The data for the present study was part of a major government-funded project. The study protocol was approved by the departmental ethical committee. All the study participants provided informed written consent. The study comprised of 206 suicide decedents (66 females and 140 males) and 150 suicide attempters (81 females and 69 males). Suicide decedents and suicide attempters were identified from Mahatma Gandhi Memorial Hospital Warangal, Telangana, with due permission from competent authority. Suicide was defined as the act of deliberately killing oneself (World Health Organization 2014). Suicide attempt was defined as self-inflicted, potentially injurious behavior with the non-fatal outcome for which there is evidence (implicit or explicit) of intent to die (Silverman et al. 2007).
Based on the secondary data provided by the hospital, 35 villages with a high proportion of suicidal cases and located up to 40 km from Warangal city were selected for conducting fieldwork. Before conducting fieldwork in the villages, the local village head (sarpanch) or representative of the municipal corporation (for census town) were met to confirm the suicide death and obtain additional suicide cases not reported to MGM Hospital. Further, their help was sought for household identification of the cases and rapport establishment with study participants. The key informant of suicide decedents comprised of spouse (28.8%), parents (19.4%), children (15.5%), siblings (10.2%), grandparents (2.9%), other blood relatives (9.7%), in-laws (13.1%), and neighborhood friends (4.4%). The key informants were contacted minimum 2 months after bereavement period.
The semi-structured interview was tested and modified during a pilot survey conducted in September 2016. The fieldwork of the present study was conducted over the tenure of 5 months. The data was collected by Ph.D. research scholars who were extensively trained prior to fieldwork. Since the fieldwork was in Telangana, an interpreter assisted the researchers during fieldwork for local language assistance. The refusal rate was 9.4% for suicide decedents and 9.1% for suicide attempters.
Suicide attempters and key informants of suicide decedents were interviewed for 30–45 min face to face to collect data on sociodemographic and characteristics of suicidal behavior, similar to the methodology used in the previous studies by DeJong et al. 2010 and Giner et al. 2013. The semi-structured interview schedule comprised of sociodemographic variables such as age, sex, caste, religious affiliation, marital status, family type, education, occupation, tobacco usage, or alcohol consumption. The semi sturctured interview was adapted from NCRB proforma (NCRB 2017). The socioeconomic status was measured using the Udai Pareek socioeconomic scale used for rural populations in India (Raj et al. 2015).
Suicidal behavior characteristics
The suicidal behavior characteristics comprised of the season, the method employed, family history of suicidal behavior, self-history of the previous attempt, alcohol intoxication during suicidal act, and reason for the suicidal act. In the present study, the method of suicide was bifurcated into either violent method (such as self-immolation, drowning, hanging, sharp self-inflicted injury, getting run over by moving vehicle) or non-violent method (such as poisoning) (Asberg et al. 1976).
The suicide cause was classified into four categories: (1) economic cause comprising of reasons such as bankruptcy or indebtedness due to crop loan or farm equipment loan or nonagricultural loan, failure of crop, poverty, career or professional problems, and unemployment; (2) health-related cause comprising of reasons such as alcohol addiction or prolonged illness; (3) marriage-related cause comprising of reasons such as non-settlement of marriage, extramarital affairs, or dowry-related issues; and (4) personal or social-related cause comprising of reasons such as family problems, property dispute, love affair, death of dear person, failure in examination, impotency or infertility, ideological issues/hero worship, and fall in social reputation (Dandona et al. 2016) In the present study, 3.3% of the suicide attempters did not share the cause of their suicide attempt while 9.7% of the key informants of suicide decedents were unaware of the reason for suicide.
In the present study, data analysis was performed in SPSS version 20 (IBM—SPSS Inc. Chicago, IL). In the present study, univariate analysis using binary logistics to compute relative risk of sociodemographic and suicide-related characteristics for suicide in comparison to suicide attempt was performed. Further multivariate backward stepwise regression was performed comprising of variables significant in univariate analysis. The predictors variables included in the multivariate backward stepwise regression were age, sex (female as reference), caste (forward caste as reference), religious affiliation (minority as reference), occupation(employed as reference), Udai Pareek socioeconomic score, alcohol consumption (no alcohol consumption as reference), season (winter as reference), method employed (nonviolent as reference), previous suicide attempt (no history as reference), and reason for suicidal act, i.e., economic, health, marriage, or personal/social (one group at risk while the other three groups as reference). All the statistical tests were considered significant at two tailed p < 0.05.