Suicidal ideation, suicide plans and suicide attempts among Australian adults: Findings from the 2020-2022 National Study of Mental Health and Wellbeing.

OBJECTIVE: This study aimed to describe the epidemiology of suicidal ideation, suicide plans and suicide attempts, examine services received for suicide attempts, and explore the relationship between suicide attempts and self-harm without suicidal intent. METHODS: We used survey data from the 2020-2022 National Study of Mental Health and Wellbeing, which involved a nationally representative sample of Australian adults aged 16-85 (n = 15,893). Comparisons were made with the 2007 National Study of Mental Health and Wellbeing (n = 8841). RESULTS: In 2020-2022, the proportions of adults who had experienced suicidal ideation, suicide plans and suicide attempts during their lifetime were 16.6%, 7.5% and 4.9%, respectively. The proportions who had experienced these in the past 12 months were 3.3%, 1.1% and 0.3%. The odds of experiencing suicidal ideation and making a suicide plan were significantly higher in 2020-2022 than in 2007. Groups at heightened risk of suicidal ideation, suicide plans and/or suicide attempts in the previous 12 months were males, young people, people who were gay, lesbian, or bisexual or used some other term to describe their sexual identity, people outside the labour force, people from disadvantaged areas and people with mental disorders. Two-fifths of those who attempted suicide during the previous 12 months did not use health services following their attempt, and two-thirds also self-harmed without suicidal intent. CONCLUSION: The implications of these findings for the forthcoming National Suicide Prevention Strategy are discussed. Suicidal thoughts and behaviours confer risk for suicide and are significant problems in their own right. Their prevention requires a strong whole-of-government response.

Comparative evaluation of success of ultrasound-guided internal jugular vein cannulation using needle with guard: A randomized, controlled study.

BACKGROUND AND AIMS: We devised a guard which can be slid and fixed over the central venous puncture needle at a desired length (measured through ultrasound) preventing the needle from penetrating deeper into the skin beyond this guard. This randomized, single blinded, controlled study was designed to evaluate the success of ultrasound guided internal jugular vein (IJV) cannulation using measured guided needle with guard in terms of success and occurrence of complications. MATERIAL AND METHODS: After ethical approval and written informed consent from the patients ultrasound-guided right-sided IJV cannulation was done with a conventional puncture needle (length of 6.4 cm) in the control group (n = 210) and with a conventional puncture needle with a guard fixed proximal to the bevel at a distance equal to the distance between the skin entry point and the midpoint of IJV measured with the help of USG in the study group (n = 210). The primary outcome studied was the number of attempts for successful cannulation. The secondary outcomes studied were complications and ease of cannulation. RESULTS: 419 patients were randomized into control (n = 209) and study groups (210). Successful IJV cannulation in the first attempt (primary endpoint) in the study group was significantly higher compared to the control group (98.6 vs. 85.7%, P = 0.007). Posterior venous wall puncture was reduced in the study group, that is, 0.5% (1/210) compared to control group, that is, 8.61% (18/209) (P = 0.001). Common carotid artery puncture was 7.18% (15/209) in control group and 0% (0/210) in study group (P = 0.001). Operators rated better ease in study group (P < 0.001). CONCLUSIONS: The use of measured guided needle with guard significantly improved the accuracy, success and ease of USG guided IJV cannulation and decreased complications.

Transcatheter closure of right pulmonary artery to left atrium fistula in an infant: technical consideration and possible closure techniques.

Congenital right pulmonary artery to left atrium fistula is rare cause of cyanosis. It is an abnormal fistulous connection between right pulmonary artery and left atrium representing a direct communication between a pulmonary artery and vein with absence of capillary network connecting between these two. Cardiovascular examination usually remains normal. High index of suspicion on clinical examination and subsequent transthoracic echocardiography is needed to suspect this entity. Bubble contrast echocardiography usually confirms the diagnosis. Cardiac catheterization is used as diagnostic as well as therapeutic modality. Cardiac catheterization is useful in classifying the fistula and helps in transcatheter closure by embolization devices. Choice of devices depends on type of fistula, vascular access, and presence of atrial communication. Here, we are reporting 8-month-old girl presenting with type 2 right pulmonary artery to left atrium fistula, which underwent successful transcatheter closure by 6 mm/4 mm duct occluder (Heart R, Lifetech Scientific, Shenzhen, China). Early closure in this young age will prevent complications of cyanosis. The technical consideration, possible access, and closure techniques are discussed in this young infant.

Trends and socio-economic determinants of suicide in India: 2001-2013.

PURPOSE: To investigate trends and socio-economic determinants of suicide in India over the period of 2001-2013. METHOD: Suicide rates between 2001 and 2013 were calculated using suicide statistics provided by National Crime Records Bureau (NCRB) and census data provided by Census of India, stratified by sex, age group, and geographical region, to investigate trends in suicide over the study period. Multilevel negative binomial regression models were specified to investigate associations between state-level indicators of economic development, education, employment and religious factors and sex-specific suicide rates. RESULTS: Male suicide rates remained relatively steady (~ 14 per 100,000) while female suicide rates decreased over the study period (9 to 7 per 100,000). The age group of 45-59 years had the highest suicide rate among males while the age group of 15-29 years had the highest suicide rate among females. On average, higher male and female suicide rates were observed in states with: higher levels of development, higher levels of agricultural employment, higher levels of literacy, and higher proportions of people identifying with Hinduism. Higher male suicide rates were also observed in states with higher levels of unemployment. CONCLUSION: The process of modernization might be contributing towards higher suicide risk in more developed parts of India. Also, increase in farmer suicides since economic liberalization might be contributing towards higher suicide rates among more agricultural regions. Furthermore, ancient sanctions towards religious suicide are possibly still influencing modern Hindu suicides.

Let us take a walk to the sustainable tourism practices: a qualitative study through the lens of tourism experts.

The rising opportunities of sustainable tourism have brought many policies to control the exploitation of the environment and increase the reach of luxurious, safe, and authentic experiences to the different segments of tourists. This study seeks to prioritize the variables influencing the development of sustainable tourism and pinpoint key success factors that align with the Sustainable Development Goals (SDGs). It adopts a tri-dimensional framework encompassing economic, social, and environmental aspects, further delineated into eleven sub-dimensions, to provide a quantitative evaluation of sustainable tourism. We conducted interviews with 26 tourism industry experts hailing from eight countries, analyzing their responses using interval type-2 fuzzy sets. The results underscore the critical role of specific components in advancing sustainable tourism. In the economic dimension, "financial resources and tourism costs" emerge as vital factors. In the social dimension, "health and safety" takes center stage, while "green infrastructure" plays a pivotal role in the environmental dimension. These findings underscore the significance of these aspects in promoting sustainable tourism. Furthermore, this study explores the strategic importance of sustainable tourism equity in shaping tourism planning and development for emerging markets.

Indonesia's first suicide statistics profile: an analysis of suicide and attempt rates, underreporting, geographic distribution, gender, method, and rurality.

Background: Timely and accurate data are critical for effective suicide prevention. Indonesia-the fourth most populous country in the world-has limited data availability and thus, limited data-driven interventions. Through a national government partnership, we obtained critical non-public data for attempts and suicides that could be analysed for the first time in Indonesia's history. Methods: We obtained and analysed data from five sources from 2016 to 2021: police data, death registry data, a provincial survey, a sample registry system, and the WHO's Global Health Observatory (WHO GHO) data. Using these data, we estimated underreporting, identified provinces with the highest suicide and suicide attempt rates, assessed gender ratios, identified methods used, and compared urban and rural suicides. Findings: The analysis yielded an underreporting rate of 859.10% for suicides, while verbal autopsies and increased quality control only increased coverage from 12.80% to 51.40%. Provinces with the highest rates of suicide were Bali, Riau Islands, Special Region of Yogyakarta, Central Java, and Central Kalimantan. Gender analysis revealed a ratio of 1: 2.11 for female to male suicides. Suicide methods analysis revealed that hanging and self-poisoning were the most used method, and rural suicides occurred at a rate 4.47 times higher than urban suicides. Interpretation: The analysis revealed the highest underreporting rate in the literature from a national sample and vast heterogeneity among provinces with high suicide rates-including provinces with strong mystic beliefs, suggesting the need for a culturally sensitive sub-national tailored approach. Through our study, we provide critical information which will allow for data-driven suicide prevention. Funding: The data collection for this was part of a project funded by the Australian Department of Foreign Affairs and Trade, Australian-Indonesian Institute (AII2020322).

Posttraumatic stress disorder and risk of suicidal behavior: A systematic review and meta-analysis.

INTRODUCTION: This study conducted a systematic review and meta-analysis of the association between posttraumatic stress disorder (PTSD) and (i) death by suicide, (ii) attempted suicide (AS), and (iii) suicidal ideation (SI). METHODS: The systematic review identified seven studies on PTSD and suicide, 33 studies for AS, and 20 studies for SI. A series of stratified meta-analyses were conducted to estimate pooled effects, in addition to meta-regression to investigate sources of heterogeneity. RESULTS: A higher relative risk of suicide was evident among those diagnosed with PTSD (RR = 2.09 [95% confidence interval (CI): 1.11-3.94]), with strongest associations among combat veterans (RR = 3.97, 95% CI 2.22-7.10). A lower relative risk of suicide among those with PTSD and co-morbid psychiatric conditions was evident (RR = 0.74, 95% CI 0.63-0.86). A strong association between PTSD and attempted suicide (RR = 4.05, 95% CI 3.14-5.23) and suicidal ideation (RR = 2.91, 95% CI 2.22-3.82) was also found, with a consistently strong association among those with co-morbid psychiatric conditions and non-clinical cohorts. CONCLUSION: This review found a strong association between PTSD and death by suicide, attempted suicide, and suicidal ideation, and also suicide among veteran populations. Early identification and treatment of PTSD across both clinical and non-clinical cohorts should be a priority for suicide prevention.

Changing profile of suicide methods in India: 2014-2021.

BACKGROUND: Restricting access to suicide methods is one of the most effective suicide prevention approaches. METHODS: Trends in method specific suicide rates (2014-2021) in India were calculated using National Crime Records Bureau data (NCRB) by sex and geographical region. Joinpoint regression analysis was used to empirically identify any changes in suicide trends. RESULTS: Suicide rates by hanging increased from 6.08 to 10.0 per 100,000 population among males and from 2.55 to 3.56 per 100,000 among females over the study period. Insecticide poisoning suicide rates also increased from 1.51 to 2.73 per 100,000 among males and from 0.74 to 1.14 per 100,000 among females. Suicide by self-immolation decreased over the study period among both sexes. In general, these national trends were mirrored among different regions. Joinpoint regression indicated an increase in suicide by hanging (annual percentage change (APC) of 12.3 among males between 2018 and 2021 and 4.9 among females between 2014 and 2021) and an increase in male suicide by insecticide poisoning between 2014 and 2021 (APC of 4.2) while a decrease in self-immolation rates was noted among males (APC of -12.7 between 2014 and 2021) and females (APC of -16.5 between 2016 and 2021). LIMITATION: The NCRB data might underestimate true suicide rates. CONCLUSION: Hanging suicides and insecticides poisoning suicides observed an increasing trend between 2014 and 2021. Self-immolation rates decreased during the study period which might be, in part, associated with the initiative to provide clean cooking fuel to households. Ban on lethal pesticides must be prioritised which might help lower insecticide poisoning suicide rates.

Midlife suicide: A systematic review and meta-analysis of socioeconomic, psychiatric and physical health risk factors.

Suicide is an increasing contributing cause of mortality in middle-aged adults; however, knowledge to guide prevention is limited. This first systematic review and meta-analysis of studies on midlife suicide has provided an overview of published research on this issue and synthesized the evidence on socioeconomic and physical and mental health factors associated with this mortality. Using PRISMA guidelines MEDLINE, Embase, PsycINFO, Scopus and Web of Science were searched for English-language publications that involved persons aged 35 to 65, used individual-level data, and reported prevalence of exposure(s) or relative risks. The search identified 62 studies on midlife suicides and associated factors (28 for SES, 22 for psychiatric disorder and 23 for physical illness). All studies were from high income countries, and most (80.6%) used data from population registries. Meta-analyses showed that the pooled prevalence of exposure in suicide decedents was 57.8% for psychiatric disorder, 56.3% for low income, 43.2% for unemployment, and 27.3% for physical illness. The associated pooled risk ratio was 11.68 (95% confidence intervals: 5.82-23.47) for psychiatric illness of any type, 12.59 (8.29-19.12) for mood disorders, 3.91 (2.72-5.59) for unemployment, 3.18 (2.72-3.72) for being separated or divorced, 2.64 (2.26-3.10) for cancer, 2.50 (0.96-6.38) for central nervous system illness, and 2.26 (1.16-4.41) for low income. In conclusion, midlife suicide is strongly associated with socioeconomic difficulties and physical and psychiatric illnesses that are common in this age population. Future investigations should consider the interactions between risk factors, the intersectionality of sex and ethnicity, and include data from low- and middle-income countries.

Suicide in India during the first year of the COVID-19 pandemic.

BACKGROUND: There has been substantial discussion as to whether the mental health and socio-economic consequences of the COVID-19 pandemic might impact suicide rates. Although India accounts for the largest proportion of global suicides, the early impacts of the COVID-19 pandemic on suicide rates in this country are unknown. METHODS: National Crime Records Bureau (NCRB) data were used to calculate annual suicide rates for the period 2010-2020, stratified by sex and state. Rate Ratios (RRs) stratified by sex and state were calculated to estimate the extent of change in suicide rates. RESULTS: Suicide rates in India generally showed a decreasing trend from 2010 until 2017, with the trend reversing after this period, particularly for males. Among males and females, the highest increase post 2017 was noted in 2020 (compared to 2017) (males: RR = 1.18 95% UI 1.17-1.19; females: RR = 1.05 95% UI 1.03-1.06). LIMITATION: Suicide rates based on the NCRB data might be an underestimation of the true suicide rates. CONCLUSION: Suicide rates in India increased during the first year of the COVID-19 pandemic, and although the increase in suicide rates, especially among males, predates the pandemic, the increase in suicide rates was highest in 2020, compared to increases in previous years. Further research is warranted to understand the potential ongoing impact of the COVID-19 pandemic on suicide in India.

Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries.

Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Funding: None.

Changes in method specific suicide following a national pesticide ban in India (2011-2014).

BACKGROUND: This paper investigates whether declines in suicide by insecticide poisoning in India following a national ban on endosulfan in 2011were associated with changes in other methods of suicide and total suicide rates. METHOD: Method-specific suicide rates between 2001-2014 were calculated using National Crime Records Bureau (NCRB) data by sex, age group and region, with observed rates compared to expected rates for the period post-2011. RESULTS: There were an estimated 20,146 fewer male and 8,418 fewer female suicides by insecticide poisoning and 5542 fewer male and 2679 fewer female suicides by all other methods following the national endosulfan ban. Contemporaneously, an estimated 92% (23,812) of male and 60% (6,735) of female suicides prevented by insecticide poisoning and all other methods were offset to increases in suicides by hanging and other poisoning. Joinpoint regression indicated a decrease in suicide by insecticide poisoning following the endosulfan ban (annual percentage change (APC) of -12.18 among males and -11.89 among females between 2010-2014) while an increase in male suicide by hanging was noted between 2009-2014 (APC of 7.05). LIMITATION: Suicide rates based on the NCRB data might be an underestimation of the true suicide rates. CONCLUSION: Declines in suicide by insecticide poisoning were largely offset by an increase in hanging suicides among males, however, this phenomenon was much less prominent in females and contributed to declines in total female suicide rates. Prevention strategies must continue to focus on pesticide bans with simultaneous attention on hanging prevention policies to reduce overall suicide rates in India.

Employment Transitions and Mental Health in a Cohort of 45 Years and Older Australians.

Background: This study investigated the associations between employment transitions and psychological distress among a cohort of 45 years and older Australians. Methods: This study was based on the 45 and Up Study, a large prospective cohort of participants aged 45 years and older (N = 267,153), followed up over the period 2006-2015. The risk of psychological distress was compared between various employment transitions categories by specifying an ordered logistic regression model adjusting for confounders. Results: Compared to participants who remained employed at baseline and follow-up, higher psychological distress was found among those who transitioned from being employed to unemployed (OR = 2.68, 95%CI 2.13-3.33) and to not being in the labour force or retired (OR = 2.21, 95%CI 1.85-2.62). Higher psychological distress was also evident among those who remained unemployed from baseline to follow-up (OR = 2.00, 95%CI 1.10-3.43), and those who transitioned from being retired to being unemployed (OR = 1.55, 95%CI 1.03-2.27). Conversely, lower psychological distress was found among those who transitioned from being unemployed to being employed (OR = 0.35, 95%CI 0.25-0.51). In general, lower psychological distress was found among 'positive' employment transitions (transitioning to being employed or retired). Conclusions: Policies focussing on re-employment in older age, as well as unemployment schemes, might be helpful in reducing psychological distress among middle- and old-age Australians.

Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries.

BACKGROUND: The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world. METHODS: We sourced real-time suicide data from countries or areas within countries through a systematic internet search and recourse to our networks and the published literature. Between Sept 1 and Nov 1, 2020, we searched the official websites of these countries' ministries of health, police agencies, and government-run statistics agencies or equivalents, using the translated search terms "suicide" and "cause of death", before broadening the search in an attempt to identify data through other public sources. Data were included from a given country or area if they came from an official government source and were available at a monthly level from at least Jan 1, 2019, to July 31, 2020. Our internet searches were restricted to countries with more than 3 million residents for pragmatic reasons, but we relaxed this rule for countries identified through the literature and our networks. Areas within countries could also be included with populations of less than 3 million. We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from at least Jan 1, 2019, to March 31, 2020) in each country or area within a country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). FINDINGS: We sourced data from 21 countries (16 high-income and five upper-middle-income countries), including whole-country data in ten countries and data for various areas in 11 countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas: New South Wales, Australia (RR 0·81 [95% CI 0·72-0·91]); Alberta, Canada (0·80 [0·68-0·93]); British Columbia, Canada (0·76 [0·66-0·87]); Chile (0·85 [0·78-0·94]); Leipzig, Germany (0·49 [0·32-0·74]); Japan (0·94 [0·91-0·96]); New Zealand (0·79 [0·68-0·91]); South Korea (0·94 [0·92-0·97]); California, USA (0·90 [0·85-0·95]); Illinois (Cook County), USA (0·79 [0·67-0·93]); Texas (four counties), USA (0·82 [0·68-0·98]); and Ecuador (0·74 [0·67-0·82]). INTERPRETATION: This is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold. FUNDING: None.

Estimating patterns in the under-reporting of suicide deaths in India: comparison of administrative data and Global Burden of Disease Study estimates, 2005-2015.

BACKGROUND: It has been proposed that the National Crime Records Bureau (NCRB), which reports suicides in India, differentially underenumerates suicides by geographic and demographic factors. We assessed the extent of potential underenumeration by comparing suicides recorded in NCRB data with recent estimates of Indian suicides developed by the Global Burden of Disease (GBD) initiative. METHODS: Age-standardised suicide rates were calculated for both data sources by sex, age and state, and rate ratios of NCRB to GBD estimates by corresponding strata were compared to ascertain the relative under-reporting in the NCRB report. RESULTS: The GBD Study reported an additional 802 684 deaths by suicide (333 558 male and 469 126 female suicide deaths) compared with the NCRB report between 2005 and 2015. Among males, the average under-reporting was 27% (range 21%-31%) per year, and among females, the average under-reporting was 50% (range 47%-54%) per year. Under-reporting was more evident among younger (15-29 years) and older age groups (≥60 years) compared with middle age groups. Indian states belonging to low Socio-Demographic Index (SDI) generally had greater underenumeration compared with middle and high-SDI states. CONCLUSION: NCRB data under-report suicides in India, and differentially by sex, age and geographic area, possibly because of lack of community-level reporting of suicides due to social stigma and legal consequences. While the recent decriminalisation of suicide is expected to improve community-level reporting of suicides, suicide prevention policies should be developed, with a priority to address social stigma attached with suicide and suicidal behaviour, especially among females.

The Geographic Heterogeneity of Suicide Rates in India by Religion, Caste, Tribe, and Other Backward Classes.

Background: Caste, tribal, and religious associations, which are perhaps the most important aspects of personal and social lives in India, have been neglected in Indian suicide research. Aim: To investigate suicide rates in India by religion, caste, tribe, and other backward classes over the period 2014-2015. Method: This study acquired unpublished suicide data from the National Crime Records Bureau (NCRB) for 2014 and 2015 including caste, tribal, and religious associations of suicide cases. National and state-specific suicide rates (2014-2015) were then calculated for Hindus, Muslims, Christians, Sikhs, and other religious groups and for scheduled caste (SC), scheduled tribe (ST), and other backward classes (OBC). Results: The findings show higher suicide rates among Christian and other religious groups compared with Hindus and higher suicide rates among general populations compared with SC, ST, and OBC populations. However, the results varied among different regions highlighting the substantial geographical heterogeneity of suicide rates across India by caste and religion. Limitations: The suicide rates presented might be an underestimation of the true rates. Conclusion: Given the heterogeneity of minority/majority status by religion, caste, tribes, and OBC in different states, further investigation of the relationship between minority status and suicide is warranted.

Suicide by hanging is a priority for suicide prevention: method specific suicide in India (2001-2014).

BACKGROUND: India accounts for over a quarter of the global burden of suicide. One of the most effective population level suicide prevention strategies has been restricting access to suicide means. METHOD: Trends in method specific suicide rates (2001-14) were calculated using National Crime Records Bureau data stratified by sex, age-group, and geographical region. Multilevel negative binomial regression models stratified by sex and suicide method were specified to investigate associations between state-level indicators of economic development, education, agricultural pesticide use and religious factors. RESULTS: Suicide by hanging increased by 56% (from 3.9 to 6.1 per 100,000) among males and by 24% (from 2.1 to 2.6 per 100,000) among females over the study period while incidence of insecticide poisoning decreased by 44% (from 2.7 to 1.5 per 100,000) among males and by 52% (from 1.7 to 0.8 per 100,000) among females. In general, states with higher levels of development, higher agricultural employment and higher literacy had higher rates of suicide for each suicide method. States with higher levels of agricultural pesticide use had higher rates of insecticide poisoning suicides. LIMITATION: Reported rates might be an underestimation of the true rates as the official data used for the analysis likely underestimates the actual number of suicide deaths in India. CONCLUSION: Responsible reporting of suicide by hanging in the media, and limiting fictional portrayals of this method may be useful areas for prevention. Further restrictions on production and sales of highly hazardous pesticides may also help with further reductions in suicide by pesticide poisoning.

Mass media representation of suicide in a high suicide state in India: an epidemiological comparison with suicide deaths in the population.

OBJECTIVES: Suicide rates in India are among the highest in the world, equating to over 200 000 suicides annually. Reports of suicides are a routine feature in major newspapers in India, and reporters may selectively present 'newsworthy' suicide stories. The aim of this paper was to systematically investigate whether mass media reports of suicides reflect the epidemiological data on suicide in a high suicide state in India. DESIGN: We undertook a content analysis study to extract sociodemographic data on suicides reported among nine of the most highly read daily newspapers in the high suicide southern state of Tamil Nadu between June and December 2016. A total of 1258 newspaper articles were retrieved containing reports on 1631 suicides. Two-tailed binomial tests on aggregate frequencies assessed whether the sociodemographic characteristics of suicides in the newspaper articles were different to the population suicide statistics for Tamil Nadu. RESULTS: We identified some statistically significant discrepancies between suicide characteristics in the population and the media. Suicides involving females (p<0.001), those aged under 30 years (p<0.001), separated or widowed males (p<0.001), unmarried females (p<0.001), those using methods with a higher case fatality rate (ie, hanging (p<0.001), jumping off high structures (p<0.001) and coming under vehicles (p<0.001) and those who were students (p<0.001) or working in the agricultural sector (p<0.001) were significantly over-reported relative to their occurrence in the broader population. Suicides involving men (p<0.001), those aged over 30 years and above (p<0.001), those who were married and suicides by poisoning (p<0.001) were significantly under-reported relative to their occurrence in the broader population. CONCLUSIONS: The suicide characteristics in the print media were not entirely representative of suicides in the broader Tamil Nadu population, which may lead the general public to develop misunderstandings about suicide in their state. The discrepancies we identified will inform tailored suicide prevention education for media professionals.