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Table of Contents
REVIEW ARTICLE
Year : 2013  |  Volume : 5  |  Issue : 1  |  Page : 33-38

Suicide intervention in India - A meta analysis


1 Lecturer, M.S. Ramaiah Institute of Nursing Education and Research, Bangalore, India
2 Lecturer, Sri Kalabyraweshwaraswamy CON, Bangalore, India
3 Principal, M.S. Ramaiah Institute of Nursing Education and Research, Bangalore, India

Date of Web Publication28-Jun-2019

Correspondence Address:
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-1505.261772

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  Abstract 


Every year, almost one million people die from suicide. Attempted suicide can be up to 40 times frequent than completed suicide and they are at high risk for completed suicide. The purpose of this study is to identify an effective treatment to prevent suicide. Randomized studies published from January 1990 to January 2011, that involved an intervention to prevent suicide were selected for review. Jadad scoring system was used to check the quality of the studies and RevMan 5.1 was used for statistical analysis. Three studies met the selection criteria. The overall effect estimate confirms that the Brief intervention and contact / lay counsellor favours the experimental group in terms of attempted suicide. The overall effect estimate confirms that the Brief intervention and contact favours the experimental in terms of completed suicide. This Meta analysis supports that follow up and counselling plays a very important role in prevention of suicide attempt and the Mental Health Nursing professionals can shoulder this responsibility to work towards suicide less India.


How to cite this article:
Balamurugan G, Vijayarani M, Prabhudeva. Suicide intervention in India - A meta analysis. Indian J Psy Nsg 2013;5:33-8

How to cite this URL:
Balamurugan G, Vijayarani M, Prabhudeva. Suicide intervention in India - A meta analysis. Indian J Psy Nsg [serial online] 2013 [cited 2022 Aug 7];5:33-8. Available from: https://www.ijpn.in/text.asp?2013/5/1/33/261772




  Introduction Top


The preservation of human life is the ultimate value, a pillar of ethics and the foundation of all morality. This held true in most cultures and societies throughout history[1] but in recent years, individuals try to end their life because of various reasons. Every year, almost one million people die from suicide; a “global” mortality rate of 16 per 100,000, or one death every 40 seconds. Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020[2] and in India the rate is 13/100000 in Males and 7.8/100000 in females[3]. Attempted suicide can be up to 40 times frequent than completed suicide[4].

Many of those who attempt suicide require medical attention and they are at high risk for completed suicide[5]. As suicide is among the top three causes of death in the population aged 15-34 years[6], there is a massive loss to societies of young people in their productive years of life.

Until now, suicide prevention efforts have been limited in developing countries, although there are pockets of excellent achievement. Various universal, selective, and indicated interventions have been implemented, many of which target a different pattern of risk factors to those in developed countries. There is a clear need to develop appropriate, relevant and effective national suicide prevention plans in developing countries and these plans should focus on their efforts at national, regional, and local levels[7]. Therefore the present study reviews the current available data on studies on suicide interventions in India.


  Method Search Method Top


Search Method

Pubmed, Science direct, and the Cochrane databases were searched using the key words “Suicide intervention in India, suicide prevention intervention in India, suicide intervention RCT, Randomized controlled trials on suicide, suicide treatment, suicide the search was not limited by the RCTs to ensure that all the studies done on the suicide intervention will be assessed. Indian journal of psychiatry and Nursing Journal of India were searched individually, dissertations in NIMHANS and RGUHS were also manually checked for the intervention in suicide and the Leading authors in the field were also contacted. The searches were performed from January 1990 to January 2011 that has been published and unpublished dissertations in English language.

Selection criteria

Randomized Controlled Trials (RCTs) predominantly including the interventions after the suicidal attempt / for the individual with suicide risk was selected where the Brief Intervention and Contact for suicide attempters and the intervention led by lay health counsellors were included for the analysis. The principle outcomes of interest were the interventions that had a positive influence on preventing the subsequent deaths or suicide attempt after an attempted suicide / individual with suicide risk.

Validity Assessment

The first author and second author independently reviewed abstracts of potentially relevant RCTs. This was followed by a consensus discussion with third author. The quality of the RCTs was coded independently by first author and second author the disagreement was resolved by consensus discussions. Jadad scoring or the Oxford quality scoring system was used to independently to assess the methodological quality of a clinical trials. The Jadad score was used as the ‘gold standard’ to assess the methodological quality of studies[8]. Basic Jadad Score is assessed based on the answer to 5 questions with answer of yes or no. One score is awarded to yes and no carries zero score. The total score ranges from 0-5 which is categorized as low quality for 0-2 and high quality for 3-5.

Data extraction

A study characteristic form was designed for data extraction which included, Entry criteria, Trail design, Participants, Recruitment method, Exclusion criteria, Age Years, Female %, Male %, Transgender%, attempted suicide and Completed suicide. Another intervention form was prepared to extract details of intervention which consists of Intervention, Sample size, Intensity & length of treatment, Type of therapist and Follow up.

Plan for data analysis

Odds ratio and forest plots will be computed to compare the outcomes between the experimental and control group with the use of Revman5.1[9].

The flow of literature review is shown in [Figure 1]. Three RCTs were included in the analysis i.e. Vijayakumar L[10], Patel e t al.[11], Fleischmann et al.[12]. Thirty two studies out of 49 were excluded from the initial screening because of non original articles. Fourteen studies were eliminated because of non RCTs.
Figure 1: Flow chart of systamatic review, RCT-Randomized Controlled Trail

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Quality of trails

Jadad scoring system revealed that all three studies have high quality scoring i.e. Vijayakumar L et al. (2011) and Fleischmann et al. (2008) has the score of 3 out of 5 and Patel et al. (2018) had 4 out of 5.


  Results Top


Literature search

In total, 5343 participants were recruited with a mean age of 28.9 years [Table 1]. Recruitment was largely from the emergency department, PHC and General Practitioners. Patel et al (2010) used the broadest recruitment strategy in 12 PHCs and 12 GPs. The minimum entry criteria of age for the studies is 12 years and two studies recruited attempted suicide individuals10,12 and one study was the individual with common mental disorders[11]. Subject who were refuse to participate in the study were excluded in all three studies. The percentage of female participants varied from 51 to 83%, males range from 17 to 49% and 8.1% was transgender.
Table 1: Characteristics of studies included in Meta analysis

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Table 2: Details of intervention followed in selected studies

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All three studies were Randomized Controlled Trails in which Patel (2010) was cluster randomized trial. Brief intervention and Contact was an intervention in two studies[10],[12] and Collaborative Stepped Care in one trial[11]. In all three studies control group received the usual treatment. Vijayakumar L et al. (2011) assessed both suicide attempt and completed suicide where as Patel et al. (2010) measured attempted suicide and Fleischmann et al. (2008) measured completed suicide. Nearly half of the suicide attempt is reduced in intervention group than in control group[10],[11] where as the completed suicide is nearly ten times higher in control group than in intervention group.[10],[12]

Interventions

Comparison of treatment

A total of 2352 subject received intervention in the form of counselling and the duration of treatment varied from 6 months to 18 months. With regard to therapist two trails predominantly used psychologist (Vijayakumar L et al. 2011 and Fleischmann et al. 2008), lay counsellor (Patel et al. 2010) and Nurse (Fleischmann et al. 2008).

[Figure 2] shows the comparison of treatment in terms of attempted suicide. The test for overall effect proves that the statistics is significant (p = 0.04) and the heterogeneity test shows both studies are homogenous (I2 = 0%). The overall effect estimate confirms that the intervention favours the experimental group (OR-0.48, 95% CI 0.24 to 0.96). The overall result is influenced 64.8% by Vijayakumar L (2011)[10] and the remaining is by Patel (2010)[11].
Figure 2: Comparison of intervention in terms of Attempted suicide

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[Figure 3] shows the comparison of treatment in terms of completed suicide. The test for overall effect proves that the statistics is significant (p = 0.0002) and the heterogeneity test shows both studies are homogenous (I2 = 8%). The overall effect estimate confirms that the intervention favours the experimental group (OR-0.11, 95% CI 0.03 to 0.35). The overall result is influenced 67.9% by Fleischmann A (2008)[12] and the remaining by Vijayakumar L (2011)[10].
Figure 3: Comparison of intervention in terms of Completed suicide

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  Discussion Top


In India RCTs related to an intervention to prevent suicide is very limited i.e. only there studies were able accessed. The overall effect estimate confirms that the Brief intervention and contact / lay counsellor favours the experimental group (OR- 0.48, 95% CI 0.24 to 0.96) in terms of attempted suicide.The overall effect estimate confirms that the Brief intervention and contact favours the experimental group (OR-0.11, 95% CI 0.03 to 0.35) in terms of completed suicide.Similar finding was observed by Oyama H (2008) in which the community based intervention with counselling reduced the risk of suicide in elderly[13].

Similarities and differences between trails

In terms of study quality none of the study had low quality. All three studies concluded that frequent follow up will reduce the suicide attempt / completed suicide. Out of three studies one study psychologist (Vijayakumar L et al. 2011 and Fleischmann et al. 2008), lay counsellor (Patel et al. 2010) and Nurse (Fleischmann et al. 2008) as therapist.

Strengths and limitations

A large number of samples were included in meat analysis but there were only a small number of studies available for analysis, reflecting the scarcity of research in this area. This Meta analysis proved that follow up and counselling plays a very important role in prevention of suicide attempt and the Mental Health Nursing professionals can shoulder this responsibility to reduce suicides in India.



 
  References Top

1.
Vaknin S. The Importance of Human Life. Global politician 2012. Available from: URL:  Back to cited text no. 1
    
2.
3.
4.
Hultén A, Wasserman D, Hawton K, Jiang GX, Salander- Renberg E, Schmidtke A et al. Recommended care for young people (15-19 years) after suicide attempts in certain European countries. Eur Child Adolesc Psychiatry. 2000 Jun;9(2):100-8. Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/10926059  Back to cited text no. 4
    
5.
Gunnell D, Frankel S. Prevention of suicide: aspirations and evidence. BMJ. 1994 May 7;308(6938):1227-33. Available from: URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540097/pdf/b mj00439-0057.pdf  Back to cited text no. 5
    
6.
7.
Vijayakumar L, Pirkis J, Whiteford H. Suicide in developing countries (3) Prevention efforts. Crisis 2005. 26(3): 120-124. Available from: URL: http://espace.library.uq.edu.au/view/UQ:77521  Back to cited text no. 7
    
8.
9.
Review Manager (RevMan) [Computer program]. Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.  Back to cited text no. 9
    
10.
Vijayakumar L, Umamaheswari C, Shujaath Ali ZS, Devaraj P, Kesavan K. Intervention for suicide attempters: A randomized controlled study. Indian J Psychiatry 2011; 53:244-8. Available from: URL: http://www.indianjpsychiatry.org/temp/IndianJPsychiatry53324 4-4437171_121931.pdf  Back to cited text no. 10
    
11.
Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. The lancet 2010;376:2086-2095.Availablefrom: URL:http://www.sciencedirect.com/sciencefi_ob=MiamiImage URL&_cid=271074&_user=41801&_pii=S0140673610615085&_check=y&_origin=search&_zone=rslt_list_item&_coverDate =2010-12-31&wchp=dGLzVlk-zSkWz&md5=156c1d38622640919295476817666439/1-s2.0-S0140673610615085-main.pdf  Back to cited text no. 11
    
12.
Fleischmann A, Bertolote JM, Wasserman D, Leo DD, Bolhari J, Botega NJ, et al. Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bulletin of the World Health Organization September 2008; 86 (9):703-9. Available from: URL: http://ukpmc.ac.uk/articles/PMC2649494/pdf/07-046995.pdf  Back to cited text no. 12
    
13.
Oyama H, Sakashita T, Ono Y, Goto M, Fujita M, Koida J. Effect of community-based intervention using depression screening on elderly suicide risk: a meta-analysis of the evidence from Japan. Community Ment Health J. 2008;44(5):311-20. Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/18363103  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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