With younger Indians and children dying by suicide, it is a new national crisis

Though a committee to draft a national suicide prevention policy was created in 2018, no national policy or strategy has yet been adopted even as younger people, children and students, are increasingly taking their own lives. There is no data on attempted suicides.

The National Crime Records Bureau (NCRB) recently released its annual report on Accidental deaths and suicides in India. For the year 2020, the NCRB0 report recorded 153,052 deaths by suicide in India, a 10% increase from the 2019 figure of 1,39,123 deaths by suicide.

India lost approximately 419 individuals to suicide every day in 2020, a figure comparable to the official recorded deaths due to COVID19 for the same period. While this is significant in itself, researchers have repeatedly highlighted that such figures on deaths by suicide are in fact an underestimate.

Suicide is the leading cause of death among young people aged 15-39 years in India. Data from NCRB 2020 highlights that young people between 18 to 30 years accounted for 34% of all suicides in 2020, the highest across all age categories. This was followed by individuals between the ages of 30-45 who accounted for 31.4% of all suicides in India in 2020.

Suicide in children & young people

2020 was the start of the ongoing Covid-19 pandemic, which led to sudden and multi-fold challenges across all domains of life. Young people are a particularly vulnerable group, affected in a myriad of ways.

Reports show challenges faced by young people during the Covid pandemic include an increase in early marriage, child labor, abuse and increased rates of dropout from school. For those whom school or college was an escape were now stuck at home for extended periods with limited access to their peers and limited autonomy or privacy at home.

The NCRB data on suicides by children in 2020 are of an alarming concern emphasizing the vulnerability of this age group to social and psychological distress. The main reported causes of suicide among children in 2020 included ‘family problems', ‘love affairs’ and ‘illness’.

The NCRB data showed approximately 31 children died by suicide every day in 2020, with a total of 11,396 deaths across the year. This is an 18% increase from 9613 such deaths in 2019 and 21% increase from the figure of 9413 such deaths in 2018. The increased rate in 2020 is a dramatic rise compared to the suicide rate among children during the past 5 years (Fig 1).

Suicide among students

Another vulnerable group are students who make up to 7%-8% of all deaths by suicide every year. In 2020, 12526 students died by suicide, a 21% increase in suicides amongst students compared to 10335 deaths in 2019. The 21% increase in student deaths in 2020 from the previous year is the highest increase among people of different broad occupations.

The abrupt switch to online education, in a country where only 8.5% of children had access to the internet may have limited access to education and this may be one of the reasons for this increase.

Those who were in a crucial year of finishing school or college and transitioning to higher education or the workforce in 2020 had the added stress of uncertainty around future plans due to the pandemic and subsequent lockdowns. Thus, while deaths by suicide due to failure in examination declined by 24% in 2020 from the previous year, which may be explained by the cancellation of exams, suicides due to professional/career problem increased by 11%.

The increased suicides linked to professional concerns may arise from circumstances around the pandemic, such as loss of work opportunities or increased work stress. While efforts have been taken toward suicide prevention, they have been insufficient.

Gender differences in suicide

The NCRB report also highlights the differences between gender in deaths by suicide, where death by suicides is at a ratio of 2.3:1 which means overall, men are dying by suicide at twice the rate of women.

However, this average ratio hides many differences for various age groups.

The graph below shows gender ratios across age groups: where under the age of 18 years, girls outnumber boys, with a gender ratio of 0.9: 1. A change in pattern of the ratio is visible as the age increases, where the gender ratio is 1.9:1 and 3.2: 1 among the age group of 18-30 and 30-45, respectively (Fig 2).

The data highlights the almost equal vulnerability of children to suicide, irrespective of gender and shows a greater vulnerability of men to suicide across the lifespan when compared to women. The stark differences across age groups indicate the need to adopt holistic and targeted suicide prevention approaches for different age groups.

A first step to this would be to develop a nuanced understanding of causes of suicide by demographic characteristics and develop research-based interventions.

Recommendations: The NCRB data is the only annual comprehensive data source on suicides in India at present. Yet, due to gaps in the data collection framework and non-standardised practices across States, there are possibilities of underreporting or misclassifying suicides, making the data source unreliable.

Another grave concern with the present data on suicide is that it does not include information on attempted suicides, an important and vulnerable population group. Research shows that individuals who attempt suicide are the most vulnerable to subsequent suicide attempts and require targeted interventions and support to optimise recovery. Further, the NCRB does not release primary suicide data to allow researchers to analyse the data in depth and instead the researchers are left to rely on the simplistic analyses presented in the annual report. Thus, the lack of data on attempted suicides and the general poor quality of suicide data hampers suicide prevention, creates barriers in the development of targeted interventions and limits evaluation.

Considering the magnitude and rate of increase in suicides in India, it would be imperative to develop and implement a suicide prevention strategy as a national priority, taking into consideration the needs of broad groups of stakeholders, including members of community.

Suicide is an urgent crisis in India, influenced by socio-economic and cultural factors that go beyond mental illness; and in the absence of effective suicide prevention interventions, rates are projected to rise. Suicides are indeed preventable with the right interventions and it is in the broader interest for the government to make suicide prevention an urgent national priority.

(Amiti Varma is a Research Associate at India Mental Health Observatory of the Centre for Mental Health Law and Policy at Indian Law Society. Soumitra Pathare is the Director of the Centre for Mental Health Law and Policy at Indian Law Society)

Note: Suicides are preventable. In case you or someone you know are experiencing distress, please reach out to the numbers of local emergency services, helplines, and mental health NGOs listed here: India Helplines – The Health Collective India.

Suicidal Myths

MYTH 1: Talking about suicide is a bad idea, as it may be seen as encouragement.

FALSE. Rather than encouraging suicide, talking openly helps prevent suicide.

MYTH 2: A person who is suicidal is determined to die.

FALSE. Suicidal persons are often ambivalent about dying. Emotional support at the right time can help prevent suicide.

MYTH 3: Most suicides happen without warning.

FALSE. Most suicides are preceded by warning signs, either verbal or behavioural. Many will talk to friends & relatives or doctors about wanting to die. Don't ignore it.

MYTH 4: People who talk about suicide do not mean to do it.

FALSE. People who talk about suicide may be reaching out for help or support. They may feel there is no other option. You can help. Sit down. Listen to them. Offer help.

MYTH 5: Once someone is suicidal, they will always remain suicidal.

FALSE. Suicidal thoughts are not permanent. They are usually short term and situation specific. Many individuals with suicidal thoughts and attempts go on to live a long life.

MYTH 6: Only people with mental illness are suicidal.

FALSE. Especially in India, where research shows less than 50% have a pre-existing mental illness. People with mental illness are not necessarily suicidal & those who die of suicide do not necessarily have a mental illness.

(Dr Soumitra Pathare)

(This article was first published in National Herald on Sunday.)