Suicide attempts in young people in India are a major public health concern but the reasons for these remain unclear. The aim of this study was to explore factors associated with suicide attempts in persons aged 15–29 years in India. We conducted a matched case–control study at a public hospital in the urban region of Pimpri-Chinchward, Pune, between 2019 and 2023. 15–29-year-olds who were admitted to the hospital following a suicide attempt (cases) were compared with 151 outpatients who presented at the general medicine department of the same hospital (controls). We administered a comprehensive semi-structured interview to participants in both groups and analysed the data using cox regression models. There were eight factors independently associated with suicide attempts. At the individual-level, these were: clinically significant depressive or anxiety symptoms over the last two weeks, previous suicide attempt, impulsivity, and low SES; alcohol use was significant only for males. Among the social factors, lack of exposure to suicide-related information in the last month, lack of social interactions over the last 12 months, and presence of interpersonal negative life events involving partners or family in the last 12 months were associated with suicide attempts. Descriptive data on life events revealed several relationship adversities, and the importance of acute interpersonal stressors in precipitating suicide attempts. A range of factors are associated with suicide attempts in young people in India which calls for a multifactorial approach towards suicide prevention. Not applicable.
Summary points Psychosocial rehabilitation is central to recovery-oriented mental health care, yet its uptake remains uneven because of persistent conceptual, methodological, organisational, and implementation barriers. Greater conceptual clarity is needed through stakeholder dialogue to establish a common set of core principles that can be adapted across diverse cultural and health system contexts. Meaningful co-creation with people with lived experience and their families should be embedded throughout the research and implementation cycle, from priority setting and intervention design to evaluation, scale-up, and dissemination. Evidence synthesis should adopt component-based and mechanism-informed approaches to identify the active components of psychosocial rehabilitation interventions and the mechanisms through which they produce change. Psychosocial rehabilitation should be recognised as a core component of mental healthcare, integrated from first contact and delivered across the continuum of care.
Postpartum depression (PPD) negatively affects maternal well-being and early child development (ECD). While research often focuses on the early postpartum depression, symptoms can emerge or persist later in the first year, potentially affecting mothers and children differently at this stage. Yet, the 12-month postpartum period remains understudied globally, particularly in low-resourced settings where contextual stressors are pronounced. This study addresses the urgent need to understand later-stage postpartum depression and how it influences child development at 18 months, a critical period for identifying early developmental delays. We analysed longitudinal data from a cluster randomised trial of an integrated mother-child intervention in rural India (Haryana). Mother-child dyads enrolled between 18 June 2015 and 1 July 2017 were assessed for PPD at 12 months using Patient Health Questionnaire-9 (PHQ-9) and for child development at 18 months with Bayley Scales of Infant and Toddler Development-III. We examined PPD risk factors using logistic regression and the association between PPD and ECD through multinomial regression models, accounting for covariates and clustering. Among 2007 mothers assessed at 12 months, PPD prevalence was 13.1
We present here the first bottom-up review of the lived experience of trans persons, co-written by experts by experience and academics. We sourced the medical and non-medical literature, focusing on first-person narratives, and critically extracted experiential themes, which were reviewed and appraised in collaborative workshops and eventually shared through a cloud-based system. Numerous experts by experience and academics from diverse gender, ethnic and cultural backgrounds were involved in the above steps and co-wrote the paper. The four overarching themes were: a) the lived experience of trans persons, b) the lived experience of gender affirmation, c) the experience of trans persons in the social and cultural context, and d) the lived experience of receiving care and support. The lived experience of trans persons is characterized by a rich diversity of gender identity experiences, which include identifying as male or female, or simultaneously as male and female and other genders, or as gender fluid. The first-person narratives indicate that common experiences may be of discovering an uncertain gender identity and feeling in the wrong body, together with some degree of mind-body disconnection. However, many trans individuals may feel satisfied with their bodies and identities. The lived experience of gender affirmation includes a process of searching for a bodily and mental redefinition of the self and - at times - fighting oneself to accept one's gender identity. Gender affirmation involves changes in the body to communicate the lived gender identity, as well as behavioral changes. The first-person narrative also highlights the emotional impact of gender affirmation, including the restoration of a sense of self, experiencing a strong emotional reaction to gender-affirming care, and, in a few cases, deciding to stop or reverse gender affirmation. The experience of trans persons in the social and cultural context can be characterized by an initial attempt to hide one's gender identity. This may be followed by coming out to others and wanting to be recognized by others in their lived gender. Exposure to high levels of transphobia, institutional discrimination and violence are commonly shared experiences. These include feeling wrong and dehumanized, pressured to "pass" as females or males, and suffering misgendering, deadnaming and verbal microaggressions. These experiences are frequently amplified by institutional discrimination and emotional, physical and sexual abuse. While some trans persons may struggle with family acceptance, others experience family and kinship structures as a safe base that provides support. Similarly, friends and romantic relationships may be experienced as sources of rejection or instead of happiness, resilience and restoration. The lived experience of seeking help and receiving general health care and support may be characterized by feeling rejected, disvalued and objectivized, but in other cases validated and cared for. Trans persons may feel lost in the maze of gender-affirming care and challenged when receiving a gender dysphoria diagnosis, although others experience a sense of relief. Mental health care may be feared, as individuals feel vulnerable and exposed, and regard it as a gatekeeping to receive gender-affirming care. In other cases, it is experienced as restorative and truly healing. The narratives provided in this paper have high educational and social value, informing medical and psychological practices and research as well as public health approaches, and promoting anti-discrimination policies and social change. This study gives voice to the lived experience of trans persons to overcome stigma and allow us to fully understand the varied nature of our gender expression and identity.
