|Year : 2019 | Volume
| Issue : 2 | Page : 143-147
Psychological distress in survivors of farmers' suicides in drought prone Aurangabad and Jalna Districts of Marathwada region in Maharashtra, India
Manik Changoji Bhise, Arun Vishwambhar Marwale, Ashish Chandrakantrao Mohide, Shraddha Shivaji Jadhav, Gaurav Pradeep Murambikar
Department of Psychiatry, MGM Medical College, Aurangabad, Maharashtra, India
|Date of Submission||20-Apr-2019|
|Date of Decision||18-May-2019|
|Date of Acceptance||01-Jun-2019|
|Date of Web Publication||18-Dec-2019|
Dr. Arun Vishwambhar Marwale
Department of Psychiatry, MGM Medical College, N-6, CIDCO, Aurangabad - 431 003, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Survivors of suicide experience psychological distress for years after suicide. In India, farmers' suicide survivors are special group, with unique set of stressors. There are very few studies examining this group in India. The objective was to assess psychological distress and its correlates in survivors of farmers' suicides. Methods: This was a cross-sectional study from two districts of Marathwada region of Maharashtra. A predesigned and pretested semi-structured questionnaire to assess sociodemographic variables was used. Self-reporting questionnaire-20 was administered to evaluate psychological distress in 93 survivors of farmers' suicides. Standard descriptive statistics (percentages, means, and Chi-square test) were used. Results: Female-to-male ratio was 2.8:1. Majority (76%) survivors were young adults and 97.8% were from rural area. Most survivors assessed in study were spouse (68.8%) followed by parents (9.6%), siblings (2.2%), progeny, and others (19.35%) of suicide victims. Of all survivors, 75% were doing farming, while rest had other sources of income in addition to farming. Out of 93 survivors, 81.7% of survivors were experiencing significant psychological distress. Twenty-eight percent survivors themselves had thought of ending their life during 1 month prior to assessment. Most commonly, distress was expressed through somatic symptoms and depressed mood. There was no significant correlation of psychological distress with age, sex, occupation, and place of residence of survivors. There was no significant correlation between psychological distress and relationship of survivor with suicide victim. Conclusions: Survivors of farmers' suicides are suffering from significant psychological distress. Suicide ideation was present in significant number of them. The current situation needs urgent psychological intervention to alleviate their suffering.
Keywords: Farmers' suicide, psychological distress, suicide survivor
|How to cite this article:|
Bhise MC, Marwale AV, Mohide AC, Jadhav SS, Murambikar GP. Psychological distress in survivors of farmers' suicides in drought prone Aurangabad and Jalna Districts of Marathwada region in Maharashtra, India. Ann Indian Psychiatry 2019;3:143-7
|How to cite this URL:|
Bhise MC, Marwale AV, Mohide AC, Jadhav SS, Murambikar GP. Psychological distress in survivors of farmers' suicides in drought prone Aurangabad and Jalna Districts of Marathwada region in Maharashtra, India. Ann Indian Psychiatry [serial online] 2019 [cited 2020 Jul 14];3:143-7. Available from: http://www.anip.co.in/text.asp?2019/3/2/143/262246
| Introduction|| |
Farmers' suicides are an important public health concern in India. As per the study on farmers' suicide trends, suicide rate for the general population was 10.6/lakh population, while that for farming population was a fifth higher, that is, 12.9/lakh farmers. In his foreword in 2015, Director General of National Crime Records Bureau of India acknowledged the need for elaborate analysis of suicide by farmers, and a separate section on “suicides in farming sector” was presented in the yearly report, “suicide and accidental deaths in India.” Survivors of suicide suffer long-term distress that leads to the distress and psychological morbidity even after years of suicide in the family. Farming, as a business faces unique sets of stressors that affect suicide survivors as well. These add to the distress of loss of a close person, further increasing their distress. Suicide by a close person triggers a wide range of psychological and social disturbances often resulting in anxiety, depression, pathological grief, and difficulties in the social arena. Literature in India focusing on problems of farmers' suicide survivors is scarce. Recently, authors have reported psychological distress in farmers' suicide survivors from Vidarbha region of Maharashtra. The present study is conducted on similar theme from drought-hit Marathwada region that has seen sudden rise of suicide by farmers in the past 5 years. The objective was to assess psychological distress and its correlates in survivors of farmers' suicides.
| Methods|| |
This cross-sectional study was conducted in a tertiary care hospital in Marathwada region of Maharashtra. It was conducted as a part of the welfare activity by the NAAM foundation, a non-governmental organization (NGO) working for alleviating distress of families affected with farmers' suicides and prevention of suicides. Two-day meeting of all of suicide victim families (n = 116) was convened in the medical college from Aurangabad and Jalna districts on May 06, 2015, for discussion about their rehabilitation and helping them to cope with this loss from social, farming, financial, and psychological aspects. A dedicated session was allotted for psychological assessment. Of all, 93 families turned up for meeting. A prior ethics committee approval was obtained from the Institute Ethics Committee for research. Data was collected with the help of a screening questionnaire to assess the psychological needs of surviving family members of the suicide victims. Before starting assessment, details of screening, and the use of data (anonymously) for research purpose were informed to the participants, and a written consent in the local language (Marathi) was obtained for same. Our team interviewed survivors one-to-one with a predesigned and pretested semi-structured questionnaire used to record sociodemographic variables of suicide survivors. Demographic variables such as age, sex, relationship with suicide victim, occupation, and place of residence were recorded. Psychological distress was assessed using the Indian version of Self-Reporting Questionnaire-20 (SRQ-20). It was devised by the World Health Organization to screen for the presence of psychiatric morbidity in primary health-care setting, especially in developing countries. In its 20-item version, it is also used for the assessment of psychological distress. It has a high face, content, criterion, and construct validity for adults (≥15 years) and can be used both as a self-rated or interviewer-administered questionnaire. In the present study, SRQ-20 was interviewer administered by researchers for all the participants in the study. Total SRQ-20 score is obtained by the sum of all positive responses. This instrument has been widely used in a variety of settings in different countries.,, This instrument was recently validated by Chincholkar from Pune, which is geographically nearest to our study site. In this validation study, high sensitivity and specificity of SRQ-20 was reported, using 10 as cutoff score. In a recent study from Wardha, India, for screening of farmer's suicide survivors a cut off of 10 was used. Taking these as nearest validation studies, we used total SRQ score of 10 as cutoff point, meaning those respondents scoring ≥10 were considered to be experiencing significant psychological distress.
Standard descriptive statistics were used to measure sociodemographic variables and to assess psychological distress. Associations between various variables were assessed using Chi-square test or Fisher's two-tailed exact test for class variables. P < 0.05 was considered statistically significant.
| Results|| |
Mean duration between the suicide and the day of assessment was 9.3 months (standard deviation = 5.9), ensuring minimum 3 months of window period for bereavement. Majority of the participants (survivors) in the study were female (n = 69, 74.2%) and only 24 (25.8%) were males. Most of the survivors were young adults in their third and fourth decades of life. Only two survivors were residing in urban areas, rest all (n = 93) belonged to rural area. Spouses of deceased person (n = 64, 69%) were most commonly assessed in the study followed by their siblings (n = 6, 6.5%) and others. Farming was the only source of livelihood for 75.3% (n = 70) of the survivors, while 24.5% (n = 23) were also engaged in some other earning activities like sewing clothes, etc., in addition to farming.
Psychological distress (total SRQ score > 10) was observed in 82% of the survivors assessed in the study. Almost one-third (34.4%) had very high SRQ-20 scores (15–20) indicating severe distress, while another 37.6% had moderate distress. Distress was most commonly expressed through symptoms of headaches, feelings of unhappiness, decreased appetite, weakness, lethargy, and cognitive dulling [Table 1]. Alarming finding was 27.9% survivors reported having thought of ending their own life in preceding 1 month. There was no significant association of psychological distress with age, sex, relationship with suicide victim, place of residence, or the presence of additional sources of income [Table 2]. Distress persisted well beyond the 6 months after death, as indicated by significantly higher number of survivors experiencing distress beyond 6 months from suicide.
|Table 1: Responses of participants to self-reporting questionnaire-20 questionnaire|
Click here to view
|Table 2: Association of sociodemographic variables with psychological distress in suicide survivors|
Click here to view
| Discussion|| |
India is facing suicides by farmers for over three decades now. While there are measures taken to mitigate crisis, there is not much reduction in total number of farmers' suicides. Rather new areas of distress and suicides like in Marathwada region are emerging. While focus was on suicides in Vidarbha region, due to consecutive 3 years of drought situation in Marathwada region, there has been sharp rise in the suicide by farmers over the past 5 years. With rising number of suicides, the number of survivors left behind also increases. A study from Vidarbha region has calculated average number of farmers' suicide survivors as four. They have included only close family members and excluded friends and other close acquaintances. Survivors assessed in the present study comprised predominantly female spouses of male farmer suicide victims. This is similar to the study on farmers' suicide survivors from Vidarbha, Maharashtra. Majority of farmers' who committed suicides in India are in their third and fourth decades of life. As we have predominantly assessed spouse of suicide victims, most survivors were in the age group of third and fourth decades. Source of livelihood is predominantly farming income. Alternative sources of income are minimal in most farming families. Predominant dependency on income from farming makes them vulnerable to the irregularity of yields, crop failures, and other dynamic market forces. This creates problems in rehabilitation of survivors. Farmer suicide survivors face double stress of loss of loved one and the economic crisis in which victim left the family. Thus, one of the important support activities for these survivors is enabling them to earn money from additional sources of income such as stitching of cloths, running small business from home, and involvement into small savings groups (Mahila Bachat Gat).
In the present study, 82% of survivors were experiencing psychological distress. Furthermore, very large number of survivors scored above 15 on SRQ-20, indicating the severity of distress. This is much higher figure as compared to one reported from the Vidarbha region, where 62% of farmers' suicide survivors were experiencing psychological distress. Suicide in family leads to long-term consequences for those left behind. Loss of loved one leads to series of negative impacts on other family members. Prolonged grief, anxiety, and sleep problems are reported even up to 10 years from suicide. This is compounded by social impacts of suicide such as isolation from community, stigma, and exclusion of widows from social functions. Suicide by earning member of family worsens economic difficulties for survivors to a great extent. Psychological distress was most commonly expressed through somatic symptoms such as headaches, feelings of unhappiness, decreased appetite, weakness, lethargy, and cognitive dulling. With these symptoms, many of survivors are likely to visit general practitioners who practice in the periphery. One alarming finding was expression of suicide ideas by a quarter of the survivors. Suicide survivors themselves confronting suicide indicates that grief rather than resolving, was getting complicated over the period of time. Similar findings were reported from farmers' suicide survivors in Wardha district of Maharashtra. Replication of this distressing finding from geographically different sample validates the urgent need for psychological intervention for survivors of farmers' suicide across the state. Training of primary health-care doctors and other health workers in early identification and management/referral can be an important intervention in alleviating distress and preventing suicides by farmers' suicide survivors themselves. For the present sample, those with significant psychological distress were provided immediate consultation on that day and advised to be on regular treatment. Family members of these survivors were explained need for a close watch and compliance to treatment. All these suicide survivor families were enrolled for free health-care services (psychological and physical both) through special scheme from our medical college and hospital.
There was no significant correlation in the presence of psychological distress and other sociodemographic variables such as age, sex, place of residence, occupation, and relationship with suicide victim. This is in contrast to other studies that reported psychological issues being more common in female survivors than males. Furthermore, spouse is reported to be suffering more than other relatives.,,, Situation for survivors appears real grim. Maharashtra government's “Prerna Prakalp” targeting mental health needs of farmers, in general, is a welcome step. This project can initiate special mental health interventions for suicide survivors. Removing hurdles in its full-fledged implementation will be a helpful step toward helping survivors.
Findings of the present study should be interpreted in light of the following limitations. The present study is a cross-sectional study with only single assessment. Distress could be variable according to settings and time of assessments. Our sample size is relatively small which may increase false-negative findings (Type II error). Detailed assessment of coping strategies, other stressors, any compounding events that may have impact on psychological status of participants was not done. Similarly, detail evaluation of grief, depression, or other phenomenology was not done. It is also possible that some survivors with distress did not honor the invitation to come to the hospital. Ideally, the survivors could have been interviewed in their own habitats to avoid selection bias. Another important limitation was these families were called upon by a NGO that was known to help farmer suicide survivor families. Although we made it very clear that findings of this study will be used only to plan psychological interventions and would not have any impact on materialistic help being given by the NGO, still some bias can arise out of this.
| Conclusions|| |
Survivors of farmers' suicide are experiencing severe psychological distress. Often it is expressed through somatic symptoms of aches, pains, and lethargy. Early identification of psychological distress and targeted interventions can help these families to stabilize under already harsh situation. Contemplation of suicide by survivors themselves calls for urgent intervention.
This study was approved by Institutional Ethics Committee with reference number MGM-ECRHS/2015/ 11 obtained on 07th April 2015.
Declaration of Patient Consent
Patient consent statement was taken from each patient as per institutional ethics committee approval along with consent taken for participation in the study and publication of the scientific results / clinical information /image without revealing their identity, name or initials. The patient is aware that though confidentiality would be maintained anonymity cannot be guaranteed.
Financial support and sponsorship
NAAM foundation had provided support for travel of the study participants.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Behere PB, Bhise MC. Farmers' suicide: Across culture. Indian J Psychiatry 2009;51:242-3.
] [Full text]
National Crime Records Bureau. Accidental Deaths and Suicides in India. Ministry of Home Affairs. Government of India; 2015.
Behere PB, Behere AP. Farmers' suicide in Vidarbha region of Maharashtra state: A myth or reality? Indian J Psychiatry 2008;50:124-7.
] [Full text]
McMenamy JM, Jordan JR, Mitchell AM. What do suicide survivors tell us they need? Results of a pilot study. Suicide Life Threat Behav 2008;38:375-89.
Bhise MC, Behere PB. A case-control study of psychological distress in survivors of farmers' suicides in Wardha district in central India. Indian J Psychiatry 2016;58:147-51.
] [Full text]
Kulkarni A, Gadgil S, Patwardhan S. Monsoon variability, the 2015 Marathwada drought and Rainfed agriculture. Current Sci 2016;111:1182-93.
Harding TW, deArango MV, Baltaker J, Climent CE, Ibrahim HH, Igansio LL, et al
. WHO collaborative study on strategies for expanding mental health care II: The development of new research methods. Am J Psychiatry 1983;140:1474-80.
Mari JJ, Williams P. A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo. Br J Psychiatry 1986;148:23-6.
Sen B, Williams P. The extent and nature of depressive phenomena in primary health care. A study in Calcutta, India. Br J Psychiatry 1987;151:486-93.
Harding TW, de Arango MV, Baltazar J, Climent CE, Ibrahim HH, Ladrido-Ignacio L, et al.
Mental disorders in primary health care: A study of their frequency and diagnosis in four developing countries. Psychol Med 1980;10:231-41.
Chincholkar SV. Use of SRQ in psychiatric epidemiology. Indian J Community Med 2004;29:190-1.
National Crime Records Bureau. Accidental Deaths and Suicide in India. Ministry of Home Affairs, Government of India; 2015.
Bhise MC, Behere PB. Risk factors for farmers' suicides in central rural India: Matched case-control psychological autopsy study. Indian J Psychol Med 2016;38:560-6.
] [Full text]
Saarinen PI, Hintikka J, Lehtonen J, Lonnqvist JK, Viinamaki H. Mental health and social isolation among survivors ten years after a suicide in family: A case control study. Arch Suicide Res 2002;6:221-6.
Manoranjitham S, Charles H, Saravanan B, Jayakaran R, Abraham S, Jacob KS, et al
. Perceptions about suicide: A qualitative study from Southern India. Natl Med J India 2007;20:176-9.
Séguin M, Lesage A, Kiely MC. Parental bereavement after suicide and accident: A comparative study. Suicide Life Threat Behav 1995;25:489-92.
[Table 1], [Table 2]