Response to Reifels et al., Suicide and Life‐Threatening Behavior

Knipe, Duleeka; Eddleston, Michael

doi:10.1111/sltb.12546

Cited by 6 publications

(3 citation statements)

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“…Medical treatment of pesticide poisoned patients is challenging, particularly in remote areas, where patients commonly present late to poorly-resourced hospitals with limited critical care facilities [22,23]. A large cluster-randomised controlled trial in Sri Lanka has demonstrated that improved HHP storage is unlikely to substantially reduce the number of deaths [24,25].…”

Section: Introductionmentioning

confidence: 99%

Suicide by pesticide poisoning in India: a review of pesticide regulations and their impact on suicide trends

et al. 2020

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Background: Pesticide self-poisoning is a common means of suicide in India. Banning highly hazardous pesticides from agricultural use has been successful in reducing total suicide numbers in several South Asian countries without affecting agricultural output. Here, we describe national and state-level regulation of highly hazardous pesticides and explore how they might relate to suicide rates across India. Methods: Information on pesticide regulation was collated from agriculture departments of the central government and all 29 state governments (excluding union territories). National and state-level data on suicides from 1995 to 2015 were obtained from the National Crime Records Bureau (NCRB). We used joinpoint analysis and negative binomial regression to investigate the trends in suicide rates nationally and in Kerala, in view of the robust measures Kerala has taken to restrict a number of HHPs, to identify any effect on suicides. Results: As of October 2019, 318 pesticides were registered for use in India, of which 18 were extremely (Class Ia) or highly (Class Ib) hazardous according to World Health Organization toxicity criteria. Despite many highly hazardous pesticides still being available, several bans have been implemented during the period studied. In our quantitative analyses we focused on the permanent bans in Kerala in 2005 (of endosulfan) and 2011 (of 14 other pesticides); and nationally in 2011 (of endosulfan). NCRB data indicate that pesticides were used in 441,918 reported suicides in India from 1995 to 2015, 90.3% of which occurred in 11 of the 29 states. There was statistical evidence of lower than expected rates of pesticide suicides (rate ratio [RR] 0.52, 95% CI 0.49-0.54) and total suicides nationally by 2014 (0.90, 0.87-0.93) after the 2011 endosulfan ban. In Kerala, there was a lower than expected rate of pesticide suicides (0.45, 0.42-0.49), but no change to the already decreasing trend in total suicides (1.02, 1.00-1.05) after the 2011 ban of 14 pesticides. The 2005 ban on endosulfan showed a similar effectlower than expected pesticide suicides (0.79, 0.64-0.99), but no change to the decreasing trend of total suicides (0.97, 0.93-1.02) in 2010. There was no evidence of a decline in agricultural outputs following the bans. Conclusion: Highly hazardous pesticides continue to be used in India and pesticide suicide remains a serious public health problem. However, some pesticide bans do appear to have impacted previous trends in the rates of both pesticide suicides and all suicides. Comprehensive national bans of highly hazardous pesticides could lead to a reduction in suicides across India, in addition to reduced occupational poisoning, with minimal effects on agricultural yield.

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Section: Introductionmentioning

confidence: 99%

Suicide by pesticide poisoning in India: a review of pesticide regulations and their impact on suicide trends

et al. 2020

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“…However, medical treatment of pesticide poisoned patients is challenging, particularly in remote areas, where patients commonly present late to poorly-resourced hospitals with limited critical care facilities [21,22]. A large cluster-randomised controlled trial has demonstrated that improved HHP storage is unlikely to substantially reduce the number of deaths [23,24]. In contrast, national bans of HHP in several countries have produced major reductions in the number of pesticide suicides and in the total number of suicides where pesticide self-poisoning is a common means of suicide [25].…”

Section: Introductionmentioning

confidence: 99%

Regulation of highly hazardous pesticides in India - implications for suicide prevention

Bonvoisin¹,

Utyasheva²,

Knipe³

et al. 2019

Preprint

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Background: Pesticide self-poisoning is a common means of suicide in India. Banning highly hazardous pesticides from agricultural use has been successful in reducing total suicide numbers in several South Asian countries without affecting agricultural output. Here, we describe national and state-level regulation of highly hazardous pesticides and relate them to suicide rates across India. Methods: Information on pesticide regulation was collated from agriculture departments of central and state governments. National and state-level data on suicides for 1995 until 2015 was obtained from the National Crime Records Bureau (NCRB). We used joinpoint analysis and negative binomial regression to investigate the possible effects of pesticide bans on trends in suicide rates. Results: As of August 2019, 314 pesticides were registered for use in India, of which 18 were extremely (Class Ia) or highly (Class Ib) hazardous according to World Health Organization toxicity criteria. Despite many highly hazardous pesticides still being available, a number of bans have been implemented during the period studied. In our quantitative analyses we focussed on the permanent bans in Kerala in 2005 (of endosulfan) and 2011 (of 14 other pesticides); and nationally in 2011 (of endosulfan). NCRB data indicate that pesticides were used in 441,918 reported suicides in India from 1995-2015, 90.3% of which occurred in 11 of the 29 states. Time series analysis demonstrated statistical evidence of lower than expected rates of pesticide suicides and total suicides nationally after the 2011 endosulfan ban. In Kerala, there was a lower than expected rate of pesticide suicides but no change to the already decreasing trend in total suicides after both the 2005 ban of endosulfan and the 2011 ban of 14 pesticides. Discussion: Highly hazardous pesticides continue to be used in India, and pesticide suicide remains a serious public health problem. However, some bans of pesticides do appear to have impacted previous trends in the rates of both pesticide suicides and all suicides. Comprehensive national bans of highly hazardous pesticides could lead to a reduction in suicides across India, in addition to reduced occupational poisoning, with minimal effects on agricultural yield.

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“…A 2019 systematic review on pesticide suicide prevention concluded efforts focused on in-home storage should end, with energy instead shifted to community-based, centralized storage options (Reifels et al, 2019). Notably, this systematic review was funded by the pesticide industry and, while methodologically sound, overstated the promise of community-based programming (Knipe and Eddleston, 2019).…”

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confidence: 99%

Firearms, pesticides, and suicide: A look back for a way forward

Betz

Anestis

2020

Preventive Medicine

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Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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Response to Reifels et al., Suicide and Life‐Threatening Behavior

Cited by 6 publications

References 5 publications

Suicide by pesticide poisoning in India: a review of pesticide regulations and their impact on suicide trends

Suicide by pesticide poisoning in India: a review of pesticide regulations and their impact on suicide trends

Regulation of highly hazardous pesticides in India - implications for suicide prevention

Firearms, pesticides, and suicide: A look back for a way forward

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