PROBLEMS

    SUICIDES

    About 800,000 people commit suicide worldwide every year, of these 135,000 (17%) are residents of India, a nation with 17.5% of world population.

    Between 1987 to 2007, the suicide rate increased from 7.9 to 10.3 per 100,000, with higher suicide rates in southern and eastern states of India.

     In 2012, Tamil Nadu (12.5% of all suicides), Maharashtra (11.9%) and West Bengal (11.0%) had the highest proportion of suicides. Among large population states, Tamil Nadu and Kerala had the highest suicide rates per 100,000 people in 2012. The male to female suicide ratio has been about 2:1.

    Estimates for number of suicides in India vary. For example, one study projected 187,000 suicides in India in 2010, while official data by the Government of India claims 134,600 suicides in 2010.

    Age and Suicide in India

    In India, about 46,000 suicides occurred each in 15-29 and 30-44 age groups in 2012 - or about 34% each of all suicides.

    Top three States with highest suicide rates are Sikkim, Tamil Nadu and Kerala respectively, while Bihar recorded lowest suicide rates.

    SOURCE "Suicidal Deaths in India, 2012" (PDF). NCRB, Government of India. 2012. p. 173. Retrieved April 21, 2014.

     A Nimhans study under way has found that 11% of college students and 7%-8% of high school students have attempted suicide. In the survey, 1,500 school and college students were studied on suicide prevention.

    DEPRESSION

    A recent large population-based study from South India, which screened more than 24,000 subjects in Chennai using Patient Health Questionnaire (PHQ)-12 reported overall prevalence of depression to be 15.1% after adjusting for age using the 2001 census data.

    In another recent study, Nandi et al. compared the prevalence of depression in the same catchment area after a period of 20 years (first in 1972 and then in 1992) and reported that the prevalence of depression increased from 49.93 cases per 1000 population to 73.97 cases per 1000 population.

    Studies done in primary care clinics/centre have estimated a prevalence rate of 21-40.45%.

    Studies done in hospitals have shown that 5 to 26.7% of cases attending the psychiatric outpatient clinics have depression.

    CHILD SEXUAL ABUSE

    A significant study at the pan Indian level has been the National Study on Child Abuse (2007). This study, which is the largest of its kind, covered 13 states with a sample size of 12447 children, 2324 young adults and 2449 stakeholders. The National Study reported the following:

    o 53.18 % children in the family environment not going to school reported facing sexual abuse

    o 49.92% children in schools reported facing sexual abuse

    o 61.61% children at work (Shop, factory or other places) reported facing sexual abuse

    o 54.51% children on the streets reported facing sexual abuse

    o 47.08 % children in institutional care reported facing sexual abuse

    o 20.90% of all children were subjected to severe forms of sexual abuse that included sexual assault, making the child fondle private parts, making the child exhibit private body parts and being photographed in the nude

    o 50% abusers are persons known to the child or in a position of trust and responsibility

    From these studies, it’s that Child Sexual Abuse (CSA) does occur and it does not occur as a sporadic incident but it is a reality that touches at least 40%-50% of children’s life in India.

    Inspite of such grim statistics, currently there are only four organizations in India working on the issue in a focused manner. Hence the need is great to make people aware about this malaise in society and bring the issue out in the open and talk about I and PARI Foundation is determined to do so.

    DRUG ABUSE

    Psychoactive substance use poses a significant threat to the health, social and economic fabric of families, communities and nations. The extent of worldwide psychoactive substance use is estimated at 2 billion alcohol users, 1.3 billion smokers and 185 million drug users. Stress is an important pre-disposing factor to Drug ABUSE.

    Drug abuse risk can be conceptualized by the “Modified Social Stress Model”. The model proposes that an increased risk for drug use stems from distress + the normalization of drug use + the effect of drugs and risk of drug abuse due to decreased social attachments + coping strategies + resources for their development.

    World extent of psychoactive substance use

    Disability Adjusted Life Years (DALY) are calculated by adding the years of life lost due to premature mortality and the years of life lost due to living with disability. The years of life lost due to disability are determined from morbidity, where each disease has been given a certain disability weight, which is multiplied with the time spent with that disease, to arrive at the years of life lost due to disability.

    In an initial estimate of factors responsible for the global burden of disease, tobacco, alcohol and illicit drugs contributed together 12.4% of all deaths worldwide in the year 2000. Looking at the percentage of total years of life lost due to these substances, it has been estimated that they account for 8.9%.

    Percentage of total years of life lost

	Mortality (% of all deaths worldwide)	DALYs (% of total years of life lost)
Tobacco	8.8	4.1
Alcohol	3.2	4.0
Illicit drugs	0.4	0.8

    Substances abused

    Rapid situation assessments (RSA) are useful to study patterns of substance use. An RSA by the UNODC showed that cannabis (40%), alcohol (33%) and opioids (15%) were the major substances used.

    A Rapid Situation and Response Assessment (RSRA) among 5800 male drug users revealed that 76% of the opioid users currently injected buprenorphine, 76% injected heroin, 70% chasing and 64% using propoxyphene.

    Most drug users concomitantly used alcohol (80%).

    According to the World Drug of 81,802 treatment seekers in India in 2004-2005, 61.3% reported use of opioids, 15.5% cannabis, 4.1% sedatives, 1.5% cocaine, 0.2% amphetamines and 0.9% solvents.

    Substance abuse in medical fraternity

    As early as 1977, a drug abuse survey in Lucknow among medical students revealed that 25.1% abused a drug at least once in a month.

    Commonly abused drugs included minor tranquilizers, alcohol, amphetamines, bhang and non barbiturate sedatives.

    In a study of internees on the basis of a youth survey developed by the WHO in 1982, 22.7% of males ‘indulged in alcohol abuse’ at least once in a month, 9.3% abused cannabis, followed by tranquilizers.

    Common reasons cited were social reasons, enjoyment, curiosity and relief from psychological stress. Most reported that it was easy to obtain drugs like marijuana and amphetamines. Substance use among medical professionals has become the subject of recent editorials.

    Substance abuse among children

    The Global Youth Tobacco Survey in 2006 showed that 3.8% of students smoke and 11.9% currently used smokeless tobacco.

    Tobacco as a gateway to other drugs of abuse has been the topic of a symposium.

    A study of 300 street child labourers in slums of Surat in 1993 showed that 135 (45%) used substances. The substances used were smoking tobacco, followed by chewable tobacco, snuff, cannabis and opioids. Injecting drug use is also becoming apparent among street children as are inhalants.

    A study in the Andamans shows that onset of regular use of alcohol in late childhood and early adolescence is associated with the highest rates of consumption in adult life, compared to later onset of drinking.

    Studies in other populations

    A majority of 250 rickshaw pullers interviewed in New Delhi in 1986 reported using tobacco (79.2%), alcohol (54.4%), cannabis (8.0%) and opioids (0.8%). The substances reportedly helped them to be awake at night while working.

    In a study of prevalence of psychiatric illness in an industrial population in 2007, harmful use/dependence on substances (42.83%) was the most common psychiatric condition. A study among industrial workers from Goa on hazardous alcohol use using the AUDIT and GHQ 12 estimated a prevalence of 211/1000 with hazardous drinking.

    In Uttrakhand, it was found that 58.7% of the students had used one or more substances at least once in life,

    However, it was much higher than 34.2% as reported in a high school survey in Delhi; 18% in schoolchildren in Goa and 18% in students at Gorakhpur.

    Regular substance use was found to be 31.3% of youth.