Authors' reply

We would like to clarify the points raised by Holikatti & Grover. We presented the current psychiatric diagnoses within the past month as assessed by the interview. The therapeutic effects of the surveillance system and the variance due to interviewing first-degree relatives are in common to both cases and controls, and hence we believe that these factors did not affect the results of our study. We could not include the variables ‘living alone’ and ‘break in steady relationship’, which were significant in the bivariate analyses, in the multivariate procedure as these variables were absent among the controls and hence it is not possible to calculate odds ratios and to include them in logistic regression.

Our study had a priori definitions for ‘chronic pain’ and ‘ongoing stress’ described in the paper, which also provides the details of psychiatric diagnoses. Holikatti & Grover suggest that chronic pain symptoms can be attributed to underlying depressive disorders. However, the contemporary classificatory systems in psychiatry have not approved the concept of ‘masked depression’ and they have not included pain symptoms in their diagnostic criteria for depression. Pain is a subjective experience, which has a psychological component. Psychiatrists tend to attribute human distress to disease and medicalise all depression. ¹ Our data argue that psychosocial stress and social isolation, rather than psychiatric morbidity, are risk factors for suicide in rural south India. ²