Why women attempt suicide: the role of mental illness and social disadvantage in a community cohort study in India.

CONTEXT: The relative importance of illness (physical and mental) and social disadvantage as risk factors for suicide is controversial. OBJECTIVES: To describe the risk for attempted suicide in women when it is associated with social disadvantage and physical and mental illness. METHODS: Data were analysed from a population-based cohort study of women aged 18-50, in Goa, India (n = 2494). Baseline information was collected on socioeconomic factors, gender disadvantage and physical and mental illness. The main outcome was self-report attempted suicide (AS) over a 12-month study period. ORs were calculated using exact logistic regression. RESULTS: One-year incidence of AS was 0.8% (n = 18+1 completed suicide) and seven of these women had baseline common mental disorders (CMDs) (37%). In unadjusted models, CMDs (OR 8.71, 95% CI 2.86 to 24.43), exposure to violence (OR 7.70, 95% CI 2.80 to 22.21) and recent hunger (OR 6.59, 95% CI 1.83 to 19.77) were the strongest predictors of incident AS cases. However, in a multivariate model, exposure to violence (OR 5.18, 95% CI 1.55 to 18.75) and physical illness (OR 3.77, 95% CI 1.05 to 12.37) emerged as independent predictors of AS. CONCLUSIONS: Multi-pronged strategies to reduce domestic violence, provide poverty relief and improve treatment of mental and physical disorders are needed to reduce the population burden of attempted suicide.