Suicide and its prevention: The urgent need in India

Abstract

Byline: Lakshmi. Vijaykumar Suicide is an important issue in the Indian context. More than one lakh (one hundred thousand) lives are lost every year to suicide in our country. In the last two decades, the suicide rate has increased from 7.9 to 10.3 per 100,000. There is a wide variation in the suicide rates within the country. The southern states of Kerala, Karnataka, Andhra Pradesh and Tamil Nadu have a suicide rate of > 15 while in the Northern States of Punjab, Uttar Pradesh, Bihar and Jammu and Kashmir, the suicide rate is The majority of suicides (37.8%) in India are by those below the age of 30 years. The fact that 71% of suicides in India[sup] [1] are by persons below the age of 44 years imposes a huge social, emotional and economic burden on our society. The near-equal suicide rates of young men and women[sup] [2] and the consistently narrow male: female ratio of 1.4: 1 denotes that more Indian women die by suicide than their Western counterparts. Poisoning (36.6%), hanging (32.1%) and self-immolation (7.9%) were the common methods used to commit suicide.[sup] [1] Two large epidemiological verbal autopsy studies in rural Tamil Nadu reveal that the annual suicide rate is six to nine times the official rate.[sup] [3],[4] If these figures are extrapolated, it suggests that there are at least half a million suicides in India every year. It is estimated that one in 60 persons in our country are affected by suicide. It includes both, those who have attempted suicide and those who have been affected by the suicide of a close family or friend. Thus, suicide is a major public and mental health problem, which demands urgent action. Although suicide is a deeply personal and an individual act, suicidal behaviour is determined by a number of individual and social factors. Ever since Esquirol wrote that All those who committed suicide are insane and Durkheim proposed that suicide was an outcome of social / societal situations, the debate of individual vulnerability vs social stressors in the causation of suicide has divided our thoughts on suicide. Suicide is best understood as a multidimensional, multifactorial malaise. Suicide is perceived as a social problem in our country and hence, mental disorder is given equal conceptual status with family conflicts, social maladjustment etc.[sup] [5] According to the official data, the reason for suicide is not known for about 43% of suicides while illness and family problems contribute to about 44% of suicides. Divorce, dowry, love affairs, cancellation or the inability to get married (according to the system of arranged marriages in India), illegitimate pregnancy, extra-marital affairs and such conflicts relating to the issue of marriage, play a crucial role, particularly in the suicide of women in India. A distressing feature is the frequent occurrence of suicide pacts and family suicides, which are more due to social reasons and can be viewed as a protest against archaic societal norms and expectations. In a population-based study on domestic violence, it was found that 64% had a significant correlation between domestic violence of women and suicidal ideation.[sup] [6] Domestic violence was also found to be a major risk factor for suicide in a study in Bangalore.[sup] [7] The population-based study has been done in various cities in India, however the Bangalore study is the only psychological autopsy study that focused on completed suicide and domestic violence.[sup] Poverty, unemployment, debts and educational problems are also associated with suicide. The recent spate of farmers' suicide in India has raised societal and governmental concern to address this growing tragedy. …