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Low cost measures should be used to tackle high suicide rate in India

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6875 (Published 11 October 2012) Cite this as: BMJ 2012;345:e6875
  1. Matthew Limb
  1. 1London

A leading global mental health expert has called for urgent action to reduce suicide rates in India, which are among the highest in the world.

Vikram Patel, professor of international mental health at the London School of Hygiene and Tropical Medicine, said suicide rates could be reduced by “relatively low cost” measures such as providing better care for people with depression and restricting access to pesticides, the ingestion of which is a common method of suicide.

Patel said there was a “hidden epidemic” of suicides among young people in India. “Completed suicides are just the tip of the iceberg. Most suicide attempts are simply unreported,” he said.

The suicide rate among Indian women, aged 15 years or older, is more than two and a half times greater than it is in women of the same age in high income countries (17.6 per 100 000 compared with 6.8).

Patel was speaking at a seminar held at King’s College, London, on 9 October entitled: Mental health, suicide and wellbeing in young people: South Asia in global perspective.

Patel led a working group that examined suicide mortality in India as part of the Million Death Study, one of the world’s largest studies of premature mortality.1

This research, which was published in the Lancet in June 2012, estimated 187 000 people (115 000 men and 72 000 women) aged 15 or older died by suicide in India in 2010.2

Among men, 40% of suicides (45 100 individuals) occurred between the ages of 15 and 29. Among women of these ages, the proportion was 56% (40 500).

About half of suicide deaths were due to poisoning, mainly ingestion of pesticides. Hanging was the second most common method in both men and women and burns accounted for about a sixth of female suicide deaths.

Almost as many young women died from suicide as died in 2010 from maternal causes such as complications from pregnancy and childbirth, the research found.

It also found 10-fold variations in suicide rates between different Indian states, with more suicide deaths occurring in richer states, many of which are in the south.

Patel said the marked variations in suicide rates could reflect the strong role played by social factors and further research was needed urgently to explore these and the reasons for suicide in young people.

He told the seminar that other studies had identified key risk factors for men such as job insecurity, involvement in violence, and alcohol abuse, and for women depression and experience of domestic violence.

“We need to take action to address some of these determinants,” he said.

He said India lacked community or support services for the prevention of suicide and there was limited access to care for mental illnesses associated with suicide, especially access to treatment for depression.

He told the BMJ there had been “precious little policy action” so far. However, he hoped a new national mental health programme being developed by the Indian government would, if properly designed and implemented, “go a long way” to reducing suicides by dealing with mental health risk factors.

Experts at the seminar discussed the potential impact of India’s economic growth on suicide rates.

Sunil Khilnani, director of the King’s India Institute, said population survey findings seemed to show “high levels of hope” among India’s youth but this was “double edged” with consequences for those who could not fulfil rising societal and family expectations.

He said, “It’s clear the problem is urgent and we need a much deeper and more sophisticated understanding. Social scientists need to be asking what are the connections between rising rates and profound changes in society.”

Notes

Cite this as: BMJ 2012;345:e6875

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