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Competing Interests: There are no conflicts of interest.

Context: There is a paucity of systematic data reflecting the practice of electroconvulsive therapy (ECT) from developing countries., Aim: We aimed to identify the number of ECT sessions required to yield response and gender diffeferences in the number of sessions across various diagnostic categories., Setting and Design: A record-based study from a teaching cum tertiary care hospital in South India., Subjects and Methods: Case records of patients who received modified ECT from January 2011 to January 2016 were reviewed. The sociodemographic details and ECT-related data were collected. Psychiatric diagnoses were ascertained as per the International Classification of Diseases, 10 th Revision criteria., Statistical Analysis Used: Kruskal-Wallis test and Mann-Whitney U-test., Results: Among 148 patients, 82 (55.4%) had mood disorder (bipolar disorder and recurrent depressive disorder), 43 (29.1%) had schizophrenia, and 22 (14.9%) had other acute and transient psychotic disorders (ATPDs). Patients with mood disorders, schizophrenia, and other ATPD received 7.3 (± 3.8), 9.7 (± 6.1), and 5.4 (± 2.0) ECT sessions, respectively, to achieve response. There was no gender difference in the number of sessions received., Conclusion: Our findings show that number of ECT sessions required to yield response may be disorder-specific. Gender does not influence the ECT dose requirement. Variations in ECT parameters across settings may limit the generalizability of results., Competing Interests: There are no conflicts of interest.

Background: There is limited cross-cultural literature on the duration of suicide process among attempters., Aims: The primary aim was to assess the duration of suicide process among suicide attempters attending the Crisis Intervention Clinic. We also aimed to identify the characteristics of those who reported a longer duration for this process., Methods: In this retrospective record-based study, we collected the duration of the suicidal process from the records of all the suicide attempters evaluated over a 3-year period ( n = 319). Attempters were divided into four groups based on the quartile value of the duration of the suicidal process. For analysis, the characteristics of those in the last quartile with suicide process time of >120 min ( n = 75) were compared with those in the first three ( n = 244). Those in the last quartile were considered to provide a window of opportunity for intervention., Results: The median time for the suicidal process was 30 min (interquartile range of 5 min to 120 min). Seventy-five (23.5%) subjects belonged to the fourth quartile (duration of suicide process >120 min). A significant proportion of them came from urban areas ( P = 0.011), had a diagnosis of mood disorder ( P = 0.028), had visited a health professional in the recent past ( P = 0.015), and had lower rates of attempt under intoxication ( P = 0.005). A lesser proportion of them showed problem-focused disengagement style of coping strategy ( P = 0.015)., Conclusions: The suicide process time among Indian suicide attempters is short. However, a quarter of them has suicide process duration of 2 h which provides some scope for intervention. Individual and community level interventions need further evaluation for their potential efficacy in preventing the progress of the suicidal process.

Background: Evidence indicates that repeat suicide attempters, as a group, may differ from 1(st) time attempters. The identification of repeat attempters is a powerful but underutilized clinical variable., Aims: In this research, we aimed to compare individuals with lifetime histories of multiple attempts with 1(st) time attempters to identify factors predictive of repeat attempts., Setting and Design: This was a retrospective record based study carried out at a teaching cum Tertiary Care Hospital in South India., Methods: Relevant data was extracted from the clinical records of 1(st) time attempters (n = 362) and repeat attempters (n = 61) presenting to a single Tertiary Care Center over a 4½ year period. They were compared on various sociodemographic and clinical parameters. The clinical measures included Presumptive Stressful Life Events Scale, Beck Hopelessness Scale, Coping Strategies Inventory - Short Form, and the Global Assessment of Functioning Scale., Statistical Analysis Used: First time attempters and repeaters were compared using appropriate inferential statistics. Logistic regression was used to identify independent predictors of repeat attempts., Results: The two groups did not significantly differ on sociodemographic characteristics. Repeat attempters were more likely to have given prior hints about their act (χ(2) = 4.500, P = 0.034). In the final regression model, beck hopelessness score emerged as a significant predictor of repeat suicide attempts (odds ratio = 1.064, P = 0.020)., Conclusion: Among suicide attempters presenting to the hospital, the presence of hopelessness is a predictor of repeat suicide attempts, independent of clinical depression. This highlights the importance of considering hopelessness in the assessment of suicidality with a view to minimize the risk of future attempts.

Background: Local language screening instruments can be helpful in early assessment of depression in the elderly in the community and primary care population. This study describes the validation of a Tamil version of Geriatric Depression Scale (short form 15 [GDS-15] item) in a rural population., Materials and Methods: A Tamil version of GDS-15 was developed using standardized procedures. The questionnaire was applied in a sample of elderly (aged 60 years and above) from a village in South India. All the participants were also assessed for depression by a clinical interview by a psychiatrist., Results: A total of 242 participants were enrolled, 64.9% of them being females. The mean score on GDS-15 was 7.4 (±3.4), while the point prevalence of depression was 6.2% by clinical interview. The area under the receiver-operator curve was 0.659. The optimal cut-off for the GDS in this sample was found at 7/8 with sensitivity and specificity being 80% and 47.6%, respectively., Conclusion: The Tamil version of GDS-15 can be a useful screening instrument for assessment of depression in the elderly population.

Background: Suicides are among the most important causes of death in the economically productive population. Characteristics of impulsive and nonimpulsive suicide attempters may differ which would have a bearing on planning preventive measures., Aims: This study aimed to characterize the clinical and psychological profile of impulsive and nonimpulsive suicide attempters., Settings and Design: This retrospective comprehensive chart-based study was conducted at a tertiary care hospital in South India., Methods: The study utilized records of patients over a period of 3 years. An attempt was considered impulsive if the time between suicidal idea and the attempt was <30 min. Stressful life events were assessed using presumptive stressful life events scale; hopelessness was evaluated using Beck Hopelessness Scale (BHS) and coping was measured using Coping Strategies Inventory Short Form., Statistical Analysis Used: Impulsive and nonimpulsive suicide attempters were compared using appropriate inferential statistical tests., Results: Of 316 patients, 151 were classified as having an impulsive suicidal attempt (47.8% of the sample). The impulsive and nonimpulsive suicide attempters did not differ on demographic characteristics. Use of natural plant products was more common in impulsive attempters (27.2% vs. 12.7%), while physical methods like hanging was less common (0.7% vs. 7.3%). Those with an impulsive attempt were more likely to have a recent contact with a health professional (24.5% vs. 4.5%). Impulsive suicide attempters had higher scores on BHS (Mann-Whitney U = 7680.5, P < 0.001), and had recollected greater number of stressors., Conclusion: Impulsive suicide attempters differ from nonimpulsive suicide attempters in clinical features like methods of attempt, presence of hopelessness, and stressors.