Sociocultural context of suicidal behaviour in the sundarban region of India.

The role of mental illness in nonfatal deliberate self-harm (DSH) is controversial, especially in Asian countries. This prospective study examined the role of psychiatric disorders, underlying social and situational problems, and triggers of DSH in a sample of 89 patients hospitalised in primary care hospitals of the Sundarban Delta, India. Data were collected by using a specially designed DSH register, Explanatory Model Interview Catalogue (EMIC), and clinical interview. Psychiatric diagnosis was made following the DSM-IV guidelines. The majority of subjects were young females (74.2%) and married (65.2%). Most of them (69.7%) were uncertain about their "intention to die," and pesticide poisoning was the commonest method (95.5%). Significant male-female differences were found with respect to education level, occupation, and venue of the DSH attempt. Typical stressors were conflict with spouse, guardians, or in-laws, extramarital affairs, chronic physical illness, and failed love affairs. The major depressive disorder (14.6%) was the commonest psychiatric diagnosis followed by adjustment disorder (6.7%); however 60.7% of the cases had no psychiatric illness. Stressful life situations coupled with easy access to lethal pesticides stood as the risk factor. The sociocultural dynamics behind suicidal behaviour and community-specific social stressors merit detailed assessment and timely psychosocial intervention. These findings will be helpful to design community-based mental health clinical services and community action in the region.

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.

Deliberate self-harm prevention in the Sundarbans region need immediate public health attention.

Deliberate self-harm is a major public health problem. This study is aimed to examine the sociodemographic characteristics of both non-fatal and fatal deliberate self-harm cases admitted at the 13 block primary health centres of the Sundarbans region under South 24 Parganas district, West Bengal. Retrospective deliberate self-harm data from the admission registers of 13 block primary health centres was collected for the year 1999. A total of 1850 deliberate self-harm cases (639 males and 1211 females) were admitted at the 13 block primary health centres, of which 159 (60 males, 99 females) were fatal (completed suicide). A higher fatality rate for male than female (9.4% compared to 8.2%) was observed. Women (65.5%), especially of younger age groups constituted the major cases. Poisoning (96.9%) was the commonest method of self-harm. Easy availability of pesticides was a common factor. Marital status and seasonal trend (March-April) had important contribution in self-harm incidents. Planned psychosocial intervention as a part of community mental health programme may help to reduce the deliberate self-harm morbidity and mortality at this primary care level.

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.

Pesticide poisoning in non-fatal deliberate self-harm: A public health issue: Study from Sundarban delta, India.

BACKGROUND: Non-fatal deliberate self-harm (DSH), particularly with pesticides, is a major public health problem in many developing countries of the world. Agriculture is the primary occupation of most people living in the Sundarban region in West Bengal, India. Pesticides are extensively used in agriculture, and these agents are most frequently used in DSH. AIM: This study aimed to identify the nature of methods and agents used in non-fatal DSH attempts in the Sundarban area under South 24 Parganas district of West Bengal. MATERIALS AND METHODS: Detailed demographic and clinical data on DSH cases of 13 Block Primary Health Centres' (BPHCs') admission registers were analyzed. One Focus Group Discussion (FGD) with the Panchayat Samiti of each block (totally 13 FDGs) was conducted to elicit the Samiti members' perception about the problem of pesticide-related DSH or suicide in the region. RESULTS: A total of 5,178 (1,887 male and 3,291 female) subjects were admitted at the BPHCs during the study period from 1999 to 2001. Organophosphorous pesticide poisoning was found to be the most common method (85.1%) in DSH. This emphasizes the importance of developing an urgent poisoning-prevention program with a special focus on improving clinical services, as well as initiating farmers' education programs focusing on safe pesticide practices at the primary-care level.

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.

Culture, ethnicity, and paranoia.

This paper defines concepts of culture, ethnicity, and paranoia. It then explores the relationship between culture and ethnicity and the development of paranoia both in mental health settings and in the wider world. The importance of cultural awareness training while dealing with an ethnic population in any multicultural setting is emphasized. When exploring paranoia, proper exploration of its genesis is essential to distinguish between pathological and nonpathological paranoia.

An epidemic of mass hysteria in a village in West Bengal.

This is a report of an outbreak of mass hysteria, attributed to an unknown infectious disease, in a small village near Baruipur, South 24 Parganas district of West Bengal. The epidemic was triggered following the death of 2 persons of the same family on the same day. Thereafter, several other family members and villagers became ill and complained of similar symptoms. They were hospitalized for observation and all were discharged after a couple of days. We report the detailed sequence of events and the management of this mini epidemic.

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.

Studies on solution and solution-cast film of polyaniline colloids prepared in the absence and presence of ultrasonic irradiation.

Spectroscopic and voltammetric features for the solution and solution-cast film of polyaniline (PANI) colloids prepared in the absence and presence of ultrasonic irradiation were examined. Significant differences in the color and absorption spectra between the solution of colloids prepared in the absence and presence of irradiation were observed. Effects of ambient atmosphere on the solution of colloids were also studied. A gradual decay in the absorption at approximately 365 nm was occurred upon ageing the solution in air for the colloid prepared under ultrasonic irradiation. PANI film, cast from its colloidal solution, exhibited excellent electroactivity. The films thus cast were applied to electrode modification to control electrochemical reaction. Clear voltammetric response was observed on the electrode modified with the colloid prepared in the presence of ultrasonic irradiation.

A case of dhat syndrome with borderline personality disorder.

Personality disorder cases exhibit varieties of abnormal sexual behaviours. The present case is exemplifying how the perception of semen loss is associated with repeated deliberate self-harm attempts.

Puppy pregnancy in humans: a culture-bound disorder in rural West Bengal, India.

BACKGROUND: Delusion of pregnancy in males, though uncommon, has been reported in the literature. Delusion of animal pregnancy in humans is unreported until now, and we are reporting here cases of puppy pregnancy in human beings from a part of rural West Bengal, India. MATERIAL: Studies of six male cases and one female case of delusion of puppy pregnancy after an alleged touch or bite of a dog are presented. DISCUSSION: Detailed phenomenological analysis revealed that there exists a strong cultural belief that dog bite may evolve into a puppy pregnancy even in the human male. Psychiatric status showed that there was a clear association of obsessive-compulsive disorder in two cases, anxiety-phobic locus in one and three showed no other mental symptom except this solitary false belief and preoccupation about the puppy pregnancy. All the cases were from rural areas and their communities endorse this pathogenic event of puppy pregnancy in humans. One case (11-year-old child) exemplified how the social imposition of this cultural belief made him a case that allegedly vomited out an embryo of a dog foetus. CONCLUSION: Although the belief in puppy pregnancy is culturally shared, the cases presented a mix of somatic and psychological complaints and their help-seeking behaviour was marked. These features prompted us to identify this phenomena as a culture-bound disorder which needs proper cultural understanding for its effective management.

Culture, psychiatry and new zealand.

This paper provides a critical appraisal of the importance of cultural perspective in the psychiatric diagnosis and management plan. The working philosophy of mental health services in New Zealand is primarily monocultural and based on Western medical conceptualisation of diagnosis and treatment protocol. In view of the emphasis on bicultural health perspectives in recent years and in tune with the objectives of the Treaty of Waitangi's ethnocultural partnership, the provision of a culturally safe and sensitive mental health coverage of Maori and Pacific Islander clients has become an important health issue in the country. The present discussion of the ethnocultural influence on clinical psychiatry highlights some of the relevant issues from the transcultural perspective.

'Impulsive pica': a new diagnostic category?

Pica is an interesting psychiatric entity that merits special clinical attention. This report describes three cases of pica and calls for its separate nosological placement in clinical psychiatry. In the Diagnostic and statistical manual of mental disorders fourth edition (DSM-IV), pica is described as persistent eating of nonutritive substances for a period of at least 1 month which is inappropriate to the developmental level and not part of a culturally sanctioned practice (American Psychiatric Association, 1994). On the other hand, impulse-control disorders not elsewhere classified is defined as failure to resist an impulse, drive or temptation to perform an act that is harmful to the person or to others, feeling of an increasing sense of tension or arousal before committing the act and pleasure, gratification or relief at the time of committing the act or shortly thereafter (American Psychiatric Association, 1994). Regarding the aetiologies of Pica most contemporary literatures have cited various causative factors, e.g. normal exploratory orality of children, pregnancy, stress and conflicts, cultural beliefs, mental retardation, psychotic disorders and even nutritional deficiencies (Chatoor, 2000; Popper & West, 2001). Here, we report 3 atypical cases of Pica, attending outpatient department of the Institute of Psychiatry, Calcutta. These reported cases are unique in their time of onset, phenomenological progression and therapeutic responsiveness.

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.

Global, national, and local approaches to mental health: examples from India.

Neuropsychiatric disorders and suicide amount to 12.7% of the global burden of disease and related conditions (GBD) according to World Health Organization (WHO) estimates for 1999, and recognition of the enormous component of mental illness in the GBD has attracted unprecedented attention in the field of international health. Focusing on low- and middle-income countries with high adult mortality, this article discusses essential functions of international agencies concerned with mental health. A review of the history and development of national mental health policy in India follows, and local case studies consider the approach to planning in a rural mental health programme in West Bengal and the experience in an established urban mental health programme in a low-income community of Mumbai. Local programmes must be attentive to the needs of the communities they serve, and they require the support of global and national policy for resources and the conceptual tools to formulate strategies to meet those needs. National programmes retain major responsibilities for the health of their country's population: they are the portals through which global and local interests, ideas, and policies formally interact. International priorities should be responsive to a wide range of national interests, which in turn should be sensitive to diverse local experiences. Mental health actions thereby benefit from the synergy of informed and effective policy at each level.

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.