Indian Journal of PsychiatryIndian Journal of Psychiatry
Home | About us | Current Issue | Archives | Ahead of Print | Submission | Instructions | Subscribe | Advertise | Contact | Login 
    Users online: 1560 Small font sizeDefault font sizeIncrease font size Print this article Email this article Bookmark this page
 


 

 
     
    Advanced search
 

 
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed934    
    Printed27    
    Emailed0    
    PDF Downloaded130    
    Comments [Add]    

Recommend this journal

 


 
 Table of Contents    
LETTER TO EDITOR  
Year : 2014  |  Volume : 56  |  Issue : 1  |  Page : 98
Methodological considerations in studying psycho-social aspects of suicide: Reply to the criticism


Department of Psychiatry, Kunhitharuvai Memorial Charitable Trust Medical College, Calicut, Kerala, India

Click here for correspondence address and email

Date of Web Publication9-Jan-2014
 

How to cite this article:
Suresh Kumar P N, Anish P K. Methodological considerations in studying psycho-social aspects of suicide: Reply to the criticism. Indian J Psychiatry 2014;56:98

How to cite this URL:
Suresh Kumar P N, Anish P K. Methodological considerations in studying psycho-social aspects of suicide: Reply to the criticism. Indian J Psychiatry [serial online] 2014 [cited 2019 Oct 21];56:98. Available from: http://www.indianjpsychiatry.org/text.asp?2014/56/1/98/124738


Sir,

Thank you very much for your positive criticism on the article "Psychosocial correlates of attempted suicide" published in the recent issue of Indian Journal of Psychiatry. As you have rightly indicated, we have attempted to explore the psychosocial aspects of attempted suicide with special reference to our own cultural background and tried to elucidate relevant prevention strategies specific to our population. The study is well conceptualized and the scales and questionnaires used are highly suitable for use in Indian population. However, we would like to clarify the methodological flaws that you have raised in your critical appraisal, which are as follows:

Universe of sample for controls was selected from the community. Age, sex, and marital status matched individuals who are not blood related to the cases and after screening by GHQ-12 [1] to rule out common mental disorders formed the control group. However, due to practical limitations, no other specific method was employed to recruit controls.

We do agree that, in screening controls, nothing would be as perfect as a detailed clinical examination by a mental health professional. But, due to time constraints and operational issues, we had to resort to a screening tool. GHQ may be poorer in picking up psychotic illness as compared with non-psychotic illness. But, it does not mean that GHQ cannot identify psychotic illness. Studies from Indian setting using GHQ-12 and, even shorter versions, have provided a reasonable yield of psychosis diagnosis. [2],[3]

Considering the overwhelming predominance of mental illness in suicides, finding respondents with no psychiatric illness or waiting for a period until all psychiatric illness has resolved to complete the evaluations may defeat the purpose of the whole study. This would affect the generalisability of the study population. With an increasing interval after the immediate emotional crisis, there could be recall bias and minimization, especially considering the fact that a major proportion of these attempts in India are impulsive in nature. In fact, a number of studies evaluating the psychosocial aspects of suicide attempters happened in an emergency room setting in the immediate aftermath of the attempt. [4],[5]

It seems unfair that, in patients with schizophrenia, one has to wait until their illness is in remission (which may take months or years) to do any assessment on their recent suicidal attempt. Also, in a study population including patients with personality disorders and substance use disorders, one can argue regarding the unreliability of responses for a variety of motives at various points in time after a suicide attempt. Therefore, isolating patients with psychosis in this regard does not seem appropriate.

Moreover, in this study, unreliable responses were unlikely. Inconsistencies in responses in the study subjects would have been mostly identified because a psychiatrist did the initial assessment (which included detailed history and mental status examination). In some cases (like students staying in hostels), friends or colleagues were able to give better information. Medical comorbidity has been assessed in both the groups, and no significant difference was found between them, as detailed in Table 1 of the original article. Albert Einstein College of Medicine Coping Styles Questionnaire [5] having 87 items has been wrongly quoted as 'AECOM Coping style scale' having 95 items.

 
   References Top

1.Goldberg D, Williams P. A user's guide to the general health questionnaire. Windsor: NFER-Nelson; 1998.  Back to cited text no. 1
    
2.Silvanus V, Subramanyan P. Epidemiological study of mental morbidity in an urban slum community in India for the development of a community mental health programme. Nepal Med Coll J 2012;14:13-7.  Back to cited text no. 2
    
3.Nebhinani N, Mattoo SK, Wanchu A. Psychiatric morbidity in HIV-positive subjects: A study from India. J Psychosom Res 2011;70:449-54.  Back to cited text no. 3
    
4.Zang J, Jia S, Jiang C, Sun J. Characteristics of Chinese suicide attempters: A emergency room study. Death Stud 2006;30:259-68.  Back to cited text no. 4
    
5.Blasco-Fontecilla H, Baca-Garcia E, Duberstein P, Perez-Rodriguez MM, Dervic K, SaizRuiz J, et al. An exploratory study of the relationship between diverse life events and specific personality disorders in a sample of suicide attempters. J Pers Disord 2010;24:773-84.  Back to cited text no. 5
    

Top
Correspondence Address:
P N Suresh Kumar
Department of Psychiatry, Kunhitharuvai Memorial Charitable Trust Medical College, Calicut, Kerala
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.124738

Rights and Permissions




 

Top