Advertisement

Social Psychiatry and Psychiatric Epidemiology

, Volume 49, Issue 9, pp 1367–1377 | Cite as

Suicidal ideation and attempts among men who inject drugs in Delhi, India: psychological and social risk factors

  • Gregory Armstrong
  • Anthony F. Jorm
  • Luke Samson
  • Lynette Joubert
  • Shalini Singh
  • Michelle Kermode
Original Paper

Abstract

Objective

Suicide is major public health problem in India. The objective of the analyses presented in this paper is to examine depressive and anxiety symptoms and socio-demographic indicators as correlates of suicidal ideation and attempts among people who inject drugs (PWID), a high-risk group for suicide.

Method

We analysed data collected in April–May of 2012 from a community-based sample of 420 PWID in Delhi using time location sampling. Self-report symptom scales were used to measure the severity of symptoms of depression (PHQ-9) and anxiety (GAD-2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts within the past 12 months.

Results

Depressive and anxiety symptoms were associated with suicidal ideation, as were a range of social stressors including poor physical health, length of injecting drug use, housing insecurity, and experiences of violence and sexual abuse. However, depressive and anxiety symptoms were not associated with suicide attempts. Factors associated with suicide attempts among ideators were housing insecurity and relational dynamics including a poor relationship with family and, interestingly, being married.

Conclusion

Suicide prevention interventions among this population should address not only individual mental health and addiction support needs but also the overwhelmingly poor psychosocial circumstances of this group.

Keywords

India Suicide Substance abuse, intravenous Mental health 

Notes

Acknowledgments

The authors are thankful to Nossal Institute for Global Health (University of Melbourne, Australia) for funding this study. The authors acknowledge the skilled contribution of all the research staff and data collectors involved in implementing this study. We thank Dr Sandy Clarke and Dr Michael Palmer for providing their time and expertise in discussing aspects of the statistical analyses. We thank the participants for their willingness to share very personal information about their lives and their mental health.

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Patel V, Ramasundarahettige C, Vijayakumar L, Thakur JS, Gajalakshmi V, Gururaj G, Suraweera W, Jha P (2012) Suicide mortality in India: a nationally representative survey. Lancet 379(9834):2343–2351PubMedCrossRefGoogle Scholar
  2. 2.
    Kessler RC, Borges G, Walters EE (1999) Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 56(7):617–626PubMedCrossRefGoogle Scholar
  3. 3.
    Diekstra RF, Gulbinat W (1993) The epidemiology of suicidal behaviour: a review of three continents. World Health Stat Q 46(1):52–68PubMedGoogle Scholar
  4. 4.
    Gururaj G, Isaac MK, Subbakrishna DK, Ranjani R (2004) Risk factors for completed suicides: a case-control study from Bangalore, India. Inj Control Saf Promot 11(3):183–191PubMedCrossRefGoogle Scholar
  5. 5.
    Hawton K, Fagg J (1988) Suicide, and other causes of death, following attempted suicide. Br J Psychiatry 152:359–366PubMedCrossRefGoogle Scholar
  6. 6.
    Durkheim E (1952) Suicide: a study in sociology. The Free Press, ScotlandGoogle Scholar
  7. 7.
    van Heeringen K (2012) Stress-diathesis model of suicidal behaviour. In: Dwivedi Y (ed) The neurobiological basis of suicide. CRC Press, FloridaGoogle Scholar
  8. 8.
    Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM (2003) Psychological autopsy studies of suicide: a systematic review. Psychol Med 33(3):395–405PubMedCrossRefGoogle Scholar
  9. 9.
    Manoranjitham SD, Rajkumar AP, Thangadurai P, Prasad J, Jayakaran R, Jacob KS (2010) Risk factors for suicide in rural south India. Br J Psychiatry 196(1):26–30PubMedCrossRefGoogle Scholar
  10. 10.
    Radhakrishnan R, Andrade C (2012) Suicide: an Indian perspective. Indian J Psychiatry 54(4):304–319PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Darke S, Ross J (2002) Suicide among heroin users: rates, risk factors and methods. Addiction 97(11):1383PubMedCrossRefGoogle Scholar
  12. 12.
    Harris EC, Barraclough B (1997) Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 170:205–228PubMedCrossRefGoogle Scholar
  13. 13.
    Rossow I, Lauritzen G (1999) Balancing on the edge of death: suicide attempts and life-threatening overdoses among drug addicts. Addiction 94(2):209–219PubMedCrossRefGoogle Scholar
  14. 14.
    Lemstra M, Rogers M, Thompson A, Moraros J, Buckingham R (2011) Risk indicators of depressive symptomatology among injection drug users and increased HIV risk behaviour. Can J Psychiatry 56(6):358–366PubMedGoogle Scholar
  15. 15.
    Perdue T, Hagan H, Thiede H, Valleroy L (2003) Depression and HIV risk behavior among Seattle-area injection drug users and young men who have sex with men. AIDS Educ Prev 15(1):81–92PubMedCrossRefGoogle Scholar
  16. 16.
    Darke S, Ross J, Williamson A, Mills KL, Havard A, Teesson M (2007) Patterns and correlates of attempted suicide by heroin users over a 3-year period: findings from the Australian treatment outcome study. Drug Alcohol Depend 87(2–3):146–152PubMedCrossRefGoogle Scholar
  17. 17.
    Iskandar S, Kamal R, De Jong CA (2012) Psychiatric comorbidity in injecting drug users in Asia and Africa. Curr Opin Psychiatry 25(3):213–218PubMedCrossRefGoogle Scholar
  18. 18.
    Sarin E, Samson L, Sweat M, Beyrer C (2011) Human rights abuses and suicidal ideation among male injecting drug users in Delhi, India. Int J Drug Policy 22(2):161–166PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Aceijas C, Friedman SR, Cooper HL, Wiessing L, Stimson GV, Hickman M (2006) Estimates of injecting drug users at the national and local level in developing and transitional countries, and gender and age distribution. Sex Transm Infect 82(Suppl 3):10–17Google Scholar
  20. 20.
    Armstrong G, Nuken A, Samson L, Singh S, Jorm AF, Kermode M (2013) Quality of life, depression, anxiety and suicidal ideation among men who inject drugs in Delhi, India. BMC Psychiatry 13(1):151PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Vijayakumar L (2007) Suicide and its prevention: the urgent need in India. Indian J Psychiatry 49(2):81–84CrossRefGoogle Scholar
  22. 22.
    Armstrong G, Jorm AF, Samson L, Joubert L, Nuken A, Singh S, Kermode M (2013) Association of depression, anxiety, and suicidal ideation with high-risk behaviors among men who inject drugs in Delhi, India. J Acquir Immune Defic Syndr 64(5):502–510PubMedCrossRefGoogle Scholar
  23. 23.
    Magnani R, Sabin K, Saidel T, Heckathorn D (2005) Review of sampling hard-to-reach and hidden populations for HIV surveillance. Aids 19(Suppl 2):S67–S72PubMedCrossRefGoogle Scholar
  24. 24.
    Indian Council of Medical Research, FHI 360 (2011) Integrated behavioural and biological assessment (IBBA), Round 2 (2009–2010), National Summary Report. Indian Council of Medical Research and FHI 360, New DelhiGoogle Scholar
  25. 25.
    Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX (2001) The Suicidal Behaviors Questionnaire-revised (SBQ-R): validation with clinical and nonclinical samples. Assessment 8(4):443–454PubMedCrossRefGoogle Scholar
  26. 26.
    Martin A, Rief W, Klaiberg A, Braehler E (2006) Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. Gen Hosp Psychiatry 28(1):71–77PubMedCrossRefGoogle Scholar
  27. 27.
    Vajda J, Steinbeck K (2000) Factors associated with repeat suicide attempts among adolescents. Aust N Z J Psychiatry 34(3):437–445PubMedCrossRefGoogle Scholar
  28. 28.
    Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B (2007) Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 146(5):317–325PubMedCrossRefGoogle Scholar
  29. 29.
    Havens JR, Sherman SG, Sapun M, Strathdee SA (2006) Prevalence and correlates of suicidal ideation among young injection vs. noninjection drug users. Subst Use Misuse 41(2):245–254PubMedCrossRefGoogle Scholar
  30. 30.
    Chen VC-H, Lin T-Y, Lee CT-C, Lai T-J, Chen H, Ferri CP, Gossop M (2010) Suicide attempts prior to starting methadone maintenance treatment in Taiwan. Drug Alcohol Depend 109(1–3):139–143PubMedCrossRefGoogle Scholar
  31. 31.
    Fairweather AK, Anstey KJ, Rodgers B, Butterworth P (2006) Factors distinguishing suicide attempters from suicide ideators in a community sample: social issues and physical health problems. Psychol Med 36(9):1235–1245PubMedCrossRefGoogle Scholar
  32. 32.
    Nock MK, Hwang I, Sampson NA, Kessler RC (2010) Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication. Mol Psychiatry 15(8):868–876PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Havens JR, Strathdee SA, Fuller CM, Ikeda R, Friedman SR, Des Jarlais DC, Morse PS, Bailey S, Kerndt P, Garfein RS (2004) Correlates of attempted suicide among young injection drug users in a multi-site cohort. Drug Alcohol Depend 75(3):261–269PubMedCrossRefGoogle Scholar
  34. 34.
    Braitstein P, Li K, Tyndall M, Spittal P, O’Shaughnessy MV, Schilder A, Johnston C, Hogg RS, Schechter MT (2003) Sexual violence among a cohort of injection drug users. Soc Sci Med 57(3):561–569PubMedCrossRefGoogle Scholar
  35. 35.
    Mattoo SK, Nebhinani N, Kumar BA, Basu D, Kulhara P (2013) Family burden with substance dependence: a study from India. Indian J Med Res 137(4):704–711PubMedCentralPubMedGoogle Scholar
  36. 36.
    Mullatti L (1995) Families in India: beliefs and realities. J Comp Fam Stud 26:11–25Google Scholar
  37. 37.
    Karasz A (2005) Cultural differences in conceptual models of depression. Soc Sci Med 60(7):1625–1635PubMedCrossRefGoogle Scholar
  38. 38.
    Latkin C, Srikrishnan AK, Yang C, Johnson S, Solomon SS, Kumar S, Celentano DD, Solomon S (2010) The relationship between drug use stigma and HIV injection risk behaviors among injection drug users in Chennai, India. Drug Alcohol Depend 110(3):221–227PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Kposowa AJ (2000) Marital status and suicide in the National Longitudinal Mortality Study. J Epidemiol Community Health 54(4):254–261PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Latha KS, Bhat SM, D’Souza P (1996) Suicide attempters in a general hospital unit in India: their socio-demographic and clinical profile—emphasis on cross-cultural aspects. Acta Psychiatr Scand 94(1):26–30PubMedCrossRefGoogle Scholar
  41. 41.
    Srivastava MK, Sahoo RN, Ghotekar LH, Dutta S, Danabalan M, Dutta TK, Das AK (2004) Risk factors associated with attempted suicide: a case control study. Indian J Psychiatry 46(1):33–38PubMedCentralPubMedGoogle Scholar
  42. 42.
    Vijayakumar L (2005) Suicide and mental disorders in Asia. Int Rev Psychiatry 17(2):109–114PubMedCrossRefGoogle Scholar
  43. 43.
    Jacob KS (2008) The prevention of suicide in India and the developing world: the need for population-based strategies. Crisis 29(2):102–106PubMedGoogle Scholar
  44. 44.
    Hawton K, van Heeringen K (2009) Suicide. Lancet 373(9672):1372–1381PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Gregory Armstrong
    • 1
  • Anthony F. Jorm
    • 2
  • Luke Samson
    • 3
  • Lynette Joubert
    • 4
  • Shalini Singh
    • 3
  • Michelle Kermode
    • 1
  1. 1.Nossal Institute for Global Health, Melbourne School of Population and Global HealthUniversity of MelbourneCarltonAustralia
  2. 2.Population Mental Health Group, Melbourne School of Population and Global HealthUniversity of MelbourneCarltonAustralia
  3. 3.The Society for Service to Urban Poverty (SHARAN)DelhiIndia
  4. 4.Department of Social Work, School of Health SciencesUniversity of MelbourneCarltonAustralia

Personalised recommendations