Department of Psychiatry, Voluntary Health Services and SNEHA Suicide Prevention Centre, Chennai, India
Centre for Mental Health Law & Policy, Indian Law Society, Pune, India.
BMJ Open. 2020 Nov 9;10(11):e038636. doi: 10.1136/bmjopen-2020-038636.
WHO reports that 78 of the 140 low-income and middle-income countries (LMICs) do not have a registration system for suicides and attempted suicides. Absence of data on suicide and attempted suicide in LMICs, which account for 79% of suicides worldwide, is a major impediment in understanding the magnitude of the problem and formulating prevention strategies to reduce suicide and self-harm. A comprehensive surveillance system has the potential to address this data gap. The objective of this study is to describe the development of a comprehensive surveillance system in rural India by adding a community based component and reflect on its added value in obtaining data on suicide and attempted suicide compared with relying only on hospital and police records.
The comprehensive system consists of three components. Community surveillance involved collecting information on suicides and attempted suicides from third party key informants such as village heads, teachers, priests, shopkeepers, private physicians, private hospitals and community health workers. The second component consisted of data from public health facilities. The final component consisted of suicide data from police records. Information was collected for a period of 12 months from August 2018 to July 2019 from 116 villages (population 377 276) in Gujarat, India.
An average of 710 community informants were interviewed each month (mean: 6.72 informants per village). The community surveillance system identified 67 cases of suicide compared with 30 cases by hospital and police records (Cochran's Q test 67.9 p<0.01) and 70 attempted suicides compared with 51 from the hospital and police records (Cochran's Q test 66.6 p<0.01).
This is the first report of implementing a large-scale comprehensive surveillance system for suicide and attempted suicide in a LMIC. The combination of community surveillance system and official data from hospital and police records addresses the problem of under-reporting of suicide and suicide attempts in India and other LMIC.
世界卫生组织报告称，在 140 个低收入和中等收入国家（LMICs）中，有 78 个国家没有自杀和自杀未遂登记系统。在占全球自杀人数 79%的 LMICs 中，缺乏关于自杀和自杀未遂的数据是理解问题严重程度和制定预防策略以减少自杀和自残的主要障碍。一个全面的监测系统有潜力解决这一数据差距。本研究的目的是描述在印度农村建立一个全面监测系统的发展情况，通过增加一个基于社区的组成部分，并反映与仅依赖医院和警察记录相比，该系统在获取自杀和自杀未遂数据方面的附加值。
全面系统由三个部分组成。社区监测包括从第三方关键信息来源（如村长、教师、牧师、店主、私人医生、私人医院和社区卫生工作者）收集自杀和自杀未遂的信息。第二部分包括公共卫生设施的数据。最后一部分由警察记录的自杀数据组成。从 2018 年 8 月至 2019 年 7 月，在印度古吉拉特邦的 116 个村庄（人口 377276 人）收集了 12 个月的信息。
平均每月采访 710 名社区信息员（平均：每个村庄 6.72 名信息员）。社区监测系统发现 67 例自杀病例，而医院和警察记录发现 30 例（Cochran's Q 检验 67.9，p<0.01），发现 70 例自杀未遂病例，而医院和警察记录发现 51 例（Cochran's Q 检验 66.6，p<0.01）。
这是在 LMIC 中实施自杀和自杀未遂大规模综合监测系统的第一份报告。社区监测系统与医院和警察记录的官方数据相结合，解决了印度和其他 LMIC 自杀和自杀未遂报告不足的问题。
