Background: Suicide is a public health problem too often neglected by researchers, health policy makers and the medical profession. In the year 2000, approximately one million people died of suicide which represents a global mortality rate of 16 per 100,000. According to WHO estimates for the year 2020 and based on current trends approximately 1.53 million people will die from suicide and 10-20 times more people will attempt suicide worldwide. This represents on average 1 death per 20 seconds and 1 attempt every 1-2 seconds. No nationwide survey on suicidal risk factors has yet been conducted in Bangladesh. Reports from police records, Media, court, hospitals and the focused study on selected population indicate that suicide is a public health problem in Bangladesh. The aim of this study was to unearth the potential risk factors of suicide or suicidal attempts and to assess psychiatric illness, non psychiatric co-morbidity, individual’s behavioral and physical factor, familial risk factors and socio-demographic risk factors of suicide and its attempts. Study Design and Setting: A case control study was carried out by members of the Department of Medicine, Shaheed Suhrawardi Medical College and Hospital at Mominpur,Haowlee and Jibonnagar unions under three Upazilla of district Chuadanga,. Statistical analyses were performed using SPSS 16. Results: A total 230 subjects (113 cases and 117 controls) were interviewed. Mean age among cases was 29.6±12.8 years and controls were 29.7±12.9 years.Majority of the participants, 65.5% of cases and 63.2% of controls were aged between 20-39 years. Among cases 38.9% were male and among the controls 42.7% were male.Among cases 30.1% and among controls 27.4% had less than 4 family members. More than half of the participants, among cases (58.4%) and among controls (55.6%) had between 4- 6 members in the family. Economic status was also similar in two groups.Problem of love affair (OR 5.2), Personal problem (OR 11.9), Feeling of economic hardship (OR 2.4) appeared to have statistically significant association with suicidal attempt. Problem with relatives (OR 3.8), death of near relative (OR 0.9) and poor academic performance (OR 1.6) didn’t appear to have any association with risk of suicidal attempt. History of chronic disease (OR 2.9) showed statistically significant association but long term physical disability (OR 4.4) and physical problems didn’t appear to have any significant association with suicidal attempt. History of suicidal attempt by any relative (OR 4.2) and previous attempt to suicide (OR 7.4) appeared as highly significant factor for suicide. Not being reared by biological parents (OR 3.2), marital disharmony (OR 4.0), Conflict within the family (OR 6.9) appeared to be strongly associated with suicidal attempts. Suicidal attempts of participants were significantly associated with sleeping disturbance (OR 2.3), uncertainty about future (7.2), impulsivity (OR 13.8), and history of criminal behavior (OR 2.1). Conclusion: Case control study on the risk factors of suicide in rural area of South-West Bangladesh revealed that the married female especially the younger age from unitary family of low income group are more vulnerable to commit suicide or parasuicide. Several emotional factors, presence of chronic diseases, familial suicidal predisposition, individual factor and mental state, premorbid persionality and psychiatric syndrome appeared to have significant association with suicidal attempts. DOI: http://dx.doi.org/10.3329/jom.v14i2.19653 J Medicine 2013, 14(2): 123-129

Background Depression is the most common comorbid psychiatric disorder in people who die by suicide and 39% of global suicides occur in the World Health Organization (WHO) South-East Asia Region. The aim of this systematic review was to identify, for countries of this region, first the prevalence of depression among people who (i) die by, or (ii) attempt, suicide, and second, the proportion of people with depression who attempt or die by suicide. Methods PubMed, PsycINFO, EMBASE and Google Scholar were searched, together with five available national databases, for quantitative research papers published in English between 1956 and 4 September 2016 from the 11 countries of the WHO South-East Asia Region. Results The 19 articles that met the predefined eligibility criteria were from five countries: Bangladesh (1), India (12), Indonesia (1), Sri Lanka (3) and Thailand (2); no eligible papers from the remaining countries of the region were retrieved. Eight studies, from Bangladesh, India, Indonesia and Sri Lanka, reported the prevalence of depression among people who had died by suicide. The study settings varied, as did the proportion of depression recorded (6.9-51.7%), and the study sample sizes ranged from 27 to 372. Eight studies from India and one from Sri Lanka investigated depression among people who had attempted suicide. Using a range of screening and diagnostic tools, the reported prevalence of depression ranged between 22.0% and 59.7%. The study sample sizes ranged from 56 to 949. Only two articles were found, both from Thailand, that reported on suicide in people with depression. Conclusion Despite the high burden of mortality of suicide in the WHO South-East Asia Region, evidence on the relation between suicide and depression is scarce. There is a need to understand this phenomenon better, in order to inform suicide-prevention strategies in the region.

Bangladesh is a densely populated emerging country in South Asia. Since its harsh independence war, it has suffered from repeated floods and other natural and man-inflicted disasters. Internal migration from rural areas to the urban centres has increased crowdedness, pollution and social conflicts. Furthermore, in recent years, the country has absorbed close to a million refugees from Myanmar. These stressors have been associated with an increase in mental disorders and symptoms with which the country is struggling. Lack of resources and a shortage of human capital have weakened the national capacity to efficiently respond to situational stressors or disasters. For assessment of stress-related mental health issues, information available from the Ministry of Health and the National Institute of Mental Health was collected and supplemented by external reports. It is promising that the government's approach of responding to mental health needs only after the occurrence of a crisis has recently been replaced by the concept of total management through primary healthcare. There is a need for development of adequate infrastructure, logistics and workforce support, as well as establishment of multidisciplinary teams of management and clinical services. Collaboration of all related sectors of the government and an overall increase in government funding for mental health are essential.

Bangladesh Journal of Medicine, Vol 24 No 1, 2013, Page 14-19 DOI: http://dx.doi.org/10.3329/bjmed.v24i1.15030

Bangladesh is a disaster prone country. According to one record during last 100 years, there had been 75 severe cyclones and floods in Bangladesh. On the other hand as many as 1200 kilometer of river banks are under active erosion in every year. The government of Bangladesh, nongovernmental organizations, members of the civil society, the health professionals – all of them have chalked out their programme embedded with economic relief and assistance. At best, some sort of medical aid in the form of medicine and physical treatment and recovery are extended to the affected people. The severity of mental and psychological trauma and casualties had always remained beyond their imagination. For the first time in the history of Bangladesh, multiple teams consisted of psychiatrists, psychologists, social workers and other support service staffs rushed to the Cyclone affected area to estimate the need for psychosocial care and for providing management on 2007. In 2013 a multistoried has collapsed in Bangladesh and died more than thousand peoples. Currently, the National Plan for Disaster Management 2010-2015 keeps no space for the people who ardently need post disaster psychosocial care. Consequently, the mental health care professionals are strongly lobbying for inclusion of post-disaster psychosocial rehabilitation service within the National Plan for Disaster Management. Mainstream health professionals specially the primary health care providers should be brought under coverage of a full-fledged training course on disaster psychiatry. In addition, infrastructure development and administrative reform is urgently required in this arena.