Evaluation of the SPIRIT Integrated Suicide Prevention Programme: study protocol for a cluster-randomised controlled trial in rural Gujarat, India

Abstract

Background: Suicide is a major public health challenge globally and specifically in India where 36.6% and 24.3% of all suicides worldwide occur in women and men, respectively. The United Nations Sustainable Development Goals uses suicide rate as one of two indicators for Target 3.4, aimed at reducing these deaths by one third by 2030. India has no examples of large-scale implementation of evidence-based interventions to prevent suicide; however, there is a sizeable evidence base to draw on for suicide prevention strategies that have been piloted in India or proven to be effective regionally or internationally. Method: The SPIRIT study is designed as a cluster-randomized superiority trial and uses mixed methods to evaluate the implementation, effectiveness and costs of an integrated suicide prevention programme consisting of three integrated interventions including (1) a secondary-school-based intervention to reduce suicidal ideation among adolescents, (2) a community storage facility intervention to reduce access to pesticides and (3) training for community health workers in recognition, management, and appropriate referral of people identified with high suicidal risk. Discussion: Combining three evidence-based interventions that tackle suicide among high-risk groups may generate a synergistic impact in reducing suicides at the community level in rural areas in India. Examination of implementation processes throughout the trial will also help to prepare a roadmap for policymakers and researchers looking to implement suicide prevention interventions in other countries and at scale.

The state of psychiatric research in the Asia Pacific region

“…Outreach programs addressing the stigma of mental illness in communities and schools through the promotion of mental health, and programs with a view to reduce suicide rates have also been developed (Patel, Varma, Nimbalkar, Shah, & Phatak, 2020; Pathare et al, 2020; Ramadas & Vijayan, 2019; Shankar, Sievers, & Sharma, 2020).…”

Implementation of a comprehensive surveillance system for recording suicides and attempted suicides in rural India

“…This study has been described extensively elsewhere. 16 From the pool of 614 inhabited villages, 124 villages were randomly chosen. Village councils were approached for participating in the SPIRIT trial and allow implementation of SPIRIT's suicide surveillance system in the villages.…”

“…This system was established to collect baseline data on suicidal behaviour as part of the Suicide Prevention and Implementation Research Initiative (SPIRIT) project. 16 The objectives of the study were twofold: (1) To assess the feasibility of adding community-based surveillance data collection to hospital and police records to create a comprehensive suicide surveillance system and (2) To assess the added value of the community surveillance in obtaining additional suicide and attempted suicides data by comparing it to data from hospital and police records.…”

Letter to the Editor: Problems with studying community-level pesticide storage to prevent suicide

“…An estimated 28.75% of the world’s suicides occur in India [ 1 , 2 ], emphasising the need for evidence-based interventions for suicide prevention that are particular to India and South Asia. We therefore read with great interest Pathare and colleagues’ study protocol for a cluster-randomised controlled trial evaluating a programme of three interventions in Gujarat, India [ 3 ].…”