Deliberate self-harm and suicide by pesticide ingestion in the Sundarban region, India

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. We examined the clinical records of 1277 patients admitted for deliberate self-harm (DSH) to the six island hospitals from 1999 to 2001. 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. 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.