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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Substance Dependence and Risk Factors for Suicide Attempt: A Retrospective Study
Correspondence Address :
Dr. Maithreyi Poguri,
Associate Professor, Department of Psychiatry, acs Medical College and Hospital, Chennai-600077, Tamil Nadu, India.
E-mail: maithpog@gmail.com
Introduction: Suicide is closely linked to substance abuse and it is one of the main component of premature death.
Aim: To assess the factors that affect the possibility of suicidal behaviour among persons who abuse substance.
Materials and Methods: The present study was a retrospective study which was conducted on 101 substance abuse patients who attempted suicide, and 101 substance abusers who have not attempted suicide. Data were collected regarding socio-demographic variables, legal problems (drunken driving/stealing/perpetrator in domestic violence or physical abuse or sexual abuse or homicide), hereditary and addiction data. The patient was diagnosed with substance dependence syndrome, Anxiety disorders, Depression disorder and Substance-induced psychosis based on The International Classification of Diseases (ICD) 10 criteria. The socio-economic status was assessed using Modified Kuppuswamy Scale.
Results: The mean age of the participants who had attempted suicide was 39 years, and those in the other was 43 years. In both the groups all subjects were males. The common abused substance was alcohol. There was a positive association between various demographic variables and attempted suicide, such as socio-economic status, education and place of residence. Early age of onset of substance abuse, abusing more than two substances, co-morbidity of psychiatry illness such as anxiety disorder, depression, and family history of psychiatry illness were the risk factors. In the ‘attempted suicide’ group, 74.2% of the participants abused drugs since more than 10 years, while it was 59.4% in the other group. There was also a positive association between the duration of abuse and attempted suicide.
Conclusion: An early age of onset of drug initiation, abusing more than two substances, family history of psychiatry disorders, and co-morbid psychiatric illness increase the risk of suicide. Suicides are preventable, the need to early identification of the risk factors, assess manage and follow-up is the utmost importance of mental health professionals.
Attempted suicide, Comorbid psychiatric illness, Substance abuse
World Health Organisation (WHO) reported in 2021, that more than 7,00,000 people die due to suicide every year (1). Approximately 5% of adults attempt suicide atleast once in their lifetime (2). According to the National Crime Records Bureau (NCRB), India lost more people to suicide than Coronavirus Disease-2019 (COVID-19).The country reported more than 1.53 lacs suicides last year (2020)- highest in the last 10 years (3).
For every suicide committed there are many more people who attempt suicide (4). A prior suicide attempt is the single most important risk factor for complete suicide in the general population (5). Suicide attempts are five to twenty times more common than complete suicide (6). Suicide is the fourth leading cause of death among 15-19 year olds. Every suicide is a tragedy that affects families, communities and entire countries and has long lasting effects on the people left behind. Suicide is a serious public health problem (7).
Suicide is closely linked to substance abuse and it is the leading cause of premature death (8). Substance use is a risk factor for both fatal and non fatal overdoses, suicide attempts and death by suicide (9). Compared to the general population, individuals with alcohol dependence and people who use drugs have a 10-14 times greater risk of death by suicide (10) and approximately 22% of deaths by suicide have involved alcohol intoxication (11). Substance abuse and suicide have a very complicated relationship, where substance abuse greatly increases risk of suicide and suicidal thoughts and tendencies greatly increase the risk of addiction. Almost all substance use disorders are associated with an increase in suicide risk (12).
Suicides are preventable. There are number of measures that can be taken at population, subpopulation and individual levels to prevent suicide and suicide attempts. The aim of the study was to confirm the factors that affect the possibility of suicidal behaviour and to treat acute, modifiable risk factors and to continuously ensure patients safety (13).
The retrospective study was conducted in August 2021-December 2021, analysis of data was done from January 2022 to February 2022 at the outpatient of Department of Psychiatry at ACS Medical College and Hospital, Chennai, Tamil Nadu, India. The multispecialty teaching hospital provides care to patients with a wide variety of disorders. The study included 101 substance abusers who have attempted suicide and 101 substance abusers who have not attempted suicide, and attended the Psychiatry Out-patient Department (OPD). Ethical approval was obtained from the Institutional Ethics Committee (IEC) (NO.218/2021/IEC/ACSMCH Dt.06.08.2021).
Inclusion criteria: Persons with co-morbid psychiatry mood disorder and psychosis were included in the study.
Exclusion criteria: Persons who were in delirium, co-morbid cognitive disorder, history of head injury and those who were not willing to take part in the study were excluded from the study.
Data collection: Socio-demographic variables, legal problems, (drunken driving/stealing/perpetrator in domestic violence or physical abuse or sexual abuse or homicide), hereditary, and addiction data were obtained using a semi-structured proforma, specifically designed to capture the relevant factors that may impact on the risk factors pertaining to suicide among substance abusers. The socio-economic status was assessed by using Modified Kuppuswamy Scale (14). The patients were diagnosed with Substance Dependence Syndrome, Anxiety disorders, Depression disorder and Substance induced Psychosis based on ICD-10 criteria (15).
Statistical Analysis
Data analysis done using the Statistical Package for the Social Science (SPSS) Version 20.0, Chi-square test for categorical outcomes. A two tailed probability value of <0.05, accepted as the level of statistical significance.
The age range of whole study sample was 18 to 65 years and the mean was 41 years. The mean age in the ‘attempted suicide group’ was 39±13.43 years, while that in ‘not attempted suicide group’ was 43±2.12 years (Table/Fig 1).
In the ‘attempted suicide group’ majority (57.4%) of the participants were educated above 10th grade; while in the other 62.4% were educated below 10th grade. In the ‘attempted suicide group’ majority (68%) sample was single/divorced /separated, while in the other 87% were married. Majority (61.3%) of the ‘attempted suicide group’ belonged to upper and upper middle socioeconomic class, while it was lower middle class (39.6%) in the other. Majority (70.3%) were urban population in ‘attempted suicide group’, while it was semiurban (48.5%) in the other group. In the ‘attempted suicide group’, 95 participants abused the drug before 25 years of age, while in the ‘not attempted suicide group’, 45 initiated drug abuse before attaining 25 years of age.
There was a significant association between the duration of abuse and attempted suicide. Total 75 participants in the ‘attempted suicide group’ abused drug for more than 10 years, while it was 60 in the other group. Total 90 participants who attempted suicide were polysubstance abusers, while 70 in the other group were polysubstance abusers (Table/Fig 2). The mean number of suicide attempts was 2.41±1.67 (Table/Fig 3).
Out of 158, 95 in the ‘attempted suicide group’ abused drug more than once a day. Depression, and psychosis was more common in the ‘attempted suicide’ group, while anxiety was more common in the ‘not attempted suicide’ group. History of legal problems were present in 63/82 of the ‘attempted suicide group’ and 19/82 in the other group (Table/Fig 4).
Total 113 participants had history of undergoing deaddiction treatment, of which only 29 belonged to the ‘atttempted suicide’ group (Table/Fig 4). Of the 59 who had family history of suicide, 56 belonged to the ‘attempted suicide’ group.
This study helps us to understand the impact of drug abuse on persons committing suicide. It is important to confirm the factors that influence the possibility of suicidal behaviour among substance abusers. As evident from previous studies (16),(17). There was a significant association among various demographics and attempted suicide. Suicide attempt was found to be more likely in persons who are intermediate/graduate/postgraduate or professional persons. Attempted suicide was more among the upper middle and upper socio-economic classes, and among the urban population compared to rural or semi urban. Social isolation (separated, divorced or widowers) is another risk factor. It can be assumed that the entry into the community with a partner is a sign of stability in social functioning and thus reduced suicide risk (18).
The results from the study conform with earlier studies that risk factors of previous suicide attempt, co-morbid psychiatry illness such as psychosis, depression, anxiety disorders are more prone for attempting suicide. More number of suicide attempts have been identified with persons with psychosis and depression (19),(20).
The tendency towards criminal behaviour that is often associated with substance abusers with abusing family members (verbally, physically, sexual abuse, emotional abuse and financial abuse) is a significant risk factor for attempting suicide and the results are similar to earlier studies (21),(22). History of sexual abuse, co-morbid medical illness are other risk factors that have been identified in the study also being confirmed with earlier studies (23),(24).
Family history is a significant predictor of attempted suicide in substance abusers (25). Family history of complete suicide or attempt suicide, psychiatry illness have been identified as another risk factor for suicide attempt. Besides the classical genetic heritage, which is primarily related to psychotic disorder, behaviour patterns can also be significant (26). No association was found with family history of substance abuse, as recognised in other studies (27),(28).
Earlier the age of onset of drug abuse, more the dependence, and suicide attempts (29). Hence, duration of drug abuse is another important risk factor. Polysubstance abuse, as risk factor, (30) was identified in the study, alcohol and tobacco smoking being more common. Most of the previous studies did not consider whether multiple substance abuse contribute greater risk of attempt suicide than single substance. Use of drug more than once a day also increases the risk of attempting suicide (31),(32). Persons who have taken deaddiction treatment in the past are less likely to attempt suicide findings are similar to previous studies (33),(34).
Limitation(s)
The tertiary care centre was in an urban area, so, the sample of rural population was low. The study sample constituted only males, so the analysis of the risk factors of drug abuse across other gender have not been studied.
Substance use disorders are associated with significant risk of suicidal mortality. The finding suggest that a heightened suicide risk screening and prevention efforts for individuals with substance use disorders are needed. History of suicide attempt is important in any substance abuse individual, thereby, assessing the psychiatry co-morbidity and treating for the same is pertinent. It is important to reduce the stigma of suicidal behaviour and increase awareness of psychological distress of individuals who experienced suicidal behaviour in their family. Health systems need to consider suicide prevention screening for persons abusing substance in other settings too, such as primary care or emergency settings.
DOI: 10.7860/JCDR/2022/55450.16675
Date of Submission: Feb 15, 2022
Date of Peer Review: Apr 08, 2022
Date of Acceptance: Jun 03, 2022
Date of Publishing: Jul 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 17, 2022
• Manual Googling: May 17, 2022
• iThenticate Software: Jun 27, 2022 (11%)
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