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 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 2  |  Page : 125-129

Background of suicide amidst COVID-19 pandemic in India: A review of published literature


1 Department of Psychiatric Nursing, St Thomas College of Nursing, Changanassery, India
2 Department of Child Health Nursing, Shri Shankaracharya College of Nursing, Bhilai, Chhattisgarh, India
3 Department of Nursing, Sree Gokulam Medical College and Research Foundation, Venjarammoodu, Kerala, India

Date of Submission07-Feb-2022
Date of Decision07-Mar-2022
Date of Acceptance09-Mar-2022
Date of Web Publication19-Aug-2022

Correspondence Address:
L Manoj Kumar
Assistant Professor, Department of Psychiatric Nursing, St Thomas College of Nursing, Changanassery
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aip.aip_23_22

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  Abstract 


Background and Objectives: Globally, suicide is a pertinent public health crisis that affects almost all nations cross-culturally. Suicide is one of the leading causes of death in many countries, even before the COVID-19 pandemic hit worldwide. India, a nation developing rapidly, is also not free from the leashes of suicide deaths. COVID-19 augmented the rate of suicide due to multifaceted determinants. Adequate empirical evidence about data on suicide is also scarce. Materials and Methods: This review synthesizes determinants, available demographic correlates, and reported rates of suicide published in the Indian context. The authors conducted a thorough literature search to find published English free full-text scientific articles related to suicide during the COVID-19 pandemic in the Indian context. Databases relied on for literature were PubMed, Google scholar, and PLOS one databases using comprehensive search strategies to avail the maximum number of studies. Results: Ten out of 76 studies available in the initial search were analyzed thoroughly for ruling out determinants, rates, and sociodemographic correlates of suicide. Fear of COVID-19 infection, financial crisis, mental breakdown, and job loss are cardinal reasons attributed for suicide, and male suicides are more prevalent in this arena. Interpretation and Conclusions: Findings portray factors such as fear of COVID-19 diagnosis, apprehension to become infected, financial crisis, loss of job, and isolation are some of the significant determinants quoted out. The study points out the need for multifaceted policies in preventing this public health crisis.

Keywords: COVID-19, India, novel SARSCOV2, self-harm, suicide


How to cite this article:
Kumar L M, George RJ, Mohanan M. Background of suicide amidst COVID-19 pandemic in India: A review of published literature. Ann Indian Psychiatry 2022;6:125-9

How to cite this URL:
Kumar L M, George RJ, Mohanan M. Background of suicide amidst COVID-19 pandemic in India: A review of published literature. Ann Indian Psychiatry [serial online] 2022 [cited 2022 Sep 30];6:125-9. Available from: https://www.anip.co.in/text.asp?2022/6/2/125/354118




  Introduction Top


Every year September 10th is observed as suicide prevention day globally. Suicide is self-injury, often by lethal measures with an intense desire to end life.[1] Globally third leading cause of death among the young generation is suicide.[2] Multifaceted determinants, psychiatric disorders, dysfunctional grieving, financial constraints, chronic medical diagnosis, family history, personality traits, family, and marital conflicts pave the way to this psychosocial crisis.[3],[4] Suicide is not only a personal event; rather, it impacts family, society, nation, and related persons left behind. According to the World Health Organization, 77% of deaths due to suicide are in developing countries across globe.[5] India, one of the pertinent developing countries globally, has one of the highest suicide rates. Certain other countries also report their significantly high rates of suicide annually, which range from 24 to 36 percent.[6] To date, several studies[3],[7],[8],[9],[10] attempted to portray the risk factors, epidemiological patterns, and determinants of suicide cross-culturally.

In 2019, China reported to the WHO about the first case of Sars Cov2/Novel coronavirus, and subsequently, in 2020 January, the first case in India was also reported in the State of Kerala.[11] In March 2020, the whole nation of India went to lockdown as per the WHO guidelines and was announced suddenly by the Indian government, which lasted for several months consecutively and unlocked gradually in multiple phases.[12] The spread of novel pandemics and strict implementation of lockdown led the nation to gross devastation in the economy, severe job loss, and mental stress among the Indian population, which spearheaded a rise in COVID-19 related suicides. There was a cardinal spike in the incidences of suicide amidst COVID-19 lockdown, nearly a 67% increase than pre-COVID-19 rates.[13] Shreds of evidence suggest financial crisis, job loss, mental conflicts, stigma related to COVID-19 diagnosis, anxiety, and related factors as determinants of suicide amidst the pandemic.[14]

Suicide is not always a crisis that arises due to a single determinant, and risk factors associated with it are complex and divergent. Published existing literature suggests that several factors related to the COVID-19 pandemic can affect the rate of suicide attempts and completed suicide in varying ways. Factors such as impaired social interaction, inactivity, least access to full-fledged health-care facilities, fear of isolation, potential mental health issues, substance use, loneliness, boredom, economic crisis, loss of job, and so on can attribute to an increased probability of suicide.[15],[16]

Certain studies attempted to portray rates of suicide during the COVID-19 pandemic due to multifaceted reasons in India based on media reports and available government data records.[13],[14] Precise data must be available to implement effective government policies, but credible data regarding suicide related to COVID-19 is scarce. To our knowledge, there is no review on suicide related to this pandemic and its associated factors conducted in Indian context. This review aims to provide data on suicide and available demographic correlates of suicide, factors attributing to suicide related to COVID-19 in India since the pandemic, and identify and integrate all available reports on the subject.


  Materials and Methods Top


Search strategy

Systematically planned searches were conducted to avail literature comprehensively. For this, we searched the literature as of February 5, 2022, to identify published articles that reported suicide amidst the COVID-19 pandemic. We did a literature search on PubMed, Google scholar, and PLOS One databases for published articles that reported suicide-related data during COVID-19. The following search terms were used; “coronavirus” OR COVID-19 OR Sars Cov2 AND “Suicide” OR “suicidal” OR “suicidality” OR “hanging” OR “drowning” OR “self-poisoning OR “overdose” OR “self-injury” AND “India” OR “Indian” AND “India.” The search terms [Table 1] were kept comprehensive to encompass all possibilities for applicable studies. Potentially relevant studies with above said titles were selected, and contents were retrieved. A preliminary screening was done based on the titles of articles retrieved. The quoted references were followed to retrieve relevant articles concerning the searched titles. Some records were also retrieved through cross-references from published papers and even some newspaper reports with government websites and reports.
Table 1: Data search strategy adopted

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Study inclusion and exclusion criteria

Studies were availed by date of publication from March 2020, since it was the inception of the COVID-19 pandemic in India. The language of articles published was filtered to English only. These full texts were then examined to determine their compliance with the following eligibility criteria: papers published after March 2020 that reported the prevalence or correlates of suicide in any part of India related to COVID-19 pandemic for either gender in any age group and published in the English language. Thereafter, eligible articles were selected for final analysis according to predefined inclusion and exclusion criteria. We included only studies in Indian and International journals, studies reporting analysis of media reports, pertinent published government reports, news reports from prominent newspapers, and articles with clearly defined clinical measures. The exclusion criteria included; published language other than English; absence or unclear reporting of outcome measures; isolated reports and commentaries.

Data extraction

After eliminating duplicates, two investigators (M. K. L and R. J. G.) independently reviewed all abstracts: free full texts of articles regarded as potentially eligible for consideration were extracted for further analysis. We searched the reference lists of relevant articles by hand to identify further articles for analysis. An extraction data sheet was designed, study design, incidence rates, year of investigation, and reported determinants of suicide were extracted and analyzed. Both authors independently conducted the screening and selection of papers; when there was a disagreement between different papers, they were re-assessed and discussed by both authors to arrive at a consensus decision.


  Results Top


The number of articles identified was 76 [Figure 1]; from PubMed (14), Google Scholar (16), and from PLOS One (46). The number of studies after removing duplicates that are present in both databases has been screened off. Sixty-nine studies after removing duplicates were screened thoroughly, and 46 studies availed from the PLOS one databases were excluded, as any of these studies were not discussed per our study objectives. Thirteen studies met the inclusion criteria and were scrutinized in depth by reading the full text. Three studies were excluded then; for not having free full text[17],[18] and one commentary article.[19] Only 10 articles exclusively met the inclusion criteria. These studies portray the number of suicide cases reported, determinants of suicide in India during the COVID-19 pandemic, sociodemographic correlations, and recommendations to prevent suicides and risk factors related to this crisis. Details of these studies are quoted in [Table 2]. Four studies were based on the pieces of evidence gathered from online and offline news media reports. One study was based on newspaper data and specific rates added on by searching available government records. Four case reports were included; emerging suicide rates in India, suicide of a student from Kerala, suicide of a farmer, and the first case report of suicide in COVID-19 from India. One letter to the editor discussed peak incidences of celebrity suicide rates in India during the pandemic. Searching in PLOS one provided 46 titles, but it did not add on to studies availed from PubMed and Google scholar.
Figure 1: Flowchart of study selection process

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Table 2: Studies about suicides amidst coronavirus disease-2019 19 pandemic in India

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  Discussion Top


In this review, ten published scientific articles were analyzed qualitatively. Studies provide a clear picture of reported cases of suicide in India during the pandemic exclusively. Several determinants are portrayed in all studies; however, study findings cannot be generalized. Available sociodemographic correlates of suicide in studies indicate that the male gender is much more prone to commit suicide. Common factors associated with suicide during COVID pandemic were; fear of COVID-19 diagnosis, apprehension to become infected, social stigma, craving for alcohol, disappointments related to job and educational aspirations, chronic illness, financial crisis, loss of job, and isolation from loved ones. On the contrary, some studies from south Asia reported a significant rise in depressive symptoms, substance use, withdrawal symptoms, and mental health issues, contributing to suicide.[28] As India is a developing country, the determinants of suicide, when compared cross-culturally[29],[30] is also contrasting.

A pertinent number of COVID-19 patients committed suicide while in an institutionalized quarantine state and during hospital stay.[14] Lack of access to technology, illness, and medical comorbidity, barriers to mental health treatment, social distancing, limited social interaction, and lack of optimal social support can lead to suicide in a hospitalized state.[31] In the case of student suicide, inability to access online classes was stated as reason,[23] when every student in the state has the privilege to online learning, a distorted cognition of no access to study platform might have caused significant psychological distress in that students and led to a thought of self-harm. Reports regarding a hike in suicide among celebrities pointed to the financial crisis, loss of contracts, and loss of stardom, lifestyle limitations, substance use, and boredom.[22] Suicide among farmers was attributed to the inability to continue farming jobs. The lack of laborers during lockdown[27] created chaos throughout farming sector. Economic vitalizing strategies should have been adopted considering low socioeconomic profile people.

Certain limitations are embraced in this study due to multifaceted issues. Underreporting of suicides is prominently present in India, especially in northern states of India.[2],[32] South Indian states are considered the suicide capital of India bolder in this concern; maximum reporting of cases.[33] Certain hurdles researchers encounter while dealing with the arena of suicide include underreporting, the stigma associated with and the illegality of suicide, the intersection of data in multiple newspapers and media portals.[34] In this study, four studies are based on newspaper reports. The data within each study are slightly different in terms of rates. However, all four studies were published in the same year. Determinants portrayed in several studies help arrive at a consensus regarding factors leading to suicide during the pandemic. Media reporting of suicide rates in India and actual government data do have a disparity as reported in certain studies,[35],[36] which makes it cumbersome to portray a clear picture about aspects of Suicide in India.


  Conclusions Top


COVID-19 is a physical and psychosocial crisis, adding to that the economic insecurity and related precipitators created a significant impact on the general population. Pandemic has paved the way to distress in multiple domains including the physical, financial, emotional, and psychosocial well-being of the Indian population. Addressing the mental health concerns of the population is of utmost importance in preventing the peak incidences of suicide. This study recommends measures such as responsible reporting of suicide and attempted suicides, making responsible baseline health workers address the need for reporting suicide-related incidents at the grassroots level. Ensuring the availability of mental health services at the doorstep can positively impact mental health issues if any. To the best of our knowledge, this is the only review gathering all available published literature related to suicide and its determinants in the light of the COVID-19 pandemic. This study can be considered while formulating protocols and guidelines for the prevention of Suicide in India. In conclusion, this study addresses data regarding suicide during the COVID-19 pandemic due to multiple determinants so far published in the Indian context.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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