© 2007 The Royal College of Psychiatrists
Correspondence |
Self-poisoning with pesticides in India
Christian Medical College, Vellore 632002, India. Email: sanju{at}cmcvellore.ac.in
EDITED BY KIRIAKOS XENITIDIS and COLIN CAMPBELL
Bertolote et al
(2006) report the global
response to deaths from pesticide poisoning. Suicide rates in southern India
have been reported to be high (Joseph
et al, 2003; Aaron
et al, 2004; Abraham
et al, 2005; Prasad
et al, 2006), with 1741 suicides documented in a
population of about 100 000 from 1986 to 2005. Hanging (804 of 1741, 46.2%)
and poisoning (746 of 1741, 42.8%) were the methods most commonly employed.
Although people under 40 years tended to use poisons, older people tended to
choose hanging (
2=36.71, d.f.=4, P < 0.001).
Significantly more males (465 of 984, 47.3%) than females (281 of 757, 37.1%)
(2=17.6, d.f.=1, P < 0.001) chose death by
poisoning. There was no significant change in the overall rate of suicide or
the method employed during the period. Detailed analysis of the data from 2001
to 2005 revealed that only 68% of the fatal episodes of self-poisoning were a
result of ingestion of pesticides.
Self-poisoning with pesticides is a significant public health problem in low- and middle-income countries. The majority of such poisoning occurs in rural agrarian households. Some suggestions to reduce such deaths are currently difficult to implement. Enforcing the hazardous chemicals and wastes conventions to restrict and control the sale and use of pesticides in such regions is no small task and requires major political, administrative, financial and social commitment. Given the many competing demands on limited governmental resources in low- and middle-income countries, such protocols are difficult to implement. In addition, the improved recognition and treatment of mental illness may not have a significant impact on the overall suicide rate as many people in the low- and middle-income countries who die by suicide do not have severe mental illness. Rather, the majority of such attempts are impulsive and follow stressful life events. Although reducing accessibility to pesticides will decrease such impulsive attempts and consequent deaths, social, economic and cultural factors must also be addressed to make a real difference. Thus, although the World Health Organization's intersectoral global initiative is a step in the right direction, it is imperative that practical issues related to its implementation are discussed. It is necessary to consider strategies to encourage governments to set up suicide prevention programmes to reduce suicide rates in populations as a whole rather than method- and site-specific rates.
Suicide in low- and middle-income countries is not only a medical and public health problem but is also related to economics and culture. A coordinated and a comprehensive response is needed to make any impact.
REFERENCES
- Aaron, R., Joseph, A., Abraham, S., et al (2004) Suicides in young people in rural southern India. Lancet, 363, 1117 -1118.[CrossRef][Medline]
- Abraham, V. J., Abraham, S. & Jacob, K. S. (2005) Suicide in the elderly in Kaniyambadi block, Tamil Nadu, South India. International Journal of Geriatric Psychiatry, 20, 953 -955.[CrossRef][Medline]
- Bertolote, J. M., Fleischmann, A., Eddleston, M., et al
(2006) Deaths from pesticide poisoning: a global response.
British Journal of Psychiatry,
189, 201
-203.
[Abstract/Free Full Text] - Joseph, A., Abraham, S., Muliyil, J. P., et al
(2003) Evaluation of suicide rates in rural India using
verbal autopsies, 1994–99. BMJ,
326, 1121
-1122.
[Free Full Text] - Prasad, J., Abraham, V. J., Minz, S., et al
(2006) Rates and factors associated with suicide in
Kaniyambadi Block, Tamil Nadu, South India, 2000–02.
International Journal of Social Psychiatry,
52, 65-71.
[Abstract/Free Full Text]
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