Suicidal behavior in Indian adolescents

ArticleinInternational journal of adolescent medicine and health 25(3):207-12 · September 2013with1 Reads
DOI: 10.1515/ijamh-2013-0054 · Source: PubMed
Abstract
Abstract Suicide is both a public and mental health problem, and is a leading cause of deaths, especially among adolescents. Two factors that contribute to the decision of adolescents to commit suicide are having a primary mood disorder and/or substance use. In the Indian culture, the family unit has both a positive and negative impact on suicide. The family serves as a protective factor that provides a strong support for the individual, but alternately creates an inseparable individual when seeking mental health care, which often complicates the situation. Due to the stigma, Indians typically perceive having a mental illness as shameful. Religion is integral to the Indian culture so much so that individuals often use herbal remedies, seek help from religious leaders, and attend religious establishments prior to obtaining a mental health evaluation in those that are subsequently deemed as mentally ill. Despite the fact that suicides are underreported and misdiagnosed in India, it is known that the highest rates are among those <30 years old. The methods most commonly used to commit suicide in India include the ingestion of poison (often pesticides), hanging, burning, and drowning. When immigrating, Indians tend to switch the methods they use to commit suicide from ingestion of poison to hanging, which may reflect a lack of available poisonous substances or the influence of the host culture. Considering the high suicide rates in adolescents, the importance of providing psychoeducation, restricting access to lethal means, and promoting social integration in immigrants are various ways by which suicides in Indian adolescents can be avoided.
    • "Among Asian cultures, research has documented a belief that " emotional reactions " do not merit professional intervention [26]. Another study among Indian adolescents documented a perception that having a mental illness is shameful [27]. Stigma may result in resistance to seeking treatment and those who might seek treatment may be reluctant for fear of discrimination. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Generalized anxiety disorder (GAD) is one of the most common mental disorders among university students; however, many students go untreated due to treatment costs, stigma concerns, and limited access to trained mental health professionals. These barriers are heightened in universities in India, where there are scant mental health care services and severe stigma surrounding help seeking. Objective: To evaluate the feasibility, acceptability, and efficacy of Internet-based, or “online,” cognitive behavioral therapy (CBT)-based unguided and guided self-help interventions (using the programs GAD Online and Lantern, respectively) to reduce GAD symptoms in students with clinical and subthreshold GAD and, ultimately, reduce the prevalence and incidence of GAD among the student population. Methods: Students will be recruited via 3 colleges in Hyderabad, India, and referred for a campus-wide online screening. Self-report data will be collected entirely online. A total of 300 qualifying students will be randomized in a 1:1:1 ratio to receive GAD Online, Lantern, or to be in a wait-list control condition, stratified by clinical and subthreshold GAD symptomatology. Students will complete a postintervention assessment after 3 months and a follow-up assessment 6 months later, at which point students in the wait-list control condition will receive one of the programs. The primary outcome is GAD symptom severity at 3 months postintervention. Secondary outcomes include GAD caseness at 9 months, other anxiety and depression symptoms, self-efficacy, and functional measures (eg, sleep, social functioning) at 3 and 9 months, respectively. Primary analyses will be differences between each of the intervention groups and the wait-list control group, analyzed on an intention-to-treat (ITT) basis using mixed-design ANOVA. Results: The study commenced in February 2015. The sample was recruited over a 3-week period at each college. The trial is expected to end in December 2015. Conclusions: This trial will be the first to evaluate the use of Internet-based CBT programs compared with a wait-list control group for the treatment of GAD among students in Indian universities. If effective, these programs have the potential to reduce the mental health care treatment gap by providing readily accessible, private, and cost-effective evidence-based care to students with GAD who do not currently receive the treatment they need. Trial Registration: ClinicalTrials.gov NCT02410265 http://clinicaltrials.gov/ct2/show/NCT02410265 (Archived by WebCite at http://www.webcitation.org/6ddqH6Rbt).
    Full-text · Article · Oct 2015
    • "As the field moves toward more systematic testing of a range of possible effective therapies for the treatment of mental health symptoms in Indian-Americans, it is important to consider examination of the efficacy of alternative approaches which might be more tolerable and acceptable to Asian Indians. These include incorporating advice about exercise and yoga, curcumin (the principal compound of the commonly used spice in Indian cooking, turmeric) as a natural supplement for treatment of depression (Lopresti et al., 2014), and recognizing the use of religious coping (including reliance on fasting, food restrictions, and prayer) as a default approach to unpleasant symptoms in first-generation Indian-Americans (Samuel and Sher, 2013). "
    [Show abstract] [Hide abstract] ABSTRACT: Asian Indians represent a significant portion of the largest growing race of Asians in the past decade in the United States. This selective review examines major cultural themes related to first- and second-generation Asian Indians living in the United States as they impact psychological and psychiatric dysfunction in this population. Specifically, we review the impact of Asian Indian culture on mental health, discuss the impact of acculturation and ethnic identity development on the mental health of Indian-Americans, and focus on typical mental health problems of Asian Indian adolescents, women and elderly in America. Finally, we provide a brief overview of empirically-supported treatment approaches and cultural considerations for additional treatments relevant to this population. This review is intended to provide an important foundation for more systematic empirically-driven investigation into better understanding how Asian Indian cultural themes impact mental health for Indian-Americans, and how to develop effective treatments for these issues in this cultural group.
    Article · Sep 2015
  • [Show abstract] [Hide abstract] ABSTRACT: This longitudinal study examined deliberate self-harm and suicidal behaviors among adolescents in junior secondary schools in Hong Kong. With specific reference to adolescents in Grade 9, the prevalence of deliberate self-harm behavior was 21.9 %, with preventing wounds from healing, self-scratching, and wrist cutting being the most prevalent self-harm behaviors; the prevalence of self-harm behavior was higher in girls than in boys. The prevalence of suicide attempts was 3.4 %, with girls manifesting more suicidal behaviors than boys. A path model with family functioning (mutuality, communication, and conflicts) at Time 1, positive youth development qualities at Time 2, and self-harm and suicidal behaviors at Time 3 was tested. The following results were obtained: (a) mutuality and communication at Time 1 predicted self-harm and suicidal behaviors at Time 3 via positive youth development at Time 2; (b) mutuality at Time 1 directly predicted self-harm behavior at Time 3; (c) family conflicts at Time 1 directly predicted suicidal behavior at Time 3. The proposed overall model was not entirely gender invariant. Although the paths were gender invariant, family conflicts at Time 1 predicted suicidal behavior at Time 3 for girls but not boys. The theoretical and applied implications of the findings are discussed in this work.
    Chapter · Jan 2014 · Asian Journal of Psychiatry
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