Violence, psychological distress and the risk of suicidal behaviour in young people in India.

BACKGROUND: Suicide among young people has emerged as a major public health issue in many low- and middle-income (LAMI) countries. Suicidal behaviour including ideation and attempt are the most important predictors of completed suicide and offer critical points for intervention. The aim of this study is to estimate the prevalence and risk factors for suicidal behaviour in young people in India.

METHOD AND FINDINGS: Cross-sectional study of 3662 youth (16-24 years) from rural and urban communities in Goa, India. Suicidal behaviour during the recent 3 months and associated factors were assessed using a structured interview. Overall 144; 3.9% [95% confidence interval (CI) 3.3-4.6] youth reported any suicidal behaviour in the previous 3 months. Suicidal behaviour was found to be associated with female gender Odds ratio (OR) 6.5 (95% CI 3.9-10.8), not attending school or college OR 1.6 (95% CI, 1.01-2.6), independent decision making OR 2.5 (95% CI 1.5-4.3), premarital sex OR 3.2 (95% CI 1.6-6.3), physical abuse at home OR 3.3 (95% CI 1.8-6.1), life time experience of sexual abuse OR 3.3 (95% CI 1.8-6.0) and probable common mental disorders (CMD) OR 9.5 (95% CI 6.3-14.5). Gender segregated analysis found independent decision making (P=0.68 for interaction), rural residence (P=0.01 for interaction) and premarital sex (P=0.41 for interaction) retained association with suicidal behaviour only among females (P<0.05). The population attributable fraction estimates were largest for CMD (42.8% for females; 35.9% for males); physical abuse in one's home (12.5% for females; 12.4% for males); sexual abuse (12.1% in females; 22.3% in males); and making independent decisions (22.9% for females). Analyses of the risk factors for the relatively less common outcome of suicide attempts found a similar set of factors as for suicidal behaviour; in addition, alcohol use was also an independent risk factor.

CONCLUSION: Violence and psychological distress are independently associated with suicidal behaviour; factors associated with gender disadvantage-in particular for rural women, may increase their vulnerabilities. Prevention programs for youth suicide in India need to address both the structural determinants of gender disadvantage, and the individual experiences of violence and poor mental health.