Suicidal Behaviour among Female and Male Commercial Sex Workers; Interpersonal Therapy as A Mode of Intervention

Suicidal behaviour and Depression among the 100 Female and 100 Male Commercial Sex Workers (CSW’S) and their mode of suicide was studied. Interpersonal therapy was initiated to lower their Depression and Suicidal behaviour. Despite the difference in the suicidal attempts among these population A 8 weeks’ therapy and 6 month follow up lowered their Depression and no further suicide attempts. This study explored these factors among this population in Bengaluru, India


HYPOTHESIS
There will be a difference in the mode of suicide attempts and level of Depression among the two categories of commercial sex workers.
Interpersonal Therapy will help them lower their depression and Suicidal behaviour .

INCLUSION CRITERIA
• Written consent was taken from all the subjects.
• Women and Men above the age of 18 years up to 25 years • Women and Men should be engaged in Commercial sex activity • They should have attempted suicide.

EXCLUSION CRITERIA
• Women and Men should not have any other physical co-morbidities • Women and Men with HIV and STD's were ruled out. METHODOLOGY 100 Women and 100 Men in sex trade since 1 year or less between the ages of 18 to 25 years were chosen for this study, after a written consent from Women had completed education up to 10 th standard they were from a low to middle socio economic status and majority of them belonged to Hindu religion. While, 80% of the Men had completed 1th and 5% had completed 11 th std and remaining15%had finished 12 th std and majority belonged to Muslim religion. To ascertain the number of suicide attempts, mode of suicide and severity of Depression Columbian Suicide History Form (CSHF) and Hamilton Rating scale for Depression (HAM-D) was administered . [4]   They were counselled about the use of Anti-Depressants they denied trying it hence an intensive Interpersonal Therapy was done.

INTERPERSONAL THERAPY
The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that an individual will not die by suicide unless s/he has both the desire to die by suicide and the ability to do so. What is the desire for suicide, and what are its constituent parts? [11] In answer to the first question of who desires suicide, the theory asserts that when people hold two specific psychological states in their minds simultaneously, and when they do so for long enough, they develop the desire for death. The two psychological states are perceived burdensomeness and a sense of low belongingness or social alienation. [12] Self-preservation is a powerful enough instinct that few can overcome it by force of will [7]. The few who have developed a fearlessness of pain, injury, and death, which, according to the theory, they acquire through a process of repeatedly experiencing painful and otherwise provocative events. These experiences often include previous self-injury, but can also include other experiences, such as repeated accidental injuries; numerous physical fights; and occupations like physician [8]and front-line soldier in which exposure to pain and injury, either directly or vicariously, is common [10].
Perceived burdensomeness is the view that one's existence burdens family, friends, and/or society. This view produces the idea that "my death will be worth more than my life to family, friends, society, etc." -a view, it is important to emphasize, that represents a potentially fatal misperception. Past research, though not designed to test the interpersonal-psychological theory, nonetheless has documented an association between higher levels of perceived burdensomeness and suicidal ideation. [12] A low sense of belongingness is the experience that one is alienated from others, not an integral part of a family, circle of friends, or other valued group. As with the research base on perceived burdensomeness, there is abundant evidence that this factor is implicated in suicidal behaviour [16].
The female population showed symptoms of higher levels of perceived burdensomeness and suicidal ideation and male Population showed high Social Alienation. Since the trauma this population is exposed to day in and day out makes them vulnerable to go against the concepts of Self preservation and commit suicide [14].
They were met three times a week and Interpersonal Therapy was initiated each session lasted for 45 minutes for a period of 8 weeks. These techniques were used to lower Depression and suicidal behaviour. A six month follow up showed that there was no suicide attempt [12].

POST INTERVENTION ANALYSIS
The HAM-D scores post CBT intervention for Female CSW group was 10 and Male CSW group was 9 respectively these were analysed using a simple t test and the values were significant at 0.001 level which indicated that there was a significant improvement in the levels of severity of depression.  In the Male CSW's group 48 people had 2 attempts by oral poisoning or Insecticide and the remaining 52 had 1 attempt by Hanging or slashing the wrist.

PRE AND POST INTERPERSONAL THERAPY INTERVENTION HAM-D SCORES FOR BOTH THE GROUPS WITH "t" ANALYSIS
Both the groups were cautious not to use burns as a mode of attempt which was significant. During interview, they expressed this concern that if they fail to complete suicide due to burns then their life is scarred permanently as they would not be able to carry out their commercial sex activity being their primary concern. [15].
There was a great deal of perceived burdensomeness and social alienation which was identified in this group [11].

MAJOR FINDINGS
There was a major difference in the mode of suicide among the two different groups i.e., Female and Male CSW's. Interpersonal therapy [12] was taken up for both the groups and this helped them maintain abstinence and the severity of depression [6] had also lessened with no attempts on life which lasted till a 6 month follow up.