRB releases summary annual data rather than weekly or monthly data to analyse trends (Important during COVID19). NCRB does not keep any record of attempted suicides as well. Analysis of media reports reveals that the rates of suicide and attempted suicide between 24 March to 3 May 2020 compared to the same dates in 2019 showed a 67.7% increase in reported suicides and attempted suicides during the lockdown. More suicides & attempted suicides were by older employed men. Suicides increased in 2020 in states which traditionally have low suicide rates such as Bihar, Uttar Pradesh, Rajasthan, Haryana, and Chandigarh (also economically less developed & inadequate health infrastructure). There were 39 alcohol-related suicides & 7 attempted suicides as compared to no such suicide/ attempted suicide cases in 2019. Conclusion3 The possibility that the pandemic may have increased the risk of suicide as reflected from the media reports has been attested by the recently released NCRB data. However, both the reports are an underestimate of the true figures. The pandemic however has now provided an opportunity for cross- sectoral collaboration for suicide prevention rather than restricting suicide prevention to the health sector Symposium Proposal Digital Phenotyping in Mental Health This symposium explores the emerging field of digital phenotyping in mental health. Despite developments, psychiatry heavily relies on patients’ interviews and self-reporting to match the diagnostic criteria of the ICD or DSM and is still handicapped by the lack of objective measurements for diagnosis and management. Smartphones and wearables, which have emerged as new tools for health investigation, generate many digital fingerprints that provide insights into human behavior. They collect data in naturalistic settings in-situ, leveraging the lived experiences of patients and no longer confined to clinics or research laboratories. However, such technology with revolutionary p tential is also associated with challenges and controversies. Various legal, ethical, and security issues concern digital phenotyping in mental health. The first presentation by Vijay Gogoi of LGBRIMH sets the scene for what follows1. He discusses the advent and concept of using digital devices and the Internet of Things (IoT) for personal sensing in the context of mental health. Terminologies like computational behavioral analysis, personal sensing, continuous measurement are being applied in similar research approaches. Hence, some researchers also view digital phenotyping as a variant of deep phenotyping, closely aligned with the goals of precision medicine and a new tool for the National Institute of Mental Health’s Research Domain Criteria. Dhrubajyoti Chetia of LGBRIMH then discusses the various research trends in mental health using digital devices2. The features studied as behavioral markers for social context, stress, sleep, mood, and clinical disorders like depression, schizophrenia, and bipolar disorder will be discussed. Changes in location and activity patterns, keyboard interaction dynamics, voice modulation, social communication logs are used to predict depressive and manic states. Proactive screening in online environments and automatic natural language processing of social media posts have been used successfully to identify individuals with evidence of psychological distress. Signals from smartphones and clinical measurements may provide a safety net for patients at risk of self-harm or suicide. The challenges and limitations of using digital technology are highlighted by Sajjadur Rehman of Lady Hardinge Medical College3. Results are not comparable across studies because of varying data collection techniques and research designs. As most research is currently being carried out in small samples as proof of concept studies, replicating the same in a large population is a challenge. Variability from geographical location, characteristics of people, data types, environments, etc., is a barrier. With rapid technological advancements, and people changing their usage, machine learning algorithms are bound to become inaccurate. Finally, as health care professionals, the ethical and security concerns were discussed by Kunal Deb of LGBRIMH4. Accountability for safety and efficacy, usually assessed by government agencies, is still not well developed for digital health technologies. Strict data privacy and protection regulations also need to be in place. The use of various data streams may assist the third party in re-identifying individuals without their knowledge, with the potential impacts of mental health diagnosis and predictions on employment, insurance, litigation, and other contexts. 1.Vijay Gogoi, Associate Professor, Psychiatry, LGBRIMH, Tezpur, Assam 2.Dhrubajyoti Chetia, Associate Professor, LGBRIMH, Tezpur Assam. 3.Sajjadur Rehman, Assistant Professor, Psychiatry, Lady Hardinge Medical College, Delhi 4.Kunal Deb, Assistant Professor, Psychiatry, LGBRIMH, Tezpur, Assam.