Chowdhury A N, Banerjee S, Brahma A, Das S, Sarker P, Biswas M K, Sanyal D, Hazra A
Institute of Psychiatry, Kolkata, West Bengal, India.
Natl Med J India. 2010 Jul-Aug;23(4):201-5.
Deliberate self-harm is a challenging public health issue but there is a paucity of data on non-fatal deliberate self-harm in the literature. We aimed to understand the behaviour of deliberate self-harm, both fatal and nonfatal, in a primary care setting.
A year-long prospective study of all admitted patients of deliberate self-harm at 13 block primary health centres of the Sundarban region was done to examine the sociodemographic profile and clinical outcome of suicidal behaviour. Data were collected by using an especially devised deliberate self-harm register. Each subject was administered a 20-item case history sheet by trained medical officers and nursing staff.
A total of 1614 deliberate self-harm subjects (619 men, 995 women) were admitted during the year, of whom 143 (62 men, 81 women) died. Although women, especially in the younger age groups, constituted the majority of subjects (61.6%), the fatality trend was higher among men than among women (10% v. 8.1%). Poisoning was the commonest (98.4%) method of self-harm, particularly using pesticide. Easy availability of pesticides was a risk factor. Psychosocial stressors, such as conflict with spouse, guardian or in-laws, failed love affairs and economic distress, were the common underlying reasons. The majority of acts of deliberate self-harm (92.6%) were committed inside the home, especially by women. Only a small proportion of subjects had a past or family history of attempt at deliberate self-harm. The overall incidence of fatal and non-fatal deliberate self-harm was 5.98 and 61.51 per 100 000 population, respectively.
Both fatal and non-fatal pesticide-related deliberate self-harm is a major public health issue in the Sundarban region. An intersectoral approach involving primary health, administration and agriculture may help in developing an effective preventive programme to reduce the morbidity and mortality from deliberate self-harm.
蓄意自我伤害是一个具有挑战性的公共卫生问题，但文献中关于非致命性蓄意自我伤害的数据匮乏。我们旨在了解在基层医疗环境中致命和非致命蓄意自我伤害行为的情况。
对孙德尔本斯地区13个街区初级卫生中心所有因蓄意自我伤害入院的患者进行了为期一年的前瞻性研究，以调查自杀行为的社会人口学特征和临床结局。通过使用专门设计的蓄意自我伤害登记册收集数据。由经过培训的医务人员和护理人员为每位受试者填写一份包含20项内容的病史表。
该年共有1614名蓄意自我伤害受试者（619名男性，995名女性）入院，其中143人（62名男性，81名女性）死亡。尽管女性，尤其是年轻年龄组的女性，占受试者的大多数（61.6%），但男性的致死率高于女性（10%对8.1%）。中毒是最常见的（98.4%）自我伤害方式，尤其是使用农药。农药容易获取是一个风险因素。心理社会压力源，如与配偶、监护人或姻亲的冲突、恋爱失败和经济困境，是常见的潜在原因。大多数蓄意自我伤害行为（92.6%）发生在家中，尤其是女性。只有一小部分受试者有过或家族中有过蓄意自我伤害未遂史。致命和非致命蓄意自我伤害的总体发生率分别为每10万人5.98例和61.51例。
致命和非致命的与农药相关的蓄意自我伤害是孙德尔本斯地区的一个主要公共卫生问题。涉及初级卫生、行政管理和农业的跨部门方法可能有助于制定有效的预防方案，以降低蓄意自我伤害的发病率和死亡率。
