Suicide has become the second-leading cause of death of young people in India, which has one of the highest suicide rates in the world, according to an Article published as part of the Lancet Series on suicide.
“Suicide kills nearly as many Indian men aged 15-29 as transportation accidents and nearly as many young women as complications from pregnancy and childbirth,” said lead author of the study Professor Vikram Patel, of the London School of Hygiene & Tropical Medicine. With the decline in maternal death rates, suicide could soon become the leading cause of death among young women.
The research is based on the Registrar General of India’s first national survey of the causes of death, conducted in 2001-03, In India, most people die at home, especially in rural areas, and without medical attention. As a result, their deaths, like most in the developing world, have no certifiable cause and are invisible to the public health system and society at large.
The Registrar General of India’s survey found that about 3% of deaths in India of people aged over 15 are due to suicide. Using projections by the United Nations of total deaths, the study authors estimated that about 187,000 suicides occurred in 2010. Of those men who died by suicide, 40 per cent were between the ages of 15 and 29. Of the women, 56 per cent were in that age bracket.
The report also found that suicide rates are much higher in rural parts of India and nearly 10 times as high in the southern states which are comparatively richer than the north of the country. Professor Patel said it was unclear why that was the case, but noted there is a similar north-south gradation in suicides reported by India's national suicide reporting system. He said: "The large variations we observed between states clearly point to the role of as yet poorly understood social factors in influencing the risk of suicide in India. We recorded a reduced risk of suicide versus other causes of death in women who were widowed, divorced or separated, compared with married women and men, a finding consistent with China but in contrast with the higher risks of suicides reported in formerly married women and men in the USA.”
“Prior to this national survey of deaths, we simply did not know the cause of death of many Indians,” Professor Patel added. “So the real credit for counting the dead, including from suicide, goes to the Registrar General for their efforts to enhance reliable reporting of causes of death in India."
About half of suicide deaths were due to poisoning, mainly ingesting of pesticides. Hanging was the second most common cause for men and women. Burns accounted for about one-sixth of suicides by women.
While suicide claims twice as many lives in India as HIV-AIDS and almost as many as maternal deaths in young women, it receives far less public attention. Many Indians do not have access to suicide prevention programs or care for mental illnesses such as depression. According to the authors, evidence-based strategies could reduce the burden of suicide. In the medium term, the most feasible strategy would be to reduce access to organophosphate pesticides.
“The Ministry of Health of the Government of India is currently in the process of revising the National Mental Health Program and we hope that the study findings will provide evidence to improve mental health care in India,” added Professor Patel.
In a linked Comment, Michael R. Phillips and Hui Cheng, of the Shanghai Mental Health Center in China and the Emory School of Medicine in the United States, emphasise the importance of the new results: “These unexpected findings…show that the importance of some of the demographic, social, and psychological factors that have been assumed to be universal risk factors for suicide can, in fact, vary greatly between cultures and over time”.