Abstract
SummaryBackgroundA systematic understanding of suicide mortality trends over time at the subnational level for India's 1·3 billion people, 18% of the global population, is not readily available. Thus, we aimed to report time trends of suicide deaths, and the heterogeneity in its distribution between the states of India from 1990 to 2016.MethodsAs part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, we estimated suicide death rates (SDRs) for both sexes in each state of India from 1990 to 2016. We used various data sources for estimating cause-specific mortality in India. For suicide mortality in India before 2000, estimates were based largely on GBD covariates. For each state, we calculated the ratio of the observed SDR to the rate expected in geographies globally with similar GBD Socio-demographic Index in 2016 (ie, the observed-to-expected ratio); and assessed the age distribution of suicide deaths, and the men-to-women ratio of SDR over time. Finally, we assessed the probability for India and the states of reaching the Sustainable Development Goal (SDG) target of a one-third reduction in SDR from 2015 to 2030, using location-wise trends of the age-standardised SDR from 1990 to 2016. We calculated 95% uncertainty intervals (UIs) for the point estimates.FindingsThere were 230 314 (95% UI 194 058–250 260) suicide deaths in India in 2016. 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. Age-standardised SDR among women in India reduced by 26·7% from 20·0 (95% UI 16·5–23·5) in 1990 to 14·7 (13·1–16·2) per 100 000 in 2016, but the age-standardised SDR among men was the same in 1990 (22·3 [95% UI 14·4–27·4] per 100 000) and 2016 (21·2 [14·6–23·6] per 100 000). SDR in women was 2·1 times higher in India than the global average in 2016, and the observed-to-expected ratio was 2·74, ranging from 0·45 to 4·54 between the states. SDR in men was 1·4 times higher in India than the global average in 2016, with an observed-to-expected ratio of 1·31, ranging from 0·40 to 2·42 between the states. There was a ten-fold variation between the states in the SDR for women and six-fold variation for men in 2016. The men-to-women ratio of SDR for India was 1·34 in 2016, ranging from 0·97 to 4·11 between the states. The highest age-specific SDRs among women in 2016 were for ages 15–29 years and 75 years or older, and among men for ages 75 years or older. Suicide was the leading cause of death in India in 2016 for those aged 15–39 years; 71·2% of the suicide deaths among women and 57·7% among men were in this age group. If the trends observed up to 2016 continue, the probability of India achieving the SDG SDR reduction target in 2030 is zero, and the majority of the states with 81·3% of India's population have less than 10% probability, three states have a probability of 10·3–15·0%, and six have a probability of 25·1–36·7%.InterpretationIndia's proportional contribution to global suicide deaths is high and increasing. SDR in India is higher than expected for its Socio-Demographic Index level, especially for women, with substantial variations in the magnitude and men-to-women ratio between the states. India must develop a suicide prevention strategy that takes into account these variations in order to address this major public health problem.FundingBill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Highlights
An estimated 817 000 suicide deaths occurred globally in 2016, accounting for 1·5% of all deaths, with a global suicide death rate (SDR) of 11 per 100 000 population.[1,2] Young and middle-aged adults die of suicides predominantly; and suicide is the second leading cause of death worldwide among those aged 15–29 years, and the third leading cause among those aged 15–39 years.[1,3,4] With increasing realisation of the public health importance of suicides, the UN Sustainable Development Goals (SDGs) include a one-third reduction in suicide death rates (SDRs) from 2015 to 2030.5India accounts for a large proportion of all suicide deaths globally.[1]
We found a variety of data related to suicide in India and several states, but no studies that comprehensively described population-based estimates of suicide death trends in every state of India over a long period
We examined age-specific SDRs and suicide deaths among men and women and their change from 1990 to 2016
Summary
An estimated 817 000 suicide deaths occurred globally in 2016, accounting for 1·5% of all deaths, with a global suicide death rate (SDR) of 11 per 100 000 population (seven per 100 000 for women and 15 per 100 000 for men).[1,2] Young and middle-aged adults die of suicides predominantly; and suicide is the second leading cause of death worldwide among those aged 15–29 years, and the third leading cause among those aged 15–39 years.[1,3,4] With increasing realisation of the public health importance of suicides, the UN Sustainable Development Goals (SDGs) include a one-third reduction in SDR from 2015 to 2030.5India accounts for a large proportion of all suicide deaths globally.[1]. A description of the epidemiology of suicide deaths in the states of India was reported from a nationally representative survey of www.thelancet.com/public-health Vol 3 October 2018 e478. A previous study reported suicide death rates for India and its states using verbal autopsy data from 2001 to 2003, and some studies assessed trends of suicide rates in the states as reported by the National Crimes Record Bureau of India that is known to have under-reporting. We searched PubMed and publicly available reports for estimates of suicide deaths across the states of India using the search terms “death”, “cause of death”, “epidemiology”, “India”, “mortality”, “self-harm”, “suicide”, and “trends” on March 31, 2018, without language or publication date restrictions. We found a variety of data related to suicide in India and several states, but no studies that comprehensively described population-based estimates of suicide death trends in every state of India over a long period
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