Suicide prevention strategy in India.

We congratulate Lakshmi Vijayakumar and colleagues for their paper on suicide prevention in India.1Vijayakumar L Chandra PS Kumar MS et al.The national suicide prevention strategy in India: context and considerations for urgent action.Lancet Psychiatry. 2022; 9: 160-168Google Scholar In this Health Policy paper, the authors called for public health approaches tackling suicide at all levels of the health service system. Vijayakumar and colleagues noted self-harm as an important target, but with scarce evidence beyond a small number of intervention studies in adults.1Vijayakumar L Chandra PS Kumar MS et al.The national suicide prevention strategy in India: context and considerations for urgent action.Lancet Psychiatry. 2022; 9: 160-168Google Scholar One neglected group that deserves further mention is young people (under 25 years of age) who self-harm. Although it is difficult to make definitive claims about the prevalence of self-harm in low-income and middle-income countries (LMICs) due to insufficient evidence, self-harm remains an important issue in many LMICs, including India.2Vijayakumar L Armstrong G Surveillance for self-harm: an urgent need in low-income and middle-income countries.Lancet Psychiatry. 2019; 6: 633-634Google Scholar Adolescents who self-harm carry high lifetime risks of suicide and all-cause mortality, as well as other health and social consequences in adulthood.3Hawton K Bale L Brand F et al.Mortality in children and adolescents following presentation to hospital after non-fatal self-harm in the Multicentre Study of Self-harm: a prospective observational cohort study.Lancet Child Adolesc Health. 2020; 4: 111-120Google Scholar To address self-harm attempts, Vijayakumar and colleagues recommended simple scalable interventions such as brief contact intervention, developed by WHO and the Healthy Activity Program, delivered to people with moderate to severe depression in primary care through lay counsellors. Although supported by some positive findings, these interventions might not cater to the developmental needs of adolescents and young people who self-harm. Adolescents who self-harm often have poor emotion regulation and social problem-solving skills.4Aggarwal S Patton G Berk M Patel V Design of a brief psychological intervention for youth who self-harm: a formative study in India.Evid Based Ment Health. 2021; 24: e2Google Scholar One systematic review5Aggarwal S Patton G Berk M Patel V Psychosocial interventions for self-harm in low-income and middle-income countries: systematic review and theory of change.Soc Psychiatry Psychiatr Epidemiology. 2021; 56: 1729-1750Google Scholar suggested that these deficits could be addressed by adapting cognitive behaviour and problem solving therapies. Treatments that have been developed or adapted to the local service system context, including service providers’ knowledge and experience and young service users’ lived experiences, are likely to be most effective and scalable. One such recently developed intervention is the ATMAN treatment, which has the potential to be delivered in India by non-specialist providers without formal training or certification in mental health (ie, by peer support workers).4Aggarwal S Patton G Berk M Patel V Design of a brief psychological intervention for youth who self-harm: a formative study in India.Evid Based Ment Health. 2021; 24: e2Google Scholar With grossly inadequate mental health services and professionals, integration of scalable psychological treatments at all levels of health-care settings including primary health care will be essential in optimising responses to the needs of young people who self-harm in India. We declare no competing interests. The national suicide prevention strategy in India: context and considerations for urgent actionIndia reports the highest number of suicide deaths in the world. At this time when the Indian Government is formulating a national suicide prevention strategy, we have reviewed the current status of suicides in India, focusing on epidemiology, risk factors, and existing suicide prevention strategies to identify key challenges and priorities for suicide prevention. The suicide rate among Indian girls and women continues to be twice the global rate. Suicide accounts for most deaths in the 15–39 years age group compared with other causes of death. Full-Text PDF Suicide prevention strategy in IndiaSuicide is a global health problem, with most deaths by suicide occurring in low-income and middle-income countries (LMICs). Globally, people aged 60 years and older have a higher risk of dying by suicide than younger age groups.1 A systematic review of deaths by suicide in LMICs during the pandemic reported “a reduction or no change in suicide and self-harm behaviour”.2 In contrast, analysis of Indian news reports suggested a possible rise in deaths by suicide in March–May 2020 compared with the same period in 2021. Full-Text PDF