Letter to the Editor: Problems with studying community-level pesticide storage to prevent suicide

Abstract

An estimated 28.75% of the world's suicides occur in India [1,2], emphasising the need for evidencebased interventions for suicide prevention that are particular to India and South Asia. We therefore read with great interest Pathare and colleagues' study protocol for a cluster-randomised controlled trial evaluating a programme of three interventions in Gujarat, India [3].The approach includes a secondary school intervention to reduce suicidal ideation among adolescents, a community-level pesticide storage facility to reduce access to pesticides at moments of crisis, and training for community health workers in recognition, management, and referral of people at high suicide risk. Follow-up is planned for up to 12 months. We note that the design of the study, with the rate of suicide and attempted suicide by all means as the primary outcome, will not allow the effect of any one intervention to be tested or quantified.Lethal pesticide self-poisoning is a particularly important means of suicide in India, because it is common (responsible for 30-40% of all suicides [4,5]) and quite preventable. The role of the second intervention-pesticide storage-as a way of preventing suicides is therefore important to understand.The World Health Organization (WHO) has supported several pilot studies to assess the feasibility of improved pesticide storage to prevent pesticide self-