Severity of suicidal intent, method and behaviour antecedent to an act of self-harm: a cross sectional study of survivors of self-harm referred to a tertiary hospital in Mysore, south India.

BACKGROUND Rates of self harm are high in south India, but little is known about the relationship between antecedent behaviour, suicidal intent and method. Aims: To identify clinical, social and behavioural antecedents preceding an act of self-harm. METHODS 200 participants, consecutively presenting with deliberate self harm to a hospital in south India,were interviewed. Socio-demographic and clinical characteristics were recorded, together with behaviours preceding self-harm. The Pierce Suicidal Intent Scale and Mini International Neuropsychiatric Inventory were administered. RESULTS Pesticide poisoning was the most common method, especially amongst men, in rural areas, and amongst professionals. No particular antecedent behaviour or activity appears to be associated with higher levels of suicidal intent. Absenteeism from work was the most commonly reported change of behaviour in the month preceding an act of self-harm. Unskilled labourers and professionals had significantly greater suicidal intent (adjusted for age, gender and method) than skilled labourers and the unemployed. There were no differences in suicidal intent between different methods. Rural dwellers had significantly greater suicidal intent compared to urban dwellers, irrespective of the method. Major Depressive Disorder was associated with significantly greater suicidal intent compared with other diagnoses and no diagnosis. CONCLUSIONS Amongst people who harm themselves in south India, professionals and unskilled labourers, rural residents, and people with current major depressive disorder have higher levels of suicidal intent. Severity of suicidal intent does not appear to influence choice of method of self-harm. Behaviours predictive of self-harm in the west may not be relevant in south India.