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Friday, June 22, 2012

Latest Suicide Statistics of India, from a national study published in The Lancet

Vikram Patel A Lancet study reports that suicide is the second highest cause of death among the young The medical journal, The Lancet has published a study today which should bring attention to a little known human tragedy which is being played out across our country. The research is based on the first national survey of the causes of death, conducted in 2001-03, by the Registrar General of India. Many people die at home in India, especially in rural areas, and without medical attention. As a result, their deaths, like many in the developing world, have no certifiable cause and are invisible to the public health system and society at large. This landmark effort of the Registrar General to systematically document the causes of death has transformed our understanding of why Indians die. Higher in the South The study has reported some startling findings with regards to suicide in India. Suicide rates in India are among the highest reported from any country. Suicide rates are much higher in rural areas, and in the southern states of the country. The fatality rates may be higher in India than in many western countries because the favoured method of suicide is the use of pesticides (in comparison to, say, taking an overdose of sleeping pills). Less surprisingly, the National Crime Records Bureau (NCRB) data, the only routinely collated national data on suicide, under-report between a quarter and a third of all suicides in men and women respectively. But perhaps the most important finding of all is that the burden of suicide falls disproportionately on India’s youth. Nearly 60 per cent of all suicide deaths in Indian women occur between the ages of 15 and 29 years, the corresponding figure for men being 40 per cent. Suicide is the second leading cause of death in young people of both genders and, with the falling trends of maternal mortality, is likely to become the leading cause of death in young women in the near future. Unless, of course, the country takes action to stem this tragic tide. The immediate course of action must be to recognise with urgency that suicide is a leading public health concern in India, in particular for young people. Policy actions need to address the causes of suicidal behaviour. The fact is that the high risk of suicidal behaviour in young people is a finding reported from many other countries and is likely to be related to the risk-taking and impulsivity which characterises this phase of life. In a nutshell, one is more likely to react to upsets in life in a risky and impulsive way during one’s youth. But this fact alone is not a sufficient explanation, for there still needs to be something which causes the person to become upset in the first place. While there are no nationally representative studies of the causes of suicide in India, a number of smaller studies, mainly from southern and western India, all point to similar findings of the risk factors which lead an individual to attempt suicide. In essence, social and inter-personal factors such as violence and disappointments in relationships, coexist with mental health factors, notably depression and substance abuse, as the leading determinants of suicidal behaviour. Surveys These individual level determinants, however, do not fully explain the dramatic regional variations in suicide in India. The new study findings show that suicide death rates were generally greater in the more developed southern states which have nearly a ten-fold higher suicide rate than some of the less developed northern states. This South-North gradient has also been observed by the NCRB, but has often been discounted as it was believed to be due to a reporting bias, viz., that the cause of death statistics were more reliable in south India. The new study has confirmed that these variations are, in fact, real. Further support for this concentration of the burden of youth suicide in southern India comes from the World Mental Health surveys whose site in Puducherry reported one of the highest rates of self-reported suicidal behaviours in the world. One is forced, then, to ask potentially sensitive questions about what contextual factors may be contributing to this dramatic regional variation. One possibility is that the higher rates of suicide in the more developed and educated communities of India may be attributed to the greater likelihood of disappointments when aspirations that define success and happiness are distorted or unmet by the reality faced by young people in a rapidly changing society where jobs may be higher paying but less secure and where social networking more accessible but loneliness more common. This might be pure conjecture, of course, but I cannot think of any more plausible explanation why a young person in a more developed society of India where health care, education and economic growth are relatively more advanced should be more likely to attempt suicide than a peer in a much less developed society of the country. Irrespective of these questions, the fact remains that suicide is a leading cause of death of young people in India, killing twice as many people as HIV/AIDS and nearly as many women as maternal causes. However, unlike these two other conditions, suicide attracts little public health attention. Beyond the toll of deaths, we need to acknowledge that completed suicide rates may reflect only the tip of the iceberg; the majority of suicide attempts are not fatal and simply go uncounted. The vast majority of people in this country have no access to any of the evidence based strategies which are well-established to address the risk of suicide, from limiting access to lethal methods such as pesticides, addressing violence experienced by young people, building life skills and promoting mental health in schools and colleges, and improving access to treatment for depression and counselling for those who survive a suicide attempt. But, we must also be honest that the story of suicide in India is likely to be a complex one which needs further inquiry to address the bigger questions about the role of society and, in particular, social change, as a driver of this marker of hopelessness. If, indeed, social change is a driver of youth suicide, then we need to reflect on our model of development for the speed of change is only increasing, and spreading, across the country. In the end, suicide is perhaps the quintessential example of a health outcome in which society plays as crucial an explanatory role as medicine — and it will need a partnership between medicine and society to understand and address its toll. (Vikram Patel is with the London School of Hygiene and Tropical Medicine, and Sangath, Goa.)

-------------------------------------------------------------------------------- The first national study of deaths in India, published in The Lancet. Authored by Prof Vikram Patel, London School of Hygeine and Tropical Medicine. The southern states Andhra pradesh Tamil Nadu, Karnataka, and kerala, home to 22% of the Indian population, account for 42% suicides in men and 40% among women in India. They account for 80,100 of 1.86 lakh victims aged 15 and above in 2010. Maharashtra and West Bengal together account for 15% of such deaths. Andhra pradesh registered 28,000 deaths among 15 years and above age group, Tamil nadu recorded 24,000, and Maharashtra 19,000. Delhi had the lowest suicide rate. The average age of women killing themselves was 25 years and of men it was 34 years. Suicide is the second biggest killer among youth in India. of the total suicides by individuals aged 15 and above, those under 29 accounted for 40% deaths in men and 56% in women. It's also set to overtake maternal mortality as leading cause of death among women in the country. Suicide rates are much higher in rural parts than urban. The educated are at a much higher risk. The risk of suicide was 43% higher for men who have finished secondary or higher education compared to those who had not completed primary education. Among women the risk of suicide increased by 90%. 1.87 lakh individuals ended their lives by suicide in 2010. 49% were men and 44% were women. Hanging was the most common method while burns accounted for 1/6th of the suicides by women. More Men commit suicide than women. Violence and depression are key determinants in suicides by women. Suicides claim twice as many lives as HIV/AiDS, almost as many as maternal deaths among young women. It also kills as many indian men aged 15-29 as accidents. Much Needed- mental health promotions amongst school kids, crisis counselling vserices and servicces for treatment of depression and alcohol abuse. ----------------------------------------------

Four of India's southern states — Tamil Nadu, Andhra Pradesh, Karnakata and Kerala — that together constitute 22% of the country's population recorded 42% of suicide deaths in men and 40% of self-inflicted fatalities in women in 2010. Maharashtra and West Bengal together accounted for an additional 15% of suicide deaths. Delhi recorded the lowest suicide rate in the country. In absolute numbers, the most suicide deaths in individuals, aged 15 years or older, were in AP (28,000), Tamil Nadu (24,000) and Maharashtra (19,000). The first national study of deaths in India, published in the British Medical journal The Lancet on Friday, says that suicide has become the second-leading cause of death among the young in India. Of the total deaths by suicide in individuals aged 15 years or older, about 40% suicide deaths in men and about 56% in women occurred in individuals aged 15-29 years. Suicide deaths occurred at younger ages in women (average age 25 years) than in men (average age 34 years). Educated persons were at greater risk of completing a suicide. The risk of completing a suicide was 43% higher in men, who finished secondary or higher education, in comparison to those who had not completed primary education. Among women, the risk increased to 90%. Lead author of the study Professor Vikram Patel of the London School of Hygiene and Tropical Medicine told TOI that the 1.87 lakh people committed suicide in India in 2010. About half of suicide deaths (49% among men, and 44% among women) were due to poisoning, mainly ingesting of pesticides. Hanging was the second most common cause for men and women, while burns accounted for about one-sixth of suicides by women. Professor Patel felt that with the decline in maternal death rates, suicide could soon become the leading cause of death among young women in India. The study says the National Crime Records Bureau underestimates suicide deaths in men by at least 25% and women (36%). He told TOI, "Overall, more Indian men commit suicide than women, but the male to female ratio for suicides is smaller in India than in many Western countries, in particular among youth. Studies have suggested that social factors such as violence and depression are key determinants of suicide in women." Prof Patel pointed out to lack of national strategy for suicide prevention in India. He said, "Suicides can be prevented through interventions like banning the most toxic pesticides and teaching rural communities on safe storage of pesticides. India should also start mental health promotion for young people through schools and colleges and introduce crisis counseling services and services for treatment of depression and alcohol addiction." Prof Patel added that although much of the current concern about suicides has focused on agricultural workers, over three in four suicide deaths in India occur in other occupational groups (including those who are unemployed and homemakers). "Compared to most other countries, suicide rates are especially high in young adults and, in particular, young women for whom suicide rates in India are four to six times higher than in developed countries. The suicide rates vary 10-fold between states with the highest rates in the southern states of India," he added. Suicide deaths among men were almost 11-times higher in Maharashtra as compared to Delhi. When it came to women, it was four times higher in Maharashtra than Delhi. The study says the age standardized suicide death rate per 100,000 people at all ages was 18.6 for boys and men and 12.7 for girls and women. The suicide death rate in men aged 15 years or older varied little across age groups in comparison with that of women, which peaked in 15-29 years and decreased thereafter. At ages 15-29 years, suicide was the second leading cause of death in both sexes. Most suicide deaths occurred in rural areas — the age standardized death rates were about two times higher in rural than in urban areas. In the absence of other causes of death, men aged 15 years or older have a lifetime risk of suicide of 2% or higher in AP, Karnataka, Kerala, and Tamil Nadu. "The large variations we observed between states clearly point to the role of as yet poorly understood social factors in influencing the risk of suicide in India. We recorded a reduced risk of suicide versus other causes of death in women who were widowed, divorced or separated, compared with married women and men," Prof Patel said. The study says, suicide claims twice as many lives in India as HIV-AIDS and almost as many as maternal deaths in young women. Suicide kills nearly as many Indian men aged 15-29 as transportation accidents. Studies have shown that the most common contributors to suicide are a combination of social problems, such as interpersonal and family problems and financial difficulties, and pre-existing mental illness. Times View A very large proportion of suicides in India can be attributed to the manner in which families and society at large deal with all forms of mental illness. Where something as common as depression is rarely recognised and when recognised is even more rarely treated because there is a stigma attached to ailments of the mind, there clearly is a problem. What can be easily treated with some medication and counselling more often than not goes untreated till it develops a more serious form. Both government and civil society need to act to change this. Above all awareness must be built that the mind is as liable to be affected as other bodily organs and there is nothing to be ashamed of in acknowledging this. __._,_.___

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