There are disturbing reports coming in from the UAE, Britain, USA, Trinidad, Malaysia and Fiji regarding suicide or attempted suicide among people of Indian origin living overseas. These reports and studies reveal that the rates of suicide and attempted suicide (Para suicide) are consistently higher among the Indian diaspora.

For example, a press release received last week by INDOLINK from Pravasi Bandhu Welfare Trust (PBWT), Sharjah, UAE, reveals: "Suicide among expatriate Indians is increasing alarmingly in GCC countries."

And it went on to give the following horror statistics. "There were three suicides recorded of Keralites in UAE this week, one in Dubai and two in Sharjah. In the last three months the number of reported suicides in UAE among Indians were 20, with a majority of them being Keralites. In the past year the total suicide cases among Indian expatriates are more than 50 in UAE alone."

K V Shamsudheen, Chairman of PBWT who initiated counseling services for NRIs in the UAE, explains that for most of the unskilled and semi-skilled NRIs in the Gulf, suicide is prompted by financial crisis resulting from the vast gap between soaring expectation and the ground reality. For example, says Shamsudheen, "many are coming here burdened with debt, going back on vacation by taking loan and retuning to their workplace again taking loan in India". In addition, he notes, "the living conditions of these middle and low income people are very pathetic."

He has called upon psychiatrists and sociologists who are ready to support PBWT's counseling effort "Sandwanam," to join in the team effort.

Consider the following news item from December 17, 2005: Suicide by two Indian workers in two days here has created a disquiet among expatriate community, raising the need to have labor officials trained in psychological counseling at Indian missions abroad. Shelva Kumar (25) from Chennai, committed suicide on Tuesday and Thomas Anthony (30), an accountant, committed suicide a day later after being found suffering from depression. Shelva Kumar, who had been earning a regular salary of 700 dhirams per month, plus an overtime of four dhirams per hour, ended his life because of mounting debts back home and the suicide of his sister, police sources told the Gulf News. Anthony, who came to Dubai about six months ago, wanted to return home after canceling his visa. According to consulate sources, in two other incidents, again involving Gulf NRIs, Vijayan Alwyn, an employee of DNATA, hailing from Kerala, and Zulfikar Qurani from West Bengal committed suicide owing to financial problems. Qurani took his life at the Arabtech labour camp and had been in the Emirates for last six months, they added. Several Indian associations expressed concern over the increasing incidence of suicide among workers and urged the Indian missions to start counseling centers in labor camps for the benefit of the workers.

Indeed, an India government study acknowledges that "difficult conditions of work, inclement weather, inability to participate in any social or cultural activities, concern for their families back home, and a troublesome feeling of emotional deprivation, have sometimes led to serious cases of mental depression and even suicide" among Indian workers in the Gulf countries.

Meanwhile, studies of women in the South Asian diaspora suggest the vulnerability of married women in immigrant communities, compared to native women. These studies reveal a strong link between marital and family problems and a wide range of health problems among Indians overseas.

Results of a recent study by Alison Karasz of the Albert Einstein College of Medicine, in NY, reported in Psychology & Developing Societies, Vol. 17, No. 2, 161-180 (2005), looked at marriage depression and illness among South Asian Americans. Conclusion: problems associated with marriage roles, including marital conflict, domestic overwork and isolation were seen as extremely serious and associated with mental health problems.

In a study on racism and mental health, Shaheen Ali, Co-Director of Across Boundaries: An Ethnoracial Mental Health Centre confirms that racism is a mental health issue. "Differences in health among people of color compared with white people, do not result from biological or genetic factors but from social, political and economic inequities...those on the receiving end of racism face higher risk of depression and suicide.

Among the first to conduct studies on suicide among Indian-Americans were S.P. Patel and A.C. Gaw of the Department of Psychiatry, Boston University Medical Center Hospital. They conducted a survey in 1995 “to increase awareness of suicide risk and to better understand social and psychological factors contributing to suicide in this group” of American immigrants.

Their findings: 1. Suicide rates of young women immigrants from the Indian subcontinent are consistently higher than those of their male counterparts and of young women in the indigenous populations of the countries to which they immigrate. 2. Use of violent methods such as hanging, burning, and poisoning is common among both men and women. Suicide rates among older men in this immigrant group have been reported to be low, although reports are less consistent 3.A disproportionately higher number of immigrant Hindus commits suicide. 4.Family conflict appears to be a precipitating factor in many suicides, whereas mental illness is rarely cited as a cause. Depression, anxiety, and domestic violence may contribute to the high rates.

The researchers conclude that more research is needed on the epidemiology of psychiatric illnesses and their contribution to suicide in this group.

When the "perceived causes of suicide attempts" were examined by Dinesh Bhugra in 180 ethnic South Asian women living in the London area, the three factors endorsed most frequently and strongly as causes of suicide attempts were violence by the husband, being trapped in an unhappy family situation, and depression.

Bhugra, of the Institute of Psychiatry, London, whose interests include cultural factors in the genesis and management of psychiatric disorders, outlined the reasons for the increase in attempted suicide in South Asian women: Gender-role expectations; Alienation from culture, especially one’s own but also from that of the majority population; Family conflict, e.g. with parents, partner; Domestic violence: by male members; Alcohol use in the family: by male members; Cultural conflict: liberal views v. traditional setting; Psychological distress expressed in the individual’s alienation and rejection of cultural values; Poor self-esteem.

In Fiji, Indo-Fijians who make up almost half the population of Fiji are five times more likely than indigenous Fijians to attempt or commit suicide, recent police statistics indicate. This trend has been consistent for at least five years.

Elsewhere in the diaspora, suicide and attempted suicide (Para suicide) have been receiving attention from mental health experts.

A Malaysian study by S.Ong and Y.K.Leng reports that both suicides and attempted suicides were heavily concentrated among the Indian ethnic group in Kuala Lumpur. They note that the percentage distribution by ethnicity of suicides and attempted suicides recorded by University Hospital was in stark contrast to the distribution of the population: The Indians form ten percent of the population but account for 30% of the suicides and 48% of the attempted suicides there.

In a study entitled "Suicide by poisoning" by G. Hutchinson at the Department of Medicine, General Hospital, Port-of-Spain, Trinidad, the author states that suicide rates were 54.4 % among PIOs, 42% among Afro-Caribbeans, 3% among people of mixed ethnic origin and 0.6% for Caucasians.

Furthermore the study reveals that "Lovers' quarrels" (35.4% of cases), psychiatric illness (27.8% of cases) and family disputes (27% of cases) were reported as the most frequent precipitating events in suicide. PIOs predominated in those suicides precipitated by "lovers' quarrels" and family disputes, accounting for 63.2% and 58.9% of these cases, respectively; while for those suicides in which psychiatric illnesses was the main precipitating event, Africans were represented by 53.3% and PIOs 45.3%. Depression was the most common psychiatric illness diagnosed. Paraquat was the most popular poison used in 63.7% of the suicidal cases, and other agrochemicals were used in 20% of cases.

It should be noted that while much of the previous research among Indians overseas has emphasized social and economic outcomes, only recently is attention being paid to psychological well-being or mental health. It is being recognized that, at an individual level, socio-economic stress, thwarted aspirations, racism, acculturation, culture clash with parents, loss of religious affiliation, difficulty with identity formation, and loss of family and community support may have effects on suicide risk.

Research among NRIs and PIOs populations suggest that a possible explanation for more negative impacts on women is that the decision to migrate is often made by the man. One study notes that in this case, ‘the woman is less aware of, and less prepared for, the difficulties that may be encountered in the country of resettlement’ . Other research indicates a reversed gender dynamic, with many immigrant women gaining more personal freedoms with migration, which in turn makes them less vulnerable to depression and suicidality.

Researchers also note that the effects of migration are likely to be mediated by a climate of xenophobia thereby heightening risk for suicidality among foreign- born nationals in countries of resettlement where racism and discrimination are. The impact of ‘cultural conflict’ compounded by intergenerational differences is noted particularly for young people of immigrant parents. One study reported that 76% of a sample of Asian American youths indicated that conflict with parents was a contributor and a ‘disciplinary crisis’ was the most common precipitant of a suicide attempt.

While suicidologists have tended to focus on suicide mortality, which is typically male and epidemiologically quite rare, non-fatal suicidal behaviour, which is typically engaged in by more women, is actually more common. Bhugra observes that the significance of marital violence as a specific factor in women’s suicidality is often obscured within the general and often vague categories of ‘family conflict’ and ‘marriage difficulties’.

Several studies of South Asian women in the UK note that the factors endorsed most frequently and strongly as probable precursors of suicidal behaviour are physical and sexual violence by the husband. Domestic violence was seen to be the dominant risk factor followed by ‘relationship problems’ with sexual assault accounting for 5% of responses.

Finally, S. Mehta of the Department of Psychology, Auburn University, conducted an interesting study on “Relationship between acculturation and mental health for Asian Indian immigrants in the United States”. Mehta looked at the relationship among several social and demographic variables, three aspects of acculturation (perception of acceptance, cultural orientation, and language usage), and three aspects of mental health (psychological distress, acculturative stress, and satisfaction). Conclusion: acceptance and cultural orientation play crucial roles in mental health, independent of various social and demographic variables. Feeling accepted by the host society and being involved with Americans and U.S. culture were related to better mental health.

WHATS BEING DONE?

The Hindu community in Trinidad was perhaps the first in the diaspora to establish a suicide prevention center at the El Sorroco Mandir in San Juan, Trinidad -- The National Hindu Lifeline/Suicide Prevention Center (NHL/SPC).

Dr. Hari D. Maharajh, specialist in psychiatry and nervous disorders, says the causes of suicide and attempted suicide in Trinidad and Tobago are lover's quarrels, interpersonal problems, cultural rigidity, marginalization, ethnic disadvantages, poverty, unemployment and family depression. "Alcoholism and drug abuse are also major contributory factors ...Why has the government been dragging its feet on this major social problem?" he challenged.

Dr. Maharajh feels that suicide is a national dilemma which has destroyed some of Trinidad's most vital young people in the prime of life. He said that there are definite ethnic differences, and all the evidence indicates that young East Indian females are more likely to attempt suicide than any other group.

Dr. John Bharath, Public Relations Officer of the suicide prevention center and a former member of Parliament, said that approximately 500 persons are being counselled every month. "I cannot venture to say how many of them would have committed suicide, but what I can say is that the majority of them came back to us expressing deep satisfaction and gratitude for putting back into their minds and hearts a sense of self-worth, love, a caring disposition and human dignity once again." Davan Ramkisson, a beneficiary of the center, said that because of the assistance he received, "I am putting my life back into order."

Explains Pundit Rambachan: "The Hindu woman is very apprehensive when it comes to speaking about her family problems or difficulties in her marriage...We thought it would be very apt if we opened a suicide prevention and counseling center in a Hindu temple, where a Hindu can feel safe in coming to a religious organization they are familiar with and see familiar faces-for example their family priest, like myself. We don't treat only Hindus or Indians. We treat people of every creed and every culture."

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