Skip to main content

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

Social Psychiatry and Psychiatric Epidemiology volume 49, pages 1367–1377 (2014)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  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):2343–2351

    PubMed  Article  Google Scholar 

  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):617–626

    CAS  PubMed  Article  Google Scholar 

  3. Diekstra RF, Gulbinat W (1993) The epidemiology of suicidal behaviour: a review of three continents. World Health Stat Q 46(1):52–68

    CAS  PubMed  Google Scholar 

  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):183–191

    CAS  PubMed  Article  Google Scholar 

  5. Hawton K, Fagg J (1988) Suicide, and other causes of death, following attempted suicide. Br J Psychiatry 152:359–366

    CAS  PubMed  Article  Google Scholar 

  6. Durkheim E (1952) Suicide: a study in sociology. The Free Press, Scotland

    Google Scholar 

  7. van Heeringen K (2012) Stress-diathesis model of suicidal behaviour. In: Dwivedi Y (ed) The neurobiological basis of suicide. CRC Press, Florida

    Google Scholar 

  8. Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM (2003) Psychological autopsy studies of suicide: a systematic review. Psychol Med 33(3):395–405

    CAS  PubMed  Article  Google Scholar 

  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):26–30

    CAS  PubMed  Article  Google Scholar 

  10. Radhakrishnan R, Andrade C (2012) Suicide: an Indian perspective. Indian J Psychiatry 54(4):304–319

    PubMed Central  PubMed  Article  Google Scholar 

  11. Darke S, Ross J (2002) Suicide among heroin users: rates, risk factors and methods. Addiction 97(11):1383

    PubMed  Article  Google Scholar 

  12. Harris EC, Barraclough B (1997) Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 170:205–228

    CAS  PubMed  Article  Google Scholar 

  13. Rossow I, Lauritzen G (1999) Balancing on the edge of death: suicide attempts and life-threatening overdoses among drug addicts. Addiction 94(2):209–219

    CAS  PubMed  Article  Google Scholar 

  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):358–366

    PubMed  Google Scholar 

  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):81–92

    PubMed  Article  Google Scholar 

  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):146–152

    PubMed  Article  Google Scholar 

  17. Iskandar S, Kamal R, De Jong CA (2012) Psychiatric comorbidity in injecting drug users in Asia and Africa. Curr Opin Psychiatry 25(3):213–218

    PubMed  Article  Google Scholar 

  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):161–166

    PubMed Central  PubMed  Article  Google Scholar 

  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):10–17

    Google Scholar 

  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):151

    PubMed Central  PubMed  Article  Google Scholar 

  21. Vijayakumar L (2007) Suicide and its prevention: the urgent need in India. Indian J Psychiatry 49(2):81–84

    Article  Google Scholar 

  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):502–510

    PubMed  Article  Google Scholar 

  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–S72

    PubMed  Article  Google Scholar 

  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 Delhi

  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):443–454

    CAS  PubMed  Article  Google Scholar 

  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):71–77

    PubMed  Article  Google Scholar 

  27. Vajda J, Steinbeck K (2000) Factors associated with repeat suicide attempts among adolescents. Aust N Z J Psychiatry 34(3):437–445

    CAS  PubMed  Article  Google Scholar 

  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):317–325

    PubMed  Article  Google Scholar 

  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):245–254

    PubMed  Article  Google Scholar 

  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):139–143

    PubMed  Article  Google Scholar 

  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):1235–1245

    CAS  PubMed  Article  Google Scholar 

  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):868–876

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  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):261–269

    PubMed  Article  Google Scholar 

  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):561–569

    PubMed  Article  Google Scholar 

  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):704–711

    PubMed Central  PubMed  Google Scholar 

  36. Mullatti L (1995) Families in India: beliefs and realities. J Comp Fam Stud 26:11–25

    Google Scholar 

  37. Karasz A (2005) Cultural differences in conceptual models of depression. Soc Sci Med 60(7):1625–1635

    PubMed  Article  Google Scholar 

  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):221–227

    PubMed Central  PubMed  Article  Google Scholar 

  39. Kposowa AJ (2000) Marital status and suicide in the National Longitudinal Mortality Study. J Epidemiol Community Health 54(4):254–261

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  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):26–30

    CAS  PubMed  Article  Google Scholar 

  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):33–38

    CAS  PubMed Central  PubMed  Google Scholar 

  42. Vijayakumar L (2005) Suicide and mental disorders in Asia. Int Rev Psychiatry 17(2):109–114

    PubMed  Article  Google Scholar 

  43. Jacob KS (2008) The prevention of suicide in India and the developing world: the need for population-based strategies. Crisis 29(2):102–106

    CAS  PubMed  Google Scholar 

  44. Hawton K, van Heeringen K (2009) Suicide. Lancet 373(9672):1372–1381

    PubMed  Article  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 4, Alan Gilbert Building, 161 Barry St, Carlton, VIC, 3010, Australia

    Gregory Armstrong & Michelle Kermode

  2. Population Mental Health Group, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia

    Anthony F. Jorm

  3. The Society for Service to Urban Poverty (SHARAN), Delhi, India

    Luke Samson & Shalini Singh

  4. Department of Social Work, School of Health Sciences, University of Melbourne, Carlton, VIC, Australia

    Lynette Joubert

Authors
  1. Gregory Armstrong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony F. Jorm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luke Samson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lynette Joubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shalini Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michelle Kermode
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory Armstrong.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Armstrong, G., Jorm, A.F., Samson, L. et al. Suicidal ideation and attempts among men who inject drugs in Delhi, India: psychological and social risk factors. Soc Psychiatry Psychiatr Epidemiol 49, 1367–1377 (2014). https://doi.org/10.1007/s00127-014-0899-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-014-0899-8

Keywords

  • India
  • Suicide
  • Substance abuse, intravenous
  • Mental health