Abstract
Background: Health demographic mortality studies use verbal autopsies to identify suicide as a cause of death. Psychological autopsies focus almost exclusively on associated high-risk psychiatric disorders. New approaches considering contextual factors are needed for preventing suicide and promoting mental health. Aims: This study examined explanations of suicide reported by surviving family members or close friends with reference to social, cultural, and environmental conditions as well as the challenges of life in the Malavani slum of Mumbai. Methods: An EMIC (Explanatory Model Interview Catalog) interview based on a cultural epidemiological framework considered underlying problems, perceived causes, and sociocultural contexts. It was administered to survivors of 76 people who had died by suicide (56.6% women). Results: Accounts of underlying problems typically referred to various aspects of tension (73.7%). Perceived causes often identified multiple factors. The sociocultural contexts of suicide included the victimization of women, the personal and social impact of problem drinking, marital problems, physical health problems, mental tension, possession and sorcery. Women were particularly vulnerable to the impact of problem drinking by a spouse or father. Conclusions: This study demonstrates the value of an approach to sociocultural autopsy examining local contexts and explanations of suicide. Findings highlight needs for both mental health services and culturally sensitive social interventions.
References
2008, 6 July). The urge to end it. New York Times Magazine.
(2007). Setting international standards for verbal autopsy. Bulletin of the World Health Organization, 85, 570–571.
(2005). Suicide attempts, plans, and ideation in culturally diverse sites: The WHO SUPRE-MISS community survey. Psychological Medicine, 35, 1457–1465.
(2004). Psychiatric diagnoses and suicide. Revisiting the evidence. Crisis, 25, 147–155.
(1987). High risk suicide factors. Journal of Nervous and Mental Disease, 193, 83–92.
(1998). Access to methods of suicide. What impact? Australian and New Zealand Journal of Psychiatry, 32, 8–14.
(2000). Psychosocial and psychiatric risk factors for suicide. Case-control psychological autopsy study. British Journal of Psychiatry, 177, 360–365.
(2006). Commentary: Verbal autopsy procedure for adult deaths. Crisis, 35, 748–750.
(1998). The role of defeat and entrapment (arrested flight) in depression: An exploration of an evolutionary view. Psychological Medicine, 28, 585–598.
(2002). Reducing suicide: A national imperative. Washington, DC: The National Academies Press.
(2001). Suicides – beyond numbers. Bangalore: National Institute of Mental Health and Neuro Sciences.
(1994). Urbanization and mental health in developing countries, a research role for social scientist, public health professionals and social psychiatrist. Social Science and Medicine, 39, 233–245.
(1995). Urbanization and mental health in developing countries. Aldershot: Ashgate.
(1997). Suicide as an outcome for mental disorders: A meta-analysis. British Journal of Psychiatry, 170, 205–228.
(2007). The loss of sadness. London: Oxford University Press.
(2000). The pattern of suicide in Pakistan. Crisis, 21, 31–35.
(006). Validity of verbal autopsy in determining causes of adult deaths. Indian Journal of Public Health, 50, 90–94.
(21998). An update on the impact of gun control legislation on suicide. Psychiatric Quarterly, 69, 127–134.
(2007). Accidental deaths and suicides in India, 2006. New Delhi, India: Government of India.
(2000). Preventing domestic violence in the African American community: The rationale for popular culture interventions. Violence against Women, 6, 533–549.
(2006). Clinical diagnostic and sociocultural dimensions of deliberate self-harm in Mumbai, India. Suicide and Life-Threatening Behavior, 36, 223–238.
(2003). Contextualizing mental health: Gendered experiences in a Mumbai slum. Anthropology and Medicine, 10, 291–308.
(2007). Assessing depressive symptoms in persons who die of suicide in mainland China. Journal of Affective Disorders, 98, 73–82.
(2002). Suicide rates in china 1995–1999. Lancet, 359, 835–840.
(2006). Critical issues in psychological autopsy studies. Suicide and Life-Threatening Behavior, 36, 491–510.
(2002). Suicide after parasuicide. British Medical Journal, 325, 1125–1126.
(2004). Suicidal behavior: Comments, advancements, challenges. A European perspective. World Psychiatry, 3, 161–162.
(2006). It’s official: Distress up, suicides appalling. The Hindu, 22 November 2006. www.hindu.com/2006/11/22/stories/2006112201731100.htm (Accessed 24 June 2009).
(1965). The Los Angeles suicide prevention center: A demonstration of public health feasibilities. American Journal of Public Health, 55, 21–26.
(2006). Core verbal autopsy procedures with comparative validation results from two countries. PLoS Medicine, 3, 1282–1291.
(2006). In this issue. Suicide and Life-Threatening Behavior, 36, iii–v.
(2006). Why do farmers commit suicide? The case of Andhra Pradesh. Economic and Political Weekly, 41, 1559–1565.
(1965). Attempted suicide: An analysis of 114 medical admissions. Indian Journal of Psychiatry, 7, 253.
(2004). Suicide prevention: The urgent need in developing countries. World Psychiatry, 3, 158–159.
(1999). Are risk factors for suicide universal? A case-control study in India. Acta Psychiatrica Scandinavica, 99, 407–411.
(2005). Suicide in developing countries (2): Risk factors. Crisis, 26, 112–119.
(2001). Cultural epidemiology: An introduction and overview. Anthropology & Medicine, 8, 5–29.
(2001). Global, national and local approaches to mental health. Examples from India. Tropical Medicine and International Health, 6, 4–23.
(2004). The World Health Report 2004: Changing history. Geneva: World Health Organization.
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