Background:Nonfatal, deliberate self-harm (DSH), particularly with pesticides, is a major public health problem in many developing countries of the world. Agriculture is the primary occupation of most people living in the Sundarban region in West Bengal, India. Pesticides are extensively used in agriculture and these agents are most frequently used in DSH.Aim:This study sought to identify the nature of methods and agents used in nonfatal DSH attempts in the Sundarban area under South 24 Parganas district of West Bengal.Materials and Methods:Detailed demographic and clinical data on DSH cases of 13 Block Primary Health Centres (BPHCs') admission registers were analysed. Focus Group Discussions (FGDs) were conducted with the Panchayat Samithy of each block to elicit their perception about the problem of pesticide-related DSH or suicide in the region.Results:Five thousand, one hundred and seventy-eight (1,887 male and 3,291 female) subjects were admitted in the BPHCs during the study period from 1999 to 2001. Organophosphorous pesticide poisoning was found to be the most common method (85.1%) in DSH. This emphasizes the importance of developing an urgent poisoning prevention program with a special focus on improving clinical services as well as initiating farmers' education programs focusing on safe pesticide practices at the primary care level.

Aims: This study attempts to examine the extent and impact of human-animal confl icts visa-vis psychosocial stressors and mental health of affected people in two villages adjacent to Sundarban Reserve Forest (SRF) in the Gosaba Block, West Bengal, India.Methods: Door to door household survey for incidents of human-animal confl icts, Focus Group Discussions, In-depth Interviews, Case studies, Community Mental health clinics and participatory observation.Results: A total of 3084 households covering a population of 16,999 were surveyed. 32.8% people live on forest-based occupation. During the last 15 years 111 persons (male 83, female 28) became victims of animal attacks, viz, Tiger (82%), Crocodile (10.8%) and Shark (7.2%) of which 73.9% died. In 94.5% cases the confl ict took place in and around the SRF during livelihood activities. Tracking of 66 widows, resulted from these confl icts, showed that majority of them (51.%) are either disabled or in a very poor health condition, 40.9% are in extreme economic stress and only 10.6% remarried. 1 widow committed suicide and 3 attempted suicide. A total of 178 persons (male 82, female 96) attended the community mental health clinics. Maximum cases were Major Depressive Disorder (14.6%), followed by Somatoform Pain Disorder (14.0%), Post Traumatic Stress Disorder-animal attack related (9.6%) and Adjustment Disorder (9%). 11.2% cases had history of deliberate self-harm attempt, of which 55% used pesticides.Conclusions: Improvement of quality of life of this deltaic population by appropriate income generation and proper bio-forest management are the key factors to save their life as well as the mangrove environment of the Sundarban region.

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Objective:Evaluation of various clinico-demographic variables and pattern of domestic violence in non-fatal deliberate self-harm (DSH) attempters admitted in 3 Block Primary Health Centers (BPHC) of Sundarban region of West Bengal, India in the year 2002.Materials and Methods:A prospective study of 89 DSH cases admitted at 3 Sundarban BPHCs by using a specially designed DSH register and a questionnaire on domestic violence in Bengali along with detail clinical interview.Results:Among the total of 89 DSH cases (23 male and 66 female), young (less than 30 years), female sex, low education and married status constituted major part of the sample. Pesticide poisoning was the commonest mode of DSH attempt. Typical stressors found were marital conflict or conflict with in-laws or guardian. A majority of DSH attempters (69.6%) experienced more than one form of domestic violence. Poverty and unemployment in the family were strongly associated with domestic violence. Among female DSH attempters, the most common perpetrator was husband (48.48%) followed by in-laws (16.67%) and parent (34.78%) was the most common perpetrator among males.Conclusion:Both DSH and domestic violence are serious socio-clinical issue of a major public health concern in the Sundarban region. Stressful life situations and various types of victimizations in the family intermixed with easy availability of lethal pesticides in this agriculture dependent community may facilitate the impulse of self-harm behavior, especially among the young housewives. Timely psychosocial intervention through community psychiatry program may mitigate the impact of psycho-cultural stressors and thus may help to reduce the morbidity and mortality from DSH.

The role of mental illness in nonfatal deliberate self-harm (DSH) is controversial, especially in Asian countries. This prospective study examined the role of psychiatric disorders, underlying social and situational problems, and triggers of DSH in a sample of 89 patients hospitalised in primary care hospitals of the Sundarban Delta, India. Data were collected by using a specially designed DSH register, Explanatory Model Interview Catalogue (EMIC), and clinical interview. Psychiatric diagnosis was made following the DSM-IV guidelines. The majority of subjects were young females (74.2%) and married (65.2%). Most of them (69.7%) were uncertain about their “intention to die,” and pesticide poisoning was the commonest method (95.5%). Significant male-female differences were found with respect to education level, occupation, and venue of the DSH attempt. Typical stressors were conflict with spouse, guardians, or in-laws, extramarital affairs, chronic physical illness, and failed love affairs. The major depressive disorder (14.6%) was the commonest psychiatric diagnosis followed by adjustment disorder (6.7%); however 60.7% of the cases had no psychiatric illness. Stressful life situations coupled with easy access to lethal pesticides stood as the risk factor. The sociocultural dynamics behind suicidal behaviour and community-specific social stressors merit detailed assessment and timely psychosocial intervention. These findings will be helpful to design community-based mental health clinical services and community action in the region.