title: Deliberate self-harm and suicide by pesticide ingestion in the Sundarban region, India.
abstract: OBJECTIVE
  To examine the clinical epidemiology, including case fatality and determinants of self-harm in six island blocks of the Sundarban region of West Bengal, India.
  
  
  METHODS
  We examined the clinical records of 1277 patients admitted for deliberate self-harm (DSH) to the six island hospitals from 1999 to 2001.
  
  
  RESULTS
  77.7% of the patients survived their attempt, 11.9% died and for 10.4% the outcome was not recorded. Women accounted for 65.2% of the DSH admissions and 67.1% of the deaths. Pesticides were the most commonly used means (88.7%). The case fatality of self-harm reported in these hospitals ranged from 6.0% to 50.0% (mean 13.3%; CI, 11.3-15.3). The age group 55-64 years was at highest risk of death, the age group 15-24 years at lowest risk. Higher lethality of pesticide ingestion compared to other methods was suggestive but not significant. Case fatality within the region varied but was high compared to industrialized nations. Case records and management of DSH were poor.
  
  
  CONCLUSIONS
  Effective DSH prevention in the Sundarban region would require better surveillance at clinical facilities and an intersectoral approach, linking the agricultural interests of pesticide safety and mental health interests for preventing DSH.
authors.affiliation: Institute of Psychiatry, Kolkata, India. s_o_h_i_n_i@rediffmail.com
authors.forename: Sohini
authors.initials: S
authors.lastname: Banerjee
authors.forename: Arabinda Narayan
authors.initials: AN
authors.lastname: Chowdhury
authors.forename: Esther
authors.initials: E
authors.lastname: Schelling
authors.forename: Arabinda
authors.initials: A
authors.lastname: Brahma
authors.forename: Mrinal Kanti
authors.initials: MK
authors.lastname: Biswas
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010575:Pesticides / Q000506:poisoning*; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D010575:Pesticides