Household survey of pesticide practice, deliberate self-harm, and suicide in the Sundarban region of West Bengal, India.

The toxicological impact and intentional ingestion of pesticides are major public health concerns globally. This study aimed to estimate the extent of deliberate self-harm (DSH) and suicides (suicidal behaviour) and document pesticide practices in Namkhana block of the Sundarban region, India. A cross-sectional study was conducted in 1680 households (21 villages) following a mixed random and cluster design sampling. The survey questionnaire (Household Information on Pesticide Use and DSH) was developed by the research team to elicit qualitative and quantitative information. The Kappa statistic and McNemar's test were used to assess the level of agreement and association between respondents' and investigators' opinions about safe storage of pesticides. Over five years, 1680 households reported 181 incidents of suicidal behaviour. Conflict with family members was the most frequently reported reason for suicidal behaviour (53.6%). The Kappa statistic indicated poor agreement between respondents and investigators about safe storage of pesticides. The pesticide-related annual DSH rate was 158.1 (95% CI 126.2-195.5), and for suicide it was 73.4 (95% CI 52.2-100.3) per 100,000. Unsafe pesticide practice and psychosocial stressors are related to the high rates of suicidal behaviour. An intersectoral approach involving the local governments, agricultural department and the health sector would help to reduce the magnitude of this public health problem.

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. METHODS: We examined the clinical records of 1277 patients admitted for deliberate self-harm (DSH) to the six island hospitals from 1999 to 2001. RESULTS: 77.7% of the patients survived their attempt, 11.9% died and for 10.4% the outcome was not recorded. Women accounted for 65.2% of the DSH admissions and 67.1% of the deaths. Pesticides were the most commonly used means (88.7%). The case fatality of self-harm reported in these hospitals ranged from 6.0% to 50.0% (mean 13.3%; CI, 11.3-15.3). The age group 55-64 years was at highest risk of death, the age group 15-24 years at lowest risk. Higher lethality of pesticide ingestion compared to other methods was suggestive but not significant. Case fatality within the region varied but was high compared to industrialized nations. Case records and management of DSH were poor. CONCLUSION: Effective DSH prevention in the Sundarban region would require better surveillance at clinical facilities and an intersectoral approach, linking the agricultural interests of pesticide safety and mental health interests for preventing DSH.

Metabolic comorbidity in schizophrenia.

People with schizophrenia are at greater risk of developing obesity, type 2 diabetes, hypertension and dyslipidemia as compared to the general population. This results in an increased incidence of cardiovascular disease, leading to greater morbidity and mortality in this vulnerable group of patients. Use of certain antipsychotic agents can compound this risk and increase the risk of developing metabolic syndrome. Appropriate identification and management of these risk factors are very important in reducing the risk and thereby improving the physical health of these patients. This review recommends a framework based on existing guidelines for the assessment, monitoring and management of patients with schizophrenia in the Indian setting.