Non-suicidal self-injury and suicidal behaviors among youth in India: An investigation of their prevalence and psychosocial risk factors

According to official statistics in India, roughly one out of every three suicides is by a young person aged 18 to 29 years.Yet there is limited research on suicidal behaviors and other non-fatal self-harming behaviors such as non-suicidal self-injury (NSSI) among Indian youth.In the Indian cultural context, knowledge of local epidemiology, especially the identified risk factors, is vital to the formulation of effective strategies to prevent suicidal behaviors and NSSI.The present research therefore aimed to investigate the prevalence and psychosocial correlates of NSSI and suicidal behaviors in a community-based sample of college youth in India.Guided by social-ecological perspectives, the premise of this research was that risk pathways for these behaviors emerge via interactions between individual characteristics and environmental factors.The research reported in this dissertation comprised two separate studies, each of which followed a distinct line of inquiry but collectively contribute to a cultural understanding of NSSI and suicidal behaviors.Study 1 was focused primarily on NSSI while Study 2 focused on suicidal behaviors.Data for both studies was collected from 1,817 undergraduate students (1,017 female, 793 male) in the western state of Gujarat.Study 1 sought to investigate the prevalence and psychosocial correlates of NSSI.A second objective was to identify risk factors for suicide ideation among those with NSSI history.Results showed that about 7.8% of the sample reported engaging in NSSI.Logistic regression analysis revealed that risk for NSSI was significantly associated with higher income, living alone, family-related stress and psychological distress.Among those with a history of NSSI, the risk for suicide ideation was significantly increased by female gender, economic stress, and psychological distress, but not NSSI severity.Study 2 sought to identify psychosocial risk factors for suicidal behaviors (ideation and attempt).Recent research indicates that in the context of a rapidly globalizing culture, one emerging concern is the rise of a consumerist culture that promotes materialistic aspirations.Studies Running head: NSSI AND SUICIDAL BEHAVIORS AMONG INDIAN YOUTH iii have found that individuals who focus on materialistic or extrinsic aspirations at the cost of intrinsically satisfying ones report poorer mental health.Therefore a second objective of Study 2 was to examine whether extrinsically or intrinsically motivated aspirations moderated the relationship between psychosocial risk factors and suicidal behaviors.Results showed that about 12.7% of participants reported a lifetime history of suicidal behaviors.Results of logistic regression analyses revealed that economic stress, social stress and psychological distress predicted suicidal behaviors.When the moderating role of aspirations was tested, results showed that placing greater importance on extrinsic aspirations increased the risk of suicidal behavior in the presence of social stress while valuing intrinsic aspirations buffered against risk.Findings draw attention to the social pressures faced by youth and the role of inherently satisfying goal pursuits in buffering the adverse effects of social pressures.Taken together, results from this research indicate that risk factors for NSSI and suicidal behaviors span individual, familial, societal and wider cultural levels, underscoring the need for multipronged prevention and intervention strategies that are aligned with these multiple contexts.Culturally meaningful approaches to help students at risk for suicidal behavior and NSSI may be developed at both the individual as well as institutional level, consistent with a social-ecological model for suicide prevention.Running head: NSSI AND SUICIDAL BEHAVIORS AMONG INDIAN YOUTH iv Résumé Selon les statistiques officielles, en Inde environ le tiers des suicides sont commis par des jeunes âgés de 18 à 29 ans.Pourtant, il existe très peu de recherches sur les comportements suicidaires chez les jeunes Indiens et encore moins de recherches sur l'automutilation non suicidaire (AMNS).Dans le contexte culturel indien, la connaissance de l'épidémiologie locale, notamment les facteurs de risque identifiés, est essentielle à l'élaboration de stratégies efficaces pour prévenir les comportements d'automutilation suicidaire et non suicidaire.Le présent programme de recherche visait donc à étudier la prévalence et les corrélats psychosociaux de l'AMNS et les comportements suicidaires au sein d'un échantillon communautaire de jeunes universitaires indiens.S'appuyant sur des perspectives socioécologiques, cette recherche reposait sur la prémisse que les trajectoires de ces comportements à risque émergent des interactions entre les caractéristiques individuelles et les facteurs environnementaux.Le programme de recherche présenté dans cette thèse comprenait deux études distinctes, chacune adoptant un axe d'enquête différent, mais contribuant conjointement à une compréhension culturelle de l'AMNS et des comportements suicidaires.L'étude # 1 était axée principalement sur l'AMNS alors que l'étude # 2 a porté sur les comportements proprement suicidaires.Les données pour les deux études ont été recueillies auprès de 1 817 étudiants de premier cycle (1 017 femmes, 793 hommes) dans l'ouest de l'état du Gujarat.L'étude # 1 visait à étudier la prévalence et les corrélats psychosociaux de l'AMNS.Un deuxième objectif consistait à identifier les facteurs de risque en lien avec les idées suicidaires chez les personnes ayant des antécédents d'AMNS.Les résultats ont montré qu'environ 7,8 % des sujets de l'échantillon ont indiqué pratiquer l'AMNS.L'analyse de régression logistique a révélé que le risque d'AMNS était fortement associé à un revenu plus élevé, au fait de vivre seul, au stress familial et à la détresse psychologique.Parmi ceux et celles ayant des antécédents d'AMNS, on observe que le fait Running head: NSSI AND SUICIDAL BEHAVIORS AMONG INDIAN YOUTH viii "tomatoes".My time at McGill would not have been the same without Ajay Venkateswaran.His kindness, warmth, endless support, and incredible humor helped me stay afloat throughout this process.I cherish our friendship and thank him for being there for me, always.My heartfelt thanks to Sanjeev Marwaha for his kindness, support and friendship.I am so thankful to the Thapa family for their warmth, love and fun times with the family.I especially thank Parakram for his help with data analysis.Above all, I feel truly blessed to have such a wonderful family.They have been instrumental in helping me achieve my academic, professional and personal goals and without them I would not be where I am.Thank you to my lovely in-laws Radhika and Jatin Singh, for their patience and love, and allowing me the space and time to pursue my goals.To my fantastic partner Ashwan for being by my side and supporting me even when it meant we had to be apart.I am very grateful to him for understanding and accommodating my needs and adjusting to the demands of my academic goals.I am so thankful for the boundless love of my wonderful siblings: Kedar and Swarnima.They have been pillars of strength throughout this long and difficult doctoral journey.My accomplishments would not have been possible without the support of my parents, Dr

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