Why women attempt suicide: the role of mental illness and social disadvantage in a community cohort study in India.

CONTEXT

The relative importance of illness (physical and mental) and social disadvantage as risk factors for suicide is controversial.

OBJECTIVES

To describe the risk for attempted suicide in women when it is associated with social disadvantage and physical and mental illness.

METHODS

Data were analysed from a population-based cohort study of women aged 18-50, in Goa, India (n = 2494). Baseline information was collected on socioeconomic factors, gender disadvantage and physical and mental illness. The main outcome was self-report attempted suicide (AS) over a 12-month study period. ORs were calculated using exact logistic regression.

RESULTS

One-year incidence of AS was 0.8% (n = 18+1 completed suicide) and seven of these women had baseline common mental disorders (CMDs) (37%). In unadjusted models, CMDs (OR 8.71, 95% CI 2.86 to 24.43), exposure to violence (OR 7.70, 95% CI 2.80 to 22.21) and recent hunger (OR 6.59, 95% CI 1.83 to 19.77) were the strongest predictors of incident AS cases. However, in a multivariate model, exposure to violence (OR 5.18, 95% CI 1.55 to 18.75) and physical illness (OR 3.77, 95% CI 1.05 to 12.37) emerged as independent predictors of AS.

CONCLUSIONS

Multi-pronged strategies to reduce domestic violence, provide poverty relief and improve treatment of mental and physical disorders are needed to reduce the population burden of attempted suicide.