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)
CGHR.ORG/SUICIDE
Twitter: CGHR_org
Prabhat.jha@utoronto.ca
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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2
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.
CGHR.ORG/SUICIDE
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3
Crude suicide death rate based on
NCRB data
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Year
4
How was the study done?
• 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)
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How was the study done?
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
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How was the study done?
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
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Deaths from all causes in India, 2010
Age at death
Estimated number of
deaths
Childhood/ early adulthood*
(0-29 years)
2.8 Million
Middle age
(30-69 years)
4.0 Million
Old age
(70+ years)
3.0 Million
Total
9.8 Million
* ~ 2 Million at ages 0-4
8
Age specific suicide death rates in India and in
high-income countries - Men
Suicide death rate per 100 000 population
40
35
30
25
20
15
10
Age standardised suicide death rate at ages 15 years or older (99%CI)
5
India
26.3 (24.5, 28.0)
High income
21.8 (21.6, 22.0)
0
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)
9
Age specific suicide death rates in India and in
high-income countries - Women
Age standardised suicide death rate at ages 15 years or older (99%CI)
Suicide death rate per 100 000 population
40
India
17.6 (16.1, 19.0)
High income 6.8 (6.7, 6.9)
35
30
25
20
15
10
5
0
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Age(years)
50-54
55-59
60-64
65-69
70+
10
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
Percentage probability of death
of a 15 year old person before
reaching 80 years
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
12
Risk of suicide deaths for men and
women aged 15 years and above
13
Estimated suicide deaths by
different regions
Region
Estimated suicide deaths x1000 (age
standardised suicide death rate per 100,000)
Male
Female
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)
114.8 (26.3)
72.1 (17.5)
Total
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Risk of death from Suicide
For Indians aged 15 years, the risk of dying before
age 80 in the absence of other diseases:
17 of 1000 men will die of suicide
10 of 1000 women will die of suicide
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Source: Dikshit et al, Lancet 2012
Age standardised suicide death rate per 100,000
Suicide death rates for selected statesaged 15 years or older
70
60
Men
Women
50
40
30
20
10
0
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Kerala
Andhra
Pradesh
Delhi
Bihar &
Jharkhand
India
16
Method of suicide among Indian
men – aged 15 years or older
Drowning (T=4, ASR=0.8)
Burns (T=5, ASR=1.1)
4%
Other (T=8.8, ASR=2.0)
8%
4%
Poisoning (T=60.2, ASR=13.8)
35%
49%
Hanging (T=37, ASR=8.3)
T = estimated suicide deaths in 1000,
CGHR.ORG/SUICIDE
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ASR = age standardised suicide death rate
per 100,000
17
Method of suicide among Indian
women – aged 15 years or older
Other (T=5, ASR=1.2)
Poisoning (T=31.5, ASR=7.9)
Drowning (T=5.4, ASR=1.3)
7%
8%
Burns (T=13.4, ASR=3.3)
15%
44%
26%
Hanging (T=17,ASR=4.2)
CGHR.ORG/SUICIDE
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T = estimated suicide deaths in 1000,
ASR = age standardised suicide death rate per
100,000
18
Significant risk factors for suicide Men aged 15 to 69 years
Odds ratio (suicide vs.
other deaths) (99% CI)
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
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Rural
1•45 (1•1 - 1•9)
Urban
1•00
--
19
Significant risk factors for suicide Women aged 15 to 69 years
Odds ratio (suicide vs.
other deaths) (99% CI)
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
CGHR.ORG/SUICIDE
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Widower/divorced/separated
0•64 (0•4 - 0•9)
Never married
0•92 (0•7 - 1•2)
Married/ remarried
1•00
--
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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 Collaborators
Indian 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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