Sohini Banerjee

Deliberate self-harm and suicide by pesticide ingestion in the Sundarban region, India.

Objective  To examine the clinical epidemiology, including case fatality and determinants of self‐harm in six island blocks of the Sundarban region of West Bengal, India.

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.

Participatory Research for Preventing Pesticide-Related DSH and Suicide in Sundarban, India: A Brief Report

Deliberate self-harm (DSH) is a major public health problem in the Sundarban region, India. This study is aimed to develop a DSH-suicide prevention programme based on the principles of community-based participatory research (CBPR). Perception and opinion of community about the problem of pesticide-related DSH and suicide were elicited in a series of facilitated focus group discussions in Namkhana block of Sundarban region. Based on their suggestion, a broad preventive programme was launched involving the development of information, education, and communication (IEC) and training modules and training of the stakeholders of the block. Most of the members of each target group found that the IEC materials were culture fair (message is acceptable, understandable, and meaningful in the local context) and very useful. Analysis of Dwariknagar BPHC, DSH admission data showed a definite reduction of DSH incidents after this CBPR approach to prevention was initiated. Similar model of DSH prevention in the other blocks of Sundarban region or in agricultural community may help to reduce the enormous mortality and morbidity from pesticide-related DSH and suicide.

Globalisation of Pesticide Ingestion in Suicides: An Overview from a Deltaic Region of a Middle-Income Nation, India

In many countries globally, intentional self-injury has become a frequent reaction to emotional distress, particularly among young adults. In high-income countries, the substances ingested are analgesics, antidepressants and sedatives, all of which are relatively harmless. However, the scenario is quite different in low- and middle-income countries (LMICs), especially in rural areas where agricultural pesticides are used to attempt self-harm. All across the world countries have accrued tremendous benefits from pesticide use. Pesticides have enhanced agricultural production dramatically in most countries thereby ensuring food for the increasing population. They have been instrumental in effectively controlling vector-borne diseases. In the 1950s and 1960s there was much glorification about the advantages of pesticides in reducing world hunger, increasing crop productivity, controlling pest infestation and crop damage and so on. However, recent evidence suggests that pesticides have considerable deleterious impact on the environment and human health. Moreover, accidental poisoning and pesticide-related self-harm/suicide is emerging as a grave public health issue in several nations, particularly in LMICs. The present chapter aims to highlight the issue of easy availability of pesticides in an agrarian region in India, the aggressive marketing by pesticide companies, the limited role of the local administration in the sale of pesticides, and specific sociocultural contexts such as dowry and domestic violence, in which pesticides are consumed.