Suicide mortality in India: a nationally representative survey

Abstract

Background: WHO estimates that about 170,000 deaths by suicide occur in India every year, but few epidemiological studies of suicide have been done in the country. We aimed to quantify suicide mortality in India in 2010.

Methods: The Registrar General of India implemented a nationally representative mortality survey to determine the cause of deaths occurring between 2001 and 2003 in 1·1 million homes in 6671 small areas chosen randomly from all parts of India. As part of this survey, fieldworkers obtained information about cause of death and risk factors for suicide from close associates or relatives of the deceased individual. Two of 140 trained physicians were randomly allocated (stratified only by their ability to read the local language in which each survey was done) to independently and anonymously assign a cause to each death on the basis of electronic field reports. We then applied the age-specific and sex-specific proportion of suicide deaths in this survey to the 2010 UN estimates of absolute numbers of deaths in India to estimate the number of suicide deaths in India in 2010.

Findings: About 3% of the surveyed deaths (2684 of 95,335) in individuals aged 15 years or older were due to suicide, corresponding to about 187,000 suicide deaths in India in 2010 at these ages (115,000 men and 72,000 women; age-standardised rates per 100,000 people aged 15 years or older of 26·3 for men and 17·5 for women). For suicide deaths at ages 15 years or older, 40% of suicide deaths in men (45,100 of 114,800) and 56% of suicide deaths in women (40,500 of 72,100) occurred at ages 15-29 years. A 15-year-old individual in India had a cumulative risk of about 1·3% of dying before the age of 80 years by suicide; men had a higher risk (1·7%) than did women (1·0%), with especially high risks in south India (3·5% in men and 1·8% in women). About half of suicide deaths were due to poisoning (mainly ingestions of pesticides).

Interpretation: Suicide death rates in India are among the highest in the world. A large proportion of adult suicide deaths occur between the ages of 15 years and 29 years, especially in women. Public health interventions such as restrictions in access to pesticides might prevent many suicide deaths in India.

Funding: US National Institutes of Health.

Figure 1. Age-specific suicide death rate per 100 000 for men and women in India and in high-income countries

The rates for high-income countries (8·14 million deaths from a population of 977 million) are drawn from WHO and are based on nearly universal vital registration of deaths with medical certification. Age-standardised suicide rates for males and females at ages 0 years or older are 18·6 and 12·7, respectively in India and 21·8 and 6·8, respectively in high-income countries. All rates are standardised to the estimated Indian population in 2010.

Figure 2. Percentage risk of suicide, age-standardised death rates per 100 000 and total suicides (1000’s) in men and women age 15 years and older by the major states of India

Abbreviations: T=estimated number of suicide deaths in 1000’s; R=cumulative risk in % (see methods); ASR= age-standardised suicide death rate per 100 000. Nationally, there were only 57 suicides below age 15 and 20 suicides above age 80 in the study, so the risks at ages 15–79 years are taken as an approximate lifetime risk. State abbreviations are as follows: JK=Jammu and Kashmir, HP=Himachal Pradesh, PB=Punjab, HR=Haryana, DL=Delhi, RJ=Rajasthan, UP=Uttar Pradesh, BR=Bihar, AS=Assam, WB=West Bengal, OR=Orissa, MP=Madhya Pradesh, GJ=Gujarat, MH=Maharashtra, AP=Andhra Pradesh, KN=Karnataka, KL=Kerala, TN=Tamil Nadu, NE=Northeast States excluding Assam

Figure 3. Age-standardised death rates per 100 000, total suicide deaths (1000’s) by method of suicide for men and women age 15 years and older

The proportions are based on 1599 male and 1085 female sample deaths, with rates based on UN national totals of deaths for 2010. Abbreviations: T = Estimated deaths by each method in 1000's, ASR = Age-standardised suicide rates per 100 000, standardised to the 2010 estimated India population. ICD-10- codes are as follows: poisoning (X60 to X69); hanging (X70), burns (X76-X77); drowning (X71); and other suicides (rest of the X60 to X84). Physician agreement varied by the method of suicide. The highest agreement rates were observed for hanging (88%) and the lowest agreement rate was observed for poisoning (53–57%). Burning deaths in women, which may be due to accidents, suicide or homicide, showed moderately high levels of agreement in women (74%).