Suicide is a leading cause of death in India, and occurs most frequently among educated young adults in the most rapidly developing parts of the country, according to new research published in the medical journal The Lancet.
"Suicide in young people is nothing short of a national crisis," said Vikram Patel of the London School of Hygiene and Tropical Medicine, lead author of the study. "Suicide will soon overtake maternal causes as the leading cause of death in young women, which is staggering."
That has important implications for government policy, he said, adding that if India is looking to address avoidable causes of death, a greater focus should be put on suicide.
Using data drawn from a cause-of-death survey carried out by the Registrar General of India in 1.1 million homes, the researchers concluded that some 3 per cent of deaths in people 15 or older were from suicide, amounting to 187,000 suicide deaths in India in 2010. (In Canada, by comparison, suicide is the cause of 1.6 per cent of deaths). Forty per cent of men who committed suicide and 56 per cent of women were between 15 and 29 years old.
The study reveals a startling difference in the occurrence of suicide across the country: Rates in the south of India are 10 times higher than those in some northern states. While in most parts of the world suicide tends to occur more frequently in groups at "social disadvantage," such as lower income or employment levels, the highest rates in India are found in Tamil Nadu and Kerala, the two states with the highest development indicators. The lowest is in Bihar, the state that finishes last in every measure of progress and developme nt.
"Our study doesn't answer why, and this is speculation, but it clearly points to something that is not biological. It has to point to the social environment young people are growing up in – there must be something toxic in the social environment in the rapidly developing states of India, which is not there in less developing states," Dr. Patel said in an interview. "We don't know what it is and we need to unpack it."
He and his colleagues speculate that the cause of the higher suicide rates may lie in the gap between the rate at which society has changed versus that at which expectations have changed. "The most obvious explanation is that the distance you fall when you hit the ground of reality is greater when your aspirations have been built up by opportunities that in reality don't exist, he said.
The study also noted that access to mental-health services, and open discussion about causes of suicide such as depression, are limited in India and have not been the focus of any public-health campaign in the way that other causes of death such as HIV/AIDS, which kill fewer people, have been.
Suicide remains a crime in India; the rates recorded in police crime statistics are much lower than those found in this study – because families report suicides as accidental deaths whenever possible. Police figures miss a quarter of male and a third of female suicides, these figures showed.
The method of suicide in nearly half of all cases in India is the ingestion of pesticides – a particularly lethal way of killing oneself that means fewer people survive attempts than they would elsewhere. But that also suggests an easy possible intervention in the restriction of pesticide sales, the researchers noted. Sri Lanka, for instance, has done this and cut its suicide rate.
Suicide rates are higher in rural India than in urban, likely because there is poorer access to care and a greater availability of pesticides, Dr. Patel said. But while the Indian media have focused considerable attention on suicide among farmers, the study found that agricultural workers were no more likely to commit suicide than rural people in other forms of employment.
The data show other intriguing differences in suicide in India compared to other countries. While in high-income countries men typically commit suicide three times more often than women, in India it's just 1 1/2 times more often across all ages, and the rates are equal for men and women in the 15 to 29 age bracket.
"The age-standardized suicide rate in Indian women aged 15 years or older is more than 2 1/2 times greater than it is in women of the same age in high-income countries and nearly as high as it is in China," which has the world's highest rate, the study says.
Separated, widowed or divorced women are less likely to commit suicide in India, in contrast to the West where married women have a lower suicide rate than their single peers who are divorced, widowed or unmarried.