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EDITORIAL
Year : 2019  |  Volume : 28  |  Issue : 1  |  Page : 1-3  Table of Contents     

Occupation-related suicide


1 Department of Psychiatry, AFMC, Pune, Maharashtra, India
2 Department of Psychiatry, Dr DY Patil Medical College, Dr DY Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission19-Sep-2019
Date of Acceptance11-Nov-2019
Date of Web Publication11-Dec-2019

Correspondence Address:
Dr. Suprakash Chaudhury
Department of Psychiatry, Dr DY Patil Medical College, Dr DY Patil Vidyapeeth, Pimpri, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipj.ipj_77_19

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How to cite this article:
Srivastava K, Chaudhury S, Bhat P S, Prakash J. Occupation-related suicide. Ind Psychiatry J 2019;28:1-3

How to cite this URL:
Srivastava K, Chaudhury S, Bhat P S, Prakash J. Occupation-related suicide. Ind Psychiatry J [serial online] 2019 [cited 2020 Jun 1];28:1-3. Available from: http://www.industrialpsychiatry.org/text.asp?2019/28/1/1/272700



Suicide in farmers has been grabbing headlines in India for the past decade. In addition to farmers, suicide also occurs frequently among students, the self-employed, unemployed, and homemakers. A great deal of discussion and debate that has taken place on this topic, in print and electronic media, is high on rhetoric but short on reasoned analysis. Let us attempt to make a rational analysis.

Official figures of suicide in India are available from the National Crime Records Bureau. Comparison of total suicides in 2000 and 2015 indicates a whopping 23.05% increase in total suicides, which should grab the headlines and send alarm bells ringing [Table 1]. However, in the same period, the estimated population of India has increased by 25.65%. Therefore, while the total number of suicides has certainly increased, this is in proportion to the increase in population, and there has been no increase in the rate of suicides.[1],[2],[3],[4]
Table 1: Number of suicides, growth of population, and rate of suicides in India during 2000-2015

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The figures do not indicate significant rise in suicide rates as per available data. In fact, the suicide rate in India in 2000 was 10.8/100,000, and despite some rise in-between, the rate was 10.6/100,000 in 2015 [Table 1]. Similarly, the suicide rate in the United Kingdom during 2011 and 2015 was 12/100,000, whereas in the United States during the period 2001–2017, the suicide rate increased from 10.7 to 14.0/100,000.[5],[6]

Suicide is a complex multifactorial phenomenon. Among the many causal factors, occupation does figure prominently. Most studies agree that unemployment is an important cause of suicide. Among the working population, studies indicate that certain occupations are associated with a higher suicidal risk than others. Despite the importance of the topic, the literature is sparse.[7]

The first literature review of occupation and suicide was by Bedeian who highlighted that suicide rates vary according to the occupation, although his review was limited to health-care workers, managerial and professionals, and military and paramilitary personnel.[8] Subsequently, the literature from 1982 to 1995 was reviewed by Boxer et al. who reported a higher risk of suicide in police officers, chemists, and farmers. In addition, both male and female doctors have an increased risk of suicide.[9] Both the authors highlighted numerous methodological limitations of the early studies including small samples, specific location, limited to specific occupations or industries, and ignoring potential confounders such as age and gender. The systematic review and meta-analysis of 34 studies performed by Milner et al. used a rigorous methodology that was an improvement on the past narrative reviews. However, their study examined the relation of suicide risk and occupational skill level and not specific occupations. They observed an increased suicide risk in skilled agricultural, forestry, and fishery workers compared to the working-age population (rate ratio: 1.64, 95% confidence interval: 1.19–2.28).[10]

Most of the studies carried out to evaluate the relation of suicide with occupation and industry were limited in scope to workers of one or few industries or occupation. The distribution of suicide in India according to profession shows that the highest suicide risk was in daily wage earners followed by homemakers, farmers, those in business-related activities, and the unemployed [Table 2]. Some earlier studies from the USA have observed an increased risk for suicide among miners, forestry and construction workers, chemists, police officers, physicians, social workers, and artists.[11]
Table 2: Distribution of suicide in India according to profession

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Data from the Office of National Statistics reveal that in England in adults below the age of 50, the leading cause of death is suicide. The suicide risk in male low-skilled laborers, especially construction workers, was three times higher than the male national average, whereas the risk among males in skilled trades was 35% higher. Among male skilled tradesman, the highest suicide risk was in building finishing trades, namely plasterers, painters, and decorators. The suicide risk was higher than the national average for both males and females in culture, media, and sports occupations. The suicide risk for female health professionals was 24% higher than the female national average, largely due to high suicide risk in female nurses. Females in the teaching profession had a lower suicide risk, but primary and nursery school teachers had an elevated risk. The highest-paid occupation – group managers, directors, and senior officials – had the lowest suicide risk.[5]

In the U.K., high suicide risk is associated with the following occupations: farmers, doctors, nurses, dentists, veterinarians, pharmacists, the police, the military, sailors, and artists. A major determinant of high suicide rates in most of these occupations is the ease of accessing the means to commit suicide (medicines, chemicals, guns, or drowning). Socioeconomic forces now seem to be a major determinant of high occupational suicide rates in Britain.[12]

A Japanese study of working-age men (25–59 years) revealed that for the year 2010, the highest incidence rate of suicide was in agriculture (54.7) followed by service (51.3), administrative and managerial (46.8), construction and mining (28.5), transport and machine operation (22.9), professional (22.2), and security (19.4). A unique feature of Japan is that unlike in many other countries, managers, professionals, and government officers have a higher risk of suicide.[13] A recent systematic review and meta-analysis of 32 studies revealed a significantly higher risk of suicide in agriculture, forestry, and fishery, and this may be even higher in Japan.[7]

In general, results from these studies suggest that stress and access to lethal compounds contribute to suicide. Stressors noted derive from such factors as work overload, threats to job security, malpractice lawsuits, various forms of harassment, and exposure to neurotoxic substances. Other investigators indicate that economic factors, such as low income and job loss, increase the risk of suicide.[12],[13],[14] However, among Indians, family disputes and chronic illnesses were the major risk factors accounting for 69.59% of suicides, while surprisingly, other risk factors such as problems relating to marriage, love affairs, substance use disorders, failure in examination, bankruptcy, unemployment, and poverty had a relatively lesser share.[15]

Evidence-based intervention strategies to prevent suicide include general measures such as reducing stigma and improving access to psychiatric care, restricting access to means of suicide, responsible media reporting and improving knowledge about mental health, use of addictive substances, and suicide. In addition, specific intervention for vulnerable populations include gatekeeper training among teachers, police and military officers, and human resource staff and managers. Other industry-specific initiatives include the Construction Industry Alliance for Suicide Prevention and intervention in military and veteran population in the USA.[16],[17] A successful workplace suicide prevention program was the multifaceted, comprehensive police suicide prevention program in Montreal that resulted in a 79% decrease in the suicide rate among police personnel. The police suicide prevention program comprises half-day training on suicide focusing on risk identification and how to provide help to officers in the police force, while supervisors and union representatives received a full day of training. A telephone helpline was established for police personnel. Simultaneously, a publicity campaign was launched on the importance of working together in suicide prevention and providing resources for help.[18]

The consensus is that despite wide regional disparities, certain occupations are associated with a higher suicide rate including agriculture, construction, mining, service, transport, security, medical, and paramedical staff. However, in India, homemakers seem to be at particular risk. Identification of occupations and industries associated with a higher risk of suicide will help us in carrying out focused studies to evaluate the causal factors and formulate targeted comprehensive suicide prevention interventions to combat the risk of suicide. There is a need for carrying out larger multicenter studies which should be repeated periodically to assess changing trends and also the effects of interventions. There are no quick-fix solutions, and a sustained long-term strategy is needed.



 
   References Top

1.
National Crime Records Bureau. Accidental Deaths and Suicide in India 2000. New Delhi: Ministry of Home Affairs, The Government of India; 2002.  Back to cited text no. 1
    
2.
National Crime Records Bureau. Accidental Deaths and Suicide in India 2005. New Delhi: Ministry of Home Affairs, The Government of India; 2006.  Back to cited text no. 2
    
3.
National Crime Records Bureau. Accidental Deaths and Suicide in India 2010. New Delhi: Ministry of Home Affairs, The Government of India; 2011.  Back to cited text no. 3
    
4.
National Crime Records Bureau. Accidental Deaths and Suicide in India 2015. New Delhi: Ministry of Home Affairs, The Government of India; 2016.  Back to cited text no. 4
    
5.
Windsor-Shellard B. Suicide by Occupation. England: Office for National Statistics; 2011-2015. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/suicidebyoccupation/england2011to2015. [Last accessed on 2019 Sep 19].  Back to cited text no. 5
    
6.
National Institute of Mental Health. Suicide. Bethesda, MD: National Institute of Mental Health; 2019. Available from: https://www.nimh.nih.gov/health/statistics/suicide.shtml. [Last accessed on 2019 Sep 19].  Back to cited text no. 6
    
7.
Klingelschmidt J, Milner A, Khireddine-Medouni I, Witt K, Alexopoulos EC, Toivanen S, et al. Suicide among agricultural, forestry, and fishery workers: A systematic literature review and meta-analysis. Scand J Work Environ Health 2018;44:3-15.  Back to cited text no. 7
    
8.
Bedeian AG. Suicide and occupation: A review. J Vocat Behav 1982;21:206-23.  Back to cited text no. 8
    
9.
Boxer PA, Burnett C, Swanson N. Suicide and occupation: A review of the literature. J Occup Environ Med 1995;37:442-52.  Back to cited text no. 9
    
10.
Milner A, Spittal MJ, Pirkis J, LaMontagne AD. Suicide by occupation: Systematic review and meta-analysis. Br J Psychiatry 2013;203:409-16.  Back to cited text no. 10
    
11.
Kposowa AJ. Suicide mortality in the United States: Differentials by industrial and occupational groups. Am J Ind Med 1999;36:645-52.  Back to cited text no. 11
    
12.
Roberts SE, Jaremin B, Lloyd K. High-risk occupations for suicide. Psychol Med 2013;43:1231-40.  Back to cited text no. 12
    
13.
Wada K, Eguchi H, Prieto-Merino D, Smith DR. Occupational differences in suicide mortality among Japanese men of working age. J Affect Disord 2016;190:316-21.  Back to cited text no. 13
    
14.
Chaudhury S, Murthy PS, Srivastava K, Bakhla AK, Rathee SP. Socio-demographic and clinical correlates of attempted suicide. Pravara Med Rev 2012;4:21-5.  Back to cited text no. 14
    
15.
Kamalja KK, Khangar NV. A statistical study of suicidal behavior of Indians. Egypt J Forensic Sci 2017;7:12.  Back to cited text no. 15
    
16.
Matthieu M, Hensley M. Gatekeeper training outcomes: Enhancing the capacity of staff in substance abuse treatment programmes to prevent suicide in a high risk population. Ment Health Subst Use 2013;6:274-86.  Back to cited text no. 16
    
17.
Schoenbaum M, Kessler RC, Gilman SE, Colpe LJ, Heeringa SG, Stein MB, et al. Predictors of suicide and accident death in the army study to assess risk and resilience in servicemembers (Army STARRS): Results from the army study to assess risk and resilience in servicemembers (Army STARRS). JAMA Psychiatry 2014;71:493-503.  Back to cited text no. 17
    
18.
Mishara BL, Martin N. Effects of a comprehensive police suicide prevention program. Crisis 2012;33:162-8.  Back to cited text no. 18
    



 
 
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  [Table 1], [Table 2]



 

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