Looking at Robin Williams’ death: The lowdown on being low
Robin Williams’ death put the spotlight on depression and suicide. Few people know that depression is second only to heart disease in lowering productivity and quality of life. Sanchita Sharma writes.health and fitness Updated: Aug 17, 2014 09:56 IST
If actor Robin Williams lived in India and had survived his suicide, he would be facing a year-long jail sentence. Under Section 309 of the Indian Penal Code, “Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with simple imprisonment for a term which may extend to one year one [or with fine, or with both].
“Attempted suicide is an act of desperation… a cry for help from troubled minds, but the law doesn’t see it as such,” says Dr Rajesh Sagar, associate professor of psychiatry at New Delhi’s All India Institute of Medical Sciences (AIIMS). “Add to this social stigma, not just against the person but the family, and we have a situation where both attempted and successful suicides are reported as accidents, if at all.”
India’s Mental Health Care Bill, 2013, seeks to change this by decriminalising suicide and treating those attempting suicide as mentally ill, unless proved otherwise.More than one lakh persons (1,35,445) committed suicide in 2012, with the numbers increasing by 22.7% (1,35,445 in 2012 from 1,10,417 in 2002) over the past decade, data from the National Crime Records Bureau (NCRB) shows. The numbers are closer to 2 lakh, estimates the World Health Organisation, but the few community studies that there are in India indicate that the numbers are higher, especially among the young.
1,35,445 people committed suicide in 2012, with the numbers increasing by 22.7% over the past decade (Source: National Crime Records Bureau)
Verbal autopsy to assign a cause of death of 10-19-year-olds in a population of 108,000 in Vellore district in Tamil Nadu showed that the average suicide rate for girls was 148 per 1 lakh population and 58 for boys (R Aaron et al, Lancet). Tamil Nadu reported the highest suicides in 2010 and 2012, and third highest in 2011, accounting for 12.3%, 11.8 and 12.5% of total deaths, shows NCRB data.
In India, more young women kill themselves than men, unlike the rest of the world where men are three times more likely to kill themselves.
The gender bias in suicide numbers exists not just because of the psychological disorders such as depression and anxiety occur more often in women, but also because gender disparity starts emerging at puberty. Social factors such as subjugation of women add to the problem, making many young women feel helpless and frustrated.
What makes a difference is family and social support. “People with suicidal thoughts should be helped in identifying ‘counters’ that would stop them from taking their lives. These counters differ with people, and include religion, children, family, responsibilities, fear of being called a coward, among others,” says Dr Samir Parikh, head of psychiatry, Fortis Hospitals. “You have to give them some hope to live.”
‘Psychological counters’, such as fixing a day to meet help, as does being around to stop the person from slipping into an abyss of hopelessness.
Drugs and treatment are a must if the condition is chronic (lasts for more than four weeks), recurrent (bouts of depression occur three four times a year), or, the mood interferes with your ability to function normally for more than two weeks.
Spotting signs early
In several cases, signs of depression appear as early as adolescence. Globally, depression among 9-17-year-olds is more than 6%, with 4.9% suffering from clinical depression that lasts more than four weeks. Before puberty, boys and girls are equally likely to develop depressive disorders. But after 14 years of age, women are twice as likely as men to have major depression, says the World Health Organisation.
The numbers are no different for India. Paediatric depressive disorders vary between 1.2% and 5.6% in under-16s, reports the Indian Journal of Medical Research. A study from the Child and Adolescent Clinic at AIIMS reports that the onset of symptoms was before age 12 in 42.2% cases (Indian Paediatrics, 2012).
“Depression and substance abuse (alcohol and drug addiction) often go hand-inhand. Ninety percent people who commit suicide have a psychiatric disorder and 75% are clinically depressed,” says Dr Parikh.
The New Mental Health Care Bill promises a lot, but to implement even a fraction of the plans, India needs to meet its shortfall of 8,000 psychiatrists, 17,000 clinical psychologists, 23,000 psychiatric social workers and 9,000 psychiatric nurses. As against the 30,000 beds needed for the mentally ill, India has a little more than 200, shows data from the Union health ministry.