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CGHR.ORG/SUICIDETwitter: CGHR_org

SUICIDE MORTALITY IN INDIA

Vikram Patel, Chinthanie Ramasundarahettige, Lakshmi Vijayakumar, JS Thakur, Vendhan

Gajalakshmi, Gopalkrishnan Gururaj, Wilson Suraweera, and Prabhat Jha, for the Million

Death Study Collaborators, and in partnership with

Centre for Global Health Research (Toronto, Canada)

[email protected]

mailto:[email protected]

2

Key findings• About 0.2 million deaths at ages 15 years and older

in 2010 were due to suicide.• 54% of female and 40% of male suicides occurred at

ages 15-29 years.• A 15 year old south Indian male had a 3.5% risk of

dying from suicide before reaching 80 years, in the absence of the other causes.

• About half of suicide deaths were due to poisoning.• Age standardised suicide death rates at ages 15

years and older were two fold higher in rural areas than urban areas.

• Suicide death rates vary markedly between states.


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What’s new about this research?

• Previous suicide estimates have used the National Crime Records Bureau numbers, which are based on police reports

• These data could under-report suicide, as attempted suicide is a crime in India

• The Million Death Study provides direct suicide estimates by age, gender, area and method of suicide from a nationally representative sample.


4

Crude suicide death rate based on NCRB data


Year

5

• Nationally representative sample (Sample Registration System)

• 6,671 of these small areas randomly chosen from all parts of India (each with about 1000 people per area)

How was the study done?


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800 Registrar General of India field workers interviewed 122 thousand families of people who had died in 2001-

2003

Written reports each coded independently by at least two physicians to attribute a probable cause of death (i.e.,

suicide)


Calculated proportion of all suicide deaths by age, gender, and area within the study

7


Combined with national 2010 UN totals of deaths, and 2007-2009 state-specific SRS death rates

Produced national and state estimates of rates and number of suicide deaths for 2010


8

Deaths from all causes in India, 2010

Age at deathEstimated number of

deaths

Childhood/ early adulthood*(0-29 years)

Middle age(30-69 years)

Old age(70+ years)

Total 9.8 Million

* ~ 2 Million at ages 0-4

2.8 Million

4.0 Million

3.0 Million

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Age specific suicide death rates in India and in high-income countries - Men

0

5

10

15

20

25

30

35

40

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

Age(years)

Su

icid

e d

eath

rat

e p

er 1

00 0

00 p

op

ula

tio

n

Age standardised suicide death rate at ages 15 years or older (99%CI)

India 26.3 (24.5, 28.0)

High income 21.8 (21.6, 22.0)

10

Age specific suicide death rates in India and in high-income countries - Women

0

5

10

15

20

25

30

35

40

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

Age(years)

Su

icid

e d

eath

rat

e p

er 1

00 0

00 p

op

ula

tio

n

Age standardised suicide death rate at ages 15 years or older (99%CI)

India 17.6 (16.1, 19.0) High income 6.8 (6.7, 6.9)

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Risk of suicide is high among Indians

Cumulative risk of suicide (%)

Country Male Female

India (2010) 1.7 1.0

US (2004-07) 1.6 0.5

Canada (2004-07) 1.2 0.4

UK (2004-07) 0.5 0.2


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Risk of suicide is higher in rural and southern India

Region

Male Female

Rural 2.05 1.08

Urban 0.81 0.60

South India 3.51 1.76

Rest of India 1.16 0.70

Total 1.69 0.96

Percentage probability of death of a 15 year old person before

reaching 80 years

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Risk of suicide deaths for men and women aged 15 years and above

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Estimated suicide deaths by different regions

Region

Rural 95.1 (31.5) 57.8 (20.4)

Urban 19.7 (14.4) 14.3 (12.0)

South India 50.6 (52.9) 29.5 (32.2)

Rest of India 64.2 (18.7) 42.6 (13.3)

Total 114.8 (26.3) 72.1 (17.5)

Male Female

Estimated suicide deaths x1000 (age standardised suicide death rate per 100,000)


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17 of 1000 men will die of suicide

10 of 1000 women will die of suicide

Risk of death from Suicide

For Indians aged 15 years, the risk of dying before age 80 in the absence of other diseases:

Source: Dikshit et al, Lancet 2012CGHR.ORG/SUICIDETwitter: CGHR_org

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Suicide death rates for selected states- aged 15 years or older


0

10

20

30

40

50

60

70

Kerala AndhraPradesh

Delhi Bihar &Jharkhand

India

Ag

e st

and

ard

ised

su

icid

e d

eath

rat

e p

er 1

00,0

00

Men Women

17

Method of suicide among Indian men – aged 15 years or older


Poisoning (T=60.2, ASR=13.8)

Other (T=8.8, ASR=2.0)

Drowning (T=4, ASR=0.8)

Burns (T=5, ASR=1.1)

Hanging (T=37, ASR=8.3)

49%

8%4%

4%

35%

T = estimated suicide deaths in 1000,

ASR = age standardised suicide death rate per 100,000

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Method of suicide among Indian women – aged 15 years or older


Poisoning (T=31.5, ASR=7.9)

Other (T=5, ASR=1.2)

Drowning (T=5.4, ASR=1.3)

Burns (T=13.4, ASR=3.3)

Hanging (T=17,ASR=4.2)

44%

7%8%

15%

26%

T = estimated suicide deaths in 1000,ASR = age standardised suicide death rate per 100,000

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Significant risk factors for suicide -Men aged 15 to 69 years

Education

Secondary or higher 1•43 (1•1 - 1•8)

Primary or middle 1•60 (1•4 - 1•9)

Below primary 1•00 --

Region

Southern 2•68 (2•3 - 3•1)

Rest of India 1•00 --

Alcohol use

Yes 1•84 (1•6 - 2•2)

No 1•00 --

Residence

Rural 1•45 (1•1 - 1•9)

Urban 1•00 --

Odds ratio (suicide vs.

other deaths) (99% CI)


20

Significant risk factors for suicide - Women aged 15 to 69 years

Education

Secondary or higher 1•90 (1•4 - 2•6)

Primary or middle 1•43 (1•1 - 1•8)

Below primary 1•00 --

Region

Southern 2•96 (2•4 - 3•6)

Rest of India 1•00 --

Marital Status

Widower/divorced/separated 0•64 (0•4 - 0•9)

Never married 0•92 (0•7 - 1•2)

Married/ remarried 1•00 --

Odds ratio (suicide vs.

other deaths) (99% CI)


21

CONCLUSIONS

• Large proportion of suicide deaths occur between the ages of15 to 29 years.

• Many suicide death might be prevented by: - restricting access to pesticides - providing community or support services - providing easy access to services for

mental illness associated with suicide - reducing binge alcohol drinking through higher taxation on alcohol


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Million Death Study CollaboratorsIndian Academic Partners (in alphabetical order): 1. Department of Community Medicine Gujarat Medical College, Ahmedabad: DV Bala, P Seth, KN Trivedi 2. Department of Community Medicine Kolkatta Medical College, Kolkatta: SK Roy 3. Department of Community Medicine Regional Institute of Medical Sciences, Imphal: L Usharani 4. Department of Community Medicine S.C.B. Medical College Cuttack, Orissa: B Mohapatra 5. Department of Community Medicine SMS Medical College Jaipur: AK Bharadwaj, R Gupta 6. Epidemiological Research Center, Chennai: V Gajalakshmi, CV Kanimozhi 7. Gandhi Medical College, Bhopal: RP Dikshit, S Sorangi 8. Healis-Seskarhia Institute of Public Health, Navi Mumbai: PC Gupta, MS Pednekar, S Sreevidya 9. Apollo Institute of Medical Sciences & Research, Hyderabad: P Bhatia 10. St. John’s Academy of Health Sciences, Bangalore: A Kurpad, P Mony, M Vaz, S Srinivasan, A Shet, AS Shet, D

Xavier, S Rathi 11. King George Medical College, Lucknow: S Awasthi 12. Najafgarh Rural Health Training Centre Ministry of Health Government of India, New Delhi: N Dhingra, J Sudhir,

I Rawat (until 2007) 13. Regional Medical Research Center, ICMR Institute, Bhubaneshwar: AS Karketta, SK Dar 14. School of Preventative Oncology, Patna: DN Sinha 15. School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh: N Kaur, R

Kumar, JS Thakur 16. Tata Memorial Cancer Hospital, Mumbai: RA Badwe, R Dikshit, M Mallath Lead Partners: 1. Office of the Registrar-General India, RK Puram, New Delhi India: C Chandramouli (Registrar General of India [RGI]), RC Sethi, B Mishra, S Jain (until 2008), DK Dey (until 2009), AK Saxena, MS Thapa, N Kumar, JK Banthia and DK Sikri (former RGIs) 2. Million Death Study Coordinating, Centre for Global Health Research (CGHR), Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, Canada: P Jha (Principal Investigator), R Jotkar, R Kamadod, S Rao-Seshadri, P Rodriguez, P Sati, J Sudhir, C Ramasundarahettige, W Suraweera Affiliated Partners: 1. Indian Council of Medical Research, New Delhi India: VM Katoch (Director General or DG from 2008), NK

Ganguly (DG to 2008), L Kant, B Bhattacharya, B Shah, DK Shukla 2. World Health Organisation, Geneva and SEARO Office, New Delhi: T Boerma, A Fric, S Habayeb (former WHO

Representative-India), S Khanum, CD Mathers, DN Sinha, N Singh, P Singh (Deputy Regional Director) 3. Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, England: N Bhala, J

Boreham, R Peto, G Whitlock

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