3 Poverty,suicide and society

POVERTY SUICIDE AND SOCIETY.
The massive and misleading media coverage depicting that suicide is the result of poverty especially among farmers.That is not only wrong way of understanding the problem but is thoroughly misdirecting resulting in groping in the dark to find a working solution to this vexing problem of suicide prevention.
During the periods of severe famine,poverty and economic collapse of twenties forties,fifties and even sixties,the suicide rates were low compared to now.
In the poorest areas of India the UP,Bihar,MP,Orissa,Rajasthan,and Jharkhand the rates are low compared to Pondicherry,Quilon,and Idukki were per capita alcohol consumption is high.
In Kerala economic conditions of Muslims are one of the lowest[Sasthra sahithya Parishath Study] and suicide among them is very low [only 12.8/lakh in Malappuram v/s stae average 27.2/Lakh]
In Adivasis and Dalits the economic conditions are the poorest but suicide rates are low.
The areas projected as areas of farmersx suicide are comparatively better off: Punjab,Maharashtra,AP,Vidarbha,Kerala.
Agricultural areas of Plakkad,Alappuzha are having less suicides compared to state average[22v/s 27.2]
Scientific studies:
Mortality from suicide and all other causes increased with increasing Townsend deprivation score, social fragmentation score, and abstention from voting in all age and sex groups. Suicide mortality was most strongly related to social fragmentation, whereas deaths from other causes were more closely associated with Townsend score. Constituencies with absolute increases in social fragmentation and Townsend scores between 1981 and 1991 tended to have greater increases in suicide rates over the same period. The relation between change in social fragmentation and suicide was largely independent of Townsend score, whereas the association with Townsend score was generally reduced after adjustment for social fragmentation.
Conclusions Suicide rates are more strongly associated with measures of social fragmentation than with poverty at a constituency level.
The association between deprivation and mortality is well established, and for most common diseases mortality is higher in people of lower socioeconomic position. Mortality also tends to be higher in populations living in poor areas, regardless of individual socioeconomic position. High risk areas have been identified by using census derived indices of poverty and voting patterns. Although strong associations have been found between these area based indices and mortality, they may not fully describe the relation with area of residence for all causes of death.

Suicide prevention strategies are usually formulated without seeking the views of people with psychiatric illnesses.
To establish what helped patients with severe psychiatric illness when they felt suicidal.
The helpfulness of the statutory and voluntary agencies was less apparent, and relatively few patients had contact with these agencies. This may in part reflect the growth of voluntary agencies over recent years which may post-date the period when some of our patients felt at their worst. The findings might also suggest that, notwithstanding the role of organizations such as the Samaritans for suicidal members of the general population, suicide prevention strategies for those with severe mental illness should be targeted in other directions.
Religious beliefs and activities were reported to be helpful. For example suicides are evidently less among Muslims and Catholics. Epidemiologically, there is a fairly consistent negative association between a population's religiosity and its suicide rate (Neeleman et al, 1997). People who commit suicide have been found to be less religious than population controls. In Northern Ireland, this relationship did not endure after controlling for the presence of psychiatric illness (Foster et al, 1999), but in the USA the protective effects were found to be independent of any increased social contact to which religious activities might give rise (Nisbet et al, 2000).
Self-help strategies were used by a considerable number of patients. This emphasizes the need for a balance between active help and intervention on the one hand, and fostering patients' autonomy and self-reliance on the other.
Efforts to improve contact with psychiatric services are more likely to be helpful than changes to those services.
Patients' social and religious support networks are highly valued and should be fostered.
Efforts to decrease the stigma attached to mental illnesses should continue.
Rtn.PP Dr. P K Sukumaran. Chairman, Suicide Prevention committee. Rotary Club Thrissur Central.