Development of a resource use measurement (RUM) instrument to estimate the economic burden of suicide in India

BACKGROUND: Suicide related events lead to the mobilization of a diverse array of resources affecting multiple sectors across society. These resources include healthcare service utilization, out-of-pocket expenditures, productivity losses of patients and caregivers, and resources borne by education, law enforcement, and the criminal justice system. These dimensions are particularly pertinent in Low and Middle-Income Countries (LMICs), where help-seeking and care provision pathways are complex, diverse and fragmented. METHODS: A previous systematic literature review and consequent focused search for existing RUM instruments for mental health informed the development of the initial draft of the instrument. The face and content validity of the instrument were assessed through an online expert consultation using cognitive interviewing techniques. RESULTS: A modular RUM instrument was developed to capture all resources from a societal perspective. Validation with diverse experts led to the validation of comprehensibility, directionality, memory recall, prioritization, feasibility, and structural aspects of the instrument. The iterative processes ensure cultural suitability, appropriateness, and user-friendly design. CONCLUSION: This study marks a methodological advancement in the development of a comprehensive and adaptable RUM instrument for use across LMICs. The instrument would aid in the generation of robust economic evidence to inform suicide prevention policies and advocacy efforts. CLINICAL TRIAL REGISTRATION: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid = MTIzNjIy&Enc=&userName=.