If Indian states were countries, three states would have the third, fourth and fifth worst rates of female suicide in the world, recent data shows. Men commit suicide at a higher rate across the world, but India has not been able to lower the suicide rate among men, the data shows.

Rakhi Dandona, a researcher at the Public Health Foundation of India, and her colleagues estimated suicide rates for both sexes in each state of India from 1990 to 2016 based on multiple sources, including official sample registration and vital registration surveys, medically certified causes of death, and verbal autopsy studies. Their research was part of the 2016 Global Burden of Diseases, Injuries and Risk Factors (GBD 2016), a worldwide database of health indicators. Their findings were published in the medical journal The Lancet Public Health last month.

India accounts for a growing share of the world’s suicides.

India now accounts for over a third of the world’s annual female suicides and nearly a fourth of male suicides, a significant increase in its global share from 1990. The suicide rates for men and women in India were much higher than the global averages (charts 1a and 1b). Who is at higher risk of suicide? In 2012, a team of researchers sent trained doctors to more than a million homes to determine causes of death.

Looking at the data for suicides within this data set, a group of public health researchers found that higher education levels, residency in South India, and being Hindu were significantly associated with the elevated risk of suicide. Drinking alcohol was associated with the risk of suicide in men. Being widowed, divorced or separated was associated with a slightly decreased risk of suicide in women.

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The big bad female suicide problem

Across the world, men commit suicide at a higher rate than women, and India is no different. But India’s female suicide problem is particularly bad. India has the sixth highest female suicide death rate in the world.

If Indian states were countries, Tamil Nadu, Karnataka and West Bengal would have the third, fourth and fifth worst rates of female suicide in the world (only Greenland and Lesotho are worse).

The three Indian states with the highest age-standardized suicide rates among men— Tripura, Karnataka and Tamil Nadu—would be the 11th, 17th and 20th highest in the world if they were countries. In all, there are 45 countries with higher male suicide death rates than India.

Violence against women is an important determinant of suicide, research suggests. However, while suicide rates have improved significantly among women, they remained nearly unchanged among men between 1990 and 2016.

Regional skew

India’s southern states are more developed, but also more suicide-prone. This follows a global pattern, with more developed states having higher suicide rates.

However, in the medical literature, instead of “more developed" and “less developed" countries or states are classed by their stage in the “epidemiological transition"—moving from high rates of fertility to lower rates as incomes grow, health improves and women become educated.

Among lower fertility states, Tamil Nadu, Haryana, Jammu and Kashmir and West Bengal, and among higher fertility states Uttarakhand had significant declines in suicide rates for women from 1990 to 2016. No state had a significant decline in suicide rates for men during this period. There is another significant difference between suicides among men and women in India. The highest age-specific rates of suicide for men were among elderly men aged 75 years or older, while among women it was for young women aged 15-29.

A youth suicide crisis

Young people in India die predominantly of suicide, the GBD data shows. For both sexes in India, suicide was the leading cause of death among those aged 15-39 in 2016, while globally it was the third most common cause of death for this age group.

ALSO READ | What is driving the young to suicide?

The under-reporting problem

In 2015, the most recent year for which data is available, there were 130,000 suicides in India, according to the Accidental Deaths and Suicides in India report brought out by the National Crime Records Bureau, India’s official source of suicide data recorded by the police. That’s 100,000 fewer suicides than Dandona et al’s estimates, or a decrease of 77%.

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The decriminalisation of suicide in 2017 “is expected to have a major role in access to mental health treatment and possible reduction in under-reporting and stigma associated with suicide", the authors write. The first step in addressing India’s suicide crisis would be to record suicide deaths accurately, and acknowledge the gravity of the crisis.

Rukmini S is a Chennai-based journalist.

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