In fact, over 77% of global suicides occurred in low- and middle-income countries in 2019.Suicide is a serious public health problem; however, suicides are preventable with timely, evidence-based and often low-cost interventions. For national responses to be effective, a comprehensive multisectoral suicide prevention strategy is needed.
Who is at risk?
While the link between suicide and mental disorders (in particular, depression and alcohol use disorders) is well established in high-income countries, many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.
In addition, experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour. Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and prisoners. By far the strongest risk factor for suicide is a previous suicide attempt.
Methods of suicide
Knowledge of the most commonly used suicide methods is important to devise prevention strategies which have shown to be effective, such as restriction of access to means of suicide.
Prevention and control
Suicides are preventable. There are a number of measures that can be taken at population, sub-population and individual levels to prevent suicide and suicide attempts. LIVE LIFE, WHO’s approach to suicide prevention, recommends the following key effective evidence-based interventions:
- limit access to the means of suicide (e.g. pesticides, firearms, certain medications);
- interact with the media for responsible reporting of suicide;
- foster socio-emotional life skills in adolescents;
- early identify, assess, manage and follow up anyone who is affected by suicidal behaviours.,
Suicide prevention efforts require coordination and collaboration among multiple sectors of society, including the health sector and other sectors such as education, labour, agriculture, business, justice, law, defence, politics, and the media. These efforts must be comprehensive and integrated as no single approach alone can make an impact on an issue as complex as suicide.
Challenges and obstacles
Stigma and taboo
Stigma, particularly surrounding mental disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need. The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it. To date, only a few countries have included suicide prevention among their health priorities and only 38 countries report having a national suicide prevention strategy.
Raising community awareness and breaking down the taboo is important for countries to make progress in preventing suicide.
Data quality
Globally, the availability and quality of data on suicide and suicide attempts is poor. Only some 80 Member States have good-quality vital registration data that can be used directly to estimate suicide rates. This problem of poor-quality mortality data is not unique to suicide, but given the sensitivity of suicide – and the illegality of suicidal behaviour in some countries – it is likely that under-reporting and misclassification are greater problems for suicide than for most other causes of death.
Improved surveillance and monitoring of suicide and suicide attempts is required for effective suicide prevention strategies. Cross-national differences in the patterns of suicide, and changes in the rates, characteristics and methods of suicide, highlight the need for each country to improve the comprehensiveness, quality and timeliness of their suicide-related data. This includes vital registration of suicide, hospital-based registries of suicide attempts and nationally-representative surveys collecting information about self-reported suicide attempts.
WHO response
WHO recognizes suicide as a public health priority. The first WHO World Suicide Report “Preventing suicide: a global imperative”, published in 2014, aims to increase the awareness of the public health significance of suicide and suicide attempts and to make suicide prevention a high priority on the global public health agenda. It also aims to encourage and support countries to develop or strengthen comprehensive suicide prevention strategies in a multisectoral public health approach.
Suicide is one of the priority conditions in the WHO Mental Health Gap Action Programme (mhGAP) launched in 2008, which provides evidence-based technical guidance to scale up service provision and care in countries for mental, neurological and substance use disorders. In the WHO Mental Health Action Plan 2013–2030, WHO Member States have committed themselves to working towards the global target of reducing the suicide rate in countries by one third by 2030.
In addition, the suicide mortality rate is an indicator of target 3.4 of the Sustainable Development Goals: by 2030, to reduce by one third premature mortality from noncommunicable diseases through prevention and treatment, and promote mental health and well-being.
About 800,000 people die by suicide worldwide every year.[2] 139,123 Indians committed suicide in 2019 and the national suicide rate was 10.4 (calculated per lakh of population).[3] According to The World Health Organization, in India, suicide is an emerging and serious public health issue.[4]
Suicide rates in India have been rising over the past five decades.[5] Suicides during 2019 increased by 3.4% in comparison to 2018[6] India's contribution to global suicide deaths increased from 25.3% in 1990 to 36.6% in 2016 among women, and from 18.7% to 24.3% among men.[7] In 2016, suicide was the most common cause of death in both the age groups of 15–29 years and 15–39 years.[8] Between 1987 and 2007, the suicide rate increased from 7.9 to 10.3 per 100,000,[9] with higher suicide rates in southern and eastern states of India.[10]
In 2019, Maharashtra recorded highest number of deaths by suicide followed by Tamil Nadu, West Bengal, Madhya Pradesh, and Karnataka.[11] These five states together accounted for almost half of the total suicides recorded in India in that year.
The male-to-female suicide ratio in 2019 was 70.2 : 29.8.[12]
Estimates for number of suicides in India vary. For example, a study published in The Lancet projected 187,000 suicides in India in 2010,[13] while official data by the Government of India claims 134,600 suicides in the same year.[14] Similarly, for 2019, while NCRB reported India's suicide rate to be 10.4, according to WHO data, the estimated age-standardized suicide rate in India for the same year is 12.9. They have estimated it to be 11.1 for women and 14.7 for men.
Regional trends[edit]
Maharashtra reported the highest number of suicides at 18,916, followed by Tamil Nadu, West Bengal, Madhya Pradesh and Karnataka. These five states collectively contributed to 49.5% of India's suicides in 2019. Nagaland reported only 41 suicides in the year. Maharashtra, Tamil Nadu, West Bengal, Madhya Pradesh and Karnataka have consistently accounted for about 8.0% (or more) suicides in India across 2017 to 2019. Among the Union Territories, Delhi reported the highest number of suicides followed by Puducherry. Lakshadweep reported zero suicides. Bihar and Punjab reported a significant increase in the percentage of suicides in 2019 over 2018.[18]
Age and suicide in India[edit]
In 2019, the age groups 18–30 and 30–45 years accounted for 35.1% and 31.8% suicides in India, respectively. Combined, this age group of young adults accounted for 67% of total suicides. Thus, out of the total 1.39 lakh total suicides in India, 93,061 were young adults. This indicates that they are the most vulnerable age groups. Compared to 2018, youth suicide rates have risen by 4%.[19]
Literacy[edit]
In 2019, 12.6% victims of suicide were illiterate, 16.3% victims of suicide were educated up to primary level, 19.6% of the suicide victims were educated up to middle level and 23.3% of the suicide victims were educated up to matric level. Only 3.7% of total suicide victims were graduates and above.[16]
Suicide in cities[edit]
The number of deaths by suicide has seen an increasing trend from 2016 to 2019. In 2019, it increased by 4.6% compared to 2018. There were 22,390 suicides reported in the largest 53 mega cities of India in 2019. In the year 2019, Chennai reported the highest total number of suicides at 2,461, followed by Delhi City (2,423), Bengaluru (2,081) and Mumbai (1,229). These four cities together reported almost 36.6% of the total suicides reported from the 53 mega cities. The suicide rate in cities was higher (13.9) compared to the all-India suicide rate (10.4). Kollam and Asansol reported the highest suicide rates at 41.2 and 37.8 respectively. "Family problems (other than marriage-related issues)" were the major contributing factors towards suicide in cities which accounted for 37.2% followed by "illness" (17.1%).[20]
Gender[edit]
In 2019, the male-to-female ratio of suicide victims was 70.2 : 29.8. The total number of male suicides was 97,613 and female suicides accounted for 41,493. A total of 17 transgender people died by suicide. The proportion of female victims were more due to "marriage-related issues" (specifically in "dowry-related issues", and "impotency/infertility"). Among males, maximum suicides were by daily wage earners (29,092), followed by self-employed persons (14,319) and unemployed persons (11,599).[21]
Dynamics[edit]
Domestic violence[edit]
Almost 40% of the world's total number of female suicides take place in India.[22] Domestic violence was found to be a major risk factor for suicide in a study performed in Bangalore.[23] In another study carried out in 2017, domestic violence was found to be a risk factor for attempted suicides among married women[24] This is found to be reflected in the NCRB 2019 data, where the proportion of female victims were more in "marriage-related issues" (specifically in "dowry-related issues").[25]
Suicide motivated by politics[edit]
Suicides motivated by ideology doubled between 2006 and 2008.[10] Mental health experts say these deaths illustrate the increasing stress on young people in a nation where, elections notwithstanding, the masses often feel powerless. Sudhir Kakar was quoted to say, "The willingness to die for a cause, as exemplified by Gandhi's epic fasts during the struggle for independence, is seen as noble and worthy. Ancient warriors in Tamil Nadu, in southeastern India, would commit suicide if their commander was killed."[26]
Mental illness[edit]
A large proportion of suicides occur in relation to psychiatric illnesses such as depression, substance use and psychosis.[27] The association between depression and death by suicide has been found to be higher among women. The National Mental Health Survey (NMHS) 2015–16 found that almost 80% of those suffering from mental illnesses did not receive treatment for more than a year.[28] The Indian government has been criticised by the media for its mental health care system, which is linked to the high suicide rate.[29][30]
Farmer's suicide in India[edit]
The National Crime Records Bureau (NCRB) reported that in 2019, 10,281 people involved in the farming sector died by suicide. 5,957 were farmers/cultivators and 4,324 were agricultural labourers. Out of the 5,957 farmers/cultivators suicides, a total of 5,563 were male and 394 were female. Together, they accounted for 7.4% of total suicides in India in 2019.[31]
Student suicides in India[edit]
At least one student commits suicide every hour in India. The year 2019 recorded the highest number of deaths by suicide (10,335) in the last 25 years. From 1995 to 2019, India lost more than 1.7 lakh students to suicide. Despite being one of the most advanced states in India, Maharashtra had the highest number of student suicides. In 2019, Maharashtra, Tamil Nadu, Madhya Pradesh, Karnataka and Uttar Pradesh accounted for 44% of the total student suicides.[32]
Every hour one student commits suicide in India, with about 28 such suicides reported every day, according to data compiled by the National Crime Records Bureau (NCRB). Maharashtra had the highest number of student suicides in 2018 with 1,448, followed by Tamil Nadu with 953 and Madhya Pradesh with 862. The NCRB data shows that 10,159 students committed suicide in 2018, an increase from 9,905 in 2017 and 9,478 in 2016.[33]
A Lancet study stated that suicide death rates in India are among the highest in the world and a large proportion of adult suicide deaths occur between the ages 15 and 29.[34]
Cram schools[edit]
Many suicides are attributed to the intense pressure and harsh regimen of students in cram schools (or coaching institutes). In the five years from 2011 to 2016, 57 students in Kota, dubbed the "coaching capital" of the country, died by suicide.[35] Cram schools or coaching institutes offer coaching to high school students for various college entrance exams, such as the JEE or NEET.[36][37]
Ragging[edit]
Ragging has been identified as a potential trigger for suicides.[38] Between 2012 and 2019, 54 ragging-related suicide incidents have occurred in the country.[39]
Suicide in the Indian Armed Forces[edit]
A total of 787 suicides have been reported in the Indian Armed Forces between 2014 and 2021. Of these, the Army reported 591 suicide cases, Navy reported 36, while the Indian Air Force reported 160 deaths by suicide.[40] More than half of the personnel in the Indian Army are under severe stress and many lives are being lost to suicides, fratricides and untoward incidents.[41]
Legislation[edit]
In India, suicide was illegal and the survivor would face jail term of up to one year and fine under Section 309 of the Indian Penal Code. However, the government of India decided to repeal the law in 2014.[42] In April 2017, the Indian parliament decriminalised suicide by passing the Mental Healthcare Act, 2017[43][44] and the act commenced in July 2018.
Suicide prevention[edit]
Approaches to preventing suicide suggested in a 2003 monograph include:
- Reducing social isolation
- Preventing social disintegration
- Treating mental disorders[45]
- Regulating the sale of pesticides and ropes[45]
- Promoting psychological motivational sessions and meditation and yoga.[45]
State-led policies are being enforced to decrease the high suicide rate among farmers of Karnataka.[46]
Each suicide is a personal tragedy that prematurely takes the life of an individual and has a continuing ripple effect, dramatically affecting the lives of families, friends and communities. Every year, more than 1,00,000 people commit suicide in our country. There are various causes of suicides like professional/career problems, sense of isolation, abuse, violence, family problems, mental disorders, addiction to alcohol, financial loss, chronic pain etc. NCRB collects data on suicides from police recorded suicide cases.Rate of suicides has been calculated using projected population for the non-census years whereas for the census year 2011, the population in the Census 2011 Report was used. A total of 1,39,123 suicides were reported in the country during 2019 showing an increase of 3.4% in comparison to 2018 and the rate of suicides has increased by 0.2% during 2019 over 2018 Number and Percentage Share of Suicides in States/UTs The State/UT and City wise information on the incidents of suicides, its percentage share in total suicides and rate of suicides during the year are presented in Table–2.2. Majority of suicides were reported in Maharashtra (18,916) followed by 13,493 suicides in Tamil Nadu, 12,665 suicides in West Bengal, 12,457 suicides in Madhya Pradesh and 11,288 suicides in Karnataka accounting for 13.6%, 9.7%, 9.1%, 9.0% and 8.1% of total suicides respectively. These 5 States together accounted for 49.5% of the total suicides reported in the country. The remaining 50.5% suicides were reported in the remaining 24 States and 7 UTs. Uttar Pradesh, the most populous State (16.9% share of country population) has reported comparatively lower percentage share of suicidal deaths, accounting for only 3.9% of the total suicides reported in the country. The States which have witnessed significantly higher number of suicidal deaths during the year 2017 to 2019 are presented in the LIST–2.2. Each of these States have continuously accounted for about 8.0% or more of the total suicides reported in the country from 2017 to 2019
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